The impact of imiquimod, a Toll-like receptor-7 ligand (TLR7L), on the immunogenicity of melanoma peptide vaccination with adjuvant Flt3 ligand

Cancer Immun. 2004 Sep 23;4:9.


Dendritic cells (DCs) show promise as adjuvants in anticancer immunotherapeutic strategies. Flt3 ligand (FL) is a hematopoietic growth factor that increases the number of immature DCs in the blood and other tissues. We treated 27 patients with metastatic or high-risk resected melanoma with s.c. FL daily for 14 d in three 28 d cycles. Eighteen of these patients also received vaccination with influenza (Flu), Melan-A (Mel), tyrosinase (Tyr), and NY-ESO-1 peptides. To induce local DC maturation, 8 of the vaccinated patients had imiquimod, a Toll-like receptor-7 ligand (TLR7L), applied topically to their vaccine sites. Patients were monitored for clinical and hematological effects. Immune responses were assessed by cutaneous reactivity to vaccination and by the induction of peptide-specific CD8+ T-cells. Eight patients did not complete the protocol due to adverse events related to their cancer. The treatment was generally safe and well tolerated, although some patients developed clinically significant toxicities related to FL. FL induced increases in immature CD11c+ and CD123+ peripheral blood (PB) DCs. Other hematological effects included monocytosis, granulocytosis, and thrombocytosis, which were marked in some patients. Cutaneous reactions to peptide vaccination and circulating peptide-specific CD8+ T-cells were more frequent in imiquimod-treated patients. FL treatment of melanoma patients has pleiotropic clinical and hematological effects. In vivo maturation of FL-generated DCs using imiquimod may increase immune responses to tumor antigens.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adjuvants, Immunologic / administration & dosage
  • Adjuvants, Immunologic / adverse effects
  • Adult
  • Aged
  • Aminoquinolines / administration & dosage*
  • Aminoquinolines / adverse effects
  • Aminoquinolines / immunology
  • Antigens, Neoplasm / immunology
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects
  • CD8-Positive T-Lymphocytes / immunology
  • Cancer Vaccines / administration & dosage*
  • Cancer Vaccines / adverse effects
  • Cancer Vaccines / immunology
  • Cytokines / blood
  • Cytokines / immunology
  • Dendritic Cells / immunology
  • Female
  • Humans
  • Imiquimod
  • Immunotherapy, Active / methods*
  • MART-1 Antigen
  • Male
  • Melanoma / immunology*
  • Melanoma / therapy*
  • Membrane Proteins / administration & dosage*
  • Membrane Proteins / adverse effects
  • Membrane Proteins / immunology
  • Middle Aged
  • Monophenol Monooxygenase / immunology
  • Neoplasm Proteins / immunology
  • Peptide Fragments / administration & dosage
  • Peptide Fragments / adverse effects
  • Peptide Fragments / immunology*


  • Adjuvants, Immunologic
  • Aminoquinolines
  • Antigens, Neoplasm
  • Antineoplastic Agents
  • CTAG1B protein, human
  • Cancer Vaccines
  • Cytokines
  • MART-1 Antigen
  • MLANA protein, human
  • Membrane Proteins
  • Neoplasm Proteins
  • Peptide Fragments
  • flt3 ligand protein
  • Monophenol Monooxygenase
  • Imiquimod