Surgery and adjuvant dendritic cell-based tumour vaccination for patients with relapsed malignant glioma, a feasibility study

Abstract

Patients with relapsed malignant glioma have a poor prognosis. We developed a strategy of vaccination using autologous mature dendritic cells loaded with autologous tumour homogenate. In total, 12 patients with a median age of 36 years (range: 11-78) were treated. All had relapsing malignant glioma. After surgery, vaccines were given at weeks 1 and 3, and later every 4 weeks. A median of 5 (range: 2-7) vaccines was given. There were no serious adverse events except in one patient with gross residual tumour prior to vaccination, who repetitively developed vaccine-related peritumoral oedema. Minor toxicities were recorded in four out of 12 patients. In six patients with postoperative residual tumour, vaccination induced one stable disease during 8 weeks, and one partial response. Two of six patients with complete resection are in CCR for 3 years. Tumour vaccination for patients with relapsed malignant glioma is feasible and likely beneficial for patients with minimal residual tumour burden.

Figure 1

Quality control of dendritic cells. Representative example obtained by FACS analysis, of the expression of surface markers on loaded mature dendritic cells at the time of injection.

Figure 2

Evolution of tumour volume and response in patient 1. Pre- and postoperative time course of tumour volume (assessed on consecutive MRI images), and of peritumoral oedema reaction (assessed by neurological clinical examination and emergency CT). The time points of operation (day 0) and vaccines (days 31, 45, 65, 89, 129) are indicated.

Figure 3

Continuous complete remission of reoperated tumour and partial response of second localisation in patient 6. MRI scan at time of pre- and postoperative status (upper panel); and postoperative evolution on MRI scan during and after vaccination (lower panel). Tumour resection was performed at 25-2-2002. Vaccinations were given at 14-3-02, 28-3-02 and 25-4-02. After the third vaccination, tumour volume in the right temporal lobe decreased by 50%.