Sirolimus and Vaccine Therapy in Treating Patients With Stage II-IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

PRIMARY OBJECTIVE:

I. Determine the safety and feasibility of NY-ESO-1 protein with MIS416 in combination with
mammalian target of rapamycin (mTOR) inhibitor sirolimus.

SECONDARY OBJECTIVES:

I. To determine the effectiveness of these combinatorial therapies by assessing NY-ESO-1
specific cellular and humoral immunity: peripheral blood NY-ESO-1 specific cluster of
differentiation (CD)8+ and CD4+ T-cells; peripheral blood NY-ESO-1 specific antibodies;
peripheral blood frequency of CD4+ CD25+ forkhead box P3 (FOXP3)+ regulatory T-cells; explore
time to disease progression.

OUTLINE:

COHORT I (C1): Patients receive NY-ESO-1 protein with MIS416 vaccine subcutaneously (SC) on
days 1, 15, 29, 57, 85, and 113 in the absence of disease progression or toxicity.

COHORT II (C2): Patients receive NY-ESO-1 protein with MIS416 vaccine as in Cohort I.
Patients also receive sirolimus orally (PO) daily for 2 weeks followed by 2 weeks off
starting on days 1, 29, 57, and 85.

After completion of study treatment, patients are followed up at 30 days and then at 12
months.

Inclusion Criteria:

- Women with stages II-IV epithelial ovarian, fallopian tube, or primary peritoneal
carcinoma who have completed standard therapy for primary or recurrent disease (i.e.,
patients who would normally be observed); eligible patients may have asymptomatic
residual measurable disease on physical examination and/or computed tomography (CT)
scan, and/or may have an elevated cancer antigen 125 (CA-125); or may be in complete
clinical remission after treatment for primary or recurrent disease; these patients
would normally enter a period of observation after standard management

- Any human leukocyte antigen (HLA) type (historic HLA typing is permitted)

- Tumor expression of NY-ESO-1 by immunohistochemistry (IHC) and/or real-time polymerase
chain reaction (RTPCR)

- No history of previous severe allergic reactions to vaccines or unknown allergens

- Life expectancy > 6 months

- Have an Eastern Cooperative Oncology Group (ECOG) performance status of =< 2

- Hematology and biochemistry laboratory results within the limits normally expected for
the patient population, without evidence of major organ failure

- Absolute neutrophil count (ANC) >= 1,000/uL

- Platelets (PLT) >= 75,000/uL

- Hemoglobin (Hgb) >= 8 g/dL

- Total bilirubin =< 1.5 x upper limits of normal (ULN)

- Serum glutamic-oxaloacetic transaminase(SGOT)/aspartate aminotransferase (AST) or
serum glutamate pyruvate transaminase(SGPT)/alanine aminotransferase (ALT) =< 3 x ULN

- Serum creatinine =< 2 x ULN

- Prothrombin time(PT)/international normalized ratio(INR) =< 1.5

- Electrocardiogram, showing no indications of cardiac problems like congestive heart
failure, myocardial infarction, and cardiomyopathy

- Have been informed of other treatment options

- Ability to swallow and retain oral medication

- Participants of child-bearing potential must agree to use adequate contraceptive
methods (e.g., hormonal or barrier method of birth control) prior to study entry;
should a woman become pregnant or suspect she is pregnant while she is participating
in this study, she should inform her treating physician immediately

- Participant or legal representative must understand the investigational nature of this
study and sign an Independent Ethics Committee/Institutional Review Board approved
written informed consent form prior to receiving any study related procedure

- Patients may have received previous NY-ESO-1 vaccine therapy

Exclusion Criteria:

- Metastatic disease to the central nervous system

- Other serious illnesses (e.g., serious infections requiring antibiotics, bleeding
disorders)

- History of severe autoimmune disorders requiring use of steroids or other
immunosuppressives

- Concomitant systemic treatment with corticosteroids, anti-histamine or non-steroidal
antiinflammatory drugs for >2 weeks,, and other platelet inhibitory agents, strong
inhibitors/inducers of cytochrome P450-3A4 (CYP450-3A4)

- Chemotherapy, radiation therapy, or immunotherapy within 4 weeks prior to first dosing
of study drug (6 weeks for nitrosoureas); concomitant hormonal therapies for breast
cancers are allowed

- Patients with a positive fecal occult blood test excluding hemorrhoids

- Clinically significant heart disease (New York Heart Association [NYHA] class III or
IV) within six months

- Participation in any other clinical trial involving another investigational agent
within 4 weeks prior to first dosing of study drug

- Known hepatitis B, hepatitis C, or human immunodeficiency virus (HIV)

- Mental impairment that may compromise the ability to give informed consent and comply
with the requirements of the study

- Lack of availability of a patient for immunological and clinical follow-up assessment

- Known pulmonary hypertension

- Known hypersensitivity to sirolimus

- Evidence of current drug or alcohol abuse or psychiatric impairment, which in the
Investigator's opinion will prevent completion of the protocol therapy or follow-up

- Pregnant or nursing female patients

- Unwilling or unable to follow protocol requirements

- Any condition which in the investigator's opinion deems the patient an unsuitable
candidate to receive study drug (i.e., any significant medical illness or abnormal
laboratory finding that would, in the investigator's judgment, increase the subject's
risk by participating in this study)