PIVOTAL: Multi-center Study of the Efficacy of L19IL2/L19TNF Neoadjuvant Intratumoral Treatment Followed by Surgery Versus Surgery Alone in Clinical Stage III B/C Melanoma Patients - PH-L19IL2TNF-02/15

Studio Clinico

Patologia: Melanoma

Osservazionale-Sperimentale: Sperimentale

Monocentrico-Multicentrico: Multicentrico

Randomizzato: Sì

Fase di studio: III

Richiesta mandatoria di tessuto: No

Linee di trattamento: Adiuvante/neoadiuvante

Criteri di inclusione: 

• Diagnosis of malignant melanoma of the skin in clinical stage III B and III C, eligible for complete surgical resection.
• Eligible subjects must have measurable disease and must be candidate for intralesional therapy with at least one injectable cutaneous, subcutaneous, or nodal melanoma lesion (≥ 10 mm in longest diameter) or with multiple injectable lesions that in aggregate have a longest diameter of ≥ 10 mm.
• Males or females, age ≥ 18 years
• ECOG Performance Status/WHO Performance Status ≤ 1
• Life expectancy of at least 24 months (see paragraph 6.3.1)
• Absolute neutrophil count > 1.5 x 109/L
• Hemoglobin > 9.0 g/dL
• Platelets > 100 x 109/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 ≤ 1.0 x ULN
• Documented negative test for HIV, HBV and HCV. For HBV serology, the determination of HBsAg, anti-HBsAg Ab and anti-HBcAg Ab is required. In patients with serology documenting previous exposure to HBV (e.g. anti-HBs Ab with no history of vaccination and/or anti-HBc Ab) negative serum HBV-DNA is also required.
• 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) (v4.03) Grade ≤ 1 unless otherwise specified above
• All female subjects must have negative pregnancy test results at the screening. Women of childbearing potential (WOCBP) must be using, from the screening to three months following the last study drug administration, highly effective contraception methods, as defined by the 'Recommendations for contraception and pregnancy testing in clinical trials' issued by the Head of Medicine Agencies' Clinical Trial Facilitation Group and which include, for instance, progesterone-only or combined (estrogen- and progesterone-containing) hormonal contraception associated with inhibition of ovulation, intrauterine devices, intrauterine hormone-releasing systems, bilateral tubal occlusion, vasectomized partner or sexual abstinence. Pregnancy test will be repeated at the end of treatment visit.
• Male patients with WOCBP partners must agree to use simultaneously two acceptable methods of contraception (i.e. spermicidal gel plus condom) from the screening to three months following the last study drug administration.
• Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study.
• Willingness and ability to comply with the scheduled visits, treatment plan, laboratory tests and other study procedures.

Criteri di esclusione: 

• Uveal melanoma and mucosal melanoma
• Evidence of distant 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 & T1), second primary melanoma in situ or any cancer curatively treated ≥ 5 years prior to study entry
• 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 stable angina pectoris.
• Inadequately controlled cardiac arrhythmias including atrial fibrillation
• Heart insufficiency (> Grade II, New York Heart Association (NYHA) criteria)
• LVEF ≤ 50% and/or abnormalities observed during baseline ECG and Echocardiogram investigations that are considered as clinically significant by the investigator.
• Uncontrolled hypertension
• Ischemic peripheral vascular disease (Grade IIb-IV)
• Severe diabetic retinopathy
• Active autoimmune disease
• History of organ allograft or stem cell transplantation
• Recovery from major trauma including surgery within 4 weeks prior to enrollment.
• Known history of allergy to IL2, TNF, or other human proteins/peptides/antibodies or any other constituent of the product.
• Breast feeding female
• Anti-tumor therapy (except small surgery) within 4 weeks before enrollment
• Previous in vivo exposure to monoclonal antibodies for biological therapy in the 6 weeks before enrollment
• Planned administration of growth factors or immunomodulatory agents within 7 days before enrollment
• 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.

Trattamento sperimentale: 

Arm 1: neoadjuvant (L19IL2 + L19TNF) + surgery

Trattamento di controllo: 

Arm 2: surgery alone

Obiettivi primari dello studio: 

Recurrence-free survival (RFS) rate [Time Frame: 1 year after randomization.]
Recurrence-free survival (RFS) rate in the L19IL2/L19TNF plus surgery treatment group (Arm 1) versus surgery alone (Arm 2), assessed at 1 year after randomization.

Obiettivi secondari dello studio: 

- Local recurrence-free survival (LRFS) rate [Time Frame: 1year, 2years, 3years after randomization and 1year after surgery]
- Distant metastasis-free survival (DMFS) rate [Time Frame: 1year, 2years, 3years after randomization and 1year after surgery]
- Recurrence-free survival (RFS) rate [Time Frame: 2years, 3years after randomization]
- Overall survival (OS) [Time Frame: 1year, 2years, 3years after randomization]
- Percentage of Participants With On-Study Adverse Events (AEs) and Serious Adverse Events (SAEs) [ Time Frame: up to 3 years]
- Percentage of Participants With Worst On-Study Hematological and Chemistry Abnormalities [ Time Frame: up to 36 months]
- Clinically Meaningful Changes in Vital Signs and Physical Examinations [Time Frame: up to 36 months]
- Changes in absolute counts and relative percentages of lymphocytic subpopulations over time [Time Frame: (1) At screening, (2) At Day of surgery: from Day 1 to Day 54, (3) After 3 months from surgery: Day 91 to Day 144]
subpopulations (e.g., Tregs, MDSCs etc.) over time (only for patients recruited in German centers).
- HAFA [ Time Frame: (1) At Day 1, (2) At Day 29, (3) After 3 months from surgery: Day 119 to Day 144]

Centri partecipanti

Nord Italia

Informazioni Generali

Protocollo

Numero di iscrizione a registro: NCT02938299

Data di inserimento: 08.04.2019

Promotore

Philogen S.p.A.

CRO

NA

Principal Investigator ITALIA

Fondazione IRCCS Istituto Nazionale dei Tumori, Milano

Riferimento: Dr. Mario Santinami

Telefono: 0223902647

Email: mario.santinami@istitutotumori.mi.it

Localita: Milano