RATIONALE: Vaccines made from peptides may help the body build an effective immune response to kill tumor cells that express HER2/neu. Biological therapies, such as GM-CSF, may stimulate the immune system in different ways and stop tumor cells from growing. It is not yet known whether vaccine therapy is more effective than GM-CSF in treating breast cancer. PURPOSE: This randomized phase II trial is studying vaccine therapy to see how well it works compared with GM-CSF in treating patients with breast cancer.
OBJECTIVES: * To determine if the GP2 peptide/GM-CSF vaccine reduces the recurrence rate in HLA-A2-positive, HER2/neu-positive, node-positive, or high-risk node-negative breast cancer patients randomized to receive the vaccine versus the immunoadjuvant, sargramostim (GM-CSF), alone. * To determine if the AE37 peptide/GM-CSF vaccine reduces the recurrence rate in HLA-A2-negative, HER2/neu-positive, node-positive or high-risk node-negative breast cancer patients randomized to receive the vaccine versus the immunoadjuvant, GM-CSF, alone. * To monitor the invitro and invivo immunologic responses to the vaccines and correlate these responses with the clinical outcomes. * To monitor for any unexpected toxicities with the vaccines. OUTLINE: This is a multicenter study. Patients are stratified according to nodal status. Patients are randomized to 1 of 4 treatment arms. * Arm I: HLA-A2-positive patients receive GP2 peptide/GM-CSF vaccine intradermally (ID) every 3-4 weeks for a total of up to 6 inoculations. * Arm II: HLA-A2-positive patients receive solely GM-CSF ID * Arm III: HLA-A2-negative patients receive AE37 peptide/GM-CSF vaccine ID every 3-4 weeks for a total of up to 6 inoculations. * Arm IV: HLA-A2-negative patients receive solely GM-CSF ID After completion of study therapy, patients are followed every 3 months for the first 24 months and then every 6 months for an additional 36 months. Booster inoculations are administered at 12, 18, 24, and 30 months from the date of patients' enrollment into the study. One booster inoculation is administered at each timepoint (+/- 2 weeks) and will be the same inoculation (vaccine or GM-CSF only) as what patients received during their regular inoculation series.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
456
Given intradermally every 3-4 weeks for a total of up to 6 inoculations
GM-CSF given intradermally very 3-4 weeks for a total of up to 6 inoculations
Given intradermally every 3-4 weeks for a total of up to 6 inoculations
Sibley Memorial Hospital
Washington D.C., District of Columbia, United States
University of Hawaii Cancer Center
Honolulu, Hawaii, United States
MedStar Union Memorial Hospital
Disease recurrence
The following will be compared: 1. disease recurrence rates between HLA-A2-negative patients receiving the AE37 + GM-CSF vaccine and HLA-A2-negative patients receiving GM-CSF alone 2. disease recurrence rates between HLA-A2-positive patients receiving the GP2 + GM-CSF vaccine and HLA-A2-positive patients receiving GM-CSF alone 3. disease recurrence rates between all four arms of the trial.
Time frame: Five years (from date of enrollment to the study through the end of the follow-up period)
Safety
Inoculations will be immediately halted if any serious adverse reactions occur which, when based upon appropriate judgment of the PI, are determined to jeopardize the patient or require medical or surgical intervention. Any death or grade 4 adverse drug experience found to be directly related to the experimental vaccine will result in suspension of patient enrollment to the study.
Time frame: Local and systemic reactions to each inoculation will be monitored every six months during the regular inoculation series and the booster series.
Immune Response
Immune response will be measured by proliferation assays, dimer assays, and ELISPOT. Delayed type hypersensitivity reactions will be compared between the vaccinated group and GM-CSF-only group.
Time frame: Immune response will be measured after every monthly inoculation in the regular inoculation series and after each inoculation in the booster series
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Given intradermally every 3-4 weeks for a total of up to 6 inoculations
Baltimore, Maryland, United States
MedStar Good Samaritan Hospital Cancer Center
Baltimore, Maryland, United States
Walter Reed National Military Medical Center
Bethesda, Maryland, United States
Wake Forest University Comprehensive Cancer Center
Winston-Salem, North Carolina, United States
Carl R. Darnall Army Medical Center
Fort Hood, Texas, United States
San Antonio Army Medical Center
Fort Sam Houston, Texas, United States
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
STOH Clinical Research
San Antonio, Texas, United States
...and 3 more locations