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A Phase II Study to Evaluate Safety and Efficacy of Combined Treatment With Ipilimumab and Intratumoral Interleukin-2

Primary Purpose

Malignant Melanoma

Status
Completed
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Interleukin-2
Ipilimumab
Sponsored by
University Hospital Tuebingen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Malignant Melanoma focused on measuring Malignant melanoma

Eligibility Criteria

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

Inclusion Criteria:

  • Willing and able to give written informed consent;
  • Histological diagnosis of malignant melanoma;
  • Stage IV melanoma;
  • At least one injectable lesions > 5 mm (longest diameter) or at least 5 injectable lesions < 5 mm.
  • Measurable disease. Note: lesions, which are designated for direct IL -2 injections, must not be considered in the evaluation of measurability;
  • Men and women, at least 18 years of age;
  • Patient must have demonstrated 1 of the following in response to at least 1 cycle of 1 or more systemic regimens:

    1. relapse following an objective response (PR/CR);
    2. failed to demonstrate an objective response (PR/CR); or
    3. inability to tolerate treatment due to unacceptable toxicity
  • At least 4 weeks since treatment (chemotherapy, biochemotherapy, surgery, radiation, immunotherapy, etc.) for melanoma and recovered from any clinically significant toxicity experienced during treatment;
  • Life expectancy ≥3 months;
  • ECOG performance status of 0 or 1;
  • Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 72 hours before the start of ipilimumab;
  • No known active or chronic infection with HIV, Hepatitis B, or Hepatitis C
  • Required values for initial laboratory tests:
  • Men of fathering potential must be using an adequate method of contraception to avoid conception throughout the study and for up to 26 weeks after the last dose of investigational product in such a manner that the risk of pregnancy is minimized

Exclusion Criteria:

  • Any other prior malignancy from which the patient has been disease-free for less than 5 years, with the exception of adequately treated and cured basal or squamous cell skin cancer, superficial bladder cancer or carcinoma in situ of the cervix;
  • Ocular melanoma; mucosal melanoma
  • Either untreated or symptomatic central nervous system (CNS) metastases (patients with brain metastases who are identified at screening may be rescreened after the lesion(s) have been appropriately treated);
  • Autoimmune disease: Patients with a history of inflammatory bowel disease are excluded from this study, as are patients with a history of symptomatic autoimmune disease (e.g., rheumatoid arthritis, systemic progressive sclerosis [scleroderma], systemic lupus erythematosus, autoimmune vasculitis [e.g., Wegener's Granulomatosis]); motor neuropathy considered of autoimmune origin (e.g., Guillain-Barre Syndrome). Patients with vitiligo may be included.
  • Any underlying medical or psychiatric condition, which in the opinion of the investigator will make the administration of ipilimumab hazardous or obscure the interpretation of AEs, such as a condition associated with frequent diarrhea.
  • Any non-oncology vaccine therapy used for prevention of infectious diseases (for up to 1 month before or after any dose of ipilimumab).
  • A history of prior systemic treatment with ipilimumab, CD137 agonist, CTLA 4 inhibitor, CTLA-4 agonist or IL-2 in stage IV melanoma.
  • Concomitant or less than 4 weeks off therapy with any of the following: interferon; other non-study immunotherapy regimens; cytotoxic chemotherapy; immunosuppressive agents; other investigation therapies; chronic use of systemic corticosteroids.
  • Women of childbearing potential (WOCBP), defined in Section 5.3, who:

    1. are unwilling or unable to use an acceptable method of contraception to avoid pregnancy for their entire study period and for at least 26 weeks after cessation of study drug, or
    2. have a positive pregnancy test at baseline, or
    3. are pregnant or breastfeeding.
  • Subjects who are compulsorily detained for treatment of either a psychiatric or physical (e.g., infectious) illness.

Sites / Locations

  • University Hospital Tübingen

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ipilimumab

Arm Description

Ipilimumab i.v. + Interleukin-2 intratumoral

Outcomes

Primary Outcome Measures

Control rate
To determine efficacy of the combined treatment with ipilimumab and intratumoral IL-2 by assessment of Disease control rate according to immune-related response criteria (irDCR) at week 12

Secondary Outcome Measures

Tolerability
Tolerability according to NCI-CTCAE-Criteria (version 4)
Overall survival
Overall survival
Best Overall Response Rate
Best Overall Response Rate (irBORR) according to irRC
Overall response rate
Overall response rate (sum of irPR and irCR) according to irRC
Overall Response Rate
Overall Response Rate according to modified mWHO criteria
Best Overall Response Rate
Best Overall Response Rate according to modified mWHO criteria
Response rate of injected metastases only
Response rate of injected metastases only
Rate of patients with substantial increase of anti-melanoma T-cells in peripheral blood during treatment
Rate of patients with substantial increase of anti-melanoma T-cells in peripheral blood during treatment
Changes in T-cell subsets during treatment
Changes in T-cell subsets during treatment
Changes in subsets of tumor-infiltrating lymphocytes during treatment
Changes in subsets of tumor-infiltrating lymphocytes during treatment

Full Information

First Posted
November 23, 2011
Last Updated
July 17, 2015
Sponsor
University Hospital Tuebingen
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1. Study Identification

Unique Protocol Identification Number
NCT01480323
Brief Title
A Phase II Study to Evaluate Safety and Efficacy of Combined Treatment With Ipilimumab and Intratumoral Interleukin-2
Official Title
A Phase II Study to Evaluate Safety and Efficacy of Combined Treatment With Ipilimumab and Intratumoral Interleukin-2 in Pretreated Patients With Stage IV Melanoma
Study Type
Interventional

2. Study Status

Record Verification Date
July 2015
Overall Recruitment Status
Completed
Study Start Date
February 2012 (undefined)
Primary Completion Date
September 2014 (Actual)
Study Completion Date
June 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Hospital Tuebingen

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The current clinical trial shall clarify a synergistic effect with regards to efficiency by the combination of intratumoral injection of interleukin-2 (IL-2) and the intra-venous application of ipilimumab.
Detailed Description
Intratumoral injection of interleukin-2 (IL-2) into melanoma metastases is a highly efficient local treatment. Furthermore, a systemic effect is assumed based on the observation of a favorable long term outcome. However, objective responses in untreated lesions have not been observed yet. Ipilimumab seems to be efficient in a subset of treated patients by inhibition of down-regulation of tumor-specific cellular immune-responses. In the context of the proposed trial, we assume (i) that ipilimumab could potentiate systemic melanoma-specific immune responses, which are primarily induced by intratumoral IL-2 and (ii) that these immune responses become more effective with regards to not IL-2 injected distant lesions. Therefore we assume a synergistic effect with regards to efficiency by the combination.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malignant Melanoma
Keywords
Malignant 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
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ipilimumab
Arm Type
Experimental
Arm Description
Ipilimumab i.v. + Interleukin-2 intratumoral
Intervention Type
Drug
Intervention Name(s)
Interleukin-2
Other Intervention Name(s)
Proleukin®
Intervention Description
intratumoral injections of 9 MIU/day on days 1, 4, 8, 11, 15, 18, 22 and 25. The administered dose will be distributed between all injectable soft-tissue metastases
Intervention Type
Drug
Intervention Name(s)
Ipilimumab
Other Intervention Name(s)
Proleukin
Intervention Description
IV infusion, 3 mg/kg, day 2, 23, 44, 65
Primary Outcome Measure Information:
Title
Control rate
Description
To determine efficacy of the combined treatment with ipilimumab and intratumoral IL-2 by assessment of Disease control rate according to immune-related response criteria (irDCR) at week 12
Time Frame
at week 12
Secondary Outcome Measure Information:
Title
Tolerability
Description
Tolerability according to NCI-CTCAE-Criteria (version 4)
Time Frame
within 12 months after start of treatment
Title
Overall survival
Description
Overall survival
Time Frame
within 12 months after start of treatment
Title
Best Overall Response Rate
Description
Best Overall Response Rate (irBORR) according to irRC
Time Frame
within 12 months after start of treatment
Title
Overall response rate
Description
Overall response rate (sum of irPR and irCR) according to irRC
Time Frame
at week 12
Title
Overall Response Rate
Description
Overall Response Rate according to modified mWHO criteria
Time Frame
at week 12
Title
Best Overall Response Rate
Description
Best Overall Response Rate according to modified mWHO criteria
Time Frame
within 12 months after start of treatment
Title
Response rate of injected metastases only
Description
Response rate of injected metastases only
Time Frame
at week 12
Title
Rate of patients with substantial increase of anti-melanoma T-cells in peripheral blood during treatment
Description
Rate of patients with substantial increase of anti-melanoma T-cells in peripheral blood during treatment
Time Frame
within 22 weeks after start of treatment
Title
Changes in T-cell subsets during treatment
Description
Changes in T-cell subsets during treatment
Time Frame
within 22 weeks after start of treatment
Title
Changes in subsets of tumor-infiltrating lymphocytes during treatment
Description
Changes in subsets of tumor-infiltrating lymphocytes during treatment
Time Frame
within 22 weeks after start of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Willing and able to give written informed consent; Histological diagnosis of malignant melanoma; Stage IV melanoma; At least one injectable lesions > 5 mm (longest diameter) or at least 5 injectable lesions < 5 mm. Measurable disease. Note: lesions, which are designated for direct IL -2 injections, must not be considered in the evaluation of measurability; Men and women, at least 18 years of age; Patient must have demonstrated 1 of the following in response to at least 1 cycle of 1 or more systemic regimens: relapse following an objective response (PR/CR); failed to demonstrate an objective response (PR/CR); or inability to tolerate treatment due to unacceptable toxicity At least 4 weeks since treatment (chemotherapy, biochemotherapy, surgery, radiation, immunotherapy, etc.) for melanoma and recovered from any clinically significant toxicity experienced during treatment; Life expectancy ≥3 months; ECOG performance status of 0 or 1; Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 72 hours before the start of ipilimumab; No known active or chronic infection with HIV, Hepatitis B, or Hepatitis C Required values for initial laboratory tests: Men of fathering potential must be using an adequate method of contraception to avoid conception throughout the study and for up to 26 weeks after the last dose of investigational product in such a manner that the risk of pregnancy is minimized Exclusion Criteria: Any other prior malignancy from which the patient has been disease-free for less than 5 years, with the exception of adequately treated and cured basal or squamous cell skin cancer, superficial bladder cancer or carcinoma in situ of the cervix; Ocular melanoma; mucosal melanoma Either untreated or symptomatic central nervous system (CNS) metastases (patients with brain metastases who are identified at screening may be rescreened after the lesion(s) have been appropriately treated); Autoimmune disease: Patients with a history of inflammatory bowel disease are excluded from this study, as are patients with a history of symptomatic autoimmune disease (e.g., rheumatoid arthritis, systemic progressive sclerosis [scleroderma], systemic lupus erythematosus, autoimmune vasculitis [e.g., Wegener's Granulomatosis]); motor neuropathy considered of autoimmune origin (e.g., Guillain-Barre Syndrome). Patients with vitiligo may be included. Any underlying medical or psychiatric condition, which in the opinion of the investigator will make the administration of ipilimumab hazardous or obscure the interpretation of AEs, such as a condition associated with frequent diarrhea. Any non-oncology vaccine therapy used for prevention of infectious diseases (for up to 1 month before or after any dose of ipilimumab). A history of prior systemic treatment with ipilimumab, CD137 agonist, CTLA 4 inhibitor, CTLA-4 agonist or IL-2 in stage IV melanoma. Concomitant or less than 4 weeks off therapy with any of the following: interferon; other non-study immunotherapy regimens; cytotoxic chemotherapy; immunosuppressive agents; other investigation therapies; chronic use of systemic corticosteroids. Women of childbearing potential (WOCBP), defined in Section 5.3, who: are unwilling or unable to use an acceptable method of contraception to avoid pregnancy for their entire study period and for at least 26 weeks after cessation of study drug, or have a positive pregnancy test at baseline, or are pregnant or breastfeeding. Subjects who are compulsorily detained for treatment of either a psychiatric or physical (e.g., infectious) illness.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Benjamin Weide, Dr. med.
Organizational Affiliation
University Hospital Tübingen
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital Tübingen
City
Tübingen
ZIP/Postal Code
72076
Country
Germany

12. IPD Sharing Statement

Learn more about this trial

A Phase II Study to Evaluate Safety and Efficacy of Combined Treatment With Ipilimumab and Intratumoral Interleukin-2

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