RATIONALE: Vaccines may make the body build an immune response to kill tumor cells.
Interleukin-2 may stimulate a person's white blood cells to kill tumor cells.
PURPOSE: Randomized phase II trial to study the effectiveness of vaccine therapy with and
without interleukin-2 in treating patients who have metastatic melanoma that has not
responded to previous treatment.
- Determine efficacy of recombinant fowlpox and vaccinia viruses encoding tyrosinase
antigen, administered with or without low-dose interleukin-2 (IL-2), in terms of
response, in patients with metastatic melanoma.
- Compare the response rate in patients to this vaccination administered with high-dose
IL-2 to that in similar patients on previous trials treated with high-dose IL-2 alone.
- Determine the immunological response in patients treated with this regimen.
OUTLINE: This is a randomized study. Patients are randomized to one of three treatment arms.
- Arm I: Patients receive recombinant fowlpox vaccine IM on day 1 followed 4 weeks later
by recombinant vaccinia vaccine IM. Treatment repeats for a minimum of 4 vaccinations.
- Arm II: Patients receive vaccinations as in arm I plus low-dose interleukin-2 (IL-2)
subcutaneously daily on days 2-13 after each vaccination.
- Arm III: Patients receive vaccinations as in arm I plus high-dose IL-2 IV over 15
minutes every 8 hours on days 2-5 after each vaccination.
Patients with stable disease or a minor, mixed, or partial response after four immunizations
(1 course) may receive a second course of the same regimen beginning 4-6 weeks after the
first course. After the second course, patients with tumor regression may continue to
receive treatment in the absence of unacceptable toxicity until best response is achieved.
Patients are followed at 4-6 weeks.
PROJECTED ACCRUAL: A total of 73 patients (13-20 for arm I, 13-20 for arm II, and 19-33 for
arm III) will be accrued for this study within 2 years.
- Histologically confirmed metastatic melanoma that has failed standard treatment
- No ocular or mucosal melanoma as primary site
- Measurable disease
- No existing brain metastases
- 16 and over
- ECOG 0 or 1
- More than 3 months
- WBC at least 3,000/mm3
- Platelet count at least 90,000/mm3
- No coagulation disorder
- Bilirubin no greater than 1.6 mg/dL
- AST/ALT less than 3 times normal
- Hepatitis B surface antigen negative
- Creatinine no greater than 1.6 mg/dL
- No major cardiovascular illness
- No major respiratory illness
- HIV negative
- No autoimmune disease
- No primary or secondary immunodeficiency
- No allergy to eggs
- No history of allergy or untoward reaction to prior smallpox vaccination
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Must be able to avoid close contact with children under 5 years, pregnant women,
people with active or a past history of eczema or other eczematoid skin disorders,
and immunosuppressed people for at least 2 weeks after each vaccinia virus
- No active systemic infections
- No active atopic dermatitis or active or past history of eczema
- No concurrent active extensive psoriasis, severe acneiform rash, impetigo, varicella
zoster, burns, or other traumatic or pruritic skin conditions or open wounds
- Surgical scars must be healed
- Healed surgical stomas (e.g., colostomy) allowed
PRIOR CONCURRENT THERAPY:
- No prior recombinant vaccinia or fowlpox vaccines for melanoma
- At least 3 weeks since prior systemic biologic therapy for melanoma
- At least 3 weeks since prior systemic chemotherapy for melanoma
- At least 3 weeks since prior systemic endocrine therapy for melanoma
- No concurrent steroid therapy
- At least 3 weeks since prior systemic radiotherapy for melanoma
- Prior surgery allowed