title: Pilot trial of tumor-specific peptide vaccination and continuous infusion interleukin-2 in patients with recurrent Ewing sarcoma and alveolar rhabdomyosarcoma: an inter-institute NIH study.
abstract: BACKGROUND
  Patients with recurrent Ewing sarcoma and alveolar rhabdomyosarcoma have poor prognoses and limited therapeutic options. We have investigated the use of peptide pulsed vaccination in an attempt to immunologically target the breakpoint region of tumor specific fusion proteins expressed in these tumors.
  
  
  METHODS
  Sixteen patients with recurrent, translocation positive, Ewing sarcoma, and alveolar rhabdomyosarcoma underwent apheresis for collection of peripheral blood mononuclear cells. Following countercurrent centrifugal elutriation, an apheresis product comprised predominantly of monocytes but containing small numbers of circulating immature dendritic cells was pulsed with peptides derived from the breakpoint region of the fusion proteins. Vaccines were administered intravenously concomitant with continuous intravenous rhIL-2 at 9 x 10(6) IU/m(2)/day.
  
  
  RESULTS
  Toxicity was limited to IL-2 related effects and was generally mild. Following vaccination, all patients showed progressive disease, most in a rapid fashion following the first vaccine. One patient showed evidence of an immunologic response and another showed a mixed clinical response. Patients enrolled on this tumor vaccine trial showed significant immunosuppression and large bulky tumors.
  
  
  CONCLUSIONS
  Peptide vaccination as administered in this trial did not alter the dismal clinical outcome for patients with recurrent pediatric sarcomas. Future trials of tumor vaccines in this population should target patient populations with improved immune competence and smaller tumor burdens. Furthermore, optimization of the antigen presenting cell populations may be important for inducing immune responses to peptide antigens.
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA. dagherr@cder.fda.gov
authors.forename: Ramzi
authors.initials: R
authors.lastname: Dagher
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Long
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Read
authors.forename: Susan F
authors.initials: SF
authors.lastname: Leitman
authors.forename: Charles S
authors.initials: CS
authors.lastname: Carter
authors.forename: Maria
authors.initials: M
authors.lastname: Tsokos
authors.forename: Theresa J
authors.initials: TJ
authors.lastname: Goletz
authors.forename: Nilo
authors.initials: N
authors.lastname: Avila
authors.forename: Jay A
authors.initials: JA
authors.lastname: Berzofsky
authors.forename: Lee J
authors.initials: LJ
authors.lastname: Helman
authors.forename: Crystal L
authors.initials: CL
authors.lastname: Mackall
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019496:Cancer Vaccines / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007376:Interleukin-2 / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D010865:Pilot Projects; D012008:Recurrence; D018232:Rhabdomyosarcoma, Alveolar / Q000235:genetics / Q000276:immunology / Q000628:therapy*; D012512:Sarcoma, Ewing / Q000235:genetics / Q000276:immunology / Q000628:therapy*; D014178:Translocation, Genetic
chemical_list: D000970:Antineoplastic Agents; D019496:Cancer Vaccines; D007376:Interleukin-2; D015514:Oncogene Proteins, Fusion