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Isolated Hepatic Perfusion in Combination With Ipilimumab and Nivolumab in Patients With Uveal Melanoma Metastases (SCANDIUM II)

Primary Purpose

Uveal Melanoma, Liver Metastases

Status
Active
Phase
Phase 1
Locations
Sweden
Study Type
Interventional
Intervention
Isolated hepatic perfusion
Ipilimumab
Nivolumab
Sponsored by
Sahlgrenska University Hospital, Sweden
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Uveal Melanoma

Eligibility Criteria

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

Inclusion Criteria

  1. Patient is ≥18 years of age on the day of signing informed consent
  2. Patient is willing and able to provide written informed consent and comply with study procedures. Written informed consent must be signed and dated before the start of specific protocol procedures
  3. Patient must have a histologically confirmed diagnosis of stage IV uveal melanoma. If tissue biopsy is judged not feasible by the investigator, cytological diagnosis from fine needle aspiration (FNA) will be accepted
  4. Measurable disease by computed tomography (CT) or Magnetic Resonance Imaging (MRI) per RECIST 1.1 criteria with at least one target lesion identified in the liver.
  5. ECOG performance status of 0 or 1
  6. No previous immunotherapy for uveal melanoma metastases.
  7. Female patient of childbearing potential should have a negative urine or serum pregnancy test within 72 hours prior to receiving the first treatment. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
  8. Female patients of childbearing potential must be willing to use an adequate method of contraception, for the course of the study through 120 days after the last dose of study medication. Note: Abstinence is acceptable if this is the usual lifestyle and preferred contraception for the subject
  9. Male patients of childbearing potential must agree to use an adequate method of contraception, starting with the first dose of study therapy through 120 days after the last dose of study therapy. Abstinence is acceptable if this is the usual lifestyle and preferred contraception for the subject

Exclusion Criteria

  1. Life expectancy of less than 3 months
  2. Body mass index above 35
  3. More than 50% of the liver volume replaced by tumor as measured by CT or MRI
  4. Known congestive heart failure with an LVEF <40%
  5. COPD or other chronic pulmonary disease with PFT's indicating an FEV< 50% predicted for age
  6. Interstitial lung disease (ILD) or (non-infectious) pneumonitis
  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 AST, ALT, bilirubin>3*ULN and PK-INR>1.5) or medical history of liver cirrhosis or portal hypertension
  9. Hemoglobin <90 g/L or platelets <100x109/L or neutrophils <1.5x109/L
  10. Use of live vaccines four weeks before or after the last study treatment
  11. History of severe hypersensitivity reactions to mAbs
  12. Known human immunodeficiency virus (HIV) infection, acquired immunodeficiency syndrome (AIDS), hepatitis B or hepatitis C
  13. Active autoimmune disease or a history of known or suspected autoimmune disease
  14. A condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 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.
  15. Concomitant therapy with any other anti-cancer therapy, concurrent medical conditions requiring use of immunosuppressive medications or use of other investigational drugs
  16. Has a known additional malignancy that is progressing or requires active treatment.
  17. Pregnant or breastfeeding or expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 120 days after the last dose of study drug.
  18. A history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the patient's participation for the full duration of the study, or is not in the best interest of the patient to participate, in the opinion of the treating investigator

Sites / Locations

  • Sahlgrenska University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm A

Arm B

Arm Description

Patients will be treated with IHP followed by 4 courses of ipilimumab 3mg/kg and nivolumab 1mg/kg every third week followed by continued nivolumab 480mg q4w up to 1 year.

Patients will be treated with 1 course of ipilimumab 3mg/kg and nivolumab 1mg/kg followed by IHP after 3 weeks and then another 3 courses of ipilimumab 3mg/kg and nivolumab 1mg/kg every third week followed by continued nivolumab 480mg q4w up to 1 year.

Outcomes

Primary Outcome Measures

Incidence and severity of adverse events (AEs) and serious adverse events (SAEs)
Incidence and severity of adverse events (AEs) and serious adverse events (SAEs)

Secondary Outcome Measures

Objective response rate (ORR)
Evaluation of objective response rate (ORR)
Clinical benefit rate (CBR)
Evaluation of clinical benefit rate (CBR)
Progression-free survival (PFS)
Evaluation of progression-free survival (PFS)
Hepatic progression-free survival (hPFS)
Evaluation of hepatic progression-free survival (hPFS)
Overall survival (OS)
Evaluation of overall survival (OS)
Time to response (TTR)
Evaluation of time to response (TTR)
Duration of response (DOR)
Evaluation of duration of response (DOR)

Full Information

First Posted
July 5, 2020
Last Updated
October 26, 2022
Sponsor
Sahlgrenska University Hospital, Sweden
Collaborators
Bristol-Myers Squibb
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1. Study Identification

Unique Protocol Identification Number
NCT04463368
Brief Title
Isolated Hepatic Perfusion in Combination With Ipilimumab and Nivolumab in Patients With Uveal Melanoma Metastases
Acronym
SCANDIUM II
Official Title
SCANDIUM II Trial - A Phase I Randomized Controlled Multicentre Trial of Isolated Hepatic Perfusion in Combination With Ipilimumab and Nivolumab in Patients With Uveal Melanoma Metastases
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 8, 2021 (Actual)
Primary Completion Date
August 10, 2023 (Anticipated)
Study Completion Date
September 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Sahlgrenska University Hospital, Sweden
Collaborators
Bristol-Myers Squibb

4. Oversight

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

5. Study Description

Brief Summary
Uveal melanoma is the most common primary intraocular malignancy in adults. Despite successful control of the primary tumour, metastatic disease will develop in approximately 35%-50% of the patients within 10 years. The liver is the most common site for metastases, and about 50% of the patients will have isolated liver metastases. Isolated hepatic perfusion is a regional treatment where the liver is completely isolated from the systemic circulation, allowing a high concentration of chemotherapy to be perfused through the liver with minimal systemic exposure. The introduction of modern immunotherapy in the treatment arsenal for cutaneous melanoma also creates hope for patients with uveal melanoma metastases. However, the results of immunotherapy have so far been disappointing. The reason for the low efficacy could be that uveal melanoma develops in the immune privileged eye. The hypothesis in this trial is that isolated hepatic perfusion with melphalan causes an immunogenic type of cell death by local tumour destruction while leaving the immune-system intact. This will cause an activation of the immune-system and the addition of ipilimumab and nivolumab will enhance this effect, ultimately increasing the treatment efficacy. The primary objective of this trial is to evaluate the safety and tolerability of isolated hepatic perfusion together with ipilimumab and nivolumab when given at the same time or as a sequenced regimen. The study design is a phase I randomized controlled, multicentre, open-label trial. Active follow-up will be performed for 2 years. Patients will be randomized after diagnoses of metastatic disease to one of the following treatment arms: Arm A. Patients will be treated with IHP followed by 4 courses of ipilimumab 3mg/kg and nivolumab 1mg/kg every third week followed by continued nivolumab 480mg q4w up to 1 year. Arm B. Patients will be treated with 1 course of ipilimumab 3mg/kg and nivolumab 1mg/kg followed by IHP after 3 weeks and then another 3 courses of ipilimumab 3mg/kg and nivolumab 1mg/kg every third week followed by continued nivolumab 480mg q4w up to 1 year.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Uveal Melanoma, Liver Metastases

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
18 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A
Arm Type
Experimental
Arm Description
Patients will be treated with IHP followed by 4 courses of ipilimumab 3mg/kg and nivolumab 1mg/kg every third week followed by continued nivolumab 480mg q4w up to 1 year.
Arm Title
Arm B
Arm Type
Experimental
Arm Description
Patients will be treated with 1 course of ipilimumab 3mg/kg and nivolumab 1mg/kg followed by IHP after 3 weeks and then another 3 courses of ipilimumab 3mg/kg and nivolumab 1mg/kg every third week followed by continued nivolumab 480mg q4w up to 1 year.
Intervention Type
Procedure
Intervention Name(s)
Isolated hepatic perfusion
Intervention Description
The procedure is performed under general anaesthesia. The caval vein is isolated infrahepatically above the renal veins and suprahepatically between the diaphragm and the pericardium. A catheter is placed in the retrohepatic portion of the caval vein for perfusion outflow. The portal vein is clamped and the proper hepatic artery is cannulated via the gastroduodenal artery. The liver perfusion is performed at a rate of 8- 9 ml/kg/min with a target liver temperature of 40 degrees Celsius. The leakage from the system was continuously recorded using Technetium labelled albumin (Vasculosis) injected into the perfusion circuit. Melphalan (1 mg/kg bodyweight divided into two doses, given 30 minutes apart) is added to the perfusion system. The perfusion is then continued for 60 minutes, after which the perfusion was discontinued.
Intervention Type
Drug
Intervention Name(s)
Ipilimumab
Intervention Description
4 courses of ipilimumab 3mg/kg every third week
Intervention Type
Drug
Intervention Name(s)
Nivolumab
Intervention Description
4 courses of nivolumab 1mg/kg every third week
Primary Outcome Measure Information:
Title
Incidence and severity of adverse events (AEs) and serious adverse events (SAEs)
Description
Incidence and severity of adverse events (AEs) and serious adverse events (SAEs)
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Objective response rate (ORR)
Description
Evaluation of objective response rate (ORR)
Time Frame
2 years
Title
Clinical benefit rate (CBR)
Description
Evaluation of clinical benefit rate (CBR)
Time Frame
2 years
Title
Progression-free survival (PFS)
Description
Evaluation of progression-free survival (PFS)
Time Frame
2 years
Title
Hepatic progression-free survival (hPFS)
Description
Evaluation of hepatic progression-free survival (hPFS)
Time Frame
2 years
Title
Overall survival (OS)
Description
Evaluation of overall survival (OS)
Time Frame
2 years
Title
Time to response (TTR)
Description
Evaluation of time to response (TTR)
Time Frame
2 years
Title
Duration of response (DOR)
Description
Evaluation of duration of response (DOR)
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Patient is ≥18 years of age on the day of signing informed consent Patient is willing and able to provide written informed consent and comply with study procedures. Written informed consent must be signed and dated before the start of specific protocol procedures Patient must have a histologically confirmed diagnosis of stage IV uveal melanoma. If tissue biopsy is judged not feasible by the investigator, cytological diagnosis from fine needle aspiration (FNA) will be accepted Measurable disease by computed tomography (CT) or Magnetic Resonance Imaging (MRI) per RECIST 1.1 criteria with at least one target lesion identified in the liver. ECOG performance status of 0 or 1 No previous immunotherapy for uveal melanoma metastases. Female patient of childbearing potential should have a negative urine or serum pregnancy test within 72 hours prior to receiving the first treatment. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required Female patients of childbearing potential must be willing to use an adequate method of contraception, for the course of the study through 120 days after the last dose of study medication. Note: Abstinence is acceptable if this is the usual lifestyle and preferred contraception for the subject Male patients of childbearing potential must agree to use an adequate method of contraception, starting with the first dose of study therapy through 120 days after the last dose of study therapy. Abstinence is acceptable if this is the usual lifestyle and preferred contraception for the subject Exclusion Criteria Life expectancy of less than 3 months Body mass index above 35 More than 50% of the liver volume replaced by tumor as measured by CT or MRI Known congestive heart failure with an LVEF <40% COPD or other chronic pulmonary disease with PFT's indicating an FEV< 50% predicted for age Interstitial lung disease (ILD) or (non-infectious) pneumonitis 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 AST, ALT, bilirubin>3*ULN and PK-INR>1.5) or medical history of liver cirrhosis or portal hypertension Hemoglobin <90 g/L or platelets <100x109/L or neutrophils <1.5x109/L Use of live vaccines four weeks before or after the last study treatment History of severe hypersensitivity reactions to mAbs Known human immunodeficiency virus (HIV) infection, acquired immunodeficiency syndrome (AIDS), hepatitis B or hepatitis C Active autoimmune disease or a history of known or suspected autoimmune disease A condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 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. Concomitant therapy with any other anti-cancer therapy, concurrent medical conditions requiring use of immunosuppressive medications or use of other investigational drugs Has a known additional malignancy that is progressing or requires active treatment. Pregnant or breastfeeding or expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 120 days after the last dose of study drug. A history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the patient's participation for the full duration of the study, or is not in the best interest of the patient to participate, in the opinion of the treating investigator
Facility Information:
Facility Name
Sahlgrenska University Hospital
City
Gothenburg
ZIP/Postal Code
413 45
Country
Sweden

12. IPD Sharing Statement

Plan to Share IPD
Undecided

Learn more about this trial

Isolated Hepatic Perfusion in Combination With Ipilimumab and Nivolumab in Patients With Uveal Melanoma Metastases

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