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A Randomized Phase II Study of Ipilimumab at 3 mg/kg or 10 mg/kg Alone or in Combination With High Dose Interferon-Alpha in Advanced Melanoma


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Recurrent Melanoma, Stage IIIA Melanoma, Stage IIIB Melanoma, Stage IIIC Melanoma, Stage IV Melanoma

Thank you

Trial Information

A Randomized Phase II Study of Ipilimumab at 3 mg/kg or 10 mg/kg Alone or in Combination With High Dose Interferon-Alpha in Advanced Melanoma


PRIMARY OBJECTIVES:

I. Test the hypothesis that the combination of ipilimumab and high-dose interferon (HDI
[recombinant interferon alfa-2b]) will improve progression free survival (PFS) of patients
with advanced metastatic melanoma as compared to ipilimumab alone (across ipilimumab
treatment status).

SECONDARY OBJECTIVES:

I. Test the hypothesis that the combination of ipilimumab and HDI will prove to be safe and
tolerable.

II. Within the constraints of the sample size, attempt to test the hypotheses that (1)
ipilimumab 10 mg/kg will lead to improved PFS in comparison to ipilimumab 3 mg/kg (across
HDI treatment status); (2) the combination of ipilimumab and HDI will improve overall
survival (OS) of patients with advanced metastatic melanoma as compared to ipilimumab alone
(across ipilimumab treatment status) and (3) ipilimumab 10 mg/kg will lead to improved OS in
comparison to ipilimumab 3 mg/kg (across HDI treatment status).

OUTLINE: Patients are randomized to 1 of 4 treatment arms.

ARM A:

INDUCTION PHASE: Patients receive higher dose ipilimumab intravenously (IV) over 90 minutes
once every 3 weeks for 4 doses and recombinant interferon alfa-2b IV over 20 minutes five
days a week for 4 weeks and then subcutaneously (SC) three times weekly for 8 weeks.

MAINTENANCE PHASE: Patients receive higher dose ipilimumab IV over 90 minutes once every 12
weeks for 4 doses beginning in week 24 and recombinant interferon alfa-2b SC three times
weekly for 48 weeks.

ARM B:

INDUCTION PHASE: Patients receive higher dose ipilimumab IV over 90 minutes once every 3
weeks for 4 doses.

MAINTENANCE PHASE: Patients receive higher dose ipilimumab IV over 90 minutes once every 12
weeks for 4 doses beginning in week 24.

ARM C:

INDUCTION PHASE: Patients receive lower dose ipilimumab IV over 90 minutes once every 3
weeks for 4 doses and recombinant interferon alfa-2b IV over 20 minutes five days a week for
4 weeks and then SC three times weekly for 8 weeks.

MAINTENANCE PHASE: Patients receive lower dose ipilimumab IV over 90 minutes once every 12
weeks for 4 doses beginning in week 24 and recombinant interferon alfa-2b SC three times
weekly for 48 weeks.

ARM D:

INDUCTION PHASE: Patients receive lower dose ipilimumab IV over 90 minutes once every 3
weeks for 4 doses.

MAINTENANCE PHASE: Patients receive lower dose ipilimumab IV over 90 minutes once every 12
weeks for 4 doses beginning in week 24.

In all arms, treatment continues in the absence of disease progression or unacceptable
toxicity.

After completion of study treatment, patients are followed up every 3 months for 2 years,
every 6 months for 3 years, and then annually for up to 5 years.


Inclusion Criteria:



- Patients must have unresectable stage III or stage IV melanoma, either initial
presentation or recurrent, that is of cutaneous origin or unknown primary origin,
that is histologically diagnosed

- No more than one prior systemic therapeutic regimen for unresectable stage III or
stage IV melanoma; this includes chemotherapy, biologic therapy, biochemotherapy, or
investigational treatment; this does not include any therapies given in the adjuvant
setting; however, patients are excluded if they have a history of prior treatment for
melanoma (either adjuvant or metastatic disease) with ipilimumab or other cytotoxic
T-lymphocyte antigen 4 (CTLA-4) inhibitor, or prior interferon-alpha treatment for
metastatic disease (history of adjuvant interferon-alpha is allowed)

- Patients must have Eastern Cooperative Oncology Group (ECOG) performance status of
0-1

- Patients must not have other significant medical, surgical, or psychiatric conditions
or require any medication or treatment that in the opinion of the investigator may
interfere with compliance, make the administration of Ipilimumab or HDI hazardous or
obscure the interpretation of adverse events (AEs), such as a condition associated
with frequent diarrhea; patients must not have an active infection requiring current
treatment with parenteral antibiotics

- Patients must not have a history of inflammatory bowel disease or diverticulitis
(history of diverticulosis is allowed)

- Patients who have other current malignancies are not eligible; patients with other
malignancies are eligible if they have been continuously disease free for > 5 years
prior to the time of randomization; one exception are patients treated with a
curative intent and are continuously disease free for > 3 years; these patients would
be considered eligible:

- Patients with prior history at any time of any in situ cancer, lobular carcinoma
of the breast in situ, cervical cancer in situ, atypical melanocytic hyperplasia
or Clark I melanoma in situ are eligible

- Patients with prior history of basal or squamous skin cancer are eligible

- Patients must not have autoimmune disorders or conditions of immunosuppression that
require current ongoing treatment with systemic corticosteroids (or other systemic
immunosuppressants), including oral steroids (e.g., prednisone, dexamethasone) or
continuous use of topical steroid creams or ointments or ophthalmologic steroids; a
history of occasional (but not continuous) use of steroid inhalers is allowed;
replacement doses of steroids for patients with adrenal insufficiency are allowed;
patients who discontinue use of these classes of medication for at least 2 weeks
prior to randomization are eligible if, in the judgment of the treating physician
investigator, the patient is not likely to require resumption of treatment with these
classes of drugs during the study; exclusion from this study also includes patients
with a history of symptomatic autoimmune disease (e.g., rheumatoid arthritis,
systemic progressive sclerosis [scleroderma], systemic lupus erythematosus, Sjogren's
syndrome, autoimmune vasculitis [e.g., Wegener's Granulomatosis]); motor neuropathy
considered of autoimmune origin (e.g., Guillain-Barre Syndrome and Myasthenia
Gravis); other central nervous system (CNS) autoimmune disease (e.g., poliomyelitis,
multiple sclerosis); patients with autoimmune hypothyroid disease or type I diabetes
on replacement treatment are eligible

- Due to the possible effect of treatment with ipilimumab on the immunologic response
to infectious disease vaccines, patients must not have had any infectious disease
vaccination (e.g, standard influenza, H1N1 influenza, pneumococcal, meningococcal,
tetanus toxoid) within 4 weeks prior to randomization

- Women must not be pregnant or breast-feeding due to the unknown effects of ipilimumab
and the combination with HDI on conception and the fetus; all females of childbearing
potential must have a blood test or urine study during screening to rule out
pregnancy; NOTE: A woman of childbearing potential (WOCBP) is any woman, regardless
of sexual orientation or whether they have undergone tubal ligation, who meets the
following criteria: has not undergone a hysterectomy or bilateral oophorectomy; or 2)
has not been naturally postmenopausal for at least 24 consecutive months (i.e., has
had menses at any time in the preceding 24 consecutive months); for the purposes of
this study, post-menopause is defined as:

- Amenorrhea >= 24 consecutive months without another cause, or

- For women with irregular menstrual periods and taking hormone replacement
therapy (HRT), a documented serum follicle stimulating hormone (FSH) level >= 35
mIU/mL Women who are using oral contraceptives, other hormonal contraceptives
(vaginal products, skin patches, or implanted or injectable products), or
mechanical products such as an intrauterine device or barrier methods
(diaphragm, condoms, spermicides) to prevent pregnancy, or are practicing
abstinence or where their partner is sterile (e.g., vasectomy) should be
considered to be of childbearing potential; men of fathering potential and WOCBP
must be using an adequate method of contraception or must abstain from sexual
intercourse to avoid conception/pregnancy throughout the study and for up to 26
weeks after the last dose of ipilimumab or HDI in such a manner that the risk of
pregnancy is minimized; men or WOCBP who are unwilling or unable to strictly
follow this requirement are not eligible

- White blood cells (WBC) >= 3000/uL

- Absolute neutrophil count (ANC) >= 1500/uL

- Platelets >= 100 x 10^3/uL

- Hemoglobin >= 10 g/dL

- Serum creatinine =< 1.8 mg/dl

- Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.5 x upper limit
of normal (ULN) for patients with liver metastases and =< 2.0 x ULN for patients
without liver metastases

- Serum bilirubin < 2 x ULN for patients with liver metastases and =< 1.5 x ULN for
patients without liver metastases, (except patients with Gilbert's syndrome, who must
have a total bilirubin < 3.0 mg/dL)

- No active or chronic infection with human immunodeficiency virus (HIV), hepatitis B,
or hepatitis C due to the unknown effects of ipilimumab or the combination with HDI

- Patients must be free of brain metastasis by contrast-enhanced computed tomography
(CT)/magnetic resonance imaging (MRI) scans within 4 weeks prior to enrollment; if
known to have prior brain metastases, must not have evidence of active brain disease
after definitive therapy (surgery, radiation therapy or stereotactic radiosurgery) on
two successive MRI evaluations at least 3 months apart (one of which is =< 4 weeks
prior to starting the study drugs)

- All sites of disease must be evaluated within 4 weeks prior to randomization;
patients must have measurable disease as defined by Response Evaluation Criteria in
Solid Tumors (RECIST) v1.1

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Progression-free survival (PFS)

Outcome Description:

The distribution of PFS will be compared using the log-rank test.

Outcome Time Frame:

Up to 10 years

Safety Issue:

No

Principal Investigator

Ahmad Tarhini

Investigator Role:

Principal Investigator

Investigator Affiliation:

Eastern Cooperative Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2012-01932

NCT ID:

NCT01708941

Start Date:

January 2013

Completion Date:

Related Keywords:

  • Recurrent Melanoma
  • Stage IIIA Melanoma
  • Stage IIIB Melanoma
  • Stage IIIC Melanoma
  • Stage IV Melanoma
  • Melanoma

Name

Location

Boulder Community Hospital Boulder, Colorado  80301-9019
Porter Adventist Hospital Denver, Colorado  80210
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
Via Christi Regional Medical Center Wichita, Kansas  67214
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Cancer Center of Kansas - Chanute Chanute, Kansas  66720
Cancer Center of Kansas - Dodge City Dodge City, Kansas  67801
Cancer Center of Kansas - Newton Newton, Kansas  67114
Cancer Center of Kansas - Salina Salina, Kansas  67042
Cancer Center of Kansas - Wellington Wellington, Kansas  67152
Associates in Womens Health Wichita, Kansas  67203
Cancer Center of Kansas - Winfield Winfield, Kansas  67156
Adena Regional Medical Center Chillicothe, Ohio  54601
Grady Memorial Hospital Delaware, Ohio  43015
Fairfield Medical Center Lancaster, Ohio  43130
Community Cancer Center of Monroe Monroe, Michigan  48162
Lima Memorial Hospital Lima, Ohio  45804
Fulton County Health Center Wauseon, Ohio  43567
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Bixby Medical Center Adrian, Michigan  49221
Swedish American Hospital Rockford, Illinois  61104
Cancer Center of Kansas - Fort Scott Fort Scott, Kansas  66701
Cancer Center of Kansas-Independence Independence, Kansas  67301
Lawrence Memorial Hospital Lawrence, Kansas  66044
Longmont United Hospital Longmont, Colorado  80501
University of Pittsburgh Pittsburgh, Pennsylvania  15261
Riverside Methodist Hospital Columbus, Ohio  43214
Licking Memorial Hospital Newark, Ohio  43055-2899
Cancer Center of Kansas - McPherson McPherson, Kansas  67460
Columbus CCOP Columbus, Ohio  43206
Presbyterian - Saint Lukes Medical Center - Health One Denver, Colorado  80218
Wichita CCOP Wichita, Kansas  67214-3882
Flower Hospital Sylvania, Ohio  43560-2197
Decatur Memorial Hospital Decatur, Illinois  62526
Littleton Adventist Hospital Littleton, Colorado  80122
Parker Adventist Hospital Parker, Colorado  80138
The Medical Center of Aurora Aurora, Colorado  80012
Penrose-Saint Francis Healthcare Colorado Springs, Colorado  80907
Saint Anthony Central Hospital Denver, Colorado  80204
Exempla Saint Joseph Hospital Denver, Colorado  80218
Colorado Cancer Research Program CCOP Denver, Colorado  80224-2522
Saint Mary Corwin Medical Center Pueblo, Colorado  81004
Mercy Medical Center-Sioux City Sioux City, Iowa  51104
Saint Luke's Regional Medical Center Sioux City, Iowa  51104
Cancer Center of Kansas - El Dorado El Dorado, Kansas  67042
Cancer Center of Kansas-Kingman Kingman, Kansas  67068
Cancer Center of Kansas - Parsons Parsons, Kansas  67357
Cancer Center of Kansas - Pratt Pratt, Kansas  67124
Cancer Center of Kansas-Wichita Medical Arts Tower Wichita, Kansas  67208
Cancer Center of Kansas - Main Office Wichita, Kansas  67214
Hickman Cancer Center Adrian, Michigan  49221
Mercy Memorial Hospital Monroe, Michigan  48162
Doctors Hospital Columbus, Ohio  43228
Grant Medical Center Columbus, Ohio  43215
Mount Carmel Health Center West Columbus, Ohio  43222
Marietta Memorial Hospital Marietta, Ohio  45750
Saint Charles Hospital Oregon, Ohio  43616
Toledo Community Hospital Oncology Program CCOP Toledo, Ohio  43617
University of Toledo Toledo, Ohio  43614
Saint Vincent Mercy Medical Center Toledo, Ohio  43608
Genesis HealthCare System Zanesville, Ohio  43701
Saint Vincent Hospital Green Bay, Wisconsin  54301
Cancer Center of Kansas-Liberal Liberal, Kansas  67901
Holy Family Memorial Hospital Manitowoc, Wisconsin  54221
Southern Ohio Medical Center Portsmouth, Ohio  45662
Saint Nicholas Hospital Madison, Wisconsin  53715
New York Oncology Hematology PC -Albany Medical Center Albany, New York  12208
Siouxland Hematology Oncology Associates Sioux City, Iowa  51101
The Toledo Hospital/Toledo Children's Hospital Toledo, Ohio  43606
Toledo Clinic Cancer Centers-Oregon Oregon, Ohio  43616
Springfield Regional Medical Center Springfield, Ohio  45505
Toledo Clinic Cancer Centers-Maumee Maumee, Ohio  43537-1839
Toledo Clinic Cancer Centers-Toledo Toledo, Ohio  43623