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A Combination of Ipilimumab and Fotemustine for Treat Unresectable Locally Advanced or Metastatic Melanoma (NIBIT-M1)

Primary Purpose

Metastatic Malignant Melanoma

Status
Completed
Phase
Phase 2
Locations
Italy
Study Type
Interventional
Intervention
Ipilimumab and Fotemustine
Sponsored by
Italian Network for Tumor Biotherapy
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Malignant Melanoma focused on measuring metastatic melanoma, Ipilimumab

Eligibility Criteria

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

Inclusion Criteria:

  • Histologic diagnosis of malignant melanoma
  • Stage III (unresectable) or Stage IV melanoma
  • Maximum 1 line of chemotherapy for advanced disease allowed
  • No prior chemotherapy within 4 weeks from treatment start (6 weeks in case of nitrosourea)
  • No previous systemic corticosteroid therapy within 10 days
  • Prior adjuvant treatment with IFN or other immunotherapy allowed
  • Asymptomatic brain metastases allowed
  • Measurable disease
  • Prior treatment of brain metastases. In case stereotactic radiotherapy (or surgery) was not applicable, whole brain radiotherapy should have been performed
  • Life expectancy >= 16 weeks
  • ECOG performance status of 0 or 1
  • Normal laboratory tests were required
  • Negative screening tests for HIV, Hepatitis B, and Hepatitis C.
  • Men and women, of and over 18 years old. Women of childbearing potential (WOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 8 weeks after the study in such a manner that the risk of pregnancy is minimized.

Exclusion Criteria:

  • Any 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, carcinoma in situ of the cervix;
  • Primary ocular or mucosal melanoma. Medical History and Concurrent Diseases
  • Symptomatic brain metastases requiring immediate local intervention (radiotherapy (RT) and/or surgery)
  • Autoimmune disease
  • Any underlying medical condition, which in the opinion of the investigator, will make the administration of study drug hazardous or obscure the interpretation of adverse events, such as a condition associated with frequent diarrhea.

Prohibited Treatments and/or Therapies

  • Concomitant therapy with any anti-cancer agent
  • Immunosuppressive agents
  • Any non-oncology vaccine therapy used for prevention of infectious diseases (for up to 1 month prior to or after any dose of study drug); surgery or radiotherapy ; other investigational anti-cancer therapies; or chronic use of systemic corticosteroids ;
  • Previous treatment with other investigational products, including cancer immunotherapy, within 30 days;
  • Previous enrollment in another clinical trial or prior treatment with a CD137 agonist or anti-CTLA-4 and/or fotemustine.

Sex and Reproductive Status

  • WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for up to 8 weeks after the study;
  • Women who are pregnant or breastfeeding;
  • Women with a positive pregnancy test on enrollment or prior to investigational product administration;
  • Sexually active fertile men not using effective birth control if their partners are WOCBP.

Other Exclusion Criteria

  • Prisoners or subjects who are involuntarily incarcerated;
  • Subjects who are compulsorily detained for treatment of either a psychiatric or physical illness.

Sites / Locations

  • National Institute for Cancer Research
  • Immunotherapy and Somatic Cell Therapy Unit, Scientific Institute of Romagna
  • European Institute of Oncology
  • Melanoma Unit, San Raffaele Hospital
  • Surgical Oncology, National Cancer Institute
  • Medical Oncology and Innovative Therapy, National Cancer Institute
  • Medical Oncology and Immunotherapy-University Hospital of Siena

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Single arm of ipilimumab and fotemustine

Arm Description

Ipilimumab in combination with Fotemustine

Outcomes

Primary Outcome Measures

The immune response disease control rate (irDCR) using the immune-related (ir) tumor response criteria of the combination of ipilimumab and fotemustine in patients with unresectable locally advanced or metastatic melanoma.
Immune-related Disease Control Rate (irDCR) is the proportion of treated subjects with a BOR of confirmed irCR, confirmed irPR or irSD. Tumor assessment (including determination of overall response at each tumor assessment and best overall response (BOR) taken over all tumor assessments prior to subsequent therapy is performed using the immune-related (ir) tumor response criteria.

Secondary Outcome Measures

safety and feasibility of the combination of ipilimumab and fotemustine
A first clinical safety assessment will be performed to identify any early safety signals from ipilimumab given in combination with fotemustine at the first 18 treated patients. All subjects who receive at least 1 dose of study drug will be evaluable for safety parameters. Additionally, any occurrence of a SAE from time of consent forward will be reported.
Immune-related Major Durable Disease Control Rate (irMDDCR)
Immune-related Major Durable Disease Control Rate (irMDDCR) is the proportion of treated subjects with a duration of disease control of >= 24 weeks measured from Week 12, or (for those subjects with a confirmed irCR or confirmed irPR prior to Week 12) from the date of first overall response of irCR or irPR, until the date of irPD or death (whichever occurs first).
Immune-related Objective Response Rate (irORR)
Immune-related Objective Response Rate (irORR) is the proportion of treated subjects with a BOR of confirmed irCR or confirmed irPR.
Immune-related Time to Response (irTTR)
irTTR is defined as the time from first dosing date until the measurement criteria (using irRC) are first met for overall response of irPR or irCR (whichever status comes first, and provided it is subsequently confirmed).
Immune-related Progression-Free Survival (irPFS)
Immune-related Progression-Free Survival (irPFS) is defined as the time between the first dosing date and the date of irPD, or date of death, whichever occurs first. (ie, subjects who die without reported irPD will be considered to have progressed on the date of death).
Brain Progression-free Survival (Brain-PFS)
Brain Progression-free Survival (Brain-PFS) is defined as the time from first dosing date to the date of progression as per MRI of existing brain lesions, or of occurrence as per MRI of a new lesion located in the brain, or of death.
Overall Survival (OS)
Overall Survival (OS) is defined as the time from first dosing date until the date of death. For those subjects who have not died, OS will be censored at the recorded last date of subject contact, and for subjects with a missing recorded last date of contact, OS will be censored at the last date the subject was known to be alive. OS will be further described using the survival rate at one year, defined as the probability that a subject is alive at 1 and 2 years following first dose of study therapy and estimated via the Kaplan-Meier method.

Full Information

First Posted
July 18, 2012
Last Updated
May 12, 2015
Sponsor
Italian Network for Tumor Biotherapy
Collaborators
Bristol-Myers Squibb
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1. Study Identification

Unique Protocol Identification Number
NCT01654692
Brief Title
A Combination of Ipilimumab and Fotemustine for Treat Unresectable Locally Advanced or Metastatic Melanoma
Acronym
NIBIT-M1
Official Title
A Phase II Study of the Combination of Ipilimumab and Fotemustine in Patients With Unresectable Locally Advanced or Metastatic Malignant Melanoma
Study Type
Interventional

2. Study Status

Record Verification Date
May 2015
Overall Recruitment Status
Completed
Study Start Date
June 2010 (undefined)
Primary Completion Date
May 2012 (Actual)
Study Completion Date
September 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Italian Network for Tumor Biotherapy
Collaborators
Bristol-Myers Squibb

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is designed to assess the safety and efficacy of a combination of ipilimumab and fotemustine in Patients with Unresectable Locally Advanced or Metastatic Malignant Melanoma.
Detailed Description
Immunotherapy, chemotherapy and chemotherapy combinations are currently the most effective accepted systemic treatments for metastatic melanoma. However, significant and prolonged responses are rare. The trial will determine the additional benefit achieved from adding fotemustine to the anti-CTLA-4 monoclonal antibody,ipilimumab . It is assumed that the mechanism by which ipilimumab augments the effects of chemotherapy in animal models relies on the ability of the cytotoxic agent to induce apoptosis of tumor cells. These apoptotic cells then can function as potent inducers of an immune response against any non-tolerized antigen that they contain. Thus, the chemotherapy may be creating an in vivo autologous tumor vaccine. Ipilimumab prevents the down regulation of this immune response, allowing for tumor rejection. Animal models evaluating the combination of anti-CTLA4 antibody and chemotherapy have given only a brief acute treatment with chemotherapy - presumably adequate to induce some tumor apoptosis, but inadequate to induce significant prolonged tumor rejection. Since patients with metastatic melanoma generally require therapy within a relatively short period of time, this protocol will allow for the use of fotemustine. Standard dosing of fotemustine will be used to optimize the chance for tumor control.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Malignant Melanoma
Keywords
metastatic melanoma, Ipilimumab

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Single arm of ipilimumab and fotemustine
Arm Type
Experimental
Arm Description
Ipilimumab in combination with Fotemustine
Intervention Type
Drug
Intervention Name(s)
Ipilimumab and Fotemustine
Other Intervention Name(s)
Ipilimumab (Yervoy), Fotemustine (Muphoran)
Intervention Description
Ipilimumab: 10 mg/kg q3 weeks for 4 doses, q12 weeks starting at Week 24 Fotemustine: 100 mg/m2 q1 week for 3 doses, q3 weeks starting at Week 9
Primary Outcome Measure Information:
Title
The immune response disease control rate (irDCR) using the immune-related (ir) tumor response criteria of the combination of ipilimumab and fotemustine in patients with unresectable locally advanced or metastatic melanoma.
Description
Immune-related Disease Control Rate (irDCR) is the proportion of treated subjects with a BOR of confirmed irCR, confirmed irPR or irSD. Tumor assessment (including determination of overall response at each tumor assessment and best overall response (BOR) taken over all tumor assessments prior to subsequent therapy is performed using the immune-related (ir) tumor response criteria.
Time Frame
Weeks 24
Secondary Outcome Measure Information:
Title
safety and feasibility of the combination of ipilimumab and fotemustine
Description
A first clinical safety assessment will be performed to identify any early safety signals from ipilimumab given in combination with fotemustine at the first 18 treated patients. All subjects who receive at least 1 dose of study drug will be evaluable for safety parameters. Additionally, any occurrence of a SAE from time of consent forward will be reported.
Time Frame
2 years
Title
Immune-related Major Durable Disease Control Rate (irMDDCR)
Description
Immune-related Major Durable Disease Control Rate (irMDDCR) is the proportion of treated subjects with a duration of disease control of >= 24 weeks measured from Week 12, or (for those subjects with a confirmed irCR or confirmed irPR prior to Week 12) from the date of first overall response of irCR or irPR, until the date of irPD or death (whichever occurs first).
Time Frame
up to 24 weeks
Title
Immune-related Objective Response Rate (irORR)
Description
Immune-related Objective Response Rate (irORR) is the proportion of treated subjects with a BOR of confirmed irCR or confirmed irPR.
Time Frame
Weeks 24
Title
Immune-related Time to Response (irTTR)
Description
irTTR is defined as the time from first dosing date until the measurement criteria (using irRC) are first met for overall response of irPR or irCR (whichever status comes first, and provided it is subsequently confirmed).
Time Frame
Weeks 24
Title
Immune-related Progression-Free Survival (irPFS)
Description
Immune-related Progression-Free Survival (irPFS) is defined as the time between the first dosing date and the date of irPD, or date of death, whichever occurs first. (ie, subjects who die without reported irPD will be considered to have progressed on the date of death).
Time Frame
2 years
Title
Brain Progression-free Survival (Brain-PFS)
Description
Brain Progression-free Survival (Brain-PFS) is defined as the time from first dosing date to the date of progression as per MRI of existing brain lesions, or of occurrence as per MRI of a new lesion located in the brain, or of death.
Time Frame
2 years
Title
Overall Survival (OS)
Description
Overall Survival (OS) is defined as the time from first dosing date until the date of death. For those subjects who have not died, OS will be censored at the recorded last date of subject contact, and for subjects with a missing recorded last date of contact, OS will be censored at the last date the subject was known to be alive. OS will be further described using the survival rate at one year, defined as the probability that a subject is alive at 1 and 2 years following first dose of study therapy and estimated via the Kaplan-Meier method.
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologic diagnosis of malignant melanoma Stage III (unresectable) or Stage IV melanoma Maximum 1 line of chemotherapy for advanced disease allowed No prior chemotherapy within 4 weeks from treatment start (6 weeks in case of nitrosourea) No previous systemic corticosteroid therapy within 10 days Prior adjuvant treatment with IFN or other immunotherapy allowed Asymptomatic brain metastases allowed Measurable disease Prior treatment of brain metastases. In case stereotactic radiotherapy (or surgery) was not applicable, whole brain radiotherapy should have been performed Life expectancy >= 16 weeks ECOG performance status of 0 or 1 Normal laboratory tests were required Negative screening tests for HIV, Hepatitis B, and Hepatitis C. Men and women, of and over 18 years old. Women of childbearing potential (WOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 8 weeks after the study in such a manner that the risk of pregnancy is minimized. Exclusion Criteria: Any 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, carcinoma in situ of the cervix; Primary ocular or mucosal melanoma. Medical History and Concurrent Diseases Symptomatic brain metastases requiring immediate local intervention (radiotherapy (RT) and/or surgery) Autoimmune disease Any underlying medical condition, which in the opinion of the investigator, will make the administration of study drug hazardous or obscure the interpretation of adverse events, such as a condition associated with frequent diarrhea. Prohibited Treatments and/or Therapies Concomitant therapy with any anti-cancer agent Immunosuppressive agents Any non-oncology vaccine therapy used for prevention of infectious diseases (for up to 1 month prior to or after any dose of study drug); surgery or radiotherapy ; other investigational anti-cancer therapies; or chronic use of systemic corticosteroids ; Previous treatment with other investigational products, including cancer immunotherapy, within 30 days; Previous enrollment in another clinical trial or prior treatment with a CD137 agonist or anti-CTLA-4 and/or fotemustine. Sex and Reproductive Status WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for up to 8 weeks after the study; Women who are pregnant or breastfeeding; Women with a positive pregnancy test on enrollment or prior to investigational product administration; Sexually active fertile men not using effective birth control if their partners are WOCBP. Other Exclusion Criteria Prisoners or subjects who are involuntarily incarcerated; Subjects who are compulsorily detained for treatment of either a psychiatric or physical illness.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michele Maio, MD, PhD
Organizational Affiliation
Medical Oncology and Immunotherapy Unit, University Hospital of Siena
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institute for Cancer Research
City
Genoa
Country
Italy
Facility Name
Immunotherapy and Somatic Cell Therapy Unit, Scientific Institute of Romagna
City
Meldola
Country
Italy
Facility Name
European Institute of Oncology
City
Milan
Country
Italy
Facility Name
Melanoma Unit, San Raffaele Hospital
City
Milan
Country
Italy
Facility Name
Surgical Oncology, National Cancer Institute
City
Milan
Country
Italy
Facility Name
Medical Oncology and Innovative Therapy, National Cancer Institute
City
Naples
Country
Italy
Facility Name
Medical Oncology and Immunotherapy-University Hospital of Siena
City
Siena
ZIP/Postal Code
53100
Country
Italy

12. IPD Sharing Statement

Citations:
PubMed Identifier
21639810
Citation
Robert C, Thomas L, Bondarenko I, O'Day S, Weber J, Garbe C, Lebbe C, Baurain JF, Testori A, Grob JJ, Davidson N, Richards J, Maio M, Hauschild A, Miller WH Jr, Gascon P, Lotem M, Harmankaya K, Ibrahim R, Francis S, Chen TT, Humphrey R, Hoos A, Wolchok JD. Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med. 2011 Jun 30;364(26):2517-26. doi: 10.1056/NEJMoa1104621. Epub 2011 Jun 5.
Results Reference
background
PubMed Identifier
20525992
Citation
Hodi FS, O'Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, Gonzalez R, Robert C, Schadendorf D, Hassel JC, Akerley W, van den Eertwegh AJ, Lutzky J, Lorigan P, Vaubel JM, Linette GP, Hogg D, Ottensmeier CH, Lebbe C, Peschel C, Quirt I, Clark JI, Wolchok JD, Weber JS, Tian J, Yellin MJ, Nichol GM, Hoos A, Urba WJ. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010 Aug 19;363(8):711-23. doi: 10.1056/NEJMoa1003466. Epub 2010 Jun 5. Erratum In: N Engl J Med. 2010 Sep 23;363(13):1290.
Results Reference
background
PubMed Identifier
15020614
Citation
Avril MF, Aamdal S, Grob JJ, Hauschild A, Mohr P, Bonerandi JJ, Weichenthal M, Neuber K, Bieber T, Gilde K, Guillem Porta V, Fra J, Bonneterre J, Saiag P, Kamanabrou D, Pehamberger H, Sufliarsky J, Gonzalez Larriba JL, Scherrer A, Menu Y. Fotemustine compared with dacarbazine in patients with disseminated malignant melanoma: a phase III study. J Clin Oncol. 2004 Mar 15;22(6):1118-25. doi: 10.1200/JCO.2004.04.165.
Results Reference
background
PubMed Identifier
22456429
Citation
Margolin K, Ernstoff MS, Hamid O, Lawrence D, McDermott D, Puzanov I, Wolchok JD, Clark JI, Sznol M, Logan TF, Richards J, Michener T, Balogh A, Heller KN, Hodi FS. Ipilimumab in patients with melanoma and brain metastases: an open-label, phase 2 trial. Lancet Oncol. 2012 May;13(5):459-65. doi: 10.1016/S1470-2045(12)70090-6. Epub 2012 Mar 27.
Results Reference
background
PubMed Identifier
25538176
Citation
Di Giacomo AM, Ascierto PA, Queirolo P, Pilla L, Ridolfi R, Santinami M, Testori A, Simeone E, Guidoboni M, Maurichi A, Orgiano L, Spadola G, Del Vecchio M, Danielli R, Calabro L, Annesi D, Giannarelli D, Maccalli C, Fonsatti E, Parmiani G, Maio M. Three-year follow-up of advanced melanoma patients who received ipilimumab plus fotemustine in the Italian Network for Tumor Biotherapy (NIBIT)-M1 phase II study. Ann Oncol. 2015 Apr;26(4):798-803. doi: 10.1093/annonc/mdu577. Epub 2014 Dec 23.
Results Reference
derived
PubMed Identifier
22894884
Citation
Di Giacomo AM, Ascierto PA, Pilla L, Santinami M, Ferrucci PF, Giannarelli D, Marasco A, Rivoltini L, Simeone E, Nicoletti SV, Fonsatti E, Annesi D, Queirolo P, Testori A, Ridolfi R, Parmiani G, Maio M. Ipilimumab and fotemustine in patients with advanced melanoma (NIBIT-M1): an open-label, single-arm phase 2 trial. Lancet Oncol. 2012 Sep;13(9):879-86. doi: 10.1016/S1470-2045(12)70324-8. Epub 2012 Aug 13.
Results Reference
derived
Links:
URL
http://www.nibit.org
Description
Italian Network for Tumor Biotherapy (NIBIT) web-site, which will allow access to the diverse activities of the Network

Learn more about this trial

A Combination of Ipilimumab and Fotemustine for Treat Unresectable Locally Advanced or Metastatic Melanoma

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