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.
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.
Amin
Asna
A
Department of Surgery, General Surgery Service, Walter Reed Army Medical Center, Washington, DC, USA.
Benavides
Linda C
LC
Holmes
Jarrod P
JP
Gates
Jeremy D
JD
Carmichael
Mark G
MG
Hueman
Matthew T
MT
Mittendorf
Elizabeth A
EA
Storrer
Catherine E
CE
Jama
Yusuf H
YH
Craig
Dianna
D
Stojadinovic
Alex
A
Ponniah
Sathibalan
S
Peoples
George E
GE
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
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