Induction of cytotoxic T cells as a novel independent survival factor in malignant melanoma with percutaneous peptide immunization

• Tumor specific CTLs were induced by attaching peptides on the barrier-disrupted skin.
• OS of the complete responders was longer than that of the incomplete responders.
• The induction of CTLs was a novel independent survival factor.

BackgroundMalignant melanoma (MM) often shows multiple chemo-resistance, leading to poor prognosis of the patients. Therapeutic anti-cancer vaccination may be a feasible way to prolong the survival of patients. We have demonstrated that application of antigenic peptides via the tape-stripped, horny layer-removed skin, known as percutaneous peptide immunization (PPI), induces tumor cell-specific cytotoxic T lymphocytes (CTLs) in rodents and humans.ObjectiveTo evaluate clinical significance of PPI in advanced MM patients.MethodsWe performed PPI in 59 patients undergoing advanced MM with Melan-A, tyrosinase, MAGE-2, MAGE-3 and gp-100 peptides based on HLA typing in individuals. The induction of CTLs was assessed by the tetramer or pentamer flow cytometry in 35 patients. Patients showing positive CTL responses to all antigens were defined as complete responder (n = 18), and those showing negative responses to at least one applied antigen were classified as incomplete responder (n = 17). The primary endpoint of the study was overall survival (OS). For statistical analysis, log-rank test, univariate and multivariate Cox proportional hazard model were used.ResultsOS of the complete responders was longer than that of the incomplete responders (median survival time: 55.8 vs 20.3 months, log rank P = 0.089). A hazard ratio for the complete responders relative to the incomplete responders was 0.23 (95% confidence interval: 0.06–0.93, P = 0.039) in a multivariate Cox proportional hazard model.ConclusionThe induction of CTLs was a novel independent survival factor, and the induction of peptide-specific CTLs by PPI contributes to the prolonged survival and represents an impact on therapeutic approaches in MM.Unique trial number: UMIN000005706.