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Immunotherapy With Ipilimumab and Nivolumab Preceded or Not by a Targeted Therapy With Encorafenib and Binimetinib (EBIN)

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ClinicalTrials.gov Identifier: NCT03235245
Recruitment Status : Recruiting
First Posted : August 1, 2017
Last Update Posted : December 6, 2018
Sponsor:
Information provided by (Responsible Party):
European Organisation for Research and Treatment of Cancer - EORTC

Brief Summary:
This is a multicenter, 2-arm open-label, randomized comparative phase II study. The objective of this trial is to prospectively evaluate whether a sequential approach with an induction period of 12 weeks with encorafenib + binimetinib followed by combination immunotherapy with nivolumab + ipilimumab improves progression free survival compared to combination immunotherapy nivolumab + ipilimumab alone in patients with BRAF V600 mutation-positive unresectable or metastatic melanoma.

Condition or disease Intervention/treatment Phase
Unresectable Stage III Melanoma Stage IV Melanoma Drug: Nivolumab + Ipilimumab Drug: Encorafenib + Binimetinib Phase 2

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 270 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Combination of Targeted Therapy (Encorafenib and Binimetinib) Followed by Combination of Immunotherapy (Ipilimumab and Nivolumab) vs Immediate Combination of Immunotherapy in Patients With Unresectable or Metastatic Melanoma With BRAF V600 Mutation : an EORTC Randomized Phase II Study (EBIN)
Actual Study Start Date : October 30, 2018
Estimated Primary Completion Date : April 2022
Estimated Study Completion Date : February 2024


Arm Intervention/treatment
Active Comparator: ARM A: Nivolumab + Ipilimumab
nivolumab 3 mg/kg q3w + ipilimumab 1 mg/kg q3w for 4 injections followed by nivolumab 480 mg IV q4w until completion of 2 years total treatment or progression. Then treatment will be left at the investigator choice and continued until the 2nd progression.
Drug: Nivolumab + Ipilimumab
nivolumab 3 mg/kg q3w + ipilimumab 1 mg/kg q3w for 4 injections followed by nivolumab 480 mg IV q4w until completion of 2 years total treatment or progression.

Experimental: ARM B: Encorafenib + Binimetinib + Nivolumab + Ipilimumab
encorafenib 450 mg QD + binimetinib 45 mg BID orally for 12 weeks followed, after a week of pause, by nivolumab 3 mg/kg q3w + ipilimumab 1 mg/kg q3w for 4 injections, followed by nivolumab 480 mg IV q4w until completion of 2 years total treatment or progression. Then patients will be rechallenged with encorafenib 450 mg QD + binimetinib 45 mg BID orally continuously until the 2nd progression.
Drug: Nivolumab + Ipilimumab
nivolumab 3 mg/kg q3w + ipilimumab 1 mg/kg q3w for 4 injections followed by nivolumab 480 mg IV q4w until completion of 2 years total treatment or progression.

Drug: Encorafenib + Binimetinib
encorafenib 450 mg QD + binimetinib 45 mg BID orally for 12 weeks




Primary Outcome Measures :
  1. Progression Free Survival (PFS) [ Time Frame: 4.1 years from first patient in ]
    PRS is defined as the time from the date of randomization until the first date of progression, or until date of death (whatever the cause), whichever occurs first. Progression will be assessed according to the RECIST criteria (version 1.1)


Secondary Outcome Measures :
  1. Overall Survival (OS) [ Time Frame: 6 years from first patient in ]
    OS is defined as the time from the date of randomization to the date of death, whatever the cause.

  2. Complete Response (CR) rate [ Time Frame: 4.1 years from first patient in ]
    CR will be assessed according to the RECIST criteria (version 1.1)

  3. Time to Complete Response (CR) [ Time Frame: 4.1 years from first patient in ]
    Time to CR is defined as the time from the date of randomization until the occurrence of first CR.

  4. Duration of Complete Response (CR) [ Time Frame: 4.1 years from first patient in ]
    Duration of CR will be measured from the time measurement criteria for CR are first met until the first date that recurrence is objectively documented.

  5. Best overall response rate [ Time Frame: 4.1 years from first patient in ]
    Best overall response will be assessed according to the RECIST criteria (version 1.1)

  6. Time to best response [ Time Frame: 4.1 years from first patient in ]
    Time to best response is defined as the time from the date of randomization until the occurrence of the best response (CR or PR, whichever comes first). CR and PR will be assessed according to the RECIST criteria (version 1.1)

  7. Duration of best response [ Time Frame: 4.1 years from first patient in ]
    Best response duration will be measured from the time measurement criteria for CR/PR (whichever is first recorded) are first met until the first date that recurrent or progressive disease is objectively documented. CR and PR will be assessed according to the RECIST criteria (version 1.1)

  8. Occurrence of adverse events [ Time Frame: 4.1 years from first patient in ]
    This study will use the International Common Terminology Criteria for Adverse Events (CTCAE), version 4.0, for adverse event reporting.

  9. Progression-free survival 2 (PFS2) [ Time Frame: 4.1 years from first patient in ]
    PFS2 is defined as the time from randomization to second objective disease progression, or death from any cause, whichever first. The second objective disease progression will be assessed according to the RECIST criteria (version 1.1)



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

Inclusion Criteria:

  • Histologically or cytologically confirmed unresectable stage III or IV cutaneous or mucosal melanoma
  • Presence of BRAF V600E or V600K mutation in tumor tissue prior to enrolment as per local assessment
  • Tumor tissue from an unresectable or metastatic site of disease must be provided for biomarker analyses. This can be an archived sample if obtained at maximum 3 months prior to randomization and if the patient did not receive treatment since then.
  • Measurable disease per RECIST 1.1 criteria by computed tomography (CT) or Magnetic Resonance Imaging (MRI) of Chest/Abdomen/Pelvis CT and brain CT/MRI performed within 28 days prior to randomization
  • Patients ≥ 18 years of age
  • Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1
  • Patients must be able to swallow and retain oral tablets
  • Adequate organ function within 14 days prior to randomization
  • Patients with hyperthyroidism or hypothyroidism but that are stable on hormone replacement can be included.
  • Adequate cardiac function

Exclusion Criteria:

  • Uveal melanoma
  • Any symptomatic brain or leptomeningeal disease. Subjects with brain metastases are eligible if these have been locally treated and there is no magnetic resonance imaging (MRI) evidence of progression for at least 4 weeks after treatment and treatment is completed within 28 days prior to first dose of study drug administration. There must also be no requirement for immunosuppressive doses of systemic corticosteroids (> 10 mg/day prednisone equivalents) for at least 2 weeks prior to study drug administration.
  • Any prior treatment for advanced disease including treatment with an anti-Programmed Death receptor-1 (PD-1), anti-Programmed Death-1 ligand-1 (PD-L1), anti-PD-L2, anti-cytotoxic T lymphocyte associated antigen-4 (anti-CTLA-4) antibody, anti-LAG-3, anti-TIM-3, anti-IDO, etc or BRAF or MEK inhibitors.
  • History of hypersensitivity to study drugs or any excipient (refer to Investigator's brochures for binimetinib and encorafenib and SmPCs for ipilimumab and nivolumab).
  • Prior adjuvant melanoma therapy with IFN, anti-PD1, anti-PDL1 or anti-CTLA-4 or any other systemic treatment is permitted if completed at least 1 year prior to randomization and all related adverse events have either returned to ≤ 1.
  • Concomitant administration of strong inducers and inhibitors of P-gp, glucuronidation, CYP3A4 (e.g. rifampicin, rifabutin, carbamazepine, phenytoin or St John's Wort [hypericin])
  • Concomitant anticoagulation at therapeutic doses with oral anticoagulants (eg, warfarin)
  • Live vaccines within 30 days prior to the first dose of study therapy. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, chicken pox, yellow fever, H1N1 flu, rabies, BCG, and typhoid vaccine.
  • Current participation or treatment with other investigational agent or use of an investigational device within 4 weeks of the first dose of study treatment
  • Child-Pugh B/C and patients with history of acute or chronic pancreatitis
  • Known history or current evidence of active Hepatitis B (e.g., HBsAg reactive) or C (e.g., HCV RNA [qualitative] is detected) or Human Immunodeficiency Virus (HIV) (HIV-1/2 antibodies)
  • Chronic use of immunosuppressive agents and/or systemic corticosteroids or any use in the last 15 days prior to the first dose of study treatment
  • Active autoimmune disease that has required systemic treatment in past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (i.e., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment and is allowed
  • Autoimmune paraneoplastic syndrome requiring immunosuppressive or dedicated treatment. A specific attention should be given in order to detect any minor myasthenia signs at enrolment; acetylcholine receptor antibodies will be systematically tested when symptoms are suggestive of a myasthenia
  • History of any other hematologic or primary solid tumor malignancy, unless in remission for at least 5 years. A patient with a history of completely resected non-melanoma skin cancer or successfully treated in situ carcinoma are eligible, for example cervical cancer in situ or pT1a incidental prostate cancer is eligible
  • Previous allogeneic tissue/solid organ transplant
  • Active infection requiring therapy
  • Major surgery or trauma within 12 weeks prior to first dose of treatment or presence of any non-healing wound. Complete wound healing from major surgery must have occurred one month before the first dose of study treatment.

Minor surgery (including uncomplicated tooth extractions) within 28 days before randomization with complete wound healing at least 10 days before randomization is permitted.

  • Any anticancer treatment within 4 weeks before randomization e.g. radiation, surgery, systemic therapy.
  • Patients with clinically relevant ongoing complications from prior anticancer therapies.
  • Severe or uncontrolled systemic disease or any concurrent condition which in the investigator's opinion makes it undesirable for the patient to participate in the study, or which would jeopardize compliance with the protocol
  • History or current evidence of retinal vein occlusion (RVO) or current risk factors to RVO (e.g. uncontrolled glaucoma or ocular hypertension, history of hyperviscosity or hypercoagulability syndromes); an ophthalmological assessment is mandatory within 28 days from the first dose of study treatment.
  • History of retinal degenerative disease
  • Impaired gastrointestinal function or disease that may significantly alter the absorption of encorafenib or binimetinib (e.g., ulcerative diseases, uncontrolled vomiting, malabsorption syndrome, small bowel resection with decreased intestinal absorption)
  • Patients with neuromuscular disorders that are associated with CK > ULN (e.g., inflammatory myopathies, muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy)
  • Patients who are planning on embarking on a new strenuous exercise regimen after first dose of study treatment. Note: Muscular activities, such as strenuous exercise, that can result in significant increases in plasma CK levels should be avoided while on binimetinib treatment
  • Impaired cardiovascular function or clinically significant cardiovascular diseases
  • Uncontrolled hypertension defined as persistent elevation of systolic blood pressure ≥ 150 mmHg or diastolic blood pressure ≥ 100mmHg, despite current therapy
  • History of chronic inflammatory bowel disease or Crohn's disease requiring medical intervention (immunomodulatory or immunosuppressive medications or surgery) ≤ 12 months prior to starting study treatment
  • History of thromboembolic or cerebrovascular events ≤ 6 months prior to starting study treatment, including stroke, transient ischemic attacks, cerebrovascular accidents, deep vein thrombosis, pulmonary emboli, aortic aneurysm requiring surgical repair or recent peripheral arterial thrombosis

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03235245


Contacts
Contact: EORTC HQ +32 2 774 1611 1612@eortc.org

Locations
Belgium
Universitair Ziekenhuis Antwerpen Recruiting
Antwerpen, Belgium
Principal Investigator: Pol Specenier         
AZ Maria Middelares Recruiting
Gent, Belgium
Principal Investigator: Christof Vulsteke         
France
Hopital Cochin Recruiting
Paris, France
Principal Investigator: Nora Kramkimel         
Centre Hospitalier De Pau Recruiting
Pau, France
Principal Investigator: Thomas Jouary         
CHU de Saint-Etienne - Hopital Nord Recruiting
Saint Priest en Jarez, France
Principal Investigator: Jean-Luc Perrot         
Gustave Roussy Recruiting
Villejuif, France
Principal Investigator: Caroline Robert         
Sponsors and Collaborators
European Organisation for Research and Treatment of Cancer - EORTC
Investigators
Principal Investigator: Caroline Robert Cancer Institute Gustave Roussy

Responsible Party: European Organisation for Research and Treatment of Cancer - EORTC
ClinicalTrials.gov Identifier: NCT03235245     History of Changes
Other Study ID Numbers: EORTC-1612-MG
2017-002887-42 ( EudraCT Number )
First Posted: August 1, 2017    Key Record Dates
Last Update Posted: December 6, 2018
Last Verified: December 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: All publications must comply with the terms specified in the EORTC Policy 009 "Release of Results and Publication Policy".

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by European Organisation for Research and Treatment of Cancer - EORTC:
cutaneous melanoma
mucosal melanoma
BRAF mutation

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
Nivolumab
Antibodies, Monoclonal
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs