title: Clinical and immune responses in advanced melanoma patients immunized with an anti-idiotype antibody mimicking disialoganglioside GD2.
abstract: OBJECTIVE
  To determine immune responses and toxicity to the anti-idiotype vaccine, as well as clinical responses and survival, we initiated a clinical trial for patients with advanced melanoma treated with an anti-idiotype antibody (TriGem) that mimics the disialoganglioside GD2.
  
  
  METHODS
  Forty-seven patients with advanced melanoma received either 1-, 2-, 4-, or 8-mg doses of TriGem (Titan Pharmaceuticals Inc, South San Francisco, CA) mixed with QS-21 adjuvant (Aquila Biopharmaceuticals, Inc, Worcester, MA) 100 microg subcutaneously weekly for 4 weeks and then monthly until disease progression. Median age was 57 years, there were 32 men and 15 women, 43% of patients had undergone prior therapy for metastatic disease, 55% had disease confined to soft tissue, and 45% had visceral metastasis.
  
  
  RESULTS
  Hyperimmune sera from 40 of 47 patients showed an anti-anti-idiotype (Ab3) response. Patient Ab3 was truly Ab1' because it specifically bound purified disialoganglioside GD2. The isotypic specificity of the Ab3 antibody consisted of predominantly immunoglobulin (Ig)G, and all IgG subclasses were represented. One patient had a complete response that persisted at 24 months, and 12 patients were stable from 14+ to 37+ months (median, 18+ months). Disease progression occurred in 32 patients on study from 1 to 17 months (median, 5.5 months), and 21 have died at 1 to 16 months (median, 6 months). The Kaplan-Meier-derived overall median survival has not been reached. Median survival has not been reached for the 26 patients with soft tissue disease only and was 13 months for 21 patients with visceral metastasis. Toxicity consisted of local reaction at the site of injection and mild fever and chills.
  
  
  CONCLUSIONS
  TriGem has minimal toxicity and generates robust and specific IgG immune responses against GD2. Objective responses were minimal, but there may be a favorable impact on disease progression and survival that will require prospective randomized trials.
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, The Barrett Cancer Center for Prevention, Treatment and Research, University of Cincinnati College of Medicine, OH 45219-2316, USA. kenneth.foon@uc.edu
authors.forename: K A
authors.initials: KA
authors.lastname: Foon
authors.forename: J
authors.initials: J
authors.lastname: Lutzky
authors.forename: R N
authors.initials: RN
authors.lastname: Baral
authors.forename: J R
authors.initials: JR
authors.lastname: Yannelli
authors.forename: L
authors.initials: L
authors.lastname: Hutchins
authors.forename: A
authors.initials: A
authors.lastname: Teitelbaum
authors.forename: O L
authors.initials: OL
authors.lastname: Kashala
authors.forename: R
authors.initials: R
authors.lastname: Das
authors.forename: J
authors.initials: J
authors.lastname: Garrison
authors.forename: R A
authors.initials: RA
authors.lastname: Reisfeld
authors.forename: M
authors.initials: M
authors.lastname: Bhattacharya-Chatterjee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000888:Antibodies, Anti-Idiotypic / Q000276:immunology* / Q000627:therapeutic use; D000918:Antibody Specificity; D018450:Disease Progression; D005260:Female; D005732:Gangliosides / Q000276:immunology* / Q000627:therapeutic use; D006801:Humans; D007114:Immunization; D007074:Immunoglobulin G / Q000276:immunology*; D008297:Male; D008545:Melanoma / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D012878:Skin Neoplasms / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D016019:Survival Analysis
chemical_list: D000888:Antibodies, Anti-Idiotypic; D005732:Gangliosides; D007074:Immunoglobulin G