Combined BRAF-Targeted Therapy & Immunotherapy for Melanoma
This research study is a Phase II clinical trial of an investigational combination of drugs (vemurafenib and aldesleukin) to learn whether the combination works in treating a specific cancer. While both vemurafenib and aldesleukin are approved by the FDA for the treatment of metastatic melanoma, the FDA has not yet approved the combination of vemurafenib and aldesleukin.
Researchers have found that a large number of melanoma cells have mutations in the BRAF gene. It has been shown that vemurafenib blocks the effects of these mutations in the BRAF gene, and, as a result, may help to prevent cancer growth.
Aldesleukin, also referred to as IL-2, is an immunotherapy drug administered via IV infusion that increases the growth of key cells within the immune system that are responsible for targeting cancer cells. Activating more of these key cells, called T-lymphocytes and natural-killer cells, leads to increased cancer cell death.
The BRAF gene is located on a larger pathway called the MAPK pathway. Studies have shown that when a BRAF inhibitor, like vemurafenib is used to block the MAPK pathway, melanocytes, or cancer cells express more proteins on their surfaces, making them easier for T-lymphocytes and natural killer cells to recognize and kill them. This suggests that combining BRAF-targeted therapy with aldesleukin, which activates more of these white blood cells, can lead to an increase in the death of cancer cells.
In this research study, we are looking to see whether the combination of vemurafenib, a BRAF-inhibitor combined with aldesleukin, an immunotherapy drug, work together to produce a better health outcome in people with metastatic melanoma.
|Study Design:||Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||COMBAT 1: A Phase II Trial of Combined BRAF-Targeted Therapy and Immunotherapy for Melanoma|
- Efficacy of Vemurafenib + Aldesleukin [ Time Frame: 2 years ] [ Designated as safety issue: No ]To assess the efficacy (as measured by progression-free survival (PFS)) of patients with metastatic melanoma with V600E mutation treated with the combination of vemurafenib and aldesleukin in comparison to an historic control of vemurafenib alone
- Determine Response Rates (Complete, Partial and Durable) [ Time Frame: 2 years ] [ Designated as safety issue: No ]To determine the complete response (CR), partial response (PR), and durable response (DR) rates (as defined as the rate of objective response (CR or PR) lasting continuously for 12 or more months, as compared to control therapy, and beginning at any point within 12 months of initiating therapy) in patients treated with aldesleukin and vemurafenib
- Overall Survival [ Time Frame: 2 years ] [ Designated as safety issue: No ]To determine the overall survival in patients treated with aldesleukin and vemurafenib
- Toxicity and Safety of Aldesleukin and Vemurafenib [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]To determine the toxicity and safety of concurrent administration of aldesleukin and vemurafenib
- Confirm Pre-Clinical Data [ Time Frame: 2 years ] [ Designated as safety issue: No ]To confirm preclinical data indicating that pharmacologic inhibition of mutated BRAF enhances the immunogenicity of melanoma without adversely affecting the cellular immune response. To assess whether the number of doses of aldesleukin that can be safely administered is affected by the co-administration of vemurafenib
- Exploration of Biomarkers [ Time Frame: 2 years ] [ Designated as safety issue: No ]To explore biomarkers that may be relevant: to further predict responsiveness to vemurafenib and aldesleukin, to explain primary or acquired resistance to vemurafenib, to indicate pharmacodynamic effects of vemurafenib and to monitor the disease.
|Study Start Date:||January 2013|
|Primary Completion Date:||February 2015 (Final data collection date for primary outcome measure)|
Experimental: Treatment Arm
Oral vemurafenib twice a day IV infusion of aldesleukin
Intravenous therapy given every 8 hours for up to 14 doses per week.
Other Names:Drug: Vemurafenib
Tablets given twice daily.
You will take oral vemurafenib twice a day for 2 weeks. Following this lead-in period, you will receive aldesleukin via IV infusion on Day 15 of the study. One course of aldesleukin is 12 weeks long; you will receive aldesleukin via IV infusion every 8 hours for the first five days. Youi will be hospitalized for the 5 days that you are receiving aldesleukin. This week that you are hospitalized will be referred to as Week 1. Week 1 of aldesleukin will be days 15-19 (M-F) of the 12 week cycle. Following Week 1 of therapy, you will be discharged from the hospital and only take vemurafenib at home for the following week. You wil then come in for one more week of aldesleukin during days 29-33 of the 12 week cycle. This is referred to as Week 2 of aldesleukin.
You will continue to take vemurafenib twice daily during the course of aldesleukin. Your cancer will be evaluated at screening and at Week 12 following the beginning of the first aldesleukin course with a CT scan. After the first cycle, your tumor will be evaluated every 8 weeks for the first year, then every 12 weeks for years 2 and 3, every 6 months for year 5, and annually thereafter.
During the research study, you will come into the clinic weekly for various tests and procedures.
If scans show that your cancer has improved after the first course of aldesleukin, your doctor may allow you to continue on the a second course. In the event of a second course of aldesleukin, you will remain on vemurafenib throughout the second course. If your doctor decides you will not receive a second course of aldesleukin, you may still remain on vemurafenib until one of the following events occurs: Your cancer becomes worse, you experience serious side effects that are from taking vemurafenib, you request to discontinue taking vemurafenib/withdraw from the study, you develop another illness that prevents you from being able to take vemurafenib, the study is terminated by the sponsor or your study doctor decides it is in your best interest to discontinue treatment with vemurafenib.
In some cases if your cancer does get worse, but you and your study doctor believe you are still benefitting from vemurafenib in some way, you may continue receiving it after you consult with the study director.
After the final dose of the study drug we would like to keep track of your medical condition for the rest of your life. We would like to do this by calling you on the telephone once a year to see how you are doing. Keeping in touch with you and checking your condition every year helps us look at the long-term effects of the research study.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01754376
|United States, Massachusetts|
|Beth Israel Deaconess Medical Center|
|Boston, Massachusetts, United States, 02215|
|Massachusetts General Hospital|
|Boston, Massachusetts, United States, 02113|
|Principal Investigator:||Ryan J Sullivan, MD||MGH Cancer Center|