Clinical Trials /

Dabrafenib, Trametinib and Hydroxychloroquine in Patients With Advanced BRAF Mutant Melanoma

NCT02257424

Description:

The primary purpose of this study is to determine the maximum tolerated dose (MTD) and preliminary safety of hydroxychloroquine (HCQ) when administered in conjunction with oral dabrafenib and trametinib (D+T) in patients with advanced BRAF mutant melanoma.

Related Conditions:
  • Melanoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Dabrafenib, Trametinib and Hydroxychloroquine in Patients With Advanced BRAF Mutant Melanoma
  • Official Title: BRAF, Autophagy and MEK Inhibition in Metastatic Melanoma: A Phase I/2 Trial of Dabrafenib, Trametinib and Hydroxychloroquine in Patients With Advanced BRAF Mutant Melanoma

Clinical Trial IDs

  • ORG STUDY ID: UPCC 02614
  • NCT ID: NCT02257424

Conditions

  • Advanced BRAF Mutant Melanoma

Interventions

DrugSynonymsArms
Trametinib 2 mg dailyPhase 1/2
hydroxychloroquine (HCQ)Phase 1/2
dabrafenib 150 mg orally twice a dayPhase 1/2

Purpose

The primary purpose of this study is to determine the maximum tolerated dose (MTD) and preliminary safety of hydroxychloroquine (HCQ) when administered in conjunction with oral dabrafenib and trametinib (D+T) in patients with advanced BRAF mutant melanoma.

Trial Arms

NameTypeDescriptionInterventions
Phase 1/2Other
  • Trametinib 2 mg daily
  • hydroxychloroquine (HCQ)
  • dabrafenib 150 mg orally twice a day

Eligibility Criteria

        Inclusion Criteria:

          -  Patients must be at least 18 years of age.

          -  Patients must have histologically confirmed diagnosis of Stage IV metastatic melanoma
             positive for BRAF V600E or V600K by a CLIA approved assay.

          -  Patients must have an ECOG performance status of 0 or 1.

          -  Patients must have adequate baseline organ function as determined by table 2.

        Table 2. Definitions for adequate baseline organ function

        Laboratory Values

        Hematologic:

          -  ANC (absolute neutrophil count) ≥1.2 × 109/L

          -  Hemoglobin ≥ 9 g/dL

          -  Platelet count ≥100 x 109/L

          -  PT/INR and PTT ≤ 1.3 x ULN (PT = prothrombin time; INR = international normalized
             ratio; PTT = partial thromboplastin time; ULN = upper limit of normal)

        Hepatic

          -  Total bilirubin ≤ 1.5 x ULN

          -  AST (aspartate aminotransferase) and ALT (alanine transaminase) ≤ 2.5 x ULN

        Renal -- Serum creatinine ≤ 1.5 mg/dL

        Cardiac

        -- Left Ventricular Ejection fraction (LVEF) ≥ LLN (lower limit of normal) by ECHO

        Subjects receiving anticoagulation treatment may be allowed to participate with INR
        established within the therapeutic range prior to randomization.

        If serum creatinine is > 1.5 mg/dL, calculate creatinine clearance using standard
        Cockcroft-Gault formula. Creatinine clearance must be ≥ 50 mL/min to be eligible.

        Except subjects with known Gilbert's syndrome. ECHO scans must be used throughout the study
        when indicated

          -  Patients must be able to provide written informed consent.

          -  Negative serum pregnancy test within 7 days prior to commencement of dosing in
             premenopausal women. Women of non-childbearing potential may be included without serum
             pregnancy test if they are either surgically sterile or have been postmenopausal for ≥
             1 year. Women must use an effective method of contraception from 14 days prior to
             randomization, throughout the treatment period, and for at least 6 months after the
             last dose of study treatment as directed by their physician. Effective methods of
             contraception are defined as those which result in a low failure rate (i.e., less than
             1% per year) when used consistently and correctly (for example implants, injectables,
             or intra-uterine devices). At the discretion of the investigator, acceptable methods
             of contraception may include total abstinence in cases where the lifestyle of the
             patient ensures compliance. (Periodic abstinence [e.g., calendar, ovulation,
             symptothermal, postovulation methods] and withdrawal are not acceptable methods of
             contraception.) Hormonal-based methods (e.g., oral contraceptives) are NOT permitted
             as contraception due to potential drug-drug interactions with dabrafenib.

          -  Patients with brain metastases treated with whole brain radiation that have been
             stable for 2 months are eligible; patients with brain metastases treated with gamma
             knife or surgery are allowed to participate after 3 weeks have elapsed since their
             procedure . Demonstration of brain stability by an imaging study after the procedure
             is required for gamma knife or CNS surgery patients. Subjects are excluded if they
             have leptomeningeal or metastases causing spinal cord compression that are symptomatic
             or untreated or not stable for ≥3 months (must be documented by imaging) or requiring
             corticosteroids. Subjects on a stable dose of corticosteroids >1 month or who have
             been off of corticosteroids for at least 1 week can be enrolled with approval of the
             medical monitor

          -  Any number and type of prior anticancer therapies are allowed except BRAF or MEK
             inhibitors .

          -  Patients must have discontinued active immunotherapy (IL-2, interferon, CTLA-4, etc.)
             or chemotherapy at least 4 weeks prior to entering the study and oral targeted therapy
             at least 2 weeks prior to entering the study. Patients must not receive any other
             investigational anticancer therapy during the period on study or the four weeks prior
             to entry.

          -  All prior anti-cancer treatment-related toxicities (except alopecia and laboratory
             values as listed in Eligibility Criteria #4) must be Grade 1 according to the Common
             Terminology Criteria for Adverse Events version 4 (CTCAE version 4.03, 2009) at the
             time of starting treatment. Patients that are asymptomatic on low dose maintenance
             hormone replacement delivered at a stable dose for prior toxicities are eligible.

          -  Patient much have measurable disease as defined by RECIST 1.1.

          -  Patients must be able to swallow and retain oral medication and must not have any
             clinically significant gastrointestinal abnormalities that may alter absorption such
             as malabsorption syndrome or major resection of the stomach or bowels.

        Exclusion Criteria:

          -  Patients with known serious concurrent infection or medical illness, including
             psychiatric disorders, which would jeopardize the ability of the patient to receive
             the treatment outlined in this protocol with reasonable safety.

          -  Patients who are pregnant or breast-feeding.

          -  Patients receiving concurrent therapy for their tumor (i.e. chemotherapeutics or
             investigational agents).

          -  Patients who are known to be experiencing an objective partial response to
             immunotherapy at the time of study enrollment

          -  History of malignancy other than disease under study within 3 years of study
             enrollment with exceptions below:

        Exception: Subjects with a history of completely resected non-melanoma skin cancer, or
        subjects with indolent second malignancies are eligible

          -  History of malignancy with confirmed activating RAS mutation at any time. Note:
             Prospective RAS testing is not required. However, if the results of previous RAS
             testing are known, they must be used in assessing eligibility.

          -  History of interstitial lung disease or chronic pneumonitis

          -  Due to risk of disease exacerbation patients with porphyria or psoriasis are
             ineligible unless the disease is well controlled and they are under the care of a
             specialist for the disorder who agrees to monitor the patient for exacerbations.

          -  Have a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs
             chemically related to study drug, or excipients or to dimethyl sulfoxide (DMSO).

          -  Patients receiving cytochrome P450 enzyme-inducing anticonvulsant drugs (EIADs) (i.e.
             phenytoin, carbamazepine, Phenobarbital, primidone or oxcarbazepine) within 4 weeks of
             the start of the study treatment

          -  Current use of a prohibited medication as described in Section 6.3.8 of the protocol
             for Potential for Drug-Drug Interaction: apply moisturizing creams frequently, topical
             keratolytics (e.g. urea 20-40 % cream, salicylic acid 6%, tazarotene 0.1% cream,
             fluorouracil 5% cream), clobetasol propionate 0.05% ointment for erythematous areas,
             topical lidocaine 2%, and / or systemic pain medication such as nonsteroidal
             anti-inflammatory drugs, codeine, and pregabalin for pain.

          -  Known Hepatitis B Virus (HBV), or Hepatitis C Virus (HCV) infection (subjects with
             laboratory evidence of cleared HBV and/or HCV will be permitted

          -  Patients with a previously documented retinal vein occlusion.

          -  History or evidence of increased cardiovascular risk including any of the following

          -  Left ventricular ejection fraction (LVEF) < institutional lower limit of normal.

          -  A QT interval corrected for heart rate using the Bazett's formula ≥ 480 msec;

          -  Current clinically significant uncontrolled arrhythmias. Exception: Subjects with
             controlled atrial fibrillation for >30 days prior to randomization are eligible.

          -  History of acute coronary syndromes (including myocardial infarction and unstable
             angina), coronary angioplasty, or stenting within 6 months prior to randomization.

          -  Current ≥ Class II congestive heart failure as defined by New York Heart Association

          -  Patients with intra-cardiac defibrillators

          -  Abnormal cardiac valve morphology (≥grade 2) documented by echocardiogram (subjects
             with grade 1 abnormalities [i.e., mild regurgitation/stenosis] can be entered on
             study). Subjects with moderate valvular thickening should not be entered on study.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Phase 1: To determine the maximum tolerated dose
Time Frame:5 weeks
Safety Issue:
Description:Phase 1: Maximum tolerated dose (MTD) = a) the dose producing Dose Limiting Toxicity (DLT) in 2/6 patients, or b) the dose level below the dose which produced DLT in ≥ 2/3 patients, or in ≥ 3/6 patients

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Abramson Cancer Center of the University of Pennsylvania

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