title: Phase 1/2 trial of autologous tumor mixed with an allogeneic GVAX vaccine in advanced-stage non-small-cell lung cancer.
abstract: Tumor vaccines composed of autologous tumor cells genetically modified to secrete granulocyte-macrophage colony-stimulating factor (GM-CSF) (GVAX) have demonstrated clinical activity in advanced-stage non-small-cell lung cancer (NSCLC). In an effort to remove the requirement for genetic transduction of individual tumors, we developed a 'bystander' GVAX platform composed of autologous tumor cells mixed with an allogeneic GM-CSF-secreting cell line. We conducted a phase I/II trial of this vaccine (3-12 biweekly vaccinations) in advanced-stage NSCLC. Tumors were harvested from 86 patients, tumor cell processing was successful in 76, and 49 proceeded to vaccination. The most common toxicity was local vaccine injection site reactions. Serum GM-CSF pharmacokinetics were consistent with secretion of GM-CSF from vaccine cells for up to 4 days with associated transient leukocytosis confirming the bioactivity of vaccine-secreted GM-CSF. Evidence of vaccine-induced immune activation was demonstrated; however, objective tumor responses were not seen. Compared with autologous GVAX vaccines prepared by transduction of individual tumors with an adenoviral GM-CSF vector, vaccine GM-CSF secretion was approximately 25-fold higher with the bystander GVAX vaccine used in this trial. However, the frequency of vaccine site reactions, tumor response, time to disease progression, and survival were all less favorable in the current study.
authors.affiliation: Mary Crowley Medical Research Center, Baylor University Medical Center, Texas Oncology PA, Dallas, TX 75201, USA. jnemunaitis@mcmrc.com
authors.forename: J
authors.initials: J
authors.lastname: Nemunaitis
authors.forename: T
authors.initials: T
authors.lastname: Jahan
authors.forename: H
authors.initials: H
authors.lastname: Ross
authors.forename: D
authors.initials: D
authors.lastname: Sterman
authors.forename: D
authors.initials: D
authors.lastname: Richards
authors.forename: B
authors.initials: B
authors.lastname: Fox
authors.forename: D
authors.initials: D
authors.lastname: Jablons
authors.forename: J
authors.initials: J
authors.lastname: Aimi
authors.forename: A
authors.initials: A
authors.lastname: Lin
authors.forename: K
authors.initials: K
authors.lastname: Hege
mesh_terms: D000328:Adult; D000368:Aged; D019496:Cancer Vaccines / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000276:immunology / Q000628:therapy*; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000009:adverse effects / Q000235:genetics* / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D020014:K562 Cells; D008175:Lung Neoplasms / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014407:Tumor Cells, Cultured
chemical_list: D019496:Cancer Vaccines; D016178:Granulocyte-Macrophage Colony-Stimulating Factor