Intratumoral Administration of L19IL2/L19TNF
Primary Purpose
Malignant Melanoma, Skin
Status
Completed
Phase
Phase 2
Locations
Italy
Study Type
Interventional
Intervention
L19IL2+L19TNF
Sponsored by
About this trial
This is an interventional treatment trial for Malignant Melanoma, Skin focused on measuring L19, monoclonal, antibody, IL-2, TNFα, Interleukin, Phase II, metastatic melanoma, clinical stage III, Clinical stage IV M1a
Eligibility Criteria
Inclusion Criteria:
- Histologically confirmed malignant melanoma of the skin in clinical stage III or stage IV M1a
- Presence of measurable and injectable cutaneous and/or subcutaneous lesions
- Males or females, age ≥ 18 years
- ECOG Performance Status/WHO Performance Status ≤ 2
- Life expectancy of at least 12 weeks
- Absolute neutrophil count > 1.5 x 10^9/L
- Hemoglobin > 9.0 g/dL
- Platelets > 100 x 10^9/L
- Total bilirubin ≤ 30 μmol/L (or ≤ 2.0 mg/dl)
- ALT and AST ≤ 2.5 x the upper limit of normal (ULN)
- Serum creatinine < 1.5 x ULN
- LDH serum level within normal range
- All acute toxic effects (excluding alopecia) of any prior therapy must have resolved to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) (v4.02) Grade ≤ 1 unless otherwise specified above
- Negative serum pregnancy test (for women of child-bearing potential only) at screening
- If of childbearing potential, agreement to use adequate contraceptive methods (e.g., oral contraceptives, condoms, or other adequate barrier controls, intrauterine contraceptive devices, or sterilization) beginning at the screening visit and continuing until 3 months following last treatment with study drug.
- Able to provide written Informed Consent
- Willingness and ability to comply with the scheduled visits, treatment plan, laboratory tests and other study procedures.
Exclusion Criteria:
- Uveal melanoma and mucosal melanoma
- Evidence of visceral metastases and/or active brain metastases at screening
- Previous or concurrent cancer that is distinct in primary site or histology from the cancer being evaluated in this study except cervical carcinoma in situ, treated basal cell carcinoma, superficial bladder tumors (TA, Tis & Ti) or any cancer curatively treated < 5 years prior to study entry
- History of HIV infection or infectious hepatitis B or C
- Presence of active infections (e.g. requiring antimicrobial therapy) or other severe concurrent disease, which, in the opinion of the investigator, would place the patient at undue risk or interfere with the study.
- History within the last year of acute or subacute coronary syndromes including myocardial infarction, unstable or severe autoimmune disease
- History of organ allograft or stem cell transplantation
- Recovery from major trauma including surgery within 4 weeks prior to administration of study treatment.
- Known history of allergy to IL2, TNF, or other human proteins/peptides/antibodies.
- Breast feeding female
- Anti-tumor therapy within 4 weeks of the administration of study treatment (except small surgery).
- Previous in vivo exposure to monoclonal antibodies for biological therapy in the 6 weeks before administration of study treatment.
- Planned administration of growth factors or immunomodulatory agents within 7 days before the administration of study treatment
- Patients in need of systemic treatment for rapidly progressive systemic disease.
- Patient requires or is taking corticosteroids or other immunosuppressant drugs on a long-term basis. Limited use of corticosteroids to treat or prevent acute hypersensitivity reactions is not considered an exclusion criterion.
- Any conditions that in the opinion of the investigator could hamper compliance with the study protocol.
Sites / Locations
- Fondazione IRCCS Istituto Nazionale dei Tumori
- Azienda Ospedaliera Universitaria Senese
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
L19IL2 + L19TNF
Arm Description
One arm, intratumoral injections of 10 Mio IU of L19IL2 and 312 μg L19TNF. Weekly administration for all combined leasions
Outcomes
Primary Outcome Measures
Rate of patients with complete response (CR) of L19IL2 treated Index/Non-Index lesions at week 12.
Secondary Outcome Measures
Efficacy of L19IL2/L19TNF treated Index/non treated lesions
Rate of patients with CR, PR and SD of all metastases at week 12, 24 and 36 (objective response rate according to RECIST v 1.1)
Duration of objective response and disease control of all metastases
Median overall survival (mOS)
Overall survival (OS)
Safety of the combination treatment with L19IL2 and L19TNF
Evaluation of the type and the number of adverse events eventually present
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02076633
Brief Title
Intratumoral Administration of L19IL2/L19TNF
Official Title
A Phase II Study of Intratumoral Application of L19IL2/L19TNF in Melanoma Patients in Clinical Stage III or Stage IV M1a With Presence of Injectable Cutaneous and/or Subcutaneous Lesions
Study Type
Interventional
2. Study Status
Record Verification Date
October 2014
Overall Recruitment Status
Completed
Study Start Date
December 2012 (undefined)
Primary Completion Date
May 2015 (Actual)
Study Completion Date
May 2015 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Philogen S.p.A.
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
This Phase II study is an uncontrolled, multicenter, prospective study for patients with malignant melanoma of the skin in clinical stage III or stage IV M1a.
Twenty Patients will be treated with a mixture of L19IL2 and L19TNF once weekly for up to 4 weeks.
The dose will be distributed among the lesions via multiple intralesional injections.
The proportion of patients with complete response at week 12 will be calculated.
Detailed Description
L19IL2 is a recombinant fusion protein composed of a fully human recombinant monoclonal antibody (L19) and the human recombinant interleukin-2 (IL-2).
IL2, is a potent stimulator of the immune response. It has a central role in the regulation of T cell responses and effects on other immune cells such as natural killer cells, B cells, monocyte/macrophages and neutrophils. IL2 can induce tumor regression through its ability to stimulate a potent cell-mediated immune response in vivo.
L19TNF is a recombinant fusion protein composed of a fully human recombinant monoclonal antibody (L19) and the human tumor necrosis factor-alpha, a primary mediator of immune regulation and inflammation.
As an anti-tumor agent, TNF exerts its major effects via a preferential toxicity for the endothelial cells of the tumor-associated vasculature and an increase of the antitumor immune response. Given at sufficient doses (e.g. intratumorally or in the ILP setting with melphalan), TNF causes significant tumor shrinkage in solid cancer subjects.
This phase II signal generating study is designed to test the efficacy and safety of an intratumorally administered mixture of L19IL2 + L19TNF in patients suffering from metastatic melanoma. It is well documented that the intratumoral administration of IL-2 leads to a high response rate and unexpectedly favorable longtime outcome and several tumor responses have been observed in clinical trials of Philogen, both using intratumorally administered L19IL2 and L19TNF in the ILP setting.
Preclinical data produced within the Philogen group now suggest that the intratumoral administration of a mixture of L19IL2 and L19TNF could be even more effective. After only one intratumoral administration of a mixture of L19IL2 and L19TNF tumors disappeared completely while neither L19IL2 nor L19TNF monotherapy was nearly as effective.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malignant Melanoma, Skin
Keywords
L19, monoclonal, antibody, IL-2, TNFα, Interleukin, Phase II, metastatic melanoma, clinical stage III, Clinical stage IV M1a
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
21 (Actual)
8. Arms, Groups, and Interventions
Arm Title
L19IL2 + L19TNF
Arm Type
Experimental
Arm Description
One arm, intratumoral injections of 10 Mio IU of L19IL2 and 312 μg L19TNF. Weekly administration for all combined leasions
Intervention Type
Drug
Intervention Name(s)
L19IL2+L19TNF
Intervention Description
Patients will be treated with intratumoral injections of 10 MioIU L19IL2 and 312μg L19TNF once weekly for up to 4 weeks.
Primary Outcome Measure Information:
Title
Rate of patients with complete response (CR) of L19IL2 treated Index/Non-Index lesions at week 12.
Time Frame
Week 12
Secondary Outcome Measure Information:
Title
Efficacy of L19IL2/L19TNF treated Index/non treated lesions
Description
Rate of patients with CR, PR and SD of all metastases at week 12, 24 and 36 (objective response rate according to RECIST v 1.1)
Duration of objective response and disease control of all metastases
Median overall survival (mOS)
Time Frame
week 12, 24 and 36
Title
Overall survival (OS)
Time Frame
1 year
Title
Safety of the combination treatment with L19IL2 and L19TNF
Description
Evaluation of the type and the number of adverse events eventually present
Time Frame
1 year
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Histologically confirmed malignant melanoma of the skin in clinical stage III or stage IV M1a
Presence of measurable and injectable cutaneous and/or subcutaneous lesions
Males or females, age ≥ 18 years
ECOG Performance Status/WHO Performance Status ≤ 2
Life expectancy of at least 12 weeks
Absolute neutrophil count > 1.5 x 10^9/L
Hemoglobin > 9.0 g/dL
Platelets > 100 x 10^9/L
Total bilirubin ≤ 30 μmol/L (or ≤ 2.0 mg/dl)
ALT and AST ≤ 2.5 x the upper limit of normal (ULN)
Serum creatinine < 1.5 x ULN
LDH serum level within normal range
All acute toxic effects (excluding alopecia) of any prior therapy must have resolved to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) (v4.02) Grade ≤ 1 unless otherwise specified above
Negative serum pregnancy test (for women of child-bearing potential only) at screening
If of childbearing potential, agreement to use adequate contraceptive methods (e.g., oral contraceptives, condoms, or other adequate barrier controls, intrauterine contraceptive devices, or sterilization) beginning at the screening visit and continuing until 3 months following last treatment with study drug.
Able to provide written Informed Consent
Willingness and ability to comply with the scheduled visits, treatment plan, laboratory tests and other study procedures.
Exclusion Criteria:
Uveal melanoma and mucosal melanoma
Evidence of visceral metastases and/or active brain metastases at screening
Previous or concurrent cancer that is distinct in primary site or histology from the cancer being evaluated in this study except cervical carcinoma in situ, treated basal cell carcinoma, superficial bladder tumors (TA, Tis & Ti) or any cancer curatively treated < 5 years prior to study entry
History of HIV infection or infectious hepatitis B or C
Presence of active infections (e.g. requiring antimicrobial therapy) or other severe concurrent disease, which, in the opinion of the investigator, would place the patient at undue risk or interfere with the study.
History within the last year of acute or subacute coronary syndromes including myocardial infarction, unstable or severe autoimmune disease
History of organ allograft or stem cell transplantation
Recovery from major trauma including surgery within 4 weeks prior to administration of study treatment.
Known history of allergy to IL2, TNF, or other human proteins/peptides/antibodies.
Breast feeding female
Anti-tumor therapy within 4 weeks of the administration of study treatment (except small surgery).
Previous in vivo exposure to monoclonal antibodies for biological therapy in the 6 weeks before administration of study treatment.
Planned administration of growth factors or immunomodulatory agents within 7 days before the administration of study treatment
Patients in need of systemic treatment for rapidly progressive systemic disease.
Patient requires or is taking corticosteroids or other immunosuppressant drugs on a long-term basis. Limited use of corticosteroids to treat or prevent acute hypersensitivity reactions is not considered an exclusion criterion.
Any conditions that in the opinion of the investigator could hamper compliance with the study protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mario Santinami, Dr
Organizational Affiliation
Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
Official's Role
Principal Investigator
Facility Information:
Facility Name
Fondazione IRCCS Istituto Nazionale dei Tumori
City
Milan
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria Senese
City
Siena
Country
Italy
12. IPD Sharing Statement
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Intratumoral Administration of L19IL2/L19TNF
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