Ticilimumab (CP-675,206) in Treating Patients With Stage IIIC or Stage IV Melanoma

NCT ID: NCT00471887

Last Updated: 2020-10-26

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 32 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2007-01-31
• Study Completion Date: 2015-03-31

Brief Summary

RATIONALE: Monoclonal antibodies, such as ticilimumab (CP-675,206), can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them.

PURPOSE: This phase II trial is studying how well ticilimumab (CP-675,206) works in treating patients with stage IIIC or stage IV melanoma.

Detailed Description

OBJECTIVES:

Primary

• Determine the change in melanoma intratumoral infiltrates by cluster of differentiation 8 (CD8 positive) cytotoxic T lymphocytes in patients with stage IIIC or IV melanoma treated with ticilimumab (CP-675,206).

Secondary

• Determine the effects of this drug on intratumoral immune effector cells and tumor cells in these patients.
• Determine the effects of this drug on circulating immune effector cells in these patients.
• Determine the gene expression profile of immune effector cells and tumor cells in regressing and nonregressing tumors in these patients.
• Bank plasma from peripheral blood obtained from patients with regressing and nonregressing tumors for future exploratory analysis of proteomic profile.
• Assess additional evidence of antitumor activity of this drug, as measured by best on-study response rate, in these patients.
• Characterize the safety profile and tolerability of this drug in these patients.
• Obtain pharmacokinetic data to be used in a future meta-analysis of this drug's pharmacokinetics.
• Determine whether the CTLA4 genotype influences the safety, immune response, and/or efficacy of this drug in these patients.
• Determine the relationships between clinical response (i.e., efficacy or toxicity) and tumor and/or blood ex vivo analysis in patients treated with this drug.

OUTLINE: This is an open-label, randomized study.

Patients receive ticilimumab (CP-675,206) IV over 2 hours on day 1. Treatment repeats every 90 days for up to 8 courses in the absence of disease progression or unacceptable toxicity.

Patients undergo blood collection periodically during study for correlative pharmacokinetic (PK), pharmacogenetic, and pharmacogenomic analyses. Blood specimens are obtained for PK measurement at baseline and periodically during study treatment for analysis by enzyme-linked immunosorbent assay. Blood specimens are also evaluated by pharmacogenetic assessment of polymorphisms in CTLA4. Patients also undergo leukapheresis at baseline and at least once between days 30-60 for biomarker analysis of immune cell activation (i.e.,biomarkers CD45RO, CD45RA, HLA-DR, CCR5, CCR7, CD62L, CD69); Treg phenotype (i.e., CD4/CD25/GITR/intracellular FoxP3); and Treg function. In HLA-A2.1 positive patients, peripheral blood mononuclear cells (PBMC) are analyzed for antigen-specific immune reactivity by MART-1, gp100, and tyrosine MHC tetramer using enzyme-linked immunosorbent spot assay. Plasma obtained during leukapheresis is assessed for levels of circulating cytokines and chemokines. Some plasma is stored for future proteomic profile analysis.

Patients also undergo excisional or punch biopsy at baseline and between days 30-60 during course 1. Tumor tissue samples embedded in paraffin are analyzed by hematoxylin-eosin and immunohistochemical staining for several biomarkers, including biomarkers of immune cell response (i.e., cluster of differentiation 3 (CD3), cluster of differentiation 4 (CD4), and cluster of differentiation 8 (CD8) and biomarkers of melanoma (i.e., S-100, MART-1, and/or HMB45). Frozen tumor tissue samples are analyzed by gene chips and gene arrays for gene expression profile and by quantitative real-time polymerase chain reaction for FoxP3. Minced tumor tissue samples are analyzed by flow cytometry in nonadherent cells for HLA-DR (if tumor-infiltrating lymphocytes are available) and by Braf sequencing in adherent cells (if melanoma cells are available).

After completion of study therapy, patients are followed every 6 months.

PROJECTED ACCRUAL: A total of 21 patients will be accrued for this study.

Conditions

Melanoma (Skin)

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Treatment-Single Arm

See intervention descriptions

Group Type: EXPERIMENTAL

CP-675,206

Intervention Type: BIOLOGICAL

Patients will receive intravenous administration of CP-675,206 at a dose of 15mg/kg on Day 1 of an every 90 day cycles. For purposes of treatment visits and scheduling, each cycle is defined as a 90 day period. Patients may receive up to 8 dose (8 cycles) in a 24-month period until progression of disease or intolerable toxicity.

Interventions

CP-675,206

Patients will receive intravenous administration of CP-675,206 at a dose of 15mg/kg on Day 1 of an every 90 day cycles. For purposes of treatment visits and scheduling, each cycle is defined as a 90 day period. Patients may receive up to 8 dose (8 cycles) in a 24-month period until progression of disease or intolerable toxicity.

Intervention Type: BIOLOGICAL

Eligibility Criteria

Inclusion Criteria

• Histologically confirmed melanoma that is surgically incurable and either:

• Stage IIIc melanoma including locally relapsed, satellite, in-transit lesions or bulky draining lymph node metastasis.
• Stage IV melanoma (M1a, M1b, M1c) with accessible lesions for biopsy.
• At least 2 lesions amenable for outpatient biopsies
• No restriction based on prior treatments
• Disease progression after the last dose of prior therapy
• A minimum of one measurable lesion defined as:

• Meeting the criteria for measurable disease according to Response Evaluation Criteria in Solid Tumors
• Skin lesion(s) selected as non-completely biopsied target lesions that can be accurately measured and recorded by color photography with a ruler to document the size of the target lesion(s).
• Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
• Adequate bone marrow and hepatic function determined within 30 days prior to enrollment, defined as:

• Absolute neutrophil count > 1.0 x 10^9 cells/L
• Platelets > 90 x 10^9 /L
• Hemoglobin > 9 g/L
• Aspartate and alanine aminotransferases < 2.5 x upper limit of normal (ULN) (< 5 x ULN, if documented liver metastases are present)
• Total bilirubin < 2 x ULN (except patients with documented Gilbert's syndrome)
• Must be willing and able to provide writing informed consent.
• Must be willing and able to accept at least two tumor biopsies.
• Must be willing and able to accept at least two leukapheresis procedures.

Exclusion Criteria

• Received treatment for cancer, including immunotherapy, within one month prior to dosing.
• Previous participation in Pfizer study A3671009: A Phase 3, Open Label, Randomized Comparative Study of CP-675,206 and Either Dacarbazine or Temozolomide in Patients with Advanced Melanoma
• Eligible for enrollment to Pfizer A3671008: A Phase 2, Open Label, Single Arm Study to Evaluate the Efficacy, Safety, Tolerability and Pharmacokinetics of CP-675,206 in Patients with Advanced Refractory and/or Relapsed Melanoma
• History of significant evidence of risk for chronic inflammatory or autoimmune disease. Patents will be eligible if prior autoimmune disease of the hypophysis was treated locally or have resulted in fibrotic damage requiring thyroid hormone replacement. Vitiligo will not be a basis for exclusion.
• History of inflammatory bowel disease, celiac disease, or other chronic gastrointestinal conditions associated with diarrhea or bleeding, or current acute colitis or any origin
• Potential requirement for systemic corticosteroids or concurrent immunosuppressive drugs based on prior history or received systemic steroids within the last 4 weeks prior to enrollment
• Dementia or significantly altered mental status that would prohibit the understanding or rendering of informed consent and compliance with the requirements of this protocol
• Clinically active brain metastases. Radiological documentation of absence of brain metastases at screening is required for all patients
• Pregnancy or breast-feeding.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Pfizer

INDUSTRY

Sponsor Role: collaborator

Jonsson Comprehensive Cancer Center

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Antoni Ribas, MD

Role: PRINCIPAL_INVESTIGATOR

Jonsson Comprehensive Cancer Center

John A. Glaspy, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Jonsson Comprehensive Cancer Center

James S. Economou, MD

Role: PRINCIPAL_INVESTIGATOR

Jonsson Comprehensive Cancer Center

Locations

Jonsson Comprehensive Cancer Center at UCLA

Los Angeles, California, United States

Countries

United States

References

von Euw E, Chodon T, Attar N, Jalil J, Koya RC, Comin-Anduix B, Ribas A. CTLA4 blockade increases Th17 cells in patients with metastatic melanoma. J Transl Med. 2009 May 20;7:35. doi: 10.1186/1479-5876-7-35.

Reference Type: BACKGROUND

PMID: 19457253 (View on PubMed)

Huang RR, Jalil J, Economou JS, Chmielowski B, Koya RC, Mok S, Sazegar H, Seja E, Villanueva A, Gomez-Navarro J, Glaspy JA, Cochran AJ, Ribas A. CTLA4 blockade induces frequent tumor infiltration by activated lymphocytes regardless of clinical responses in humans. Clin Cancer Res. 2011 Jun 15;17(12):4101-9. doi: 10.1158/1078-0432.CCR-11-0407. Epub 2011 May 10.

Reference Type: DERIVED

PMID: 21558401 (View on PubMed)

Comin-Anduix B, Sazegar H, Chodon T, Matsunaga D, Jalil J, von Euw E, Escuin-Ordinas H, Balderas R, Chmielowski B, Gomez-Navarro J, Koya RC, Ribas A. Modulation of cell signaling networks after CTLA4 blockade in patients with metastatic melanoma. PLoS One. 2010 Sep 15;5(9):e12711. doi: 10.1371/journal.pone.0012711.

Reference Type: DERIVED

PMID: 20856802 (View on PubMed)

Other Identifiers

UCLA-0606093-01

Identifier Type: -

Identifier Source: secondary_id

PFIZER-UCLA-0606093-01

Identifier Type: -

Identifier Source: secondary_id

CDR0000543416

Identifier Type: OTHER

Identifier Source: secondary_id

11-0002360

Identifier Type: -

Identifier Source: org_study_id