Description:
Currently, the first line treatment options for surgically unresectable metastatic melanoma
includes anti-PD1 agents such as nivolumab and pembrolizumab. In western countries, UV
associated cutaneous melanoma has 30-40% response rates to immune checkpoint inhibitors
(ICIs). However, response rates are lower in Asians. The reason for this discrepancy is
attributed to the difference in subtypes since most of the Asian patients are mostly
subgrouped as acral lentiginous or mucosal types that are unrelated to UV exposures. Thus,
there is an unmet need to bolster the effect of ICIs in these patients.
The combination of radiotherapy with ICIs have been demonstrated by several pre-clinical
studies. High dose radiation has shown to promote STING pathway which activates dendritic
cells needed in priming phase. In addition, low dose radiation may activate macrophage
differentiation. These mechanisms in turn may enhance responses to immunotherapy.
In this study, the investigators aim to evaluate the efficacy and tolerability of anti-PD-1
blockade in combination with radiotherapy in surgically unresectable, treatment naive
metastatic melanoma.
Title
- Brief Title: The Combination of Anti-PD-1 With Radiotherapy in Previously Untreated Metastatic Melanoma
- Official Title: The Combination of Anti-PD-1 With Radiotherapy in Previously Untreated Metastatic Melanoma
Clinical Trial IDs
- ORG STUDY ID:
4-2019-0461
- NCT ID:
NCT04017897
Conditions
Interventions
Drug | Synonyms | Arms |
---|
The combination of radiotherapy with anti-PD1 (pembrolizumab or nivolumab) | | Experimental |
Purpose
Currently, the first line treatment options for surgically unresectable metastatic melanoma
includes anti-PD1 agents such as nivolumab and pembrolizumab. In western countries, UV
associated cutaneous melanoma has 30-40% response rates to immune checkpoint inhibitors
(ICIs). However, response rates are lower in Asians. The reason for this discrepancy is
attributed to the difference in subtypes since most of the Asian patients are mostly
subgrouped as acral lentiginous or mucosal types that are unrelated to UV exposures. Thus,
there is an unmet need to bolster the effect of ICIs in these patients.
The combination of radiotherapy with ICIs have been demonstrated by several pre-clinical
studies. High dose radiation has shown to promote STING pathway which activates dendritic
cells needed in priming phase. In addition, low dose radiation may activate macrophage
differentiation. These mechanisms in turn may enhance responses to immunotherapy.
In this study, the investigators aim to evaluate the efficacy and tolerability of anti-PD-1
blockade in combination with radiotherapy in surgically unresectable, treatment naive
metastatic melanoma.
Trial Arms
Name | Type | Description | Interventions |
---|
Experimental | Experimental | | - The combination of radiotherapy with anti-PD1 (pembrolizumab or nivolumab)
|
Eligibility Criteria
Inclusion Criteria:
- 1. Subject has provided informed consent prior to initiation of any study-specific
activities/procedures
- 2. Male or female age > 20 years at the time of informed consent
- 3. Histologically confirmed diagnosis of unresectable stage III or IV melanoma as per
AJCC staging system 8th edition
- 4. Subject with no prior systemic treatment
- 5. Eastern Cooperative Oncology Group (ECOG) Performance Status < 1
- 6. Screening labs performed within 7 days of randomization demonstrating adequate
hematologic, coagulation, liver, and kidney functions
- 7. Indications for radiotherapy
- 8. BRAF status must be checked, but patient is eligible regardless of BRAF mutations
(BRAF V600 wild type or BRAF V600 mutation positive are both eligible)
Exclusion Criteria:
- 1. Ocular melanoma
- 2. Active brain metastasis (stable after 1 month of radiotherapy, gamma knife surgery
or surgery)
- 3. Requires palliative radiotherapy
- 4. Previous treatment with chemotherapy, a CTLA-4 or PD-1/PD-L1 antagonist agent,
including treatment in adjuvant setting
- 5. Autoimmune disease requiring chronic treatment with systemic corticosteroids or any
other immunosuppressive agents 7 days prior to inclusion. (physiologic dose of
prednisolone 10mg or equivalent are accepted)
- 6. Concurrent medical disease which would significantly limit full compliance with the
study such as, but not limited to the following: heart failure (III, IV as per NYHA
classification), renal insufficiency, active infection (requires negative gest for
clinically suspected HIV, hepatitis B virus, hepatitis C virus).
If positive results are not indicative of true active or chronic infection, the subject may
enter the study after discussion and agreement between the investigator and medical
director.
- 7. Has known malignancy that is progressing and requires active treatment
- 8. Has known psychiatric or substance abuse disorders that would interfere with
cooperation requirements of the trial
- 9. Lack of availability for clinical follow-up assessments
Maximum Eligible Age: | 80 Years |
Minimum Eligible Age: | 20 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall response rate (ORR) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | assessment of efficacy of anti-PD1 with radiotherapy in terms of overall response rate (ORR) |
Secondary Outcome Measures
Measure: | treatment-related adverse events (TRAE) |
Time Frame: | 3 years |
Safety Issue: | |
Description: | |
Measure: | rate of progression-free survival (PFS) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | |
Measure: | overall survival (OS) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | |
Measure: | disease control rate (DCR) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Yonsei University |
Last Updated
July 12, 2019