title: Complete remission following decitabine/dendritic cell vaccine for relapsed neuroblastoma.
abstract: Patients with relapsed stage 4 neuroblastoma have an extremely poor long-term prognosis, making the investigation of new agents of interest. We report the outcome of the first patient treated in a phase 1 study for relapsed neuroblastoma, using the chemotherapy agent decitabine to upregulate cancer testis antigen expression, followed by a dendritic cell vaccine targeting the cancer testis antigens MAGE-A1, MAGE-A3, and NY-ESO-1. Our patient had persistent tumor in his bone marrow after completion of standard therapy for neuroblastoma, including multiagent chemotherapy, tumor resection, stem cell transplantation, radiation therapy, and anti-GD2 monoclonal antibodies. His marrow disease persisted despite chemotherapy, which was given while the vaccine was being produced. After 3 cycles of decitabine and vaccine, this patient achieved a complete remission and is now 1 year from his last treatment, with no evidence of tumor in his bone marrow or other sites. This patient was noted to have an increase in MAGE-A3-specific T cells. This is the first report combining demethylating chemotherapy to enhance tumor antigen expression followed by a cancer antigen vaccine.
authors.affiliation: Division of Hematology/Oncology, Department of Pediatrics, Stem Cell Transplantation Program, Penn State Children’s Hospital, Hershey, Pennsylvania 17033, USA.
authors.forename: Deepa Kolaseri
authors.initials: DK
authors.lastname: Krishnadas
authors.forename: Teresa
authors.initials: T
authors.lastname: Shapiro
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lucas
mesh_terms: D001374:Azacitidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D019496:Cancer Vaccines / Q000008:administration & dosage* / Q000276:immunology; D002648:Child; D000077209:Decitabine; D003713:Dendritic Cells / Q000637:transplantation*; D018380:Hematopoietic Stem Cell Transplantation / Q000639:trends; D006801:Humans; D008297:Male; D009447:Neuroblastoma / Q000175:diagnosis* / Q000276:immunology / Q000517:prevention & control*; D012008:Recurrence; D012074:Remission Induction / Q000379:methods
chemical_list: D019496:Cancer Vaccines; D000077209:Decitabine; D001374:Azacitidine