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Evaluating the Effect of Nivolumab for Patients With In-transit Metastases Treated With Isolated Limb Perfusion (NivoILP)

Primary Purpose

Melanoma, In-Transit Metastasis

Status
Recruiting
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Nivolumab
Isolated limb perfusion (ILP)
Sponsored by
Sahlgrenska University Hospital, Sweden
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Melanoma

Eligibility Criteria

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

Inclusion Criteria

  1. Male or female aged above 18 years.
  2. Signed and dated written informed consent before the start of specific protocol procedures.
  3. Histologically or cytologically proven in-transit metastases of malignant melanoma with or without regional lymph node metastases (AJCC v8 stage N1c, N2c and N3c).
  4. Measurable disease with at least 1 metastases measuring at least 5mm
  5. ECOG performance status of 0-2

Exclusion Criteria

  1. Life expectancy of less than 6 months
  2. Inability to understand given information or undergo study procedures according to protocol
  3. Pregnant or breast-feeding. Women of childbearing potential must have a negative pregnancy test performed within 24 hours before the administration of study drug.
  4. Patients must agree to follow instructions for method of contraception for 5 months (women) and 7 months (males) after treatment described in section 8.4
  5. History of ischemic cardiac disease or history of congestive heart failure with an LVEF < 40%.
  6. History of COPD or other chronic pulmonary disease with PFT's indicating an FEV< 50% predicted for age.
  7. Reduced renal function defined as S-Creatinine >=1.5xULN or Creatinine Clearance < 40 mL/min, calculated using the Cockroft and Gault formula.
  8. Reduced hepatic function (defined as ASAT, ALAT, bilirubin >1.5 ULN and PK-INR >1.5) or a medical history of liver cirrhosis or portal hypertension
  9. Reduced blood leukocytes or platelets defined as a leucocyte count < 2.0x109/L and thrombocyte count <100x109/L
  10. Active, known or suspected autoimmune disease. Subjects are permitted to enrolment if they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger.
  11. Has evidence of interstitial lung disease or active, non-infectious pneumonitis.
  12. A condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 30 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses >10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
  13. Has an active infection requiring systemic therapy.
  14. Has received a live vaccine within 30 days prior to the first dose of trial treatment and 3 months after treatment.
  15. Concomitant therapy with any of the following: IL 2 or other non-study immunotherapy regimens; cytotoxic chemotherapy except melphalan (ILP); other investigational therapies 30 days before and after treatment in this trial.

Sites / Locations

  • Netherlands Cancer InstituteRecruiting
  • Erasmus MC Cancer Institute
  • Erasmus MC Cancer Institute
  • Sahlgrenska University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

ILP + Nivolumab

ILP + Placebo

Arm Description

The day before planned ILP, the patient will receive one infusion of nivolumab 480mg

The day before planned ILP, the patient will receive one infusion of placebo

Outcomes

Primary Outcome Measures

Complete response rate (CR)
To evaluate if melphalan based isolated limb perfusion (ILP) synergizes with nivolumab in inducing complete responses (CR) at 6 months after treatment in melanoma patients with in-transit metastasis.

Secondary Outcome Measures

Local progression-free survival (LPFS)
Evaluation of local progression-free survival (LPFS). LPFS is defined as the number of months from the date of ILP to the date of the first documented disease recurrence or progression in the treated area (defined as the area below the tourniquet used for ILP). LPFS will be determined based on clinical assessments according to RECIST version 1.1 criteria.
Overall survival (OS)
Evaluation of overall survival (OS), OS is calculated as the time from date of treatment to date of death due to any cause. Both median OS and the per cent of patients alive at 36 months will be evaluated.
Melanoma specific survival (MSS)
Evaluation of melanoma specific survival (MSS), MSS is calculated as the time from date of treatment to date of death due to any cause. Both median MSS and the per cent of patients alive at 36 months will be evaluated.
Quality of life measured by FACT-M
Quality of life (QoL) by FACT-M. Change from baseline for all subscales as well as for the total scores.
Quality of life measured by EQ-5D
Quality of life (QoL) by EQ-5D measured as the change from baseline

Full Information

First Posted
September 23, 2018
Last Updated
May 3, 2022
Sponsor
Sahlgrenska University Hospital, Sweden
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1. Study Identification

Unique Protocol Identification Number
NCT03685890
Brief Title
Evaluating the Effect of Nivolumab for Patients With In-transit Metastases Treated With Isolated Limb Perfusion
Acronym
NivoILP
Official Title
A Phase Ib/II Randomized Double-blind Placebo Controlled Trial Evaluating the Effect of Nivolumab for Patients With In-transit Melanoma Metastases Treated With Isolated Limb Perfusion - the NivoILP Trial
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Recruiting
Study Start Date
April 1, 2019 (Actual)
Primary Completion Date
December 1, 2023 (Anticipated)
Study Completion Date
December 1, 2025 (Anticipated)

3. Sponsor/Collaborators

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

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To evaluate safety and the effect of isolated limb perfusion together with nivolumab as a way to increase efficacy and give further insights in early immunological mechanisms. In the first phase Ib part, 20 patients will be enrolled and followed for a minimum of 3 months. An independent data safety monitoring board (DSMB) will continuously review safety and judge the seriousness of the events and also recommend the study to stop if necessary. If the DSMB do not find safety issues, the trial will continue as a phase II trial.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Melanoma, In-Transit Metastasis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Model Description
The study is a randomized placebo controlled double blind trial. Patients will be randomized to ILP with nivolumab or ILP with placebo. Active follow-up for 3 years.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
74 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
ILP + Nivolumab
Arm Type
Experimental
Arm Description
The day before planned ILP, the patient will receive one infusion of nivolumab 480mg
Arm Title
ILP + Placebo
Arm Type
Placebo Comparator
Arm Description
The day before planned ILP, the patient will receive one infusion of placebo
Intervention Type
Drug
Intervention Name(s)
Nivolumab
Intervention Description
One infusion of nivolumab (Opdivo®) 480mg (flat dose) in NaCl (Natriumklorid Baxter Viaflo, 9 mg/ml) during 60 minutes
Intervention Type
Procedure
Intervention Name(s)
Isolated limb perfusion (ILP)
Intervention Description
Patients will be treated with ILP according to clinical routine at each separate site. The procedure is performed under general anaesthesia. The major artery and vein of the limb is catheterized, and a tourniquet is placed proximally on the limb. Continuous leakage monitoring is performed. The perfusate is heated to 40C and after ensuring steady state, melphalan (Alkeran®) at a dose of 13 mg/L (upper limb) or 10 mg/L (lower limb) is infused into the circulation during 20 minutes for a total perfusion time of 60 minutes. According to local routine tasonermin (Beromun®) will be added to the perfusate 30 minutes before the melphalan as a bolus dose of 1-4 mg.
Primary Outcome Measure Information:
Title
Complete response rate (CR)
Description
To evaluate if melphalan based isolated limb perfusion (ILP) synergizes with nivolumab in inducing complete responses (CR) at 6 months after treatment in melanoma patients with in-transit metastasis.
Time Frame
3 months
Secondary Outcome Measure Information:
Title
Local progression-free survival (LPFS)
Description
Evaluation of local progression-free survival (LPFS). LPFS is defined as the number of months from the date of ILP to the date of the first documented disease recurrence or progression in the treated area (defined as the area below the tourniquet used for ILP). LPFS will be determined based on clinical assessments according to RECIST version 1.1 criteria.
Time Frame
36 months
Title
Overall survival (OS)
Description
Evaluation of overall survival (OS), OS is calculated as the time from date of treatment to date of death due to any cause. Both median OS and the per cent of patients alive at 36 months will be evaluated.
Time Frame
36 months
Title
Melanoma specific survival (MSS)
Description
Evaluation of melanoma specific survival (MSS), MSS is calculated as the time from date of treatment to date of death due to any cause. Both median MSS and the per cent of patients alive at 36 months will be evaluated.
Time Frame
36 months
Title
Quality of life measured by FACT-M
Description
Quality of life (QoL) by FACT-M. Change from baseline for all subscales as well as for the total scores.
Time Frame
36 months
Title
Quality of life measured by EQ-5D
Description
Quality of life (QoL) by EQ-5D measured as the change from baseline
Time Frame
36 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Male or female aged above 18 years. Signed and dated written informed consent before the start of specific protocol procedures. Histologically or cytologically proven in-transit metastases of malignant melanoma with or without regional lymph node metastases (AJCC v8 stage N1c, N2c and N3c). Measurable disease with at least 1 metastases measuring at least 5mm ECOG performance status of 0-2 Exclusion Criteria Life expectancy of less than 6 months Inability to understand given information or undergo study procedures according to protocol Pregnant or breast-feeding. Women of childbearing potential must have a negative pregnancy test performed within 24 hours before the administration of study drug. Patients must agree to follow instructions for method of contraception for 5 months (women) and 7 months (males) after treatment described in section 8.4 History of ischemic cardiac disease or history of congestive heart failure with an LVEF < 40%. History of COPD or other chronic pulmonary disease with PFT's indicating an FEV< 50% predicted for age. Reduced renal function defined as S-Creatinine >=1.5xULN or Creatinine Clearance < 40 mL/min, calculated using the Cockroft and Gault formula. Reduced hepatic function (defined as ASAT, ALAT, bilirubin >1.5 ULN and PK-INR >1.5) or a medical history of liver cirrhosis or portal hypertension Reduced blood leukocytes or platelets defined as a leucocyte count < 2.0x109/L and thrombocyte count <100x109/L Active, known or suspected autoimmune disease. Subjects are permitted to enrolment if they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger. Has evidence of interstitial lung disease or active, non-infectious pneumonitis. A condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 30 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses >10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease. Has an active infection requiring systemic therapy. Has received a live vaccine within 30 days prior to the first dose of trial treatment and 3 months after treatment. Concomitant therapy with any of the following: IL 2 or other non-study immunotherapy regimens; cytotoxic chemotherapy except melphalan (ILP); other investigational therapies 30 days before and after treatment in this trial.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Roger Olofsson Bagge, MD, PhD
Phone
+46 31 3428207
Email
roger.olofsson.bagge@gu.se
First Name & Middle Initial & Last Name or Official Title & Degree
Therese Bengtsson
Phone
+46 31 3420000
Email
therese.bengtsson@vgregion.se
Facility Information:
Facility Name
Netherlands Cancer Institute
City
Amsterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Winan van Houdt, MD, PhD
First Name & Middle Initial & Last Name & Degree
Winan van Houdt, MD, PhD
Facility Name
Erasmus MC Cancer Institute
City
Groningen
Country
Netherlands
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lukas Been
First Name & Middle Initial & Last Name & Degree
Lukas Been, Md, PhD
Facility Name
Erasmus MC Cancer Institute
City
Rotterdam
Country
Netherlands
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dirk Grünhagen
First Name & Middle Initial & Last Name & Degree
Dirk Grünhagen, MD, PhD
Facility Name
Sahlgrenska University Hospital
City
Gothenburg
ZIP/Postal Code
413 45
Country
Sweden
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Roger Olofsson Bagge, Dr
Phone
+46 31 3428207
Email
roger.olofsson.bagge@gu.se
First Name & Middle Initial & Last Name & Degree
Roger Olofsson Bagge, Dr

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
34132224
Citation
Tulokas SKA, Kohtamaki LM, Makela SP, Juteau S, Alback A, Vikatmaa PJ, Mattila KE, Skytta TK, Koivunen JP, Tyynela-Korhonen K, Hernberg MM. Isolated limb perfusion with melphalan as treatment for regionally advanced melanoma of the limbs: results of 60 patients treated in Finland during 2007-2018. Melanoma Res. 2021 Oct 1;31(5):456-463. doi: 10.1097/CMR.0000000000000755.
Results Reference
derived

Learn more about this trial

Evaluating the Effect of Nivolumab for Patients With In-transit Metastases Treated With Isolated Limb Perfusion

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