Durable Complete Response of Refractory, Progressing Metastatic Melanoma After Treatment with a Patient-Specific Vaccine

Abstract

A patient with metastatic melanoma who experienced a durable complete response after treatment with a patient-specific vaccine has been described in this article. This 59-year-old woman presented with cervical spine metastases and, within the year, had experienced local disease progression and, despite various therapies, metastases to the axilla, rectum, gall bladder, and multiple soft-tissue sites. She had previously received radiation therapy, combination chemotherapy, interleukin-2 plus interferon biotherapy, and gamma knife radiosurgery, and undergone multiple surgical resections. At the time vaccine therapy was initiated, she had multiple, new, measurable, soft-tissue metastases that were increasing in size. She was treated with a vaccine consisting of autologous dendritic cells incubated with irradiated tumor cells from an autologous tumor cell line and suspended in granulocyte-macrophage colony stimulating factor (GM-CSF), with subcutaneous injections once a week for 3 weeks and monthly for 5 months. There was evidence of disease regression by the completion of therapy. A few months later a complete response was documented by radiologic scans, and subsequently reconfirmed at 6-month intervals. She remains in complete remission >2.5 years after starting the vaccine, and >2 years after completing the vaccine, and survives >4 years after her initial presentation with bone, bowel, and lymph node metastases. This is the first time she has been in a complete remission since her initial diagnosis. Patient-specific vaccines can sometimes induce durable complete regression of progressing soft-tissue melanoma metastases.

High-Dose IL2 in Metastatic Melanoma: Better Survival in Patients Immunized with Antigens from Autologous Tumor Cell Lines

“…She underwent resection of gallbladder and abdominal wall metastases after IL2, and already had new soft tissue sites of disease at the time she started DC/TC 5 months after completing IL2. She achieved a complete remission, 23 and was still alive and disease-free 5 years after starting the vaccine. Another patient who was previously reported, 20 had presented with lung and brain metastases, had progressed following IL2, and was started on ASI following partial resection of an adrenal metastasis.…”

“…As previously reported in detail, 21 one patient who experienced disease progression immediately after completion of IL2, subsequently responded to DC/TC. 23 She had presented with metastases to the spine, lung, and rectum, progressed in several sites, including the brain, despite surgery, radiation, and chemotherapy, and then developed additional sites of metastases after 2 months of IL2. She underwent resection of gallbladder and abdominal wall metastases after IL2, and already had new soft tissue sites of disease at the time she started DC/TC 5 months after completing IL2.…”

Cancer Vaccines: Can They Improve Survival?

“…29 The DC-TC arm was associated with a longer survival with a median OS of 43 versus 20 months (a 115% increase in median survival) and a doubling of the 2-year OS at 72% vs. 31% ( p = 0.007). There were no measurable responses in either arm of the trial, although one patient in the DC-TC arm, who had new, progressing measurable disease, had stabilization during treatment that evolved to a complete response by 15 months after initiation of the vaccine, in the absence of any other therapy, 30 and was still in remission 5 years after initiating DC-TC therapy. The median EFS in this trial was 5.3 months overall, 5.4 months for DC-TC, and 3.7 months for TCs ( p = 0.44).…”

Intramural Metastases of Rectum From Carcinosarcoma (Malignant Müllerian Mixed Tumor) of Uterine Cervix

“…4,5 Because of the relative abundance of blood supply, the small intestine tends to develop metastasis more frequently than the colon and rectum. 4,6 Rectal metastasis from hematogenous spread is rare and has been reported from prostate cancer, 7 breast cancer, 8,9 gastric cancer, 10 malignant fibrous histiocytoma, 11 ovarian cancer, 12 melanoma, 13 and lung cancer. 14 In our current case, the rectal intramural mass appears as a well-defined submucosal lesion with central ulceration and separates from the adjacent right pelvic mass.…”