Transfection with siRNA targeting the immunoproteasome alters proteasome-mediated antigen
processing by the dendritic cell, generating TAA-derived peptides that we hypothesize, based
on preclinical results, will induce enhanced anti-melanoma immune responses. This phase I
study, open to subjects with metastatic melanoma, will assess the safety of vaccination with
melanoma tumor associated antigen-encoding RNA-transfected mature dendritic cells derived
from monocytes that have been either untreated, transfected with control siRNA, or
transfected with siRNA targeting the inducible immunoproteasome beta subunits LMP2, LMP7,
and MECL1. A combination of RNAs encoding melanoma tumor associated antigens MART-1,
tyrosinase, gp100, and MAGE-3 will be utilized for dendritic cell transfection. The vaccine
will be administered by intradermal injection in the extremities. Clinical and laboratory
toxicities will be characterized for each study arm. As a secondary objective, this phase
I study will also assess the anti-melanoma immune responses, as well as clinical responses,
induced by vaccination with this dendritic cell-based product.
- Patients with confirmed metastatic melanoma.
- Karnofsky performance status greater than or equal to 70%.
- Estimated life expectancy > 6 months.
- Age > 18 years.
- Adequate hematologic function
- Adequate renal and hepatic function
- Ability to understand and provide signed informed consent that fulfills Institutional
Review Board guidelines.
- Ability to return to Duke University Medical Center for adequate follow-up as
required by this protocol.
- Subjects undergoing concurrent chemotherapy, radiation therapy, or immunotherapy will
- The subject has previously irradiated, surgically treated, or newly diagnosed central
nervous system (CNS) metastases will be excluded (Pre-enrollment head CT is not
required if not indicated by clinical signs or symptoms).
- Subjects with a history of autoimmune disease such as, but not restricted to,
inflammatory bowel disease, systemic lupus erythematosus, ankylosing spondylitis,
scleroderma, or multiple sclerosis will be excluded.
- Subjects with serious concurrent chronic or acute illness such as pulmonary (asthma
or COPD), cardiac (NYHA class III or IV) or hepatic disease, or other illness
considered by the principal investigator to constitute an unwarranted high risk for
investigational drug administration will be excluded.
- Subjects with medical or psychological impediment to probable compliance with the
protocol will be excluded.
- Subjects with concurrent second malignancy other than melanoma or non-melanoma skin
cancer will be excluded. In the event of prior non-melanoma malignancies treated
surgically, the subject must be considered NED (no evidence of disease) for a minimum
of 3 years prior to enrollment.
- Presence of an active acute or chronic infection, including symptomatic urinary tract
infection, HIV (as determined by ELISA and confirmed by Western Blot) or viral
hepatitis (as determined by HBsAg and Hepatitis C serology) will lead to subject
- Subjects receiving steroid therapy (or other immunosuppressive agents such as
azathioprine or cyclosporine A) are excluded on the basis of potential immune
- Subjects with inadequate peripheral vein access to undergo leukapheresis will be
- Female subjects with a positive pregnancy test, as well as those who have not
previously undergone hysterectomy and/or bilateral oophorectomy and are unwilling to
utilize a medically approved form of contraception, from the time of enrollment until
6 weeks after the final immunization, will be excluded.
- Male subjects, not previously surgically sterilized, who are unwilling to use a
condom with spermicide during any sexual activity occurring over the entire
immunization period and for the 6 weeks that immediately follow the final
immunization will be excluded.
- Subjects with a documented history of severe allergic reaction to beta-lactams, eggs
or soy products.