A Phase I/II Trial of Vemurafenib and Metformin to Melanoma Patients

• ClinicalTrials.gov Identifier: NCT01638676
• Recruitment Status: Unknown
• First Posted: July 12, 2012
• Last Update Posted: November 23, 2016
• Sponsor: James Graham Brown Cancer Center
• Collaborator: University of Louisville
• Information provided by (Responsible Party): James Graham Brown Cancer Center

Study Description

Brief Summary:

The main purpose of this study is to evaluate the safety of Vemurafenib in combination with Metformin in melanoma patients. The phase II part of the study will also evaluate the clinical activity of the combined regiment. Based on pre-clinical studies and a phase I trial, the investigators hypothesize that the combination of an FDA-approved non-toxic dose of oral Metformin with Vemurafenib will yield little toxicity and improve clinical outcomes in terms of objective response rates and survival in metastatic melanoma patients.

Condition or disease	Intervention/treatment	Phase
Melanoma	Drug: Vemurafenib; Drug: Metformin	Phase 1; Phase 2

Detailed Description:

This is a Phase I/II study. Phase I will be evaluating the safety of the FDA-approved Vemurafenib (960 mg orally, daily) in combination with Metformin (500 mg orally, twice daily for 2 weeks, then 850 mg orally,twice daily) in patients with unresectable Stage IIIC and Stage IV melanoma. Phase II will evaluate the clinical activity of the combined Vemurafenib/Metformin regimen. The safety profile of this combined Vemurafenib/Metformin regimen will be monitored during both phases. The treatment period consists of 28-day cycles until progression or unacceptable toxicity occurs.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 55 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase I/II Trial of Vemurafenib and Metformin to Unresectable Stage IIIC and Stage IV BRAF.V600E+ Melanoma Patients
• Study Start Date: July 2012
• Estimated Primary Completion Date: June 2018
• Estimated Study Completion Date: June 2019

Arms and Interventions

Arm	Intervention/treatment
Experimental: Vemurafenib and Metformin	Drug: Vemurafenib; Vemurafenib (960 mg PO daily) in patients with unresectable BRAFV600E positive Stage IIIC and Stage IV melanoma; Other Name: Vemurafenib branded as Zelboraf; Drug: Metformin; Metformin (500 mg PO BID x 2 weeks, then 850 mg PO BID); Other Name: Metformin hydrochloride branded as Glucophage

Outcome Measures

Primary Outcome Measures :

1. Observation of CTCAE grade 4 or higher adverse events in six patients [ Time Frame: Duration of phase I portion, approximately six months ]
   In the phase I portion, six patients will be enrolled and observed for CTCAE grade 4 or higher events. If three or more grade 4 or higher adverse events are observed among the six patients, the study will be halted.

Secondary Outcome Measures :

1. Overall Survival Follow up [ Time Frame: Every 12 weeks (+/- 7 days) after last drug dose, for up to 3 full years ]
   Patients will be followed for up to three years following the last treatment administration. The Investigator or designees will make every possible attempt at least every 12 weeks (±7 days), for up to three years after the last treatment to contact the patient or family to obtain the survival information of the patient and, if applicable, the start date of additional anticancer treatment.
2. Number of adverse events [ Time Frame: Duration of study, estimated to be approximately 60 months ]
   Descriptive statistics of all AEs observed during the study period.
3. type of adverse events [ Time Frame: Duration of study, estimated to be approximately 60 months ]
   Descriptive statistics of all AEs observed during the study period.
4. Objective response rate (ORR)as measure of efficacy [ Time Frame: Duration of study (approximately 60 months) ]
   Efficacy estimated as the objective response rate (ORR), which is the sum of Partial Responses (PR) and Complete Responses (CR) as determined by RECIST 1.1

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Male or female patients ≥ 18 years of age;
2. Patients with histological confirmed BRAFV600E melanoma (Stage IIIC or Stage IV, American Joint Commission on Cancer);
3. Eastern Cooperative Oncology Group (ECOG) Performance Status(PS) of 0 to 2;
4. Life expectancy ≥ 3 months;
5. At least 1 site of radiographically measurable disease by RECIST 1.1

6. Adequate hematologic, renal, and liver function as defined by laboratory values performed within 42 days prior to initiation of dosing:

   • Absolute neutrophil count (ANC) ≥ 1.0 x 109/L;
   • Platelet count ≥ 50 x 109/L;
   • Hemoglobin ≥ 8 g/dL;
   • Serum creatinine ≤ 2 x upper limit of normal (ULN)
   • Total serum bilirubin ≤ 3 x ULN;
   • Serum aspartate transaminase (AST/SGOT) or serum alanine transaminase (ALT/SGPT) ≤ 3x ULN, and ≤ 4 x ULN if liver metastases are present.
7. Fertile males should use an effective method of contraception during treatment and for at least 3 months after completion of treatment, as directed by their physician;
8. Pre-menopausal females and females < 2 years after the onset of menopause should have a negative pregnancy test at Screening. Pre-menopausal females must agree to use an acceptable method of birth control from the time of the negative pregnancy test up to 90 days after the last dose of study drug. Females of non-childbearing potential may be included if they are either surgically sterile or have been postmenopausal for ≥ 1 year;
9. Before study entry, written informed consent must be obtained from the patient prior to performing any study-related procedures.

Exclusion Criteria:

1. Prior treatment with Vemurafenib;
2. Known hypersensitivity to Metformin or any of its components;
3. Previous progression of melanoma while on Metformin;
4. Received radiotherapy for non CNS disease within the 2 weeks prior to commencing study treatment or have not recovered from side effects of all radiation-related toxicities to Grade ≤ 1, except for alopecia;
5. Pregnant, breast-feeding, or refusing double barrier contraception, oral contraceptives, or avoidance of pregnancy measures;
6. Have any other uncontrolled infection or medical condition that could interfere with the conduct of the study

Contacts and Locations

Locations

United States, Kentucky

James Graham Brown Cancer Center-University of Louisville; Recruiting

Louisville, Kentucky, United States, 40202

Contact: Jason A Chesney, MD PhD 502-562-3429 jason.chesney@louisville.edu

Contact: Sarah Lush, RN 502-540-1537 s.lush@louisville.edu

Sponsors and Collaborators

James Graham Brown Cancer Center

University of Louisville

Investigators

• Principal Investigator: Jason A Chesney, MD PhD; James Graham Brown Cancer Center-U of Louisville

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Cerezo M, Tomic T, Ballotti R, Rocchi S. Is it time to test biguanide metformin in the treatment of melanoma? Pigment Cell Melanoma Res. 2015 Jan;28(1):8-20. doi: 10.1111/pcmr.12267. Epub 2014 Jun 26. Review.

• Responsible Party: James Graham Brown Cancer Center
• ClinicalTrials.gov Identifier: NCT01638676
• Other Study ID Numbers: BCC-MEL-11-03
• First Posted: July 12, 2012
• Last Update Posted: November 23, 2016
• Last Verified: November 2016

Keywords provided by James Graham Brown Cancer Center:

Unresectable melanoma; Stage IIIC and Stage IV BRAFV600E+ Melanoma

Additional relevant MeSH terms:

Melanoma; Nevi and Melanomas; Neuroendocrine Tumors; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms by Histologic Type; Neoplasms; Neoplasms, Nerve Tissue; Metformin; Vemurafenib; Hypoglycemic Agents; Physiological Effects of Drugs; Antineoplastic Agents; Protein Kinase Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action