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High-dose IL-2 in metastatic melanoma: better survival in patients who also received patient-specific autologous tumor cell vaccine
  1. Robert O Dillman1,2,3,
  2. Carol DePriest3 and
  3. Stephanie E McClure1,2
  1. Aff1 grid.414587.b0000000097556590Hoag Institute for Research and EducationHoag Hospital Newport Beach CA USA
  2. Aff2 grid.414587.b0000000097556590Hoag Family Cancer Institute, Hoag Hospital Newport Beach CA USA
  3. Aff3 Cancer Biotherapy Research Group Newport Beach CA USA

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Meeting abstracts

Treatment with high-dose Interleukin-2 (IL-2) has been associated with long-term survival in small proportion of metastatic melanoma patients. We recently reported a median survival of 15.6 months, and a 20% 5-year survival rate for 150 such patients who were hospitalized for high-dose i.v. IL-2 between May 1987 and April 2010. [1] A recent report showed a survival advantage for the addition of gp100 vaccine plus high-dose IL-2 compared to treatment with IL-2 alone [2]. We were aware that several of our IL-2 patients had also received patient-specific tumor cell vaccines derived from autologous tumor cell lines. We wished to determine whether this may have contributed to their high 5-year survival rate. Comparison of existing data bases revealed that 27 of the 150 IL-2 patients had also received a patient-specific vaccine; 123 had not. The table below (Table 1) summarizes survival data, which was calculated from the date IL-2 was initiated. Survival was much better in patients who received a patient-specific vaccine in addition to IL-2 (p<0.001). That group was also younger, but age was not a predictor of survival in as much as median and 5-year survival rates were not dissimilar: 14.1 months and 23% for patients age <50 years at the time of IL-2, compared to 15.9 months and 17% for patients > age of 50 (NSD). Of the 27 vaccine patients, 7 started vaccine therapy an average of 8.7 mos. before receiving IL-2 (range 2.4 to 40 mos.) and 20 received vaccine a median of 14.2 months after starting IL-2 (range 1 to 42 mos.); 12 received injections of irradiated autologous tumor cells and 15 received injections of dendritic cells loaded with antigens from irradiated autologous tumor cells, and suspended in 500 microgram GM-CSF. Survival was longer in patients who received IL-2 first (5-yr survival 55% vs 14%), and in patients who received the dendritic cell vaccine (5-yr survival 53% vs 33%). This analysis suggests that receipt of high-dose IL-2 followed by a patient specific vaccine results in better survival than IL-2 alone, but the limitations of such a retrospective analysis, and the risk of confounding unintended bias, are significant.

Table 1


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