A randomized phase II clinical trial of personalized peptide vaccination with metronomic low-dose cyclophosphamide in patients with metastatic castration-resistant prostate cancer
Aged, 80 and over
Male
Middle Aged
Cancer Vaccines
Combined Modality Therapy
Survival Analysis
T-Lymphocytes, Regulatory
7. Clean energy
3. Good health
Prostatic Neoplasms, Castration-Resistant
03 medical and health sciences
Treatment Outcome
0302 clinical medicine
Administration, Metronomic
Vaccines, Subunit
Humans
Neoplasm Grading
Neoplasm Metastasis
Precision Medicine
Peptides
Cyclophosphamide
Aged
T-Lymphocytes, Cytotoxic
DOI:
10.1007/s00262-015-1781-6
Publication Date:
2016-01-04T09:51:39Z
AUTHORS (8)
ABSTRACT
This study investigated the effect of metronomic cyclophosphamide (CPA) in combination with personalized peptide vaccination (PPV) on regulatory T cells (Treg) and myeloid-derived suppressor cells (MDSC), and whether it could improve the antitumor effect of PPV. Seventy patients with metastatic castration-resistant prostate cancer were randomly assigned (1:1) to receive PPV plus oral low-dose CPA (50 mg/day), or PPV alone. PPV treatment used a maximum of four peptides chosen from 31 pooled peptides according to human leukocyte antigen types and antigen-specific humoral immune responses before PPV, for 8 subcutaneous weekly injections. Peptide-specific cytotoxic T lymphocyte (CTL) and immunoglobulin G responses were measured before and after PPV. The incidence of grade 3 or 4 hematologic adverse events was higher in the PPV plus CPA arm than in the PPV alone arm. Decrease in Treg and increase in MDSC were more pronounced in PPV plus CPA treatment than in PPV alone (p = 0.036 and p = 0.048, respectively). There was no correlation between the changes in Treg or MDSC and CTL response. There was no difference in positive immune responses between the two arms, although overall survival in patients with positive immune responses was longer than in those with negative immune responses (p = 0.001). Significant differences in neither progression-free survival nor overall survival were observed between the two arms. Low-dose CPA showed no change in the antitumor effect of PPV, possibly due to the simultaneous decrease in Treg and increase in MDSC, in patients under PPV.
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