The aim of the present study was to investigate the safety and immunological responses of personalized peptide vaccination in combination with oral administration of a 5-fluorouracil derivative (TS-1) in advanced gastric or colorectal carcinoma patients. Eleven patients (four with gastric cancer and seven with colorectal cancer) who failed to improve by prior TS-1-based chemotherapies were enrolled in this study. Peptides to be administered to patients were determined based on the presence of peptide-specific cytotoxic T lymphocyte ( (1) Cancer vaccines have emerged as a promising therapeutic approach, (2) but their clinical responses have been limited.(3) In order to develop a new treatment modality, we recently devised a new regime of peptide-based vaccination that consists of measuring pre-existing CTL precursors and IgG reactive to many kinds of vaccine candidates, followed by administration. (4)(5)(6)(7)(8) In addition, we recently reported the benefits of the combination of this type of peptide vaccination with a low dose of estramustine phosphate in hormone refractory prostate cancer patients.(9) This chemoimmunotherapy may break through the impasse in the clinical efficacy of cancer vaccines.TS-1 is an oral fluoropyrimidine derivative consisting of Tegafur (FT) and two modulators, 5-chloro-2,4-dihydroxypyrimidine (CDHP) and potassium oxonate (Oxo). FT is a prodrug of 5-fluorouracil (5-FU) and CDHP is a reversible competitive inhibitor of an enzyme involved in the degradation of 5-FU. Therefore, the FT-derivative 5-FU remains in tumor tissue a long time, resulting in an enhanced antitumor effect.(10,11) Indeed, TS-1 has been reported to be effective at prolonging the survival of patients with advanced gastric cancer.(12) Furthermore, TS-1 can be administered as an oral formulation that permits treatment on an outpatient basis, leading to improvement in the quality of life (QOL) of patients. In the present study, we investigated the safety and immunological responses of personalized peptide vaccination in combination with the oral administration of TS-1 in advanced gastric or colorectal carcinoma patients.
Materials and MethodsPatients and eligibility criteria. The study protocol was approved by the Institutional Ethical Review Boards of Hokkaido University, Okayama University and Kurume University. Complete written informed consent was obtained from all patients at the time of enrolment. According to the protocol, patients were confirmed to be HLA-A24 or HLA-A2 positive and had a histologically confirmed lesion of gastric or colorectal carcinoma. In HLA-A2 + patients, their HLA-A2 genotypes were determined using sequence-specific oligonucleotide DNA typing after polymerase chain reaction. All patients had failed to improve by prior chemotherapy with TS-1. The other eligibility criteria included an age of 85 years or less, serum creatinine of less than 1.4 mg/dL, bilirubin of less than 1.5 mg / dL, a platelet count of 100 000 µL or more, hemoglobin of 8.0 g / dL or more, and total white blood cell count (W...