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Granulocyte Macrophage Colony-Stimulating Factor–Secreting Allogeneic Cellular Immunotherapy for Hormone-Refractory Prostate Cancer

Authors' Affiliations: ¹ University of California, San Francisco, Comprehensive Cancer Center, San Francisco, California; ² Cell Genesys, Inc., South San Francisco, California; ³ Mary Crowley Medical Research Center, Dallas, Texas; ⁴ Earle A. Chiles Research Institute, Providence Portland Medical Center, Portland, Oregon; ⁵ West Coast Clinical Research, Tarzana, California; ⁶ Urology San Antonio, San Antonio, Texas; ⁷ Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, Maryland; and ⁸ Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia

Requests for reprints: Eric J. Small, University of California, San Francisco, 1600 Divisadero Street, 7th Floor Box 1711, San Francisco, CA 94115. Phone: 415-353-7095; Fax: 415-353-7779; E-mail: smalle{at}medicine.ucsf.edu.

Purpose: This trial evaluated the safety, clinical activity, and immunogenicity of an allogeneic cellular immunotherapy in 55 chemotherapy-naïve patients with hormone-refractory prostate cancer (HRPC). The immunotherapy, based on the GVAX platform, is a combination of two prostate carcinoma cell lines modified with the granulocyte macrophage colony-stimulating factor (GM-CSF) gene.

Experimental Design: HRPC patients with radiologic metastases (n = 34) or rising prostate-specific antigen (PSA) only (n = 21) received a prime dose of 500 million cells and 12 boost doses of either 100 million cells (low dose) or 300 million cells (high dose) biweekly for 6 months. End points were changes in PSA, time to progression, and survival.

Results: Median survival was 26.2 months (95% confidence interval, 17, 36) in the radiologic group: 34.9 months (8, 57) after treatment with the high dose (n = 10) of immunotherapy and 24.0 months (11, 35) with the low dose (n = 24). The median time to bone scan progression in the radiologic group was 5.0 months (2.6, 11.6) with the high dose and 2.8 months (2.8, 5.7) with the low dose. In the rising-PSA group (n = 21) receiving the low dose, the median time to bone scan progression was 5.9 months (5.6, not reached), and median survival was 37.5 months (29, 56). No dose-limiting or autoimmune toxicities were seen; the most common adverse events were injection site reaction and fatigue.

Conclusions: These results suggest that this GM-CSF–secreting, allogeneic cellular immunotherapy is well tolerated and may have clinical activity in patients with metastatic HRPC. Phase 3 trials to confirm these results are under way.

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