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Monoclonal Antibody Therapy and Vaccine Therapy in Treating Patients With Resected Stage III or Stage IV Melanoma

Primary Purpose

Intraocular Melanoma, Melanoma (Skin)

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
ipilimumab
Tyrosinase/gp100/MART-1 Peptides
Sponsored by
Bristol-Myers Squibb
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Intraocular Melanoma focused on measuring stage III melanoma, stage IV melanoma, ciliary body and choroid melanoma, medium/large size, extraocular extension melanoma, iris melanoma, recurrent melanoma, recurrent intraocular melanoma, metastatic intraocular melanoma

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically confirmed melanoma Stage III (≥ 3 positive lymph nodes) or stage IV disease Mucosal or ocular melanoma allowed Completely resected within the past 6 months Patients with stage III resected melanoma rendered free of disease may have failed, been ineligible for, or refused prior treatment with interferon alfa Positive staining of tumor tissue for at least one of the following: Antibody HMB-45 for gp100 Antibody HMB-45 for tyrosinase Antibody HMB-45 for MART-1 HLA-A*0201 positive by DNA allele-specific polymerase chain reaction assay PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-1 Life expectancy At least 6 months Hematopoietic WBC ≥ 2,500/mm^3 Absolute neutrophil count ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Hematocrit ≥ 30% Hemoglobin ≥ 10 g/dL Hepatic AST ≤ 3 times upper limit of normal (ULN)* Bilirubin ≤ ULN* (< 3.0 mg/dL for patients with Gilbert's syndrome) No significant hepatic disease that would preclude study participation Hepatitis B surface antigen negative Hepatitis C antibody negative NOTE: * Unless attributable to disease Renal Creatinine ≤ 2.0 mg/dL No significant renal disease that would preclude study participation Cardiovascular No significant cardiac disease that would preclude study participation Pulmonary No significant pulmonary disease that would preclude study participation Immunologic No history of any of the following: Inflammatory bowel disease or any other autoimmune bowel disease Systemic lupus erythematosus Rheumatoid arthritis Autoimmune ocular disease No systemic hypersensitivity to Montanide ISA-51 or any vaccine component No active infection requiring therapy HIV negative Other No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, superficial bladder cancer, or carcinoma in situ of the cervix No significant gastrointestinal disease that would preclude study participation No significant psychiatric disease that would preclude study participation No other medical condition that would preclude study participation Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for at least 4 months after study participation PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics No prior anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-010) No prior gp100 antigen, MART-1 antigen, or tyrosinase peptide At least 4 weeks since prior immunotherapy for melanoma and recovered No other concurrent immunotherapy Chemotherapy At least 4 weeks since prior chemotherapy for melanoma (6 weeks for nitrosoureas) and recovered No concurrent chemotherapy Endocrine therapy At least 4 weeks since prior hormonal therapy for melanoma and recovered At least 4 weeks since prior systemic, inhaled, or topical corticosteroids No concurrent systemic, inhaled, or topical corticosteroids Radiotherapy At least 4 weeks since prior radiotherapy for melanoma and recovered Surgery See Disease Characteristics At least 4 weeks since prior surgery for melanoma and recovered Other No concurrent immunosuppressive agents (e.g., cyclosporine and its analog) Concurrent analgesic therapy allowed provided the dose is stable for the past 14 days

Sites / Locations

  • H. Lee Moffitt Cancer Center and Research Institute at University of South Florida

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Arm 1

Arm Description

Outcomes

Primary Outcome Measures

Percentage of Participants With Immune-related Adverse Events (irAEs)
Percentage of participants who experienced an irAE during the course of the study defined by the induction of Grade 1, Grade 2, or acceptable Grade 3 drug-related irAEs. For the purposes of this trial, acceptable drug-related irAEs are skin-related immune-mediated adverse events < or = Grade 3 (potentially reversible inflammation < Grade 4 that can be attributable to a local antitumor reaction that could potentially be a therapeutic response will also be considered an acceptable irAE). Note: The confidence interval was calculated using the Clopper Pearson method
Time to Disease Relapse
To determine the time (months) from first dose to disease relapse. Time to disease relapse is defined from the start of treatment to the first occurrence of any new lesion (reported by the investigator on physical exam or diagnostic imaging assessments that are attributed to metastatic melanoma) or death. Participants who neither relapse nor died will be censored on the date of their last tumor evaluation. Median estimated using Kaplan-Meier method; A two-sided 95% CI for median in each treatment group was computed via the log-log transformation method.

Secondary Outcome Measures

Number of Participants With Drug-related irAEs of Any Grade
The number of participants who experienced a drug-related irAE of any grade over the course of the study. Note: The confidence interval was calculated using the Clopper Pearson method
Immunologic Response to the Dose Regimen
The secondary objective was to determine the immunologic response to the dosing regimen, via Human Anti-Human Antibody (HAHA) Assessment, displayed by number of participants observed as HAHA positive or negative. Note: If participant had at least one post-baseline HAHA result with increase in titer over pre-study, the participant is counted as HAHA Positive. A participant with all negative post-baseline results is counted as HAHA negative.
Number of Participants Experiencing Hematology-related Lab Abnormalities
The number of participants who experienced a Hematology-related laboratory abnormality (grade 1-4 and grade 3-4 categories, grade 4 being the worst) during the course of the study. Laboratory tests were graded using the NCI Common Terminology Criteria for Adverse Events (CTCAE), version 3.0.
Number of Participants Experiencing Serum Chemistry-related Lab Abnormalities
The number of participants who experienced a Serum Chemistry-related laboratory abnormality (grade 1-4 and grade 3-4 categories, grade 4 being the worst) during the course of the study. Laboratory tests were graded using the NCI Common Terminology Criteria for Adverse Events (CTCAE), version 3.0.
Time to Disease Relapse
To determine the time (months) from first dose to disease relapse. Time to disease relapse is defined from the start of treatment to the first occurrence of any new lesion (reported by the investigator on physical exam or diagnostic imaging assessments that are attributed to metastatic melanoma) or death. Participants who neither relapse nor died will be censored on the date of their last tumor evaluation. Median estimated using Kaplan-Meier method; A two-sided 95% CI for median in each treatment group was computed via the log-log transformation method.

Full Information

First Posted
June 10, 2004
Last Updated
April 13, 2022
Sponsor
Bristol-Myers Squibb
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00084656
Brief Title
Monoclonal Antibody Therapy and Vaccine Therapy in Treating Patients With Resected Stage III or Stage IV Melanoma
Official Title
An Extended Dosing, Two-phase Study of MDX-010 as Monotherapy or in Combination With Tyrosinase/gp100/MART-1 Peptides Emulsified With Montanide ISA 51 VG in the Treatment of Subjects With Resected Stage III or Stage IV Melanoma
Study Type
Interventional

2. Study Status

Record Verification Date
April 2022
Overall Recruitment Status
Completed
Study Start Date
May 31, 2004 (Actual)
Primary Completion Date
October 31, 2009 (Actual)
Study Completion Date
October 31, 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Bristol-Myers Squibb
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Monoclonal antibodies can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Vaccines may make the body build an immune response to kill tumor cells. Combining the vaccines with Montanide ISA-51 may cause a stronger immune response and kill more tumor cells. Giving monoclonal antibody therapy together with vaccine therapy may be an effective treatment for stage III or stage IV melanoma. PURPOSE: This phase II trial is studying how well giving monoclonal antibody therapy together with vaccine therapy works in treating patients with resected stage III or stage IV melanoma.
Detailed Description
OBJECTIVES: Primary Achieve at least a 40% autoimmune breakthrough event rate, as defined by the induction of grade 1, grade 2, or acceptable grade 3 drug-related autoimmune adverse events, in patients with resected stage III or IV melanoma treated with anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-010) and peptide vaccine comprising tyrosinase, gp100 antigen, and MART-1 antigen emulsified in Montanide ISA-51. Secondary Determine the incidence of drug-related autoimmune adverse events of any grade in patients treated with this regimen. Determine the time to disease relapse in patients treated with this regimen. Determine the immunologic response in patients treated with this regimen. OUTLINE: This is an open-label study. Patients receive anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-010) IV over 90 minutes on day 1 of weeks 1, 9, 17, 25, 33, 41, and 53 and peptide vaccine comprising tyrosinase, gp100 antigen, and MART-1 antigen emulsified in Montanide ISA-51 subcutaneously on day 1 of weeks 1, 3, 5, 7, 9, 11, 17, 21, 25, 33, 41, and 53. Patients are followed every 3 months for 2 years, every 6 months for 2 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 25 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Intraocular Melanoma, Melanoma (Skin)
Keywords
stage III melanoma, stage IV melanoma, ciliary body and choroid melanoma, medium/large size, extraocular extension melanoma, iris melanoma, recurrent melanoma, recurrent intraocular melanoma, metastatic intraocular melanoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
77 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm 1
Arm Type
Experimental
Intervention Type
Biological
Intervention Name(s)
ipilimumab
Intervention Description
IV over 90 mins on day 1, wks 1,9,17,25,33,41,53 Dose: 3 mg/kg (Part I), 10 mg/kg (Part II)
Intervention Type
Biological
Intervention Name(s)
Tyrosinase/gp100/MART-1 Peptides
Intervention Description
(All subjects in Part I and HLA-A*0201 positive subjects only in Part II): SC, day 1 of wks 1,3,5,7,9,11,17, 21,25,33,41,53 Dose: 1 mg peptide emulsified in 1 mL Montanide ISA 51 VG.)
Primary Outcome Measure Information:
Title
Percentage of Participants With Immune-related Adverse Events (irAEs)
Description
Percentage of participants who experienced an irAE during the course of the study defined by the induction of Grade 1, Grade 2, or acceptable Grade 3 drug-related irAEs. For the purposes of this trial, acceptable drug-related irAEs are skin-related immune-mediated adverse events < or = Grade 3 (potentially reversible inflammation < Grade 4 that can be attributable to a local antitumor reaction that could potentially be a therapeutic response will also be considered an acceptable irAE). Note: The confidence interval was calculated using the Clopper Pearson method
Time Frame
Between first dose and 70 days after last dose of study therapy (up to 3 years including maintenance phase)
Title
Time to Disease Relapse
Description
To determine the time (months) from first dose to disease relapse. Time to disease relapse is defined from the start of treatment to the first occurrence of any new lesion (reported by the investigator on physical exam or diagnostic imaging assessments that are attributed to metastatic melanoma) or death. Participants who neither relapse nor died will be censored on the date of their last tumor evaluation. Median estimated using Kaplan-Meier method; A two-sided 95% CI for median in each treatment group was computed via the log-log transformation method.
Time Frame
up to 3 years
Secondary Outcome Measure Information:
Title
Number of Participants With Drug-related irAEs of Any Grade
Description
The number of participants who experienced a drug-related irAE of any grade over the course of the study. Note: The confidence interval was calculated using the Clopper Pearson method
Time Frame
Between first dose and 70 days after last dose of study therapy (up to 3 years including maintenance phase)
Title
Immunologic Response to the Dose Regimen
Description
The secondary objective was to determine the immunologic response to the dosing regimen, via Human Anti-Human Antibody (HAHA) Assessment, displayed by number of participants observed as HAHA positive or negative. Note: If participant had at least one post-baseline HAHA result with increase in titer over pre-study, the participant is counted as HAHA Positive. A participant with all negative post-baseline results is counted as HAHA negative.
Time Frame
up to 3 years
Title
Number of Participants Experiencing Hematology-related Lab Abnormalities
Description
The number of participants who experienced a Hematology-related laboratory abnormality (grade 1-4 and grade 3-4 categories, grade 4 being the worst) during the course of the study. Laboratory tests were graded using the NCI Common Terminology Criteria for Adverse Events (CTCAE), version 3.0.
Time Frame
Between first dose and 70 days after last dose of study therapy (up to 3 years including maintenance phase)
Title
Number of Participants Experiencing Serum Chemistry-related Lab Abnormalities
Description
The number of participants who experienced a Serum Chemistry-related laboratory abnormality (grade 1-4 and grade 3-4 categories, grade 4 being the worst) during the course of the study. Laboratory tests were graded using the NCI Common Terminology Criteria for Adverse Events (CTCAE), version 3.0.
Time Frame
Between first dose and 70 days after last dose of study therapy (up to 3 years including maintenance phase)
Title
Time to Disease Relapse
Description
To determine the time (months) from first dose to disease relapse. Time to disease relapse is defined from the start of treatment to the first occurrence of any new lesion (reported by the investigator on physical exam or diagnostic imaging assessments that are attributed to metastatic melanoma) or death. Participants who neither relapse nor died will be censored on the date of their last tumor evaluation. Median estimated using Kaplan-Meier method; A two-sided 95% CI for median in each treatment group was computed via the log-log transformation method.
Time Frame
up to 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed melanoma Stage III (≥ 3 positive lymph nodes) or stage IV disease Mucosal or ocular melanoma allowed Completely resected within the past 6 months Patients with stage III resected melanoma rendered free of disease may have failed, been ineligible for, or refused prior treatment with interferon alfa Positive staining of tumor tissue for at least one of the following: Antibody HMB-45 for gp100 Antibody HMB-45 for tyrosinase Antibody HMB-45 for MART-1 HLA-A*0201 positive by DNA allele-specific polymerase chain reaction assay PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-1 Life expectancy At least 6 months Hematopoietic WBC ≥ 2,500/mm^3 Absolute neutrophil count ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Hematocrit ≥ 30% Hemoglobin ≥ 10 g/dL Hepatic AST ≤ 3 times upper limit of normal (ULN)* Bilirubin ≤ ULN* (< 3.0 mg/dL for patients with Gilbert's syndrome) No significant hepatic disease that would preclude study participation Hepatitis B surface antigen negative Hepatitis C antibody negative NOTE: * Unless attributable to disease Renal Creatinine ≤ 2.0 mg/dL No significant renal disease that would preclude study participation Cardiovascular No significant cardiac disease that would preclude study participation Pulmonary No significant pulmonary disease that would preclude study participation Immunologic No history of any of the following: Inflammatory bowel disease or any other autoimmune bowel disease Systemic lupus erythematosus Rheumatoid arthritis Autoimmune ocular disease No systemic hypersensitivity to Montanide ISA-51 or any vaccine component No active infection requiring therapy HIV negative Other No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, superficial bladder cancer, or carcinoma in situ of the cervix No significant gastrointestinal disease that would preclude study participation No significant psychiatric disease that would preclude study participation No other medical condition that would preclude study participation Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for at least 4 months after study participation PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics No prior anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-010) No prior gp100 antigen, MART-1 antigen, or tyrosinase peptide At least 4 weeks since prior immunotherapy for melanoma and recovered No other concurrent immunotherapy Chemotherapy At least 4 weeks since prior chemotherapy for melanoma (6 weeks for nitrosoureas) and recovered No concurrent chemotherapy Endocrine therapy At least 4 weeks since prior hormonal therapy for melanoma and recovered At least 4 weeks since prior systemic, inhaled, or topical corticosteroids No concurrent systemic, inhaled, or topical corticosteroids Radiotherapy At least 4 weeks since prior radiotherapy for melanoma and recovered Surgery See Disease Characteristics At least 4 weeks since prior surgery for melanoma and recovered Other No concurrent immunosuppressive agents (e.g., cyclosporine and its analog) Concurrent analgesic therapy allowed provided the dose is stable for the past 14 days
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bristol-Myers Squibb
Organizational Affiliation
Bristol-Myers Squibb
Official's Role
Study Director
Facility Information:
Facility Name
H. Lee Moffitt Cancer Center and Research Institute at University of South Florida
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612-9497
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
32161584
Citation
Garg SK, Ott MJ, Mostofa AGM, Chen Z, Chen YA, Kroeger J, Cao B, Mailloux AW, Agrawal A, Schaible BJ, Sarnaik A, Weber JS, Berglund AE, Mule JJ, Markowitz J. Multi-Dimensional Flow Cytometry Analyses Reveal a Dichotomous Role for Nitric Oxide in Melanoma Patients Receiving Immunotherapy. Front Immunol. 2020 Feb 25;11:164. doi: 10.3389/fimmu.2020.00164. eCollection 2020.
Results Reference
derived
PubMed Identifier
21106722
Citation
Sarnaik AA, Yu B, Yu D, Morelli D, Hall M, Bogle D, Yan L, Targan S, Solomon J, Nichol G, Yellin M, Weber JS. Extended dose ipilimumab with a peptide vaccine: immune correlates associated with clinical benefit in patients with resected high-risk stage IIIc/IV melanoma. Clin Cancer Res. 2011 Feb 15;17(4):896-906. doi: 10.1158/1078-0432.CCR-10-2463. Epub 2010 Nov 24.
Results Reference
derived

Learn more about this trial

Monoclonal Antibody Therapy and Vaccine Therapy in Treating Patients With Resected Stage III or Stage IV Melanoma

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