This has been a busy week or two, so I haven’t had time to update posts with new melanoma research out there. Here’s a vaccine that’s showing promise. This vaccine, different from Amgen’s talimogene laherparapvec, (also known as TVEC) is also showing promise.
I am still a big believer in TVEC’s potential, by the way, although Kevin’s oncology staff tells me this is mostly for subcutaneous lesions, not metastasized late-stage melanoma, clinical trials are showing promise treating even late-stage, metastasized melanoma. I still think it’s worth investigating… but I digress.
An Adelaide research team says it has developed a vaccine to tackle melanoma, a disease which kills about 1,500 Australians annually. About 12,000 new cases are being diagnosed each year. Here’s the article, below:
Barry Foote was 50 when he was diagnosed with aggressive melanoma and given just a year to live.
“The doctor told me to get my house into order and I didn’t think I’d live for 12 months, but 14 years later I’m still here,” he said.
Mr Foote’s surgeon cut out melanomas 24 times as they kept developing in different parts of his body.
“I even got to the stage where I could feel a tumor coming on,” he said.
“I’d get a burning sensation and then I’d have to race to the doctor and he’d cut it out and we’d keep going until he just couldn’t do it any longer.”
Eventually Mr Foote was referred to oncologist Brendon Coventry.
The Associate Professor from Adelaide University and the Australian Melanoma Research Foundation had just started trials of a melanoma vaccine.
“I was a bit scared at first, but when I realised that these tumours were starting to disappear I was very pleased,” Mr Foote said.
“Dr Coventry … said ‘if it’s going to work you’ll feel pain where the tumours are’ and I certainly did feel a lot of pain and I was pretty happy with that because I knew it was working.”
Vaccine trial has spanned 14 years
Mr Foote is among 54 patients with advanced melanoma who have been involved in the vaccine trial over the past 14 years.
At first, he was injected with the vaccine every fortnight then monthly and now he gets a shot twice per year.
Dr Coventry says the key is giving repetitive and prolonged doses of the vaccine.
The immune system works in ways that seems to be switching on and off constantly and now what we’re trying to do is to see whether we can identify periods or phases in that cycle where we can target the vaccine more effectively and perhaps even increase the responses beyond the 17 per cent.Dr Brendon Coventry
“What it’s shown is that the vaccine can successfully modulate or modify the immune system of the cancer patient to produce long-term survival with complete removal of all tumour in about 17 per cent of cases,” he said.
“It’s one of a handful of studies where complete responses or complete remissions have actually exceeded 15 per cent for advanced melanoma.
“A lot of other studies have used very complex regimens, and very toxic regimens. The vaccine has very little in terms of side-effects at all, there’s sometimes a little redness but apart from that nothing else is experienced.”
Here’s the link to the original article. I copied it here in case the link changes.
Watch the video report here: http://www.abc.net.au/news/2014-04-17/promise-with-melanoma-vaccine/5398730
Dr Coventry says the trial is helping researchers understand how a patient’s immune system can be manipulated to fight cancer.
He says the next step is to look at what happens to the immune system after the vaccine is given.
“The immune system works in ways that seems to be switching on and off constantly and now what we’re trying to do is to see whether we can identify periods or phases in that cycle where we can target the vaccine more effectively and perhaps even increase the responses beyond the 17 per cent,” he said.
Dr Coventry says success with the vaccine could see it used to treat other cancers.
The latest research findings have been published in the Journal for ImmunoTherapy of Cancer.
Prolonged repeated vaccine immuno-chemotherapy induces long-term clinical responses and survival for advanced metastatic melanoma
Repetitive long-term Vaccinia Melanoma Cell Lysate (VMCL) vaccination schedules have proved clinically effective in producing Complete Responses and strong durable survivals for up to 6.1 years in a previous study of patients with advanced Stage IV and Stage IIIc melanoma. These studies were expanded to include 54 patients for further evaluation of these findings.
54 patients comprising 48 Stage IV (6 M1a, 14 M1b, 28 M1c) and 6 advanced Stage III (5 IIIc; 1 IIIb) were studied using repeated intra-dermal VMCL vaccine therapy. If disease progressed, vaccine was continued together with standard chemotherapy (DTIC and/or Fotemustine). Overall survival was the primary end-point assessed, with clinical responses and toxicity recorded.
From vaccine commencement, median overall survival was 14 months, ranging from 4 to 121 months. Kaplan-Meier survival analysis demonstrated overall 1, 2 and 3-year survival estimates of 57%, 26% and 18.5% respectively, and overall 5-year survival of 15.4%. No appreciable toxicity was observed. Complete Responses (CR) occurred in 16.7% (9) and partial responses (PR) in 14.8% (8) of patients. Stable disease was noted in a further 25 patients (46.3%). No response to therapy was apparent in 12 patients (22.2%). The overall response rate was 31.5% (CR + PR), with clinically significant responses (CR + PR + SD) in 77.8% of patients. Strong, durable clinical responses with overall survivals >= 23 months occurred in 29.6% of patients treated with repeated VMCL vaccine for advanced melanoma, (+/- concurrent chemotherapy).
Prolonged, repetitive VMCL vaccination immunotherapy appears to be a clinically effective means of generating relatively high CR rates, useful clinical responses and long-term survivals, with little toxicity, but remains notably under-explored. Successive immunomodulation might explain the results. Closer analysis of repetitive dosing is required to improve clinical response rates and survival, perhaps by optimising the timing of immunotherapy delivery.
Trial registration: Australian and New Zealand Clinical Trials Registry ANZCTRN12605000425695.