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Evaluation of Safety and Efficacy of Patients With Four and More Symptomatic Brain Metastases of Melanoma

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ClinicalTrials.gov Identifier: NCT03728465
Recruitment Status : Recruiting
First Posted : November 2, 2018
Last Update Posted : November 6, 2018
Sponsor:
Information provided by (Responsible Party):
University Hospital Tuebingen

Brief Summary:
Up to 50% of patients with unresectable metastatic melanoma will develop brain metastases during their lifetime. A possible treatment options for patients with brain metastases are surgery and radiotherapy but usually for lesions in the range of < 3 brain metastases. This study was performed to evaluate the addition of immune checkpoint inhibitors in patients with stage IV melanoma with > 3 symptomatic brain metastases, who are not eligible for surgery or radiosurgery.

Condition or disease Intervention/treatment Phase
Metastatic Melanoma Brain Metastases Biological: Nivolumab Biological: Ipilimumab Phase 2

Detailed Description:

Brain metastases are a frequent problem in patients with melanoma. Up to 50% of patients with unresectable metastatic melanoma will develop brain metastases during their lifetime with a median overall survival of 4 months. Surgical removal or stereotactic radiosurgery of brain metastases can improve overall survival in patients with a limited number of lesions, usually in the range of one to three brain metastases depending on neuroanatomical localization. This benefit is no longer present when considering patients with > 3 brain metastases. As cytotoxic chemotherapy and multiple chemotherapeutic agents show only limited activity in > 3 brain metastases patients, immune checkpoint inhibitors such as ipilimumab and nivolumab offer new opportunities to improve disease outcomes for these patients.

This open label phase II study evaluates safety and efficacy of combined treatment with ipilimumab and nivolumab in patients with stage IV melanoma with four or more symptomatic brain metastases, who are not eligible for surgery or radiosurgery.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 68 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: An Open Label Phase II Study to Evaluate Safety and Efficacy of Combined Treatment With Ipilimumab and Nivolumab in Patients With Four and More Symptomatic Brain Metastases of Melanoma
Actual Study Start Date : April 10, 2018
Estimated Primary Completion Date : September 2021
Estimated Study Completion Date : September 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Melanoma

Arm Intervention/treatment
Experimental: Treatment Phase
Treatment phase is divided into the "Induction Phase" and "Maintenance Phase". During the induction phase patients are treated with 1 mg/kg nivolumab and 3 mg/kg ipilimumab, during the maintenance phase with nivolumab 3 mg/kg only .
Biological: Nivolumab
In the induction phase of this study nivolumab is administered as a IV infusion in combination with ipilimumab at a dose of 1 mg/kg for 4 cycles at three weeks interval and in a maintenance phase alone at a dose of 3 mg/kg every two weeks.
Other Name: OPDIVO

Biological: Ipilimumab
In the induction phase of this study ipilimumab is administered as a IV infusion in combination with nivolumab at a dose of 3 mg/kg for 4 cycles at three weeks interval.
Other Name: YERVOY




Primary Outcome Measures :
  1. Intracranial Control Rate after 6 months of treatment [ Time Frame: 6 months ]
    Proportion of patients with complete intracranial responses (CR), partial intracranial responses (PR) or stable intracranial disease (SD) after 6 months of treatment.


Secondary Outcome Measures :
  1. Overall survival [ Time Frame: 2 years ]
    Number of patients who stay alive after 2 years.

  2. Progression-free survival [ Time Frame: 2 years ]
    Number of patients without progression after 2 years.

  3. Stereotactic irradiation or surgery of brain metastases after partial tumor remission [ Time Frame: 2 years ]
    Percentage of patients in whom stereotactic irradiation or surgery of all metastases becomes applicable after partial tumor remission.

  4. Tolerability according to NCI-CTCAE-Criteria [ Time Frame: 2 years ]
    All adverse events of all grades.

  5. Best Overall Response Rate with Complete Respone (CR) [ Time Frame: 6 months ]
    Percentage of patients with CR at six months of treatment.

  6. Best Overall Response Rate with Partial Response (PR) [ Time Frame: 6 months ]
    Percentage of patients with PR at six months of treatment.

  7. Cognitive function evaluation by standardized diagnostic procedures [ Time Frame: 2 years ]
    Systemic longitudinal neuropsychological evaluation to investigate the influence of therapy on cognitive performance will be performed by standardized diagnostic procedures.

  8. Quality of life evaluation with RAND 36-Item Health Survey 1.0 [ Time Frame: 2 years ]
    Quality of life assessment is evaluated with the RAND 36-Item Health Survey questionnaires which include physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. Evaluation will be performed according to the manual.



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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:

  • Signed informed consent (ICF) prior to any screening procedures being performed
  • Ability to comply with protocol requirements
  • Metastatic histologically confirmed melanoma that is unresectable
  • Presence of > 3 active brain metastases confirmed/evaluated by MRI
  • Measurable disease by MRI per iRANO and RECIST 1.1 criteria
  • The time between the baseline MRI and the date of registration should not exceed 28 days. Steroid treatment is permissible before brain MRI evaluation but the dose should have been stable for at least 7 days and should be carefully documented
  • Patient must agree to the cerebro-spinal fluid (CSF) collections according to the study protocol
  • Patients naïve for systemic treatment are eligible
  • Patients pretreated with systemic immunotherapy, targeted therapy or chemotherapy are eligible (exception: previous treatment with the combination of CTLA-4 and PD-1 antibodies)
  • Patients must have recovered completely from any treatment-related acute toxicity associated with prior therapy
  • At least two weeks must have passed since the last systemic anti-cancer treatment
  • Patients with prior local therapy of brain metastases are eligible
  • Patients may have received irradiation therapies: A) None; B) Whole brain irradiation only, C) Stereotactic irradiation of single or few metastases, D) Combined B+C)
  • Screening laboratory values within 14 days prior to registration must meet the criteria: WBC ≥ 2,000/μL, Neutrophils ≥ 1,500/μL, Platelets ≥ 100 x103/μL, Hemoglobin > 9.0 g/dL, Serum creatinine ≤ 1.5 x ULN or creatinine clearance (CrCl) ≥ 40 mL/min, AST/ALT ≤ 3 x ULN, total bilirubin ≤ 1.5 x ULN (except patients with Gilbert Syndrome, who can have total bilirubin < 3.0 mg/dL), INR ≤ 1.5
  • ECOG Performance Status 0, 1 or 2
  • Expected life expectancy of ≥ 3 months
  • Males and females ≥ 18 years old
  • Negative serum pregnancy test within 24 hours prior to the start of study drug for women of childbearing potential (WOCBP)
  • Women must not be breastfeeding
  • WOCBP must agree to follow instructions for method(s) of contraception, as indicated in the ICF, throughout the study and for 23 weeks after the last dose of investigational drug
  • Males who are sexually active with WOCBP must agree to follow instructions for method(s) of contraception, as indicated in the ICF, throughout the study and for a period of 31 weeks after the last dose of investigational drug. In addition, male patients must be willing to refrain from sperm donation during this time
  • Azoospermic males are exempt from contraceptive requirements. WOCBP who are permanently not heterosexually active are also exempt from contraceptive requirements, but must still undergo pregnancy testing as previously described.
  • Patients must agree to use at least two methods of contraception, with at least one highly effective method as listed in the ICF

Exclusion Criteria:

  • Diagnosed ocular melanoma
  • Previous systemic therapy with the combination of CTLA-4 and PD-1 antibodies
  • Use of any investigational or non-registered product within the 30 days before registration in the study
  • Prior active malignancy within the previous 3 years except locally curable cancers that have been apparently cured, such as: basal or squamous cell skin cancer, superficial bladder cancer or carcinoma in situ of the prostate, cervix, or breast
  • History of organ transplantation
  • Active infection requiring systemic therapy
  • Active, known or suspected autoimmune disease (exceptions: patients with controlled Type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders not requiring systemic treatment).
  • Interstitial lung disease that is symptomatic or may interfere with the detection or management of suspected drug-related pulmonary toxicity
  • Any serious or uncontrolled medical disorders thatmay increase the risk associated with study participation or study drug administration, impair the ability of the patient to receive protocol therapy, or interfere with the interpretation of study results in the opinion of the investigator
  • Known substance abuse or psychiatric disorders that would preclude cooperation with tany requirements of the trial
  • Legal incapacity or limited legal capacity
  • Administration of live, attenuated vaccine within 4 weeks prior to the start of study drug
  • Positive test for HBs Ag or HCV antibody
  • Known history of a positive test for HIV or known AIDS
  • Patients with known allergy or hypersensitivity to any of the study drugs or excipients
  • Patients with results of imaging or radiological examinations indicating increased cerebral pressure which would prevent lumbar puncture

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): NCT03728465


Contacts
Contact: Thomas Eigentler, Dr. med. 07071 29 85748 thomas.eigentler@med.uni-tuebingen.de

Locations
Germany
Elbe Kliniken Stade - Buxtehude GmbH Recruiting
Buxtehude, Germany
Contact: Peter Mohr, Dr.med.       Peter.Mohr@elbekliniken.de   
Principal Investigator: Peter Mohr, Dr.med.         
Universitätsklinik Carl Gustav Carus Dresden Recruiting
Dresden, Germany
Contact: Friedegund Meier, Prof.Dr.med.       friedegund.meier@uniklinikum-dresden.de   
Principal Investigator: Friedegund Meier, Prof.Dr.med.         
HELIOS Klinikum Erfurt Recruiting
Erfurt, Germany
Contact: Rudolf Herbst, Prof.Dr.med.       rudolf.herbst@helios-kliniken.de   
Principal Investigator: Rudolf Herbst, Prof.Dr.med.         
Universitätsklinikum Essen Not yet recruiting
Essen, Germany
Contact: Dirk Schadendorf, Prof.Dr.med.       dirk.schadendorf@uk-essen.de   
Principal Investigator: Dirk Schadendorf, Prof.Dr.med.         
Universitätsklinikum Heidelberg Recruiting
Heidelberg, Germany
Contact: Jessica Hassel, Dr.med.       jessica.hassel@med.uni-heidelberg.de   
Principal Investigator: Jessica Hassel, Dr.med.         
Gesellschaft für Klinische Forschung Ludwigshafen mbH Not yet recruiting
Ludwigshafen, Germany
Contact: Edgar Dippel, Prof.Dr.med.       dippele@klilu.de   
Principal Investigator: Edgar Dippel, Prof.Dr.med         
Universitätsklinikum Mannheim Recruiting
Mannheim, Germany
Contact: Jochen Utikal, Prof.Dr.med.       Jochen.Utikal@umm.de   
Principal Investigator: Jochen Utikal, Prof.Dr.med.         
Klinikum rechts der Isar Recruiting
München, Germany
Contact: Angela Krackhardt, Prof.Dr.med.       angela.krackhardt@tum.de   
Principal Investigator: Angela Krackhardt, Prof.Dr.med.         
Harzklinikum Dorothea Christiane Erxleben GmbH Recruiting
Quedlinburg, Germany
Contact: Jens Ulrich, Prof.Dr.med.       jens.ulrich@harzklinikum.com   
Principal Investigator: Jens Ulrich, Prof.Dr.med.         
Universitätsklinikum Regensburg Not yet recruiting
Regensburg, Germany
Contact: Sebastian Haferkamp, Dr.med       sebastian.haferkamp@klinik.uni-regensburg.de   
Principal Investigator: Sebastian Haferkamp, Dr.med         
Universitätsklinikum Tübingen Recruiting
Tübingen, Germany
Contact: Thomas Eigentler, Dr.med.    07071 29 85748    thomas.eigentler@med.uni-tuebingen.de   
Principal Investigator: Claus Garbe, Prof.Dr.med.         
Sponsors and Collaborators
University Hospital Tuebingen
Investigators
Principal Investigator: Claus Garbe, Prof.Dr.med. University Hospital Tuebingen

Responsible Party: University Hospital Tuebingen
ClinicalTrials.gov Identifier: NCT03728465     History of Changes
Other Study ID Numbers: CA209-429
First Posted: November 2, 2018    Key Record Dates
Last Update Posted: November 6, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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

Additional relevant MeSH terms:
Melanoma
Neoplasm Metastasis
Brain Neoplasms
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Nerve Tissue
Nevi and Melanomas
Neoplastic Processes
Pathologic Processes
Central Nervous System Neoplasms
Nervous System Neoplasms
Neoplasms by Site
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Nivolumab
Antibodies, Monoclonal
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs