title: Assessment of immunologic response and recurrence patterns among patients with clinical recurrence after vaccination with a preventive HER2/neu peptide vaccine: from US Military Cancer Institute Clinical Trials Group Study I-01 and I-02.
abstract: BACKGROUND
  E75, a HER2/neu immunogenic peptide, is expressed in breast cancer (BCa). We have performed clinical trials of E75 + GM-CSF vaccine in disease-free, node-positive and node-negative BCa patients at high recurrence risk and recurrences were noted in both control and vaccine groups.
  
  
  METHODS
  Among the 186 BCa patients enrolled, 177 completed the study. Patients were HLA typed; the HLA-A2(+)/A3(+) patients were vaccinated; HLA-A2(-)/A3(-) patients were followed as controls. Standard clinicopathological factors, immunologic response to the vaccine, and recurrences were collected and assessed.
  
  
  RESULTS
  The control group recurrence rate was 14.8 and 8.3% in the vaccinated group (P = 0.17). Comparing the 8 vaccinated recurrences (V-R) to the 88 vaccinated nonrecurrent patients (V-NR), the V-R group had higher nodal stage (> or = N2: 75 vs. 5%, P = 0.0001) and higher grade tumors (%grade 3: 88 vs. 31%, P = 0.003). The V-R group did not fail to respond immunologically as noted by equivalent dimer responses and post-DTH responses. Compared to control recurrent patients (C-R), V-R patients trended toward higher-grade tumors and hormone-receptor negativity. C-R patients had 50% bone-only recurrences, compared to V-R patients with no bone-only recurrences (P = 0.05). Lastly, V-R mortality rate was 12.5% compared with 41.7% for the C-R group (P = 0.3).
  
  
  CONCLUSIONS
  The vaccinated patients who recurred had more aggressive disease compared to V-NR patients. V-R patients had no difference in immune response to the vaccine either in vitro or in vivo. V-R patients, when compared to C-R patients, trended towards more aggressive disease, decreased recurrence rates, decreased mortality, and no bone-only recurrences.
authors.affiliation: Department of Surgery, General Surgery Service, Walter Reed Army Medical Center, Washington, DC, USA.
authors.forename: Asna
authors.initials: A
authors.lastname: Amin
authors.forename: Linda C
authors.initials: LC
authors.lastname: Benavides
authors.forename: Jarrod P
authors.initials: JP
authors.lastname: Holmes
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Gates
authors.forename: Mark G
authors.initials: MG
authors.lastname: Carmichael
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Hueman
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mittendorf
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Storrer
authors.forename: Yusuf H
authors.initials: YH
authors.lastname: Jama
authors.forename: Dianna
authors.initials: D
authors.lastname: Craig
authors.forename: Alex
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: Sathibalan
authors.initials: S
authors.lastname: Ponniah
authors.forename: George E
authors.initials: GE
authors.lastname: Peoples
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000276:immunology* / Q000473:pathology / Q000517:prevention & control*; D019496:Cancer Vaccines / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage; D015789:HLA-A2 Antigen / Q000235:genetics / Q000276:immunology; D015791:HLA-A3 Antigen / Q000235:genetics / Q000276:immunology; D006801:Humans; D053208:Kaplan-Meier Estimate; D009364:Neoplasm Recurrence, Local / Q000276:immunology* / Q000473:pathology / Q000517:prevention & control*; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000276:immunology / Q000627:therapeutic use*; D022223:Vaccines, Subunit / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology
chemical_list: D000276:Adjuvants, Immunologic; D019496:Cancer Vaccines; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D015789:HLA-A2 Antigen; D015791:HLA-A3 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; D022223:Vaccines, Subunit