search
Back to results

Immunotherapy With Nivolumab or Nivolumab Plus Ipilimumab vs. Double Placebo for Stage IV Melanoma w. NED

Primary Purpose

Malignant Melanoma

Status
Completed
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Nivolumab + Placebo
Nivolumab + Ipilimumab
Double Placebo Control
Sponsored by
Prof. Dr. med. Dirk Schadendorf
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Malignant Melanoma

Eligibility Criteria

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

Inclusion Criteria:

  • Stage IV melanoma arising from a primary cutaneous site or metastatic from an unknown primary site with no evidence of disease (NED) after surgery or radiation therapy (conducted within 8 weeks before enrolment)
  • Signed written informed consent
  • Known BRAF status
  • Subjects must be willing and able to comply with scheduled visits, treatment schedule, laboratory testing, and other requirements of the study
  • Minimum life expectancy of five years excluding their melanoma diagnosis
  • ECOG performance status of 0 or 1
  • Tumor tissue from the resected site of disease must be provided for biomarker analyses. In order to be randomized a subject must have a PD-L 1 expression classification (positive (≥ 5% tumor cells expressing PD-L1) or negative (< 5% tumor cells expressing PD-L1)). If an insufficient amount of tumor tissue from the resected site is provided for analysis, acquisition of additional archived tumor tissue (block and/or slides) for the biomarker analyses is required.
  • Prior radiotherapy must have been completed at least 2 weeks prior to study drug administration
  • Required laboratory values
  • Negative pregnancy test for female subjects and effective contraception (Pearl-Index <1) for both male and female subjects if the risk of conception exists

Exclusion Criteria:

  • History of primary uveal or mucosal melanoma
  • Prior therapy with CTLA4 or PD1 antibodies
  • The patient has psychiatric or addictive disorders that may compromise his/her ability to give informed consent or to comply with the trial procedures.
  • Lack of availability for clinical follow-up assessments.
  • Any immunosuppressive therapy given within the past 30 days prior to study drug administration (excluding physiologic steroid hormone replacement)
  • Other malignancies within the past five years requiring treatment except basal or squamous skin carcinomas or carcinoma in situ of the cervix
  • Serious cardiac, gastrointestinal, hepatic or pulmonary disease reducing life expectancy to less than five years
  • Patients with serious intercurrent illness, requiring hospitalization.
  • Other serious illnesses, e.g., serious infections requiring antibiotics or bleeding disorders.
  • The patient is known to be positive for Human Immunodeficiency Virus (HIV) or other chronic infections (HBV, HCV) or has another confirmed or suspected immunosuppressive or immunodeficient condition.
  • Known hypersensitivity reaction to any of the components of study treatment
  • Pregnancy (absence to be confirmed by ß-HCG urinary test, minimum sensitivity 25IU/L or equivalent units of HCG)) or lactation period
  • Women of childbearing potential (WOCBP): Refusal or inability to use effective means of contraception (Pearl-Index <1). WOCBP will be instructed to adhere to contraception until 31 weeks after the last dose of investigational product
  • Men who are sexually active with WOCBP must use any contraceptive method with a failure rate of less than 1% per year (Pearl-Index <1). Men receiving Nivolumab and who are sexually active with WOCBP will be instructed to adhere to contraception until 31 weeks after the last dose of investigational product
  • Known alcohol or drug abuse
  • Participation in another clinical study and use of any investigational or non-registered product (drug or vaccine) within the 30 days before registration
  • Significant disease or condition which, in the investigator's opinion, would exclude the patient from the study
  • Legal incapacity or limited legal capacity

Sites / Locations

  • Charité Berlin
  • Elbe Klinikum Buxtehude
  • Universitätsklinikum Dresden
  • HELIOS Klinikum Erfurt
  • Studienzentrum Hautklinik Universitätsklinikum Essen (AöR) Klinik für Dermatologie
  • SRH Wald-Klinikum Gera GmbH
  • Medizinische Hochschule Hannover
  • Universitätrsklinikum Heidelberg Dermatologie / NCT
  • SLK Kliniken Heilbronn GmbH
  • Universitäts-Hautklinik Kiel Klinik f. Dermatologie, Venerologie u. Allergologie
  • Universitätsklinikum Leipzig Klinik u. Poliklinik f. Dermatologie, Venerologie u. Allergologie
  • Klinikum der Stadt Ludwigshafen
  • UKSH Campus Lübeck
  • Universitätsklinikum Mainz Hautklinik und Polklinik
  • Klinik für Dermatologie, Venerologie und Allergologie UMM - Universitätsmedizin Mannheim
  • Johannes Wesling Klinikum Minden Hautklinik
  • Universitätsklinikum München (LMU)
  • Fachklinik Hornheide
  • Universitätsklinikum Regensburg
  • Universitätshautklinik Tübingen

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Experimental

Placebo Comparator

Arm Label

Nivolumab + Placebo

Nivolumab + Ipilimumab

Double Placebo Control

Arm Description

Nivolumab (3 mg/kg) i.v. every 2 weeks + Placebo instead of Ipilimumab on weeks 1, 4, 7 and 10 + Placebo instead of Nivolumab on weeks 4 and 10

Nivolumab (1 mg/kg) and Ipilimumab (3 mg/kg) i.v. every 3 weeks for 4 doses. Both study drugs are administered on the same day over the first 12 weeks + Placebo instead of Nivolumab on weeks 3, 5, 9 and 11. After week 12: Nivolumab as maintenance and at a dose of 3 mg/kg IV every 2 weeks for up to 1 year after initial dosing (of the combination) or until PD.

Placebo instead of Nivolumab and Placebo instead of Ipilimumab i.v. every 3 weeks for 4 doses. Both placebos are administered on the same day over the first 12 weeks + Placebo instead of Nivolumab on weeks 3, 5, 9 and 11. After week 12 Placebo instead of Nivolumab as maintenance and applied as IV every 2 weeks for up to 1 year after initial dosing (of the combination) or until PD.

Outcomes

Primary Outcome Measures

Efficacy of adjuvant immunotherapy with Nivolumab alone or in combination with Ipilimumab (Recurrence-free survival)
Recurrence-free survival (RFS) defined as the time from date of randomization until the date of the first recurrence (local or distant metastasis), new primary melanoma or death from any cause, whichever occurs first.

Secondary Outcome Measures

Overall survival (OS)
The OS of a patient is defined as the time from date of randomization until date of death.
Time to recurrence (TTR)
The TTR of a patient is defined as the time from date of randomization until date of disease recurrence (local or distant metastasis) or melanoma-related death.
Progression/recurrence free survival 2 (PRFS2) for crossover patients of Arm C
The PRFS2 is defined as time from date of randomization until the date of first disease progression per RECIST 1.1 beyond the initial unresectable disease recurrence, the date of second recurrence in patients without evidence of disease after surgery of a resectable first recurrence or the date of death, whichever occurs first.

Full Information

First Posted
August 5, 2015
Last Updated
December 10, 2021
Sponsor
Prof. Dr. med. Dirk Schadendorf
search

1. Study Identification

Unique Protocol Identification Number
NCT02523313
Brief Title
Immunotherapy With Nivolumab or Nivolumab Plus Ipilimumab vs. Double Placebo for Stage IV Melanoma w. NED
Official Title
A Phase II Randomized, Double-Blind Trial of Immunotherapy With Nivolumab or Nivolumab Plus Ipilimumab Versus Double-Placebo Control as a Post-Surgical/Post-Radiation Treatment for Stage IV Melanoma With No Evidence of Disease
Study Type
Interventional

2. Study Status

Record Verification Date
December 2021
Overall Recruitment Status
Completed
Study Start Date
September 2, 2015 (Actual)
Primary Completion Date
June 27, 2021 (Actual)
Study Completion Date
June 27, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Prof. Dr. med. Dirk Schadendorf

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a prospective, double-blind placebo-controlled, multicenter, randomized phase II trial testing the adjuvant immunotherapy with Nivolumab plus Ipilimumab Placebo or Nivolumab plus Ipilimumab versus Double Placebo Control as a post-surgical/post-radiation treatment for stage IV melanoma with no evidence of disease (NED).
Detailed Description
This study will allow for direct comparison of the clinical benefit provided by Nivolumab monotherapy or Nivolumab combined with Ipilimumab versus double placebo control. Furthermore, it will also allow for direct comparison of the respective safety profiles of Nivolumab monotherapy or Nivolumab combined with Ipilimumab. Nivolumab monotherapy was chosen as one of the experimental arms because of a favourable risk-benefit ratio assessed in the large Phase 1 study (MDX1106-03/CA209-003). The combination of Nivolumab and Ipilimumab was chosen as an experimental arm because of the preliminary evidence from the Phase 1 study CA209-004 suggesting synergy between Nivolumab and Ipilimumab resulting in a higher frequency of patients with increased tumour burden reduction. Evaluating both Nivolumab monotherapy and the combination of Nivolumab and Ipilimumab will provide clinical data allowing clinicians to select the appropriate treatment for each patient based on their individual risk-benefit ratio.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malignant Melanoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
167 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Nivolumab + Placebo
Arm Type
Active Comparator
Arm Description
Nivolumab (3 mg/kg) i.v. every 2 weeks + Placebo instead of Ipilimumab on weeks 1, 4, 7 and 10 + Placebo instead of Nivolumab on weeks 4 and 10
Arm Title
Nivolumab + Ipilimumab
Arm Type
Experimental
Arm Description
Nivolumab (1 mg/kg) and Ipilimumab (3 mg/kg) i.v. every 3 weeks for 4 doses. Both study drugs are administered on the same day over the first 12 weeks + Placebo instead of Nivolumab on weeks 3, 5, 9 and 11. After week 12: Nivolumab as maintenance and at a dose of 3 mg/kg IV every 2 weeks for up to 1 year after initial dosing (of the combination) or until PD.
Arm Title
Double Placebo Control
Arm Type
Placebo Comparator
Arm Description
Placebo instead of Nivolumab and Placebo instead of Ipilimumab i.v. every 3 weeks for 4 doses. Both placebos are administered on the same day over the first 12 weeks + Placebo instead of Nivolumab on weeks 3, 5, 9 and 11. After week 12 Placebo instead of Nivolumab as maintenance and applied as IV every 2 weeks for up to 1 year after initial dosing (of the combination) or until PD.
Intervention Type
Drug
Intervention Name(s)
Nivolumab + Placebo
Other Intervention Name(s)
Treatment Arm A
Intervention Description
Nivolumab will be applied at a dose of 3 mg/kg given as IV infusion every 2 weeks for up to 1 year after initial dosing or until PD + Placebo instead of Ipilimumab on weeks 1, 4, 7 and 10 + Placebo instead of Nivolumab on weeks 4 and 10.
Intervention Type
Drug
Intervention Name(s)
Nivolumab + Ipilimumab
Other Intervention Name(s)
Treatment Arm B
Intervention Description
Nivolumab (1 mg/kg) and Ipilimumab (3 mg/kg) will be applied as IV infusion every 3 weeks for 4 doses. Both study drugs are to be administered on the same day over the first 12 weeks + Nivolumab-Placebo on weeks 3, 5, 9 and 11. After week 12 Nivolumab is given as maintenance and will be applied at a dose of 3 mg/kg IV every 2 weeks for up to 1 year after initial dosing (of the combination) or until PD.
Intervention Type
Drug
Intervention Name(s)
Double Placebo Control
Other Intervention Name(s)
Treatment Arm C
Intervention Description
Placebo instead of Nivolumab and Placebo instead of Ipilimumab will be applied as IV infusion every 3 weeks for 4 doses. Both placebos are to be administered on the same day over the first 12 weeks + Placebo instead of Nivolumab on weeks 3, 5, 9 and 11. After week 12 Placebo instead of Nivolumab is given as maintenance and will be applied intravenously every 2 weeks for up to 1 year after initial dosing (of the combination) or until PD.
Primary Outcome Measure Information:
Title
Efficacy of adjuvant immunotherapy with Nivolumab alone or in combination with Ipilimumab (Recurrence-free survival)
Description
Recurrence-free survival (RFS) defined as the time from date of randomization until the date of the first recurrence (local or distant metastasis), new primary melanoma or death from any cause, whichever occurs first.
Time Frame
24 months after the last patient ended treatment
Secondary Outcome Measure Information:
Title
Overall survival (OS)
Description
The OS of a patient is defined as the time from date of randomization until date of death.
Time Frame
24 months after the last patient ended treatment
Title
Time to recurrence (TTR)
Description
The TTR of a patient is defined as the time from date of randomization until date of disease recurrence (local or distant metastasis) or melanoma-related death.
Time Frame
24 months after the last patient ended treatment
Title
Progression/recurrence free survival 2 (PRFS2) for crossover patients of Arm C
Description
The PRFS2 is defined as time from date of randomization until the date of first disease progression per RECIST 1.1 beyond the initial unresectable disease recurrence, the date of second recurrence in patients without evidence of disease after surgery of a resectable first recurrence or the date of death, whichever occurs first.
Time Frame
24 months after the last patient ended treatment
Other Pre-specified Outcome Measures:
Title
Safety / Toxicity All adverse events ≥ Grade 3 according to CTCAE Version 4.0 criteria
Description
All adverse events ≥ Grade 3 according to CTCAE Version 4.0 criteria, that are related to the administration of the investigational agents will be assessed
Time Frame
until 90 days after discontinuation of dosing

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Stage IV melanoma arising from a primary cutaneous site or metastatic from an unknown primary site with no evidence of disease (NED) after surgery or radiation therapy (conducted within 8 weeks before enrolment) Signed written informed consent Known BRAF status Subjects must be willing and able to comply with scheduled visits, treatment schedule, laboratory testing, and other requirements of the study Minimum life expectancy of five years excluding their melanoma diagnosis ECOG performance status of 0 or 1 Tumor tissue from the resected site of disease must be provided for biomarker analyses. In order to be randomized a subject must have a PD-L 1 expression classification (positive (≥ 5% tumor cells expressing PD-L1) or negative (< 5% tumor cells expressing PD-L1)). If an insufficient amount of tumor tissue from the resected site is provided for analysis, acquisition of additional archived tumor tissue (block and/or slides) for the biomarker analyses is required. Prior radiotherapy must have been completed at least 2 weeks prior to study drug administration Required laboratory values Negative pregnancy test for female subjects and effective contraception (Pearl-Index <1) for both male and female subjects if the risk of conception exists Exclusion Criteria: History of primary uveal or mucosal melanoma Prior therapy with CTLA4 or PD1 antibodies The patient has psychiatric or addictive disorders that may compromise his/her ability to give informed consent or to comply with the trial procedures. Lack of availability for clinical follow-up assessments. Any immunosuppressive therapy given within the past 30 days prior to study drug administration (excluding physiologic steroid hormone replacement) Other malignancies within the past five years requiring treatment except basal or squamous skin carcinomas or carcinoma in situ of the cervix Serious cardiac, gastrointestinal, hepatic or pulmonary disease reducing life expectancy to less than five years Patients with serious intercurrent illness, requiring hospitalization. Other serious illnesses, e.g., serious infections requiring antibiotics or bleeding disorders. The patient is known to be positive for Human Immunodeficiency Virus (HIV) or other chronic infections (HBV, HCV) or has another confirmed or suspected immunosuppressive or immunodeficient condition. Known hypersensitivity reaction to any of the components of study treatment Pregnancy (absence to be confirmed by ß-HCG urinary test, minimum sensitivity 25IU/L or equivalent units of HCG)) or lactation period Women of childbearing potential (WOCBP): Refusal or inability to use effective means of contraception (Pearl-Index <1). WOCBP will be instructed to adhere to contraception until 31 weeks after the last dose of investigational product Men who are sexually active with WOCBP must use any contraceptive method with a failure rate of less than 1% per year (Pearl-Index <1). Men receiving Nivolumab and who are sexually active with WOCBP will be instructed to adhere to contraception until 31 weeks after the last dose of investigational product Known alcohol or drug abuse Participation in another clinical study and use of any investigational or non-registered product (drug or vaccine) within the 30 days before registration Significant disease or condition which, in the investigator's opinion, would exclude the patient from the study Legal incapacity or limited legal capacity
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dirk Schadendorf, Prof. Dr.
Organizational Affiliation
Studienzentrum Hautklinik Universitätsklinikum Essen Klinik f. Dermatologie
Official's Role
Principal Investigator
Facility Information:
Facility Name
Charité Berlin
City
Berlin
ZIP/Postal Code
10117
Country
Germany
Facility Name
Elbe Klinikum Buxtehude
City
Buxtehude
ZIP/Postal Code
21614
Country
Germany
Facility Name
Universitätsklinikum Dresden
City
Dresden
ZIP/Postal Code
01307
Country
Germany
Facility Name
HELIOS Klinikum Erfurt
City
Erfurt
ZIP/Postal Code
99089
Country
Germany
Facility Name
Studienzentrum Hautklinik Universitätsklinikum Essen (AöR) Klinik für Dermatologie
City
Essen
ZIP/Postal Code
45147
Country
Germany
Facility Name
SRH Wald-Klinikum Gera GmbH
City
Gera
ZIP/Postal Code
07548
Country
Germany
Facility Name
Medizinische Hochschule Hannover
City
Hannover
ZIP/Postal Code
30625
Country
Germany
Facility Name
Universitätrsklinikum Heidelberg Dermatologie / NCT
City
Heidelberg
ZIP/Postal Code
69120
Country
Germany
Facility Name
SLK Kliniken Heilbronn GmbH
City
Heilbronn
ZIP/Postal Code
74078
Country
Germany
Facility Name
Universitäts-Hautklinik Kiel Klinik f. Dermatologie, Venerologie u. Allergologie
City
Kiel
ZIP/Postal Code
24105
Country
Germany
Facility Name
Universitätsklinikum Leipzig Klinik u. Poliklinik f. Dermatologie, Venerologie u. Allergologie
City
Leipzig
ZIP/Postal Code
04103
Country
Germany
Facility Name
Klinikum der Stadt Ludwigshafen
City
Ludwigshafen
ZIP/Postal Code
67063
Country
Germany
Facility Name
UKSH Campus Lübeck
City
Lübeck
ZIP/Postal Code
23538
Country
Germany
Facility Name
Universitätsklinikum Mainz Hautklinik und Polklinik
City
Mainz
ZIP/Postal Code
55131
Country
Germany
Facility Name
Klinik für Dermatologie, Venerologie und Allergologie UMM - Universitätsmedizin Mannheim
City
Mannheim
ZIP/Postal Code
68167
Country
Germany
Facility Name
Johannes Wesling Klinikum Minden Hautklinik
City
Minden
ZIP/Postal Code
32429
Country
Germany
Facility Name
Universitätsklinikum München (LMU)
City
München
ZIP/Postal Code
80337
Country
Germany
Facility Name
Fachklinik Hornheide
City
Münster
ZIP/Postal Code
48157
Country
Germany
Facility Name
Universitätsklinikum Regensburg
City
Regensburg
ZIP/Postal Code
93053
Country
Germany
Facility Name
Universitätshautklinik Tübingen
City
Tübingen
ZIP/Postal Code
72076
Country
Germany

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
36099927
Citation
Livingstone E, Zimmer L, Hassel JC, Fluck M, Eigentler TK, Loquai C, Haferkamp S, Gutzmer R, Meier F, Mohr P, Hauschild A, Schilling B, Menzer C, Kiecker F, Dippel E, Roesch A, Ziemer M, Conrad B, Korner S, Windemuth-Kieselbach C, Schwarz L, Garbe C, Becker JC, Schadendorf D; Dermatologic Cooperative Oncology Group. Adjuvant nivolumab plus ipilimumab or nivolumab alone versus placebo in patients with resected stage IV melanoma with no evidence of disease (IMMUNED): final results of a randomised, double-blind, phase 2 trial. Lancet. 2022 Oct 1;400(10358):1117-1129. doi: 10.1016/S0140-6736(22)01654-3. Epub 2022 Sep 10.
Results Reference
derived
PubMed Identifier
32416781
Citation
Zimmer L, Livingstone E, Hassel JC, Fluck M, Eigentler T, Loquai C, Haferkamp S, Gutzmer R, Meier F, Mohr P, Hauschild A, Schilling B, Menzer C, Kieker F, Dippel E, Rosch A, Simon JC, Conrad B, Korner S, Windemuth-Kieselbach C, Schwarz L, Garbe C, Becker JC, Schadendorf D; Dermatologic Cooperative Oncology Group. Adjuvant nivolumab plus ipilimumab or nivolumab monotherapy versus placebo in patients with resected stage IV melanoma with no evidence of disease (IMMUNED): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet. 2020 May 16;395(10236):1558-1568. doi: 10.1016/S0140-6736(20)30417-7.
Results Reference
derived

Learn more about this trial

Immunotherapy With Nivolumab or Nivolumab Plus Ipilimumab vs. Double Placebo for Stage IV Melanoma w. NED

We'll reach out to this number within 24 hrs