Melanoma Vaccine May Prolong Survival

Laurie Barclay, MD

December 20, 2002

Dec. 20, 2002 — Canvaxin, a therapeutic cancer vaccine, may prolong survival of stage IV melanoma after complete resection, according to the results of a prospective phase II trial reported in the Dec. 1 issue of the Journal of Clinical Oncology. A randomized prospective trial is underway at 40 cancer centers in the U.S., Europe, and Australia.

"The curative effect of surgery in certain patients with metastatic melanoma suggests the presence of endogenous antitumor responses," write Eddy C. Hsueh and colleagues from the John Wayne Cancer Institute, Saint John's Health Center in Santa Monica, California. "Because melanoma is immunogenic, we investigated whether...Canvaxin (CancerVax Corporation, Carlsbad, California) could enhance antitumor immune responses and thereby prolong survival."

Of 263 patients who underwent complete resection of stage IV melanoma according to American Joint Committee on Cancer criteria, 150 received postoperative adjuvant vaccine therapy and 113 did not.

Five-year overall survival rates were 39% for vaccinated and 19% for nonvaccinated patients, and multivariate analysis suggested that vaccine therapy was the most significant prognostic variable ( P=.0001).

Using computer matching of vaccinated to nonvaccinated patients based on sex, metastatic site, and number of tumor-involved organ sites, there was a significant overall survival advantage for vaccine therapy in 107 matched pairs ( P=.0009), with five-year survival of 39% for vaccinated patients vs. 20% for nonvaccinated patients.

Vaccine therapy was associated with a significant delayed-type hypersensitivity (DTH) response ( P=.0001). Overall survival was significantly correlated with DTH to vaccine ( P=.0001) but not to purified protein derivative (PPD) used as a control antigen.

"Prolonged survival was observed in patients who received postoperative active immunotherapy with Canvaxin therapeutic cancer vaccine," the authors write. "The correlation of survival with vaccine-DTH responses but not PPD-DTH indicates a treatment-specific effect. These findings suggest that adjuvant active specific immunotherapy should be considered after cytoreductive surgery for advanced melanoma."

J Clin Oncol. 2002;20:4549-4554

Reviewed by Gary D. Vogin, MD

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