A Phase I Study of Regulatory T Cell Depletion With Denileukin Diftitox Followed by Active Immunotherapy With Autologous Dendritic Cells Infected With CEA-6D Expressing Fowlpox-Tricom in Patients With Advanced or Metastatic Malignancies Expressing CEA
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed malignancy
- Metastatic disease
- Tumor expresses carcinoembryonic antigen (CEA), as evidenced by any of the following:
- At least 50% of tumor expresses CEA by immunohistochemistry (IHC) with ≥ a
moderate intensity of staining
- Peripheral blood CEA level > 5.0 ng/mL
- Tumor known to be universally CEA-positive (e.g., colon or rectal cancer)
- Measurable or evaluable disease
- Received or refused prior therapy with a possible survival or palliative benefit AND
meets the following disease-specific criteria:
- Patients with colorectal cancer must have experienced disease progression during
≥ 1 prior palliative chemotherapy regimen for metastatic disease comprising 1 of
the following regimens:
- Fluorouracil or capecitabine AND oxaliplatin
- Fluorouracil or capecitabine AND irinotecan
- Chemotherapy in combination with bevacizumab
- Patients with breast cancer must have experienced disease progression during ≥ 1
prior palliative chemotherapy regimen for metastatic disease comprising 1 of the
following regimens:
- Anthracycline- or taxane-based chemotherapy
- Chemotherapy AND trastuzumab (Herceptin®) (required for patients with
tumors overexpressing HER2/neu (i.e., 3+ by IHC or positive by fluorescence
in situ hybridization [FISH])
- Patients with lung cancer must have experienced disease progression during ≥ 1
prior palliative chemotherapy regimen for metastatic disease comprising 1 of the
following regimens:
- Platinum-based (e.g., cisplatin or carboplatin) chemotherapy (for
chemotherapy-naive patients only)
- Taxane-based (e.g., docetaxel or paclitaxel) chemotherapy OR vinorelbine
(for patients who received prior chemotherapy)
- Patients with pancreatic cancer must have experienced disease progression during
prior chemotherapy, including gemcitabine
- Patients with other malignancies must have experienced disease progression after
prior first-line therapy that would confer a survival or palliative benefit, if
such a therapy exists
- Patients who experienced disease progression during prior first-line
palliative chemotherapy must be advised regarding second-line therapy
before study enrollment
- Previously resected brain metastases allowed provided there is no evidence of brain
metastasis within the past month by MRI or CT scan
- No requirement for further systemic chemotherapy for ≥ 3 months
- Hormone receptor status:
- Not specified
PATIENT CHARACTERISTICS:
Age
- 18 and over
Sex
- Male or female
Menopausal status
- Not specified
Performance status
- Karnofsky 70-100%
Life expectancy
- More than 6 months
Hematopoietic
- WBC ≥ 3,000/mm^3
- Hemoglobin ≥ 9 g/dL (transfusion or epoetin alfa allowed)
- Platelet count ≥ 100,000/mm^3
Hepatic
- Bilirubin < 1.5 mg/dL (≤ 2.0 mg/dL for patients with Gilbert's syndrome)
- SGOT and SGPT < 1.5 times upper limit of normal
- Albumin ≥ 3.0 g/dL
- No active acute or chronic viral hepatitis
- Hepatitis B surface antigen negative
- Hepatitis C negative
- No other hepatic disease that would preclude study treatment
Renal
- Creatinine < 1.5 mg/dL
- No active acute or chronic urinary tract infection
Cardiovascular
- No New York Heart Association class III-IV cardiac disease
Immunologic
- HIV negative
- No history of autoimmune disease*, including, but not limited to, the following:
- Inflammatory bowel disease
- Systemic lupus erythematosus
- Ankylosing spondylitis
- Scleroderma
- Multiple sclerosis
- No active cytomegalovirus (CMV) disease
- Patients with CMV-seropositivity are eligible
- No other active acute or chronic infection
- No history of allergies to eggs or any component of the study vaccine, denileukin
diftitox, or diphtheria toxin NOTE: *Patients with a positive anti-nuclear antibody
(ANA) ≤ 1:256 with no other evidence of autoimmune disease are eligible
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 4 months after
completion of study treatment
- No acute or chronic skin disorder that would preclude study treatment
- No other malignancy within the past 5 years except nonmelanoma skin cancer,
controlled carcinoma in situ of the cervix, or controlled superficial bladder cancer
- No psychological or medical impediment that would preclude study compliance
- No other serious acute or chronic illness that would preclude study treatment
PRIOR CONCURRENT THERAPY:
Biologic therapy
- See Disease Characteristics
- Prior vaccine, dendritic cell, or CEA-targeted immunotherapy allowed
- At least 4 weeks since prior and no other concurrent immunotherapy
- Concurrent palliative single-agent trastuzumab for breast cancer allowed provided
patient has been on therapy for ≥ 3 months before study entry
Chemotherapy
- See Disease Characteristics
- At least 4 weeks since prior and no concurrent chemotherapy
Endocrine therapy
- At least 4 weeks since prior hormonal therapy
- At least 6 weeks since prior steroid therapy except steroids used as premedication
for chemotherapy or contrast-enhanced studies
- No concurrent steroids, including corticosteroids administered to manage toxic
effects from dendritic cell or denileukin diftitox administration
- Concurrent palliative endocrine therapy for breast cancer allowed provided patient
has been on therapy for ≥ 3 months before study entry
Radiotherapy
- At least 4 weeks since prior and no concurrent radiotherapy
Surgery
- See Disease Characteristics
Other
- Recovered from all prior therapy
- At least 4 weeks since prior investigational drugs or procedures
- At least 4 weeks since other prior therapy
- No other concurrent immunosuppressive therapy (e.g., azathioprine or cyclosporine)