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Interferon Alfa-2b in Treating Patients With Melanoma and Early Lymph Node Metastasis

Primary Purpose

Melanoma (Skin)

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
recombinant interferon alfa
lymphangiography
Observation
Sponsored by
University of Alabama at Birmingham
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Melanoma (Skin) focused on measuring stage I melanoma, stage II melanoma, stage III melanoma

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically confirmed invasive cutaneous melanoma Breslow thickness at least 1.0 mm Primary site must be on head, neck, trunk or extremity No more than 90 days since biopsy Protocol A: One or more sentinel lymph nodes with histologic or immunohistochemical evidence of metastatic melanoma Prior regional lymph node dissection Protocol B: Sentinel lymph nodes with no histologic or immunohistochemical evidence of metastatic melanoma Sentinel lymph node positive by reverse transcriptase polymerase chain reaction No prior wide local excision of the primary tumor with a margin greater than 1.5 cm No primary melanoma involving the eye or mucous membranes No clinical evidence of satellite lesions or intransit, regional nodal, or distant metastases No second primary invasive melanoma No prior surgery in the region of the primary draining nodal basin that would disrupt normal lymphatic drainage patterns (e.g., skin grafts, tissue transfers or flaps, or lymph node dissections) PATIENT CHARACTERISTICS: Age: 18 to 70 Performance status: Karnofsky 70-100% Life expectancy: At least 10 years Hematopoietic: WBC at least 3,000/mm^3 Absolute granulocyte count at least 1,500/mm^3 Platelet count at least 70,000/mm^3 Hemoglobin at least 10.0 g/dL Hepatic: Bilirubin less than 2.0 mg/dL SGOT/SGPT less than 3 times upper limit of normal (ULN) Alkaline phosphatase less than 3 times ULN No severe decompensated liver disease (e.g., cirrhosis or autoimmune hepatitis) No other significant liver disease that would preclude study participation Renal: Creatinine normal Cardiovascular: No cardiovascular disease (e.g., angina or congestive heart failure) No myocardial infarction within the past year No tachyarrhythmias Pulmonary: No severe debilitating pulmonary disease (e.g., chronic obstructive pulmonary disease) Other: No hypersensitivity to interferon alfa-2b or related compounds or any component of the injection No major depression or other major psychiatric illness No thyroid disorder with thyroid function that is not maintained within the normal range with medications No autoimmune disease No primary or secondary immunodeficiencies No severe diabetes mellitus prone to ketoacidosis No significant retinal abnormalities No evidence of infection No other malignancy within the past 5 years except basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or stage I laryngeal cancer No other medical condition that would preclude study participation Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 6 months after the study PRIOR CONCURRENT THERAPY: Biologic therapy: No prior immunotherapy Chemotherapy: No prior chemotherapy Endocrine therapy: At least 6 months since prior oral or parenteral steroids Radiotherapy: No prior radiotherapy Surgery: See Disease Characteristics No prior organ transplantation Other: At least 6 months since prior immunosuppressants No concurrent immunosuppressants resulting from prior organ transplantation

Sites / Locations

  • University of Alabama at Birmingham Comprehensive Cancer Center
  • James Graham Brown Cancer Center at University of Louisville
  • Cancer Institute of New Jersey
  • Roswell Park Cancer Institute

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

AI

Arm AII

Arm BI

Arm B II

Arm BIII

Arm Description

Patients with metastasis in a single sentinel node with no evidence of extracapsular extension and no metastatic disease in nonsentinel nodes are randomized to 1 of 2 treatment arms. Patients receive adjuvant high-dose interferon alfa-2b IV 5 days a week for 4 weeks, then subcutaneously 3 times a week for 48 weeks

Patients with metastasis in a single sentinel node with no evidence of extracapsular extension and no metastatic disease in nonsentinel nodes are randomized to 1 of 2 treatment arms. Observational arm: Patients with metastases in more than one sentinel node with evidence of extracapsular extension or metastasis in any nonsentinel node receive adjuvant high-dose interferon alfa-2b as in arm AI.

Patients with positive sentinel node(s) by PCR analysis are randomized to one of three treatment arms. Patients undergo observation. Patients are followed every 3 months for 2 years, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter.

Patients with positive sentinel node(s) by PCR analysis are randomized to one of three treatment arms. Patients undergo lymph node dissection. Patients are followed every 3 months for 2 years, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter.

Patients with positive sentinel node(s) by PCR analysis are randomized to one of three treatment arms. Patients undergo lymph node dissection followed by adjuvant high-dose interferon alfa-2b IV 5 days a week for 4 weeks. Patients are followed every 3 months for 2 years, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter.

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
January 21, 2000
Last Updated
January 16, 2014
Sponsor
University of Alabama at Birmingham
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00004196
Brief Title
Interferon Alfa-2b in Treating Patients With Melanoma and Early Lymph Node Metastasis
Official Title
A Multicenter Trial of Adjuvant Interferon Alfa-2b for Melanoma Patients With Early Lymph Node Metastasis Detected by Lymphatic Mapping and Sentinel Lymph Node Biopsy
Study Type
Interventional

2. Study Status

Record Verification Date
April 2013
Overall Recruitment Status
Completed
Study Start Date
October 1999 (undefined)
Primary Completion Date
October 2004 (Actual)
Study Completion Date
November 2007 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Alabama at Birmingham
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Interferon alfa-2b may interfere with the growth of cancer cells. PURPOSE: Randomized phase III trial to study the effectiveness of interferon alfa-2b in treating patients who have melanoma with early lymph node metastasis.
Detailed Description
OBJECTIVES: Compare the efficacy of regional lymphadenectomy with or without adjuvant high-dose interferon alfa-2b on disease-free survival and overall survival of patients with invasive cutaneous melanoma with early or submicroscopic sentinel lymph node metastasis detected by histology or immunohistochemistry or by polymerase chain reaction (PCR). Compare the effect of lymphadenectomy vs observation on disease-free survival and overall survival of patients with submicroscopic sentinel lymph node metastasis detected only by PCR. Determine the recurrence rate and survival of patients with submicroscopic sentinel lymph node metastasis detected only by PCR. Determine the positive and negative predictive value of reverse transcriptase PCR analysis of sentinel lymph nodes and peripheral blood to identify patients at risk for recurrence and death. OUTLINE: This is a randomized, multicenter study. Patients in the randomized portions of Protocols A and B are stratified according to tumor thickness (1-2 mm vs 3-4 mm vs greater than 4 mm) and tumor ulceration (yes vs no). All patients undergo wide local tumor excision with lymphatic mapping and sentinel node biopsy. Patients with tumors with ambiguous drainage patterns undergo lymphoscintigraphy prior to tumor excision. Patients with evidence of metastatic melanoma in the sentinel node(s) by routine histology, serial sectioning, or immunohistochemistry and who have undergone a prior regional lymph node dissection proceed to protocol A. Protocol A: Patients with metastasis in a single sentinel node with no evidence of extracapsular extension and no metastatic disease in nonsentinel nodes are randomized to 1 of 2 treatment arms. Arm I: Patients receive adjuvant high-dose interferon alfa-2b IV 5 days a week for 4 weeks, then subcutaneously 3 times a week for 48 weeks. Arm II: Patients undergo observation. Patients with metastases in more than one sentinel node with evidence of extracapsular extension or metastasis in any nonsentinel node receive adjuvant high-dose interferon alfa-2b as in arm I. Patients with no evidence of sentinel node(s) metastases by routine histology, serial sectioning, and immunohistochemistry and are negative by polymerase chain reaction (PCR) analysis are observed. Protocol B: Patients with positive sentinel node(s) by PCR analysis are randomized to one of three treatment arms. Arm I: Patients undergo observation. Arm II: Patients undergo lymph node dissection. Arm III: Patients undergo lymph node dissection followed by adjuvant high-dose interferon alfa-2b IV 5 days a week for 4 weeks. Patients are followed every 3 months for 2 years, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 3,000 patients will be accrued for this study within 5 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Melanoma (Skin)
Keywords
stage I melanoma, stage II melanoma, stage III melanoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
3000 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
AI
Arm Type
Experimental
Arm Description
Patients with metastasis in a single sentinel node with no evidence of extracapsular extension and no metastatic disease in nonsentinel nodes are randomized to 1 of 2 treatment arms. Patients receive adjuvant high-dose interferon alfa-2b IV 5 days a week for 4 weeks, then subcutaneously 3 times a week for 48 weeks
Arm Title
Arm AII
Arm Type
Experimental
Arm Description
Patients with metastasis in a single sentinel node with no evidence of extracapsular extension and no metastatic disease in nonsentinel nodes are randomized to 1 of 2 treatment arms. Observational arm: Patients with metastases in more than one sentinel node with evidence of extracapsular extension or metastasis in any nonsentinel node receive adjuvant high-dose interferon alfa-2b as in arm AI.
Arm Title
Arm BI
Arm Type
Experimental
Arm Description
Patients with positive sentinel node(s) by PCR analysis are randomized to one of three treatment arms. Patients undergo observation. Patients are followed every 3 months for 2 years, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter.
Arm Title
Arm B II
Arm Type
Experimental
Arm Description
Patients with positive sentinel node(s) by PCR analysis are randomized to one of three treatment arms. Patients undergo lymph node dissection. Patients are followed every 3 months for 2 years, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter.
Arm Title
Arm BIII
Arm Type
Experimental
Arm Description
Patients with positive sentinel node(s) by PCR analysis are randomized to one of three treatment arms. Patients undergo lymph node dissection followed by adjuvant high-dose interferon alfa-2b IV 5 days a week for 4 weeks. Patients are followed every 3 months for 2 years, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter.
Intervention Type
Biological
Intervention Name(s)
recombinant interferon alfa
Intervention Type
Procedure
Intervention Name(s)
lymphangiography
Intervention Type
Drug
Intervention Name(s)
Observation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed invasive cutaneous melanoma Breslow thickness at least 1.0 mm Primary site must be on head, neck, trunk or extremity No more than 90 days since biopsy Protocol A: One or more sentinel lymph nodes with histologic or immunohistochemical evidence of metastatic melanoma Prior regional lymph node dissection Protocol B: Sentinel lymph nodes with no histologic or immunohistochemical evidence of metastatic melanoma Sentinel lymph node positive by reverse transcriptase polymerase chain reaction No prior wide local excision of the primary tumor with a margin greater than 1.5 cm No primary melanoma involving the eye or mucous membranes No clinical evidence of satellite lesions or intransit, regional nodal, or distant metastases No second primary invasive melanoma No prior surgery in the region of the primary draining nodal basin that would disrupt normal lymphatic drainage patterns (e.g., skin grafts, tissue transfers or flaps, or lymph node dissections) PATIENT CHARACTERISTICS: Age: 18 to 70 Performance status: Karnofsky 70-100% Life expectancy: At least 10 years Hematopoietic: WBC at least 3,000/mm^3 Absolute granulocyte count at least 1,500/mm^3 Platelet count at least 70,000/mm^3 Hemoglobin at least 10.0 g/dL Hepatic: Bilirubin less than 2.0 mg/dL SGOT/SGPT less than 3 times upper limit of normal (ULN) Alkaline phosphatase less than 3 times ULN No severe decompensated liver disease (e.g., cirrhosis or autoimmune hepatitis) No other significant liver disease that would preclude study participation Renal: Creatinine normal Cardiovascular: No cardiovascular disease (e.g., angina or congestive heart failure) No myocardial infarction within the past year No tachyarrhythmias Pulmonary: No severe debilitating pulmonary disease (e.g., chronic obstructive pulmonary disease) Other: No hypersensitivity to interferon alfa-2b or related compounds or any component of the injection No major depression or other major psychiatric illness No thyroid disorder with thyroid function that is not maintained within the normal range with medications No autoimmune disease No primary or secondary immunodeficiencies No severe diabetes mellitus prone to ketoacidosis No significant retinal abnormalities No evidence of infection No other malignancy within the past 5 years except basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or stage I laryngeal cancer No other medical condition that would preclude study participation Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 6 months after the study PRIOR CONCURRENT THERAPY: Biologic therapy: No prior immunotherapy Chemotherapy: No prior chemotherapy Endocrine therapy: At least 6 months since prior oral or parenteral steroids Radiotherapy: No prior radiotherapy Surgery: See Disease Characteristics No prior organ transplantation Other: At least 6 months since prior immunosuppressants No concurrent immunosuppressants resulting from prior organ transplantation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marshall M. Urist, MD
Organizational Affiliation
University of Alabama at Birmingham
Official's Role
Study Chair
Facility Information:
Facility Name
University of Alabama at Birmingham Comprehensive Cancer Center
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35294-3300
Country
United States
Facility Name
James Graham Brown Cancer Center at University of Louisville
City
Louisville
State/Province
Kentucky
ZIP/Postal Code
40202
Country
United States
Facility Name
Cancer Institute of New Jersey
City
New Brunswick
State/Province
New Jersey
ZIP/Postal Code
08903
Country
United States
Facility Name
Roswell Park Cancer Institute
City
Buffalo
State/Province
New York
ZIP/Postal Code
14263-0001
Country
United States

12. IPD Sharing Statement

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Interferon Alfa-2b in Treating Patients With Melanoma and Early Lymph Node Metastasis

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