Clinical Trials /

Trial With BNT111 and Cemiplimab in Combination or as Single Agents in Patients With Anti-PD1-refractory/Relapsed, Unresectable Stage III or IV Melanoma

NCT04526899

Description:

This is an open-label, randomized, multi-site, Phase II, interventional trial designed to evaluate the efficacy, tolerability, and safety of BNT111 + cemiplimab in anti-PD1-refractory/relapsed patients with unresectable Stage III or IV melanoma. The contributions of BNT111 and cemiplimab will be delineated in single agent calibrator arms. Patients in single agent calibrator arms, who experience disease progression under single agent treatment, may be offered addition of the other compound to the ongoing treatment after re-consent.

Related Conditions:
  • Cutaneous Melanoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Trial With BNT111 and Cemiplimab in Combination or as Single Agents in Patients With Anti-PD1-refractory/Relapsed, Unresectable Stage III or IV Melanoma
  • Official Title: Open-label, Randomized Phase II Trial With BNT111 and Cemiplimab in Combination or as Single Agents in Patients With Anti-PD1-refractory/Relapsed, Unresectable Stage III or IV Melanoma

Clinical Trial IDs

  • ORG STUDY ID: BNT111-01
  • SECONDARY ID: 2020-002195-12
  • NCT ID: NCT04526899

Conditions

  • Melanoma Stage III
  • Melanoma Stage IV
  • Unresectable Melanoma

Interventions

DrugSynonymsArms
BNT111BNT111 + cemiplimab
CemiplimabBNT111 + cemiplimab

Purpose

This is an open-label, randomized, multi-site, Phase II, interventional trial designed to evaluate the efficacy, tolerability, and safety of BNT111 + cemiplimab in anti-PD1-refractory/relapsed patients with unresectable Stage III or IV melanoma. The contributions of BNT111 and cemiplimab will be delineated in single agent calibrator arms. Patients in single agent calibrator arms, who experience disease progression under single agent treatment, may be offered addition of the other compound to the ongoing treatment after re-consent.

Trial Arms

NameTypeDescriptionInterventions
BNT111 + cemiplimabExperimental
  • BNT111
  • Cemiplimab
BNT111 monotherapyExperimental
  • BNT111
Cemiplimab monotherapyExperimental
  • Cemiplimab

Eligibility Criteria

        Inclusion Criteria:

          -  Patients must sign the written informed consent form (ICF) before any screening
             procedure.

          -  Patients must be aged ≥18 years on the date of signing the informed consent.

          -  Patients must be willing and able to comply with scheduled visits, treatment schedule,
             laboratory tests, and other requirements of the trial.

          -  Patients must have histologically confirmed unresectable Stage III or IV (metastatic)
             cutaneous melanoma and measurable disease by RECIST 1.1.

          -  Patients must have confirmed disease progression on/after approved anti-PD1 regimen
             for melanoma as defined by RECIST 1.1 and further defined according to the Society for
             ImmunoTherapy of Cancer (SITC) Immunotherapy Resistance Taskforce:

               1. Previous exposure to approved anti-PD1 containing regimen for at least 12
                  consecutive weeks and

               2. Radiological progression to be confirmed by 2 scans 4-12 weeks apart. If
                  progression is accompanied by new symptoms, or deterioration of performance
                  status not attributed to toxicity, one scan is sufficient.

               3. Progression must be while on treatment with approved anti-PD1 regimen for
                  melanoma or within 6 months of discontinuing anti-PD1 treatment, and regardless
                  of any intervening therapy.

          -  Patients should have received pembrolizumab or nivolumab (with/without ipilimumab).

          -  Patients should have received at least 1 but no more than 5 lines of prior therapy for
             advanced disease.

          -  Patients must be able to tolerate additional anti-PD1 therapy (i.e., did not
             permanently discontinue anti-PD1 therapy due to toxicity).

          -  Patients must have known BRAF mutation status.

          -  Patients with BRAF V600-positive tumor(s) should have received prior treatment with a
             BRAF inhibitor (alone or in combination with a MEK inhibitor) in addition to treatment
             with pembrolizumab or nivolumab with or without ipilimumab Note: Patients with BRAF
             V600-positive tumors with no clinically significant tumor-related symptoms or evidence
             of rapidly progressive disease are not required to be treated with a BRAF inhibitor
             (alone or in combination with a MEK inhibitor) based on investigator's decision.

          -  Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status
             (PS) ≤1.

          -  Adequate bone marrow function as defined in the protocol.

          -  Patients must have serum lactate dehydrogenase (LDH) ≤ ULN.

          -  Patient should have adequate hepatic function, as defined in the protocol.

          -  Patient should have adequate kidney function, assessed by the estimated glomerular
             filtration rate (eGFR) ≥30 mL/min using the CKD-EPI equation.

          -  Patient should be stable with adequate coagulation, as defined in the protocol.

          -  Patients must provide the following biopsy samples:

               1. All patients: must provide a tumor tissue sample (formalin-fixed
                  paraffin-embedded [FFPE] blocks/slides) from fresh biopsy collected before Cycle
                  1 Day 1, preferably derived from advanced disease stage, or archival tissue (not
                  older than 3 years).

               2. Patients at selected trial sites: must be amenable to a pre-treatment and
                  on-treatment biopsy and must provide a mandatory biopsy which contains tumor
                  tissue and is taken after failure/stop of last prior treatment and an
                  on-treatment biopsy.

          -  Women of childbearing potential (WOCBP) must have a negative serum (beta-human
             chorionic gonadotropin [beta-hCG]) at screening. Patients that are postmenopausal or
             permanently sterilized can be considered as not having reproductive potential. Female
             patients of reproductive potential must agree to use highly effective contraception
             during and for 6 months after the last trial drug administration.

          -  WOCBP must agree not to donate eggs (ova, oocytes) for the purposes of assisted
             reproduction during trial starting at screening, during the trial and for 6 months
             after receiving the last trial treatment.

          -  A man who is sexually active with a WOCBP and has not had a vasectomy must agree to
             use a barrier method of birth control, e.g., either condom with spermicidal
             foam/gel/film/cream/suppository or partner with occlusive cap (diaphragm or
             cervical/vault caps) with spermicidal foam/gel/film/cream/suppository, and all men
             must also not donate sperm during the trial and for 6 months after receiving the last
             trial treatment. For a definition of adequate contraception.

        Exclusion Criteria:

          -  Patients must not be pregnant or breastfeeding.

          -  Patients must not have history of uveal, acral, or mucosal melanoma.

          -  Patients must have no ongoing or recent evidence (within the last 5 years) of
             significant autoimmune disease that required treatment with systemic immunosuppressive
             treatments which may suggest risk for immune-related adverse events (irAEs).

          -  Patients must have no known primary immunodeficiencies, either cellular (e.g.,
             DiGeorge syndrome, T cell-negative severe combined immunodeficiency [SCID]) or
             combined T and B cell immunodeficiencies (e.g., T and -B negative SCID, Wiskott
             Aldrich syndrome, ataxia telangiectasia, common variable immunodeficiency).

          -  Patients with uncontrolled type 1 diabetes mellitus or with uncontrolled adrenal
             insufficiency are not eligible.

          -  Patients must have no uncontrolled infection with human immunodeficiency virus,
             hepatitis B or hepatitis C infection; or diagnosis of immunodeficiency that is related
             to, or results in chronic infection. Mild cancer-related immunodeficiency (such as
             immunodeficiency treated with gamma globulin and without chronic or recurrent
             infection) is allowed.

               1. Patients with known HIV who have controlled infection (undetectable viral load
                  and CD4 count above 350 either spontaneously or on a stable antiviral regimen)
                  are permitted. For patients with controlled HIV infection, monitoring will be
                  performed per local standards.

               2. Patients with known hepatitis B (HepBsAg+) who have controlled infection (serum
                  hepatitis B virus DNA PCR that is below the limit of detection AND receiving
                  anti-viral therapy for hepatitis B) are permitted. Patients with controlled
                  infections must undergo periodic monitoring of HBV DNA per local standards.
                  Patients must remain on anti-viral therapy for at least 6 months beyond the last
                  dose of trial treatment.

               3. Patients who are known hepatitis C virus antibody positive (HCV Ab+) who have
                  controlled infection (undetectable HCV RNA by PCR either spontaneously or in
                  response to a successful prior course of anti-HCV therapy) are permitted.

               4. Patients with HIV or hepatitis must have their disease reviewed by the specialist
                  (e.g., infectious disease specialist or hepatologist) managing this disease prior
                  to commencing and throughout the duration of their participation in the trial.

        Prior/concomitant therapy:

          -  Systemic immune suppression:

               1. use of chronic systemic steroid medication (up to 5 mg/day prednisolone
                  equivalent is allowed); patients using physiological replacement doses of
                  prednisone for adrenal or pituitary insufficiency are eligible,

               2. other clinically relevant systemic immune suppression.

          -  Treatment with other anti-cancer therapy including chemotherapy, radiotherapy,
             investigational, or biological cancer therapy within 3 weeks prior to the first dose
             of trial treatment (6 weeks for nitrosureas). Adjuvant hormonotherapy used for breast
             cancer in long term remission is allowed.

        Other comorbidities:

          -  Current evidence of Common Terminology Criteria for Adverse Events (CTCAE version 5.0)
             Grade >1 toxicity before the start of treatment, except for hair loss, hearing loss,
             or laboratory abnormalities not considered clinical significant per investigator's
             discretion, and those Grade 2 toxicities listed as permitted in other eligibility
             criteria. Patients with Grade 2 neuropathy may be eligible at investigator's
             discretion.

          -  Patients who have a local infection (e.g., cellulitis, abscess) or systemic infection
             (e. g., pneumonia, septicemia) which requires systemic antibiotic treatment within 2
             weeks prior to the first dose of trial treatment.

          -  Patients who have had a splenectomy.

          -  Patients who have had major surgery (e.g., requiring general anesthesia) within 4
             weeks before screening, or have not fully recovered from surgery, or have a surgery
             planned during the time of trial participation.

          -  Current evidence of new or growing brain or spinal metastases during screening.
             Patients with leptomeningeal disease are excluded. Patients with known brain or spinal
             metastases may be eligible if they:

               1. had radiotherapy or another appropriate therapy for the brain or spinal bone
                  metastases,

               2. have no neurological symptoms that can be attributed to the current brain
                  lesions,

               3. have stable brain or spinal disease on the CT or MRI scan within 4 weeks before
                  signing the informed consent (confirmed by stable lesions on two scans at least 4
                  weeks apart),

               4. do not require steroid therapy within 14 days before the first dose of trial
                  treatment,

               5. spinal bone metastases are allowed, unless imminent fracture or cord compression
                  is anticipated.

          -  History or current evidence of significant cardiovascular disease including, but not
             limited to:

               1. angina pectoris requiring anti-anginal medication, uncontrolled cardiac
                  arrhythmia(s), severe conduction abnormality, or clinically significant valvular
                  disease,

               2. QTc (F) prolongation >480 ms,

               3. arterial thrombosis or pulmonary embolism within ≤6 months before the start of
                  treatment,

               4. myocardial infarction within ≤6 months before the start of treatment,

               5. pericarditis (any CTCAE grade), pericardial effusion (CTCAE Grade ≥2),
                  non-malignant pleural effusion (CTCAE Grade ≥2) or malignant pleural effusion
                  (CTCAE Grade ≥3) within ≤6 months before the start of treatment,

               6. Grade ≥3 symptomatic congestive heart failure (CHF) or New York Heart Association
                  (NYHA) criteria Class ≥II within ≤6 months before the start of treatment.

          -  Patients who have received a live vaccine within 28 days of planned start of trial
             therapy.

        Other exclusions:

          -  Known hypersensitivity to the active substances or to any of the excipients.

          -  Presence of a severe concurrent illness or other condition (e.g., psychological,
             family, sociological, or geographical circumstances) that does not permit adequate
             follow-up and compliance with the protocol.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Objective response rate (ORR) - Arm: BNT111 + cemiplimab
Time Frame:up to 24 months
Safety Issue:
Description:ORR defined as the proportion of patients in whom a complete response (CR) or partial response (PR) according to Response Criteria in Solid Tumors (RECIST 1.1) is observed as best overall response by blinded independent central review (BICR).

Secondary Outcome Measures

Measure:Objective response rate - Arm: BNT111 monotherapy and Arm: Cemiplimab monotherapy
Time Frame:up to 24 months
Safety Issue:
Description:ORR defined as the proportion of patients in whom a CR or PR according to RECIST 1.1 is observed as best overall response by BICR.
Measure:Duration of response (DOR) according to RECIST 1.1
Time Frame:up to 24 months
Safety Issue:
Description:DOR defined as the time from first objective response (CR or PR) to first occurrence of objective tumor progression (progressive disease, PD) by BICR or death from any cause (whichever occurs first).
Measure:Disease control rate (DCR) according to RECIST 1.1
Time Frame:up to 24 months
Safety Issue:
Description:DCR defined as the proportion of patients in whom a CR, PR or stable disease (SD; assessed at least 6 weeks after first dose) is observed as best overall response by BICR.
Measure:Time to response (TTR) according to RECIST 1.1
Time Frame:up to 24 months
Safety Issue:
Description:TTR defined as the time from randomization to the first objective tumor response (CR or PR) by BICR.
Measure:Progression-free survival (PFS) according to RECIST 1.1
Time Frame:up to 24 months
Safety Issue:
Description:PFS defined as the time from randomization to first objective tumor progression (PD) or death from any cause (whichever occurs first) by BICR.
Measure:ORR according to RECIST 1.1 as assessed by the investigator
Time Frame:up to 24 months
Safety Issue:
Description:
Measure:DOR according to RECIST 1.1 as assessed by the investigator
Time Frame:up to 24 months
Safety Issue:
Description:
Measure:DCR according to RECIST 1.1 as assessed by the investigator
Time Frame:up to 24 months
Safety Issue:
Description:
Measure:TTR according to RECIST 1.1 as assessed by the investigator
Time Frame:up to 24 months
Safety Issue:
Description:
Measure:PFS according to RECIST 1.1 as assessed by the investigator
Time Frame:up to 24 months
Safety Issue:
Description:
Measure:Overall survival (OS) - Arm: BNT111 + cemiplimab
Time Frame:up to 48 months
Safety Issue:
Description:OS defined as the time from randomization to death from any cause.
Measure:Occurrence of treatment-emergent adverse events (TEAE) within a patient including Grade ≥3, serious and/or fatal TEAE by relationship
Time Frame:up to 27 months
Safety Issue:
Description:
Measure:Occurrence of immune-related adverse events (irAE)
Time Frame:up to 27 months
Safety Issue:
Description:
Measure:Occurrence of dose reduction and discontinuation of trial treatment within a patient due to TEAE
Time Frame:up to 27 months
Safety Issue:
Description:
Measure:Incidence of abnormal laboratory parameters (hematology) within a patient
Time Frame:up to 25 months
Safety Issue:
Description:Blood samples will be collected for the assessment of hematology parameters.
Measure:Incidence of abnormal laboratory parameters (clinical chemistry) within a patient
Time Frame:up to 25 months
Safety Issue:
Description:Blood samples will be collected for the assessment of clinical chemistry parameters.
Measure:Incidence of abnormal laboratory parameters (coagulation factors) within a patient
Time Frame:up to 25 months
Safety Issue:
Description:Blood samples will be collected for the assessment of coagulation factors.
Measure:Incidence of abnormal laboratory parameters (endocrine tests) within a patient
Time Frame:up to 25 months
Safety Issue:
Description:Blood samples will be collected for the assessment of endocrine tests.
Measure:Incidence of abnormal laboratory parameters (serology) within a patient
Time Frame:up to 25 months
Safety Issue:
Description:Blood samples will be collected for the assessment of serology parameters.
Measure:Incidence of abnormal laboratory parameters (urinalysis) within a patient
Time Frame:up to 25 months
Safety Issue:
Description:Urine samples will be collected for the assessment of urinalysis parameters.
Measure:Incidence of abnormal vital signs parameters (body temperature) within a patient
Time Frame:up to 25 months
Safety Issue:
Description:Body temperature (in °C) will be assessed.
Measure:Incidence of abnormal vital signs parameters (pulse rate) within a patient
Time Frame:up to 25 months
Safety Issue:
Description:Pulse rate (in beats per minute [bpm]) will be assessed.
Measure:Incidence of abnormal vital signs parameters (blood pressure) within a patient
Time Frame:up to 25 months
Safety Issue:
Description:Blood pressure (systolic/diastolic, in mmHg) will be assessed.
Measure:Incidence of abnormal vital signs parameters (respiratory rate) within a patient
Time Frame:up to 25 months
Safety Issue:
Description:Respiratory rate will be assessed.
Measure:Patient-reported outcome (PRO) Quality of Life Questionnaire Core 30 (QLQ-C30) - Arm: BNT111 + cemiplimab
Time Frame:up to 25 months
Safety Issue:
Description:PRO scores derived from the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire scales as difference from baseline.
Measure:PRO Patient Global Impression of Severity (PGI-S) - Arm: BNT111 + cemiplimab
Time Frame:up to 24 months
Safety Issue:
Description:PRO scores derived from PGIS scales as difference from baseline.
Measure:PRO Patient Global Impression of Change (PGIC) - Arm: BNT111 + cemiplimab
Time Frame:up to 24 months
Safety Issue:
Description:PRO scores derived from PGIC scales as difference from baseline.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:BioNTech SE

Trial Keywords

  • Cancer vaccine
  • Melanoma
  • Checkpoint inhibitor
  • Libtayo®
  • BNT111
  • Cemiplimab
  • RNA vaccine

Last Updated

June 8, 2021