Immunotherapy for Recurrent Ependymomas in Children Treatment for Recurrent Ependymomas Using HLA-A2 Restricted Tumor Antigen Peptides in Combination With Imiquimod

Inclusion Criteria: All grades of ependymoma are eligible.

- Patients must have recurrent/progressive ependymoma that has progressed or recurred
after initial adjuvant therapy.

- HLA-A2 positive based on flow cytometry performed at the University of Pittsburgh.

- Patients must have previously received standard initial therapy including attempted
gross total resection, where safely feasible, and in appropriate circumstances (e.g.,
those older than one year at initial diagnosis, with non-metastatic tumors and at
least microscopic residual disease), involved field fractionated radiation therapy
(RT). Patients may have received re-irradiation but not to the index lesion within 4
weeks.

- Patients must be clinically stable and off or on low-dose (no more than 0.1 mg/kg/day,
max 4 mg/day Dexamethasone) corticosteroid for at least one week prior to study
registration.

- Patients must be ≥ 12 months and <22 years of age at the time of study registration.

- Patients must have a performance status of ≥ 70; (Karnofsky if > 16 years and Lansky
if ≤ 16 years of age).

- Patients may have non-bulky, asymptomatic metastatic disease.

- Males and females must agree to use effective birth control methods during the course
of vaccination (from the first vaccine to two weeks after the last vaccine).

- Patients must be free of systemic infection requiring IV antibiotics at the time of
registration and off IV antibiotics for at least 7 days prior to registration.

- Patients must have adequate organ function as measured by:

- Bone marrow: ANC > 1,000/µl; Platelets > 100,000/µl (transfusion independent);
ALC ≥ 500/µl; Hemoglobin >8 g/dl (may be transfused).

- Hepatic: bilirubin ≤ 1.5x institutional normal for age; SGPT (ALT) < 3x
institutional normal

- Renal: Serum creatinine based on age or creatinine clearance or radioisotope GFR
> 70 ml/min/1.73 m²

- Patients must have recovered from the toxic effects of prior therapy and be at least 3
weeks from the last dose of standard cytotoxic chemotherapy or myelosuppressive
biological therapy, at least one week from the last dose of non-myelosuppressive
biological therapy and at least 4 weeks from the completion of radiation therapy.

- Patients must have no overt cardiac, gastrointestinal, pulmonary, or psychiatric
disease.

Patients must be willing to travel to Pittsburgh to receive the vaccine. Visits: Every 3
weeks x 9, then every 6 weeks x 12 depending on response/side effects

Exclusion Criteria:

- Patients living outside of North America are not eligible.

- Patients must be off concurrent treatment or medications for at least 1 week
including: Interferon (e.g. Intron-A®), allergy desensitization injetions, growth
factors (e.g. Pricrut®, Aranesp®, Neulasta®), interleukins (e.g. Proleukin®), and any
investigational therapeutic medication.

- Patients must not have a history of any immune system disorder or laboratory
abnormality or any condition that could potentially alter immune function.

- Use of immunosuppressives within four weeks prior to study entry or anticipated use of
immunosuppressive agents. Patients must be on no more than 0.1 mg/kg/day, max 4 mg/day
dexamethasone for at least one week before study registration. Topical corticosteroids
are acceptable.

- Patients with a known immune deficiency.

- Pregnancy or breastfeeding. Female patients who are post-menarchal must have a
documented negative pregnancy test.

- Tetanus vaccine during therapy or within 1 week prior to enrollment.

- Patients who have received prior immunotherapy.