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Journal of Clinical Oncology, Vol 19, Issue 9 (May), 2001: 2370-2380
© 2001 American Society for Clinical Oncology


RAPID PUBLICATION

High-Dose Interferon Alfa-2b Significantly Prolongs Relapse-Free and Overall Survival Compared With the GM2-KLH/QS-21 Vaccine in Patients With Resected Stage IIB-III Melanoma: Results of Intergroup Trial E1694/S9512/C509801

By John M. Kirkwood, Joseph G. Ibrahim, Jeffrey A. Sosman, Vernon K. Sondak, Sanjiv S. Agarwala, Marc S. Ernstoff, Uma Rao

From the Division of Hematology-Oncology and Department of Pathology, Department of Medicine, University of Pittsburgh Cancer Institute Melanoma Center, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Biostatistics, Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, MA; College of Medicine, University of Illinois at Chicago, Chicago, IL; Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, MI; Department of Medicine, Division of Hematology-Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Eastern Cooperative Oncology Group, Boston, MA; and Southwest Oncology Group, San Antonio, TX.

Address reprint requests to John M. Kirkwood, MD, Department of Medicine, University of Pittsburgh School of Medicine, Melanoma Center, University of Pittsburgh Cancer Institute, 200 Lothrop St, Pittsburgh, PA 15213-2582; email: jmk{at}jimmy.harvard.edu

PURPOSE: Vaccine alternatives to high-dose interferon alfa-2b therapy (HDI), the current standard adjuvant therapy for high-risk melanoma, are of interest because of toxicity associated with HDI. The GM2 ganglioside is a well-defined melanoma antigen, and anti-GM2 antibodies have been associated with improved prognosis. We conducted a prospective, randomized, intergroup trial to evaluate the efficacy of HDI for 1 year versus vaccination with GM2 conjugated to keyhole limpet hemocyanin and administered with QS-21 (GMK) for 96 weeks (weekly x 4 then every 12 weeks x 8).

PATIENTS AND METHODS: Eligible patients had resected stage IIB/III melanoma. Patients were stratified by sex and number of positive nodes. Primary end points were relapse-free survival (RFS) and overall survival (OS).

RESULTS: Eight hundred eighty patients were randomized (440 per treatment group); 774 patients were eligible for efficacy analysis. The trial was closed after interim analysis indicated inferiority of GMK compared with HDI. For eligible patients, HDI provided a statistically significant RFS benefit (hazard ratio [HR] = 1.47, P = .0015) and OS benefit (HR = 1.52, P = .009) for GMK versus HDI. Similar benefit was observed in the intent-to-treat analysis (RFS HR = 1.49; OS HR = 1.38). HDI was associated with a treatment benefit in all subsets of patients with zero to >= four positive nodes, but the greatest benefit was observed in the node-negative subset (RFS HR = 2.07; OS HR = 2.71 [eligible population]). Antibody responses to GM2 (ie, titers >= 1:80) at days 29, 85, 365, and 720 were associated with a trend toward improved RFS and OS (P2 = .068 at day 29).

CONCLUSION: This trial demonstrated a significant treatment benefit of HDI versus GMK in terms of RFS and OS in melanoma patients at high risk of recurrence.


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Adjuvant Immunotherapy of Patients With High-Risk Melanoma Using Vaccinia Viral Lysates of Melanoma: Results of a Randomized Trial
J. Clin. Oncol., October 15, 2002; 20(20): 4181 - 4190.
[Abstract] [Full Text] [PDF]


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B. Mellado, M. del Carmen Vela, D. Colomer, L. Gutierrez, T. Castel, L. Quinto, M. Fontanillas, N. Reguart, J. M. Domingo-Domenech, C. Montagut, et al.
Tyrosinase mRNA in Blood of Patients With Melanoma Treated With Adjuvant Interferon
J. Clin. Oncol., October 1, 2002; 20(19): 4032 - 4039.
[Abstract] [Full Text] [PDF]


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JCOHome page
J. M. Kirkwood, J. Ibrahim, V. K. Sondak, M. S. Ernstoff, L. Flaherty, F. J. Haluska, M.B. Lens, and M. Dawes
Use and Abuse of Statistics in Evidence-Based Medicine
J. Clin. Oncol., October 1, 2002; 20(19): 4122 - 4124.
[Full Text] [PDF]


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JCOHome page
R. Bukowski, M. S. Ernstoff, M. E. Gore, J. J. Nemunaitis, R. Amato, S. K. Gupta, and C. L. Tendler
Pegylated Interferon Alfa-2b Treatment for Patients With Solid Tumors: A Phase I/II Study
J. Clin. Oncol., September 15, 2002; 20(18): 3841 - 3949.
[Abstract] [Full Text] [PDF]


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JCOHome page
J. M. Kirkwood, C. Bender, S. Agarwala, A. Tarhini, J. Shipe-Spotloe, B. Smelko, S. Donnelly, and L. Stover
Mechanisms and Management of Toxicities Associated With High-Dose Interferon Alfa-2b Therapy
J. Clin. Oncol., September 1, 2002; 20(17): 3703 - 3718.
[Abstract] [Full Text] [PDF]


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Mayo Clin Proc.Home page
S. D. Thome, C. L. Loprinzi, and M. P. Heldebrant
Determination of Potential Adjuvant Systemic Therapy Benefits for Patients With Resected Cutaneous Melanomas
Mayo Clin. Proc., September 1, 2002; 77(9): 913 - 917.
[Abstract] [PDF]


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The OncologistHome page
I. Espinoza-Delgado
Cancer Vaccines
Oncologist, August 1, 2002; 7(90003): 20 - 33.
[Abstract] [Full Text] [PDF]


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JNMHome page
G. Mariani, M. Gipponi, L. Moresco, G. Villa, M. Bartolomei, G. Mazzarol, M. C. Bagnara, A. Romanini, F. Cafiero, G. Paganelli, et al.
Radioguided Sentinel Lymph Node Biopsy in Malignant Cutaneous Melanoma*
J. Nucl. Med., June 1, 2002; 43(6): 811 - 827.
[Abstract] [Full Text] [PDF]


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L. Kretschmer, C. Neumann, B. Coldiron, S. Dinehart, J. M. Kirkwood, S. S. Agarwala, J. Ibrahim, J. Manola, V. K. Sondak, M. S. Ernstoff, et al.
Sentinel-Node Technique Will Change the Design of Clinical Trials in Malignant Melanoma
J. Clin. Oncol., April 15, 2002; 20(8): 2208 - 2210.
[Full Text] [PDF]


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J. Leukoc. Biol.Home page
D. L. Brassard, M. J. Grace, and R. W. Bordens
Interferon-{alpha} as an immunotherapeutic protein
J. Leukoc. Biol., April 1, 2002; 71(4): 565 - 581.
[Abstract] [Full Text] [PDF]


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K. L. Kilbridge, B. F. Cole, J. M. Kirkwood, F. G. Haluska, M. A. Atkins, J. C. Ruckdeschel, D. E. Sock, R. F. Nease Jr, and J. C. Weeks
Quality-of-Life-Adjusted Survival Analysis of High-Dose Adjuvant Interferon Alfa-2b for High-Risk Melanoma Patients Using Intergroup Clinical Trial Data
J. Clin. Oncol., March 1, 2002; 20(5): 1311 - 1318.
[Abstract] [Full Text] [PDF]


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Arch SurgHome page
G. I. Salti, A. Kansagra, M. A. Warso, S. G. Ronan, and T. K. Das Gupta
Clinical Node-Negative Thick Melanoma
Arch Surg, March 1, 2002; 137(3): 291 - 295.
[Abstract] [Full Text] [PDF]


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JCOHome page
K. Wilson, J. M. Kirkwood, J. Ibrahim, and J. Manola
High-Dose Interferon Versus GM2 Vaccine in High-Risk Malignant Melanoma
J. Clin. Oncol., December 1, 2001; 19(23): 4350 - 4350.
[Full Text]


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JCOHome page
G. J. van Londen, B. Mascarenhas, and J. M. Kirkwood
Rhabdomyolysis, When Observed With High-Dose Interferon-Alfa (HDI) Therapy, Does Not Always Exclude Resumption of HDI
J. Clin. Oncol., September 1, 2001; 19(17): 3794 - 3794.
[Full Text]


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Clin. Cancer Res.Home page
P. Livingston
The Unfulfilled Promise of Melanoma Vaccines
Clin. Cancer Res., July 1, 2001; 7(7): 1837 - 1838.
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