VX15/2503 With or Without Ipilimumab and/or Nivolumab in Patients With Resectable Stage IIIB-D Melanoma

• ClinicalTrials.gov Identifier: NCT03769155
• Recruitment Status: Recruiting
• First Posted: December 7, 2018
• Last Update Posted: March 2, 2022
• Sponsor: Emory University
• Collaborators: Bristol-Myers Squibb; Vaccinex Inc.
• Information provided by (Responsible Party): Michael Lowe, Emory University

Study Description

Brief Summary:

This pilot phase I trial studies how well VX15/2503 (pepinemab) with or without ipilimumab and/or nivolumab work in treating participants with stage IIIB-D melanoma that can be removed by surgery. Monoclonal antibodies, such as VX15/2503, ipilimumab, and nivolumab may interfere with the ability of tumor cells to grow and spread.

Condition or disease	Intervention/treatment	Phase
Pathologic Stage IIIB Cutaneous Melanoma AJCC v8; Pathologic Stage IIIC Cutaneous Melanoma AJCC v8; Pathologic Stage IIID Cutaneous Melanoma AJCC v8	Biological: Ipilimumab; Biological: Nivolumab; Biological: VX15/2503; Procedure: Surgery	Phase 1

Detailed Description:

PRIMARY OBJECTIVE:

I. Evaluate the effect of VX15/2503 (pepinemab) in combination with immune checkpoint inhibitors on T cell infiltrate into the tumor microenvironment in involved and uninvolved lymph nodes and peripheral blood.

SECONDARY OBJECTIVES:

I. Evaluate the effect of VX15/2503 in combination with immune checkpoint inhibitors on the immune profile of involved and uninvolved lymph nodes and peripheral blood.

II. Assess safety and tolerability of profile and tolerability of single agent VX15/2503 to the combination of VX15/2503 and immune checkpoint inhibitors in patients with resectable metastatic melanoma.

III. Document pathologic response rates of single agent VX15/2503 and combination VX15/2503 and immune checkpoint inhibitors in patients with resectable melanoma.

IV. Compare pathologic response to radiographic response using Response Evaluation Criteria in Solid Tumors (RECIST) criteria in patients receiving single agent VX15/2503 and combination VX15/2503 and immune checkpoint inhibitors in patients with resectable melanoma.

OUTLINE: Participants are assigned to 1 of 5 arms.

ARM I: Participants receive VX15/2503 intravenously (IV) over 60 minutes and nivolumab IV over 30 minutes on days 1 and 21 and undergo surgery between days 35-49.

ARM II: Participants receive VX15/2503 IV over 60 minutes and ipilimumab IV over 30 minutes on days 1 and 21 and undergo surgery between days 35-49.

ARM III: Participants receive VX15/2503 IV over 60 minutes, nivolumab IV over 30 minutes, and ipilimumab IV over 30 minutes on days 1 and 21 and undergo between days 35-49.

ARM IV: Participants nivolumab IV over 30 minutes on days 1 and 21 and undergo between days 35-49.

ARM V: Participants undergo surgery.

After completion of study treatment, participants are followed up at 90 days, every 12 weeks for 2 years, every 6 months for 3 years, then annually up to 10 years.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 42 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Pilot Integrated Biomarker Study of VX15/2503 in Combination With Ipilimumab or Nivolumab in Patients With Resectable Metastatic Melanoma
• Actual Study Start Date: December 13, 2018
• Estimated Primary Completion Date: December 31, 2022
• Estimated Study Completion Date: December 31, 2031

Arms and Interventions

Arm	Intervention/treatment
Experimental: A (VX15/2503, nivolumab, surgery); Participants receive VX15/2503 (pepinemab) IV over 60 minutes and nivolumab IV over 30 minutes on days 1 and 21 and undergo surgery between days 35-49.	Biological: Nivolumab; Given IV; Other Names: BMS-936558; MDX-1106; NIVO; ONO-4538; Opdivo; Biological: VX15/2503; Given IV; Other Names: moAb VX15/2503; Pepinemab; Procedure: Surgery; Undergo therapeutic conventional surgery
Experimental: B (VX15/2503, ipilimumab, surgery); Participants receive VX15/2503 (pepinemab) IV over 60 minutes and ipilimumab IV over 30 minutes on days 1 and 21 and undergo surgery between days 35-49.	Biological: Ipilimumab; Given IV; Other Names: BMS-734016; MDX-010; MDX-CTLA4; Yervoy; Biological: VX15/2503; Given IV; Other Names: moAb VX15/2503; Pepinemab; Procedure: Surgery; Undergo therapeutic conventional surgery
Experimental: C (VX15/2503, nivolumab, ipilimumab, surgery); Participants receive VX15/2503 (pepinemab) IV over 60 minutes, nivolumab IV over 30 minutes, and ipilimumab IV over 30 minutes on days 1 and 21 and undergo between days 35-49.	Biological: Ipilimumab; Given IV; Other Names: BMS-734016; MDX-010; MDX-CTLA4; Yervoy; Biological: Nivolumab; Given IV; Other Names: BMS-936558; MDX-1106; NIVO; ONO-4538; Opdivo; Biological: VX15/2503; Given IV; Other Names: moAb VX15/2503; Pepinemab; Procedure: Surgery; Undergo therapeutic conventional surgery
Experimental: D (nivolumab, surgery); Participants receive nivolumab IV over 30 minutes on days 1 and 21 and undergo between days 35-49.	Biological: Nivolumab; Given IV; Other Names: BMS-936558; MDX-1106; NIVO; ONO-4538; Opdivo; Procedure: Surgery; Undergo therapeutic conventional surgery
Active Comparator: E (surgery); Participants undergo surgery.	Procedure: Surgery; Undergo therapeutic conventional surgery

Outcome Measures

Primary Outcome Measures :

1. Biomarker parameter analysis: extent of cluster of differentiation 8 (CD8)+ T cell infiltration between experimental groups following treatment [ Time Frame: Up to 10 years after study start ]
   The two-sample t-test will be used to compare the change in CD8+ T cell infiltration after treatment between each experimental group (Cohort A, B, C, and D) and the control group (cohort E), respectively.

Secondary Outcome Measures :

1. Incidence of adverse events assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 [ Time Frame: Up to 8 weeks after surgery ]
   Descriptive statistics for worst grade of each laboratory parameter by the NCI CTCAE scale version 4.0 at baseline and follow-up will be presented.
2. Response rate [ Time Frame: Up to 10 years after study start ]
   For participants to be considered evaluable for efficacy, they must have completed the treatment and have a baseline tumor assessment. Response rate will be calculated as proportion (responders/total participants).
3. Overall survival (OS) [ Time Frame: Assessed up to 10 years after study start ]
   For overall survival, death from any cause will be defined as the event.
4. Progression-free survival (PFS) [ Time Frame: Assessed up to 10 years after study start ]
   Progression or death from any cause will be defined as the event.

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:

• Stage IIIB, IIIC, IIID histologically-proven melanoma.

  • Cancer confirmed to be surgically resectable, with surgery evaluation with planned prior to resection.
  • No prior immunotherapy with cytotoxic T-lymphocyte associated protein-4 (CTLA-4), anti programmed cell death-1 (PD-1) or VX15/2503. Prior interferon (at least 1 year prior to consent) will be allowed.
• Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1.
• Absolute neutrophil count ≥ 1,500 cells/µL.
• Platelets ≥ 100,000/µL.
• Hemoglobin ≥ 9.0g/dL (may receive packed red blood cells [PRBC] transfusion).
• Total bilirubin ≤ 1.5 x the upper limit of normal (ULN).
• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 x ULN.
• Albumin ≥ 3.0 g/dL.
• Serum creatinine ≤ 1.5 x ULN OR calculated creatinine clearance of ≥ 50 mL/min using Cockcroft-Gault formula.
• International normalized ration (INR) ≤ 1.5. Anticoagulation is allowed only with low molecular weight heparin (LMWH). Patient receiving LMW heparin on stable therapeutic dose for more than 2 weeks or with factor Xa level < 1.1 U/mL are allowed on the trial.
• Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures.
• Ability to understand and willingness to sign a written informed consent document.
• Female subjects of childbearing potential must agree to use adequate contraception (at least one highly effective method and one additional method of birth control at the same time or complete abstinence) prior to study entry, for the duration of study treatment and 5 months after last dose of study treatment.
• Male subjects must agree to use adequate contraception (at least one highly effective method and one additional method of birth control at the same time or complete abstinence) prior to study entry, for the duration of study treatment and 7 months after last dose of study treatment.
• Female subjects of childbearing age must have a negative serum pregnancy test at study entry.

Exclusion Criteria:

• Determined not to be a surgical candidate due to medical co-morbidities.
• Treatment with chronic immunosuppressants (e.g., cyclosporine following transplantation).
• Prior organ allograft or allogeneic bone marrow transplantation.
• Subjects with active or history of immune mediated pneumonitis, colitis, hepatitis, endocrinopathy, nephritis, or skin reactions as these patients may be at increased risk for developing immune therapy-induced exacerbation or recurrence of their immune mediated disease, potentially delaying surgery.
• Subjects with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
• Women who are pregnant or lactating.
• Uncontrolled intercurrent illness including, but not limited to, human immunodeficiency virus (HIV)-positive subjects receiving combination antiretroviral therapy, ongoing or active infection, symptomatic congestive heart failure (NYHA class III or IV), unstable angina pectoris, ventricular arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
• Other medications, or severe acute/chronic medical or psychiatric condition, or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, and in the judgment of the investigator would make the subject inappropriate for entry into this study.
• Clinical evidence of bleeding diathesis or coagulopathy.
• Patients with prior malignancies, including pelvic cancer, are eligible if they have been disease free for > 5 years. Patients with prior non-melanoma skin cancers and in situ carcinomas are eligible provided there was complete removal.
• Active bacterial or fungal infections requiring systemic treatment within 7 days of treatment.
• Use of other investigational drugs (drugs not marked for any indication) within 28 days or at least 5 half-lives (whichever is longer) before study drug administration.
• History of severe hypersensitivity reactions to other monoclonal antibodies.
• Non-oncology vaccines within 28 days prior to or after any dose of ipilimumab.
• Prisoners and subjects who are compulsory detained.
• Patients with rapidly progressive disease.

Contacts and Locations

Contacts

Contact: Michael Lowe, MD, MA; 404-778-2981; mlowe3@emory.edu

Locations

United States, Georgia

Emory University Hospital/Winship Cancer Institute; Recruiting

Atlanta, Georgia, United States, 30322

Contact: Ashley Trumbull 404-778-3969 ashley.lynn.trumbull@emory.edu

Sponsors and Collaborators

Emory University

Bristol-Myers Squibb

Vaccinex Inc.

Investigators

• Principal Investigator: Michael Lowe, MD, MA; Emory University

More Information

• Responsible Party: Michael Lowe, Principal Investigator, Emory University
• ClinicalTrials.gov Identifier: NCT03769155
• Other Study ID Numbers: IRB00104273; NCI-2018-01229 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ); Winship4400-18 ( Other Identifier: Emory University Hospital/Winship Cancer Institute )
• First Posted: December 7, 2018
• Last Update Posted: March 2, 2022
• Last Verified: February 2022

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

Additional relevant MeSH terms:

Melanoma; Skin Neoplasms; Neuroendocrine Tumors; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms by Histologic Type; Neoplasms; Neoplasms, Nerve Tissue; Nevi and Melanomas; Neoplasms by Site; Skin Diseases; Nivolumab; Ipilimumab; Antineoplastic Agents, Immunological; Antineoplastic Agents; Immune Checkpoint Inhibitors; Molecular Mechanisms of Pharmacological Action