Autologous hapten-modified melanoma vaccine as postsurgical adjuvant treatment after resection of nodal metastases

Purpose: To determine whether treatment with an autologous whole-cell vaccine modified with the hapten dinitrophenyl (DNP vaccine) is an effective postsurgical adjuvant treatment for melanoma patients with clinically evident nodal metastases. Patients and Methods: Eligible patients had regional nodal metastases that were large enough (greater than or equal to 3 diameter) to prepare vaccine. Following standard lymphadenectomy, patients were treated with DNP vaccine on a monthly or weekly schedule, Results: Of 62 patients with metastasis in a single lymph node bed (stage III), 36 are olive after a median follow-up time of 55 months (range, 29 to 76); the projected 5-year relapse-free and overall survival rates are 45% and 58%, respectively, Of 15 patients with metastases in two nodal sites, five are alive with a median follow-up time of 73 months. An unexpected finding was the significantly better survival of older patients; the projected 5-year survival of patients greater than 50 versus less than or equal to 50 years was 71% and 47%, respectively (P = .011, log-rank test). The development of a positive delayed-type hypersensitivity (DTH) response to unmodified autologous melanoma cells was associated with significantly longer 5-year survival (71% v 49%; P = .031). Finally, the median survival time from date of first recurrence was significantly longer for patients whose subcutaneous recurrence exhibited on inflammatory response (> 19.4 v 5.9 months; P < .001). Conclusion: Postsurgical adjuvant therapy with autologous DNP-modified vaccine appears to produce survival rates that are markedly higher than have been reported with surgery alone, Moreover, this approach has some intriguing immunobiologic features that might provide insights into the human tuner-host relationship. (C) 1997 by American Society of Clinical Oncology.