To the exception of early stages of disease, the morbidity and mortality of
melanoma is considerable, with no acknowledged therapeutic options beyond surgery.
Immunotherapy of
melanoma has achieved some success, but further refinements are urgently needed in order to realize its potential. This paper describes a multi-centre phase I/II open labeled, controlled clinical trial investigating 2 innovative immunotherapeutic
reagents. Two successive groups of 20 resected AJCC stages IIb-IV
melanoma patients will be treated, first with
melanoma epitopes included into
Influenza virosomes (group 1), and second with a heterologous prime-boost protocol priming with a recombinant Vaccinia virus, and boosting with
Influenza virosomes (group 2). Five
melanoma epitopes from three different
melanoma differentiation antigens were included into
Influenza virosomes, that cross-stimulate CD4+ T cells and are endowed with high adjuvant capacity in the generation of CTL. The same five
melanoma epitopes, two co-stimulatory molecules CD80 and CD86, and the
CD40 ligand, a marker known to play a crucial role in CTL generation and memory maintenance were encoded in a recombinant Vaccinia virus.
GM-CSF will be administered as a supporting
cytokine. Both
Influenza virosomes and octo-recombinant Vaccinia virus are innovative and original constructs assessed for the first time in human.
Immunotherapy foresees 12 weekly immunizations for each group. Toxicity and adverse events will be monitored clinically. Immunological efficacy will be assessed dynamically by ex-vivo multimer analysis, Elispot, and quantitative real-time PCR for up to 3 months following completion of
immunotherapy schedule. Disease free survival will be assessed by 4-monthly serial
clinic visits, including physical and FDG-PET examinations, for a follow-up time of 2 years. Quality of life will be assessed with a dedicated FACT-BRM 4 questionnaire.