Dendritic Cells (White Blood Cells) Vaccination for Advanced Melanoma

Eligible patients that provide written informed consent will undergo apheresis to collect
blood mononuclear cells for vaccine production. All patients will be given cyclophosphamide
300mg/m2 IV three days prior to vaccine dose #1 in order to deplete regulatory T cells. All
patients will receive mature DC for each dose of vaccine. For each dose all patients will
receive autologous dendritic cells pulsed with 2 gp100 melanoma peptides (G209-2M and
G280-9V) plus up to an additional 10 unique melanoma tumor-specific peptides. All patients
will receive booster doses with mature DC. The DC vaccine will be given intravenously every
three weeks for a total of six vaccine doses. Peripheral blood (16 ml) will be taken weekly
to monitor the immune response to each peptide by tetramer assay. Apheresis is repeated
after vaccine dose #3 and dose #6 in order to collect PBMC for immune monitoring. Restaging
is performed after three and six vaccine doses. Patients with stable disease or better
(partial response/complete response) after six doses will be eligible to receive additional
vaccinations as maintenance therapy every 2 months until progression.

Inclusion Criteria:

- Unresectable stage III and stage IV M1a/M1b/M1c melanoma including patients with
uveal melanoma

- Age ≥ 18 years

- Life expectancy ≥ 4 months

- ECOG performance status 0-2

- At least 28 days from prior treatment (including adjuvant interferon) except in cases
of a BRAF inhibitor (such as vemurafenib); concurrent treatment with a BRAF inhibitor
+/- MEK inhibitor is permitted

- Required initial laboratory values (submitted within 14 days prior to registration):

- WBC >3,000/mm3

- Hg ≥ 9.0 gm/dl

- Platelets >75,000/mm3

- Serum Bilirubin < 2.0 mg/dl

- Serum Creatinine < 2.0 mg/dl

- Sexually active women of childbearing potential must use effective birth control
during the trial and for at least two months following the trial, and sexually active
men must be willing to avoid fathering a new child while receiving therapy.

Exclusion Criteria:

- Prior treatment with more than one line of cytotoxic chemotherapy; prior treatment
with one line of cytotoxic chemotherapy is permitted. Prior treatment with targeted
therapy (such as ipilumumab, anti-PD1, and BRAF inhibitor) is permitted.

- Active untreated CNS metastasis

- Active infection

- Prior malignancy (except non-melanoma skin cancer) within 3 years

- Pregnant or nursing

- Concurrent treatment with corticosteroids; local (inhaled or topical) steroids are
permitted.

- Inability to provide adequate informed consent

- Known allergy to eggs

- Prior history or uveitis or autoimmune inflammatory eye disease.

- Known positivity for hepatitis BsAg, hepatitis C antibody, or HIV antibody.