Relapse of renal cell carcinoma with disappearance of HLA class I following hTERT peptide vaccination.

A 74-year-old woman who had undergone right nephrectomy due to renal cell carcinoma (RCC) was found to have developed multiple lung metastasis of RCC 5 years after surgery. The patient was treated with interferon-a, but she was unable to tolerate this therapy because of fever and severe malaise. At this time, as molecular-targeted therapy, such as the multikinase inhibitor sorafenib, was not available, the patient was enrolled in a phase I/II clinical study of human telomerase reverse transcriptase (hTERT) peptide vaccination, as reviewed and approved by the Institutional Review Board of Ehime University Hospital. She received s.c. injection of 1 mg hTERT324–332 (VYAETKHFL) peptide [1] in Montanide ISA51 adjuvant biweekly. During the following 2 years, she received hTERT peptide vaccination a total of 20 times with some discontinuations. The protocol was well tolerated; only local erythema occurred at the peptide vaccine injection sites. As shown in Figure 1A, during vaccination with hTERT peptide for 2 years, the sizes of the RCC metastases did not change significantly. The results of enzyme-linked immunospot (ELISPOT) assay for monitoring hTERT324–332-specific CD8 + cytotoxic T lymphocytes (CTLs) in peripheral blood are shown in Figure 1B. The hTERT peptide-specific CTLs were not detectable in peripheral blood of the patient before hTERT peptide vaccination and became detectable after the fifth vaccination. The frequency of hTERT peptide-specific CTLs in peripheral blood appeared to increase as the vaccinations were repeated. letters to the editor Annals of Oncology