Uptake and Biodistribution of 89Zirconium-labeled Ipilimumab in Ipilimumab Treated Patients With Metastatic Melanoma (Zirconipi)
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|ClinicalTrials.gov Identifier: NCT03313323|
Recruitment Status : Recruiting
First Posted : October 18, 2017
Last Update Posted : August 30, 2019
Ipilimumab, a monoclonal antibody targeting CTLA-4, is approved for the treatment of metastatic melanoma and significantly increases median overall survival. However, use of this drug is associated with immune related adverse events (IRAEs) like colitis, hepatitis, dermatitis, alveolitis and hypophysitis in 10-40% of the patients. In general IRAEs are manageable by cessation of ipilimumab in combination with treatment with corticosteroids or TNF-alpha blockade but they can be severe or even life-threatening. In addition, treatment with ipilimumab is expensive. Because of the high costs and the potential serious toxicity of ipilimumab, it is of great importance to identify biomarkers that correlate with clinical activity and can be used to select patients that will benefit from CTLA-4 blockade therapy.
The investigators hypothesize that differences in response to treatment with ipilimumab are due to variability in the pharmacodynamics and -kinetics of the antibody. It is hypothesized that patients who do not respond to treatment with ipilimumab have lower drug levels in tumor tissues as compared to patients with a good response to therapy. In addition, the investigators hypothesize that IRAEs are associated with high drug levels in the affected tissue.
To visualize molecular interactions a novel technique is used in which positron emission tomography (PET) is combined with labeled monoclonal antibodies. Because ipilimumab induces activation of T-lymphocytes it is hypothesized that uptake of 89Zr-ipilimumab in tumor lesions and normal tissue is different (i.e. higher) after the second administration of ipilimumab (3 weeks after first injection). Therefore immuno-PET scans will be performed after the first and after the second injection of ipilimumab.
Part one: The primary objective is:
1. To assess uptake (visual and quantitative) of 89Zr-ipilimumab in tumor lesions and biodistribution at two timepoints (at start of ipilimumab therapy and after the second injection 3 weeks later).
The secondary objectives are:
- To determine the correlation between tumor targeting of ipilimumab and response to therapy.
- To assess uptake (visual and quantitative) of 89Zr-ipilimumab in normal tissues.
- To determine de correlation between organ targeting and toxicity
|Condition or disease||Intervention/treatment||Phase|
|Melanoma||Biological: 89Zirconium-labeled ipilimumab||Phase 2|
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||29 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Uptake and Biodistribution of 89Zirconium-labeled Ipilimumab in Ipilimumab Treated Patients With Metastatic Melanoma|
|Actual Study Start Date :||February 16, 2017|
|Estimated Primary Completion Date :||February 16, 2021|
|Estimated Study Completion Date :||February 15, 2022|
Zirconium-ipilimumab is an experimental tracer and is administered at start of ipilimumab treatment and after second infusion 3 weeks later
Biological: 89Zirconium-labeled ipilimumab
Metastatic melanoma patients, who are treated with ipilimumab (3 mg/kg), will be infused with 89Zr-labeled ipilimumab within 2 hours after injection of the first and second standard ipilimumab doses. Peripheral blood mononuclear cells (PBMCs) will be collected for immunomonitoring.
- The detection of 89Zr-ipilimumab in tumor lesions [ Time Frame: 3 weeks ]The detection (visual and quantitative) of 89Zr-ipilimumab in tumor lesions (the short axis diameter of a measurable tumor lesion is ≥1 cm. The five largest lesions will be used for evaluation).
- The visual detection of 89Zr-ipilimumab in normal tissue [ Time Frame: 3 weeks ]The visual detection of 89Zr-ipilimumab in normal tissue after the first injection of ipilimumab and after the second injection 3 weeks later. Visual: Description of the biodistribution.
- The quantitative detection of 89Zr-ipilimumab in normal tissue [ Time Frame: 3 weeks ]The quantitative detection of 89Zr-ipilimumab in normal tissue after the first injection of ipilimumab and after the second injection 3 weeks later. Quantitative: The % uptake (of total injected) 89Zr-ipilimumab in normal tissue, measured in VOI's.
- Comparison between uptake of 89Zr-ipilimumab [ Time Frame: 3 weeks ]Comparison between uptake (SUVmean and SUVpeak) of 89Zr-ipilimumab after the first injection of ipilimumab and after the second injection 3 weeks later.
- Clinical outcome (response) [ Time Frame: Every 12 weeks, from date of starting therapy until the date of first documented progression or date of death from any cause, whichever came first. Assessed through study completion, an average of 1 year ]Response after starting therapy with ipilimumab at 12 and 24 weeks and every 12 weeks thereafter
- Clinical outcome (survival) [ Time Frame: Through study completion, an average of 1 year ]Overall survival
- Side effects [ Time Frame: Until 30 days after the last immuno-PET scan ]
- Adverse events using Common Terminology Criteria Adverse Events, version 4.0 (CTCAE 4.0)
- Correlation between side effects of ipilimumab and uptake of 89Zr-ipilimumab in normal tissue
- Pharmacokinetics of 89Zr-ipilimumab [ Time Frame: 144 hours after first injection of 89Zr-ipilimumab ]Pharmacokinetics of 89Zr-ipilimumab. The concentration of ipilimumab in blood samples will be measured at t = 5, 30, 60, 120 minutes and 72, 144 hours after injection of 89Zr-ipilimumab in the first three patients.
- CTLA-4+CD4+ expression of PBMCs [ Time Frame: Before start of ipilimumab and during treatment, up to 11 weeks ]
- Immunohistochemical analysis [ Time Frame: 3 weeks ]Immunohistochemical analysis (% of tissue with inflammatory infiltrate and characterization of intratumoral T-lymphocytes (CD4, CD8, HLA-DR, FOX-P3, CTLA-4) of tumor biopsy
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03313323
|Contact: Jelle Arts||+31 (0)20 email@example.com|
|Contact: Alfonsus JM van den Eertwegh, Prof.dr.||+31 (0)20 firstname.lastname@example.org|
|VU Medical Center||Recruiting|
|Amsterdam, Noord-Holland, Netherlands, 1181HV|
|Contact: Alfonsus MJ van den Eertwegh, Dr. +31 (0)20-4444321 email@example.com|
|Principal Investigator:||Alfonsus JM van den Eertwegh, Prof.dr.||Amsterdam UMC, location VUmc|