Patient-Specific Dendritic-Cell Vaccines for Metastatic Melanoma
http://www.100md.com
《新英格兰医药杂志》
To the Editor: We are investigating the safety and efficacy of patient-specific vaccines derived from short-term autologous tumor-cell lines in the treatment of melanoma.1 In our current trial, patients with distant metastatic or recurrent regional melanoma are candidates for the receipt of an investigational vaccine consisting of autologous dendritic cells that have been incubated with irradiated autologous tumor cells from a proliferating cell culture and then suspended in granulocyte–macrophage colony-stimulating factor. The vaccine is administered subcutaneously once a week for 3 weeks, then monthly for 5 months.2 Of the first 21 patients enrolled, 18 are alive a median of 3 years (range, 2 to 5) after starting the vaccine therapy. The clinical courses of six of these patients are summarized in Table 1. These six patients, all of whom had either extensive metastatic disease or repeated regional recurrences despite multiple therapies, are currently disease-free 24 to 58 months after the completion of the therapy.
Table 1. Summary of Diagnoses and Clinical Courses in Six Patients Who Received Patient-Specific Dendritic-Cell Vaccine for Metastatic Melanoma.
This result was rarely observed in our previous trial of an autologous tumor-cell vaccine that did not include dendritic cells.3 Although all the patients in the current trial received a patient-specific autologous dendritic-cell vaccine, we cannot conclude that the vaccine alone produced the favorable outcomes, since all the patients had undergone more than one type of treatment. The long survival of the six patients is unusual, especially given the failure of multiple therapeutic interventions to prevent repeated recurrences in five of them and the extent of widespread metastatic disease in the sixth.
Robert O. Dillman, M.D.
Senthamil R. Selvan, Ph.D.
Patric M. Schiltz, Ph.D.
Hoag Cancer Center
Newport Beach, CA 92658
rdillman@hoaghospital.org
References
Dillman RO, Nayak SK, Beutel L. Establishing in vitro cultures of autologous tumor cells for use in active specific immunotherapy. J Immunother 1993;14:65-69.
Dillman RO, DeLeon C, Beutel LD, et al. Short-term autologous tumor cell lines for the active specific immunotherapy of patients with metastatic melanoma. Crit Rev Oncol Hematol 2001;39:115-123.
Dillman RO, Selvan SR, Schiltz PM, et al. Phase I/II trial of melanoma patient-specific vaccine of proliferating autologous tumor cells, dendritic cells, and GM-CSF: planned interim analysis. Cancer Biother Radiopharm 2004;19:658-665.
Table 1. Summary of Diagnoses and Clinical Courses in Six Patients Who Received Patient-Specific Dendritic-Cell Vaccine for Metastatic Melanoma.
This result was rarely observed in our previous trial of an autologous tumor-cell vaccine that did not include dendritic cells.3 Although all the patients in the current trial received a patient-specific autologous dendritic-cell vaccine, we cannot conclude that the vaccine alone produced the favorable outcomes, since all the patients had undergone more than one type of treatment. The long survival of the six patients is unusual, especially given the failure of multiple therapeutic interventions to prevent repeated recurrences in five of them and the extent of widespread metastatic disease in the sixth.
Robert O. Dillman, M.D.
Senthamil R. Selvan, Ph.D.
Patric M. Schiltz, Ph.D.
Hoag Cancer Center
Newport Beach, CA 92658
rdillman@hoaghospital.org
References
Dillman RO, Nayak SK, Beutel L. Establishing in vitro cultures of autologous tumor cells for use in active specific immunotherapy. J Immunother 1993;14:65-69.
Dillman RO, DeLeon C, Beutel LD, et al. Short-term autologous tumor cell lines for the active specific immunotherapy of patients with metastatic melanoma. Crit Rev Oncol Hematol 2001;39:115-123.
Dillman RO, Selvan SR, Schiltz PM, et al. Phase I/II trial of melanoma patient-specific vaccine of proliferating autologous tumor cells, dendritic cells, and GM-CSF: planned interim analysis. Cancer Biother Radiopharm 2004;19:658-665.