101. Direct injection of protamine-protected mRNA: results of a phase 1/2 vaccination trial in metastatic melanoma patients.
- Author
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Weide B, Pascolo S, Scheel B, Derhovanessian E, Pflugfelder A, Eigentler TK, Pawelec G, Hoerr I, Rammensee HG, and Garbe C
- Subjects
- Adolescent, Adult, Aged, Antigens, Neoplasm metabolism, Antigens, Neoplasm therapeutic use, Bone Neoplasms metabolism, Bone Neoplasms secondary, CD11b Antigen, CD4 Antigens, Cell Proliferation, Feasibility Studies, Female, Forkhead Transcription Factors, Granulocyte-Macrophage Colony-Stimulating Factor administration & dosage, HLA-DR Antigens, Hemocyanins metabolism, Humans, Injections, Intradermal, Lung Neoplasms metabolism, Lung Neoplasms secondary, Male, Melanoma metabolism, Melanoma pathology, Melanoma-Specific Antigens, Middle Aged, Myeloid Cells immunology, Myeloid Cells pathology, Neoplasm Proteins metabolism, Neoplasm Proteins therapeutic use, Neoplasm Staging, Protamines metabolism, RNA, Messenger genetics, RNA, Messenger metabolism, RNA, Messenger therapeutic use, Remission Induction, T-Lymphocytes, Regulatory immunology, T-Lymphocytes, Regulatory pathology, Antigens, Neoplasm genetics, Antigens, Neoplasm immunology, Bone Neoplasms immunology, Bone Neoplasms therapy, Cancer Vaccines, Immunotherapy, Active, Lung Neoplasms immunology, Lung Neoplasms therapy, Melanoma immunology, Melanoma therapy, Myeloid Cells metabolism, Neoplasm Proteins genetics, Neoplasm Proteins immunology, T-Lymphocytes, Regulatory metabolism
- Abstract
In mice, injection of messenger RNA (mRNA) coding for tumor-associated antigens can induce antitumor immune responses and therefore offers a broadly applicable immunotherapy approach. We injected intradermally protamine-stabilized mRNAs coding for Melan-A, Tyrosinase, gp100, Mage-A1, Mage-A3, and Survivin in 21 metastatic melanoma patients. In 10 patients keyhole limpet hemocyanin (KLH) was added to the vaccine. Granulocyte macrophage colony-stimulating factor was applied as an adjuvant. Endpoints were toxicity and immune responses. No adverse events more than grade II have been observed. During treatment the frequency of Foxp3+/CD4+ regulatory T cells was significantly decreased upon mRNA vaccination in peripheral blood of the patients in the KLH arm, whereas myeloid suppressor cells (CD11b+HLA-DR lo monocytes) were reduced in the patients not receiving KLH. A reproducible increase of vaccine-directed T cells was observed in 2 of 4 immunologically evaluable patients. One of 7 patients with measurable disease showed a complete response. In conclusion, we show here that direct injection of protamine-protected mRNA is feasible and safe. The significant influence of the treatment on the frequency of immunosuppressive cells, the increase of vaccine-directed T cells upon treatment in a subset of patients together with the demonstration of a complete clinical response encourage further clinical investigation of the protamine-mRNA vaccine.
- Published
- 2009
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