Study of Efficacy and Safety of Novel Spartalizumab Combinations in Patients With Previously Treated Unresectable or Metastatic Melanoma

NCT ID: NCT03484923

Last Updated: 2024-06-18

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 196 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-09-10
• Study Completion Date: 2022-12-30

Brief Summary

The primary purpose of this study is to evaluate the efficacy of novel spartalizumab (PDR001) combinations in previously treated unresectable or metastatic melanoma

Detailed Description

This study was a randomized, open-label, two-part, multi-center, open platform phase II study designed to evaluate the efficacy and safety of the anti-PD-1 antibody PDR001 in combination with novel agents for previously treated unresectable or metastatic melanoma. Additionally, a non-randomized single-arm was added based on interim analysis findings to assess the efficacy and safety of PDR001 in combination with LAG525 in subjects with previously treated unresectable or metastatic LAG-3 positive melanoma.

The study consisted of two parts: the selection part and the expansion part, which were applicable to both the randomized and non-randomized sections. In the randomized section, participants were randomized to one of four combination arms available for enrollment:

• Arm 1: LAG525 600 mg intravenously (i.v.) every 4 weeks (Q4W) and PDR001 400 mg i.v. Q4W.
• Arm 2: INC280 400 mg orally (p.o.) twice daily (BID) and PDR001 400 mg i.v. Q4W.
• Arm 3: ACZ885 300 mg subcutaneously (s.c.) every 4 weeks (Q4W) and PDR001 400 mg i.v. Q4W.
• Arm 4: LEE011 600 mg p.o. once daily (QD) on Days 1-21 of a 28-day cycle and PDR001 400 mg i.v. Q4W.

At each interim analysis, the following determinations were made: (1) which arm met the pre-specified efficacy criteria and expanded to the expansion part, (2) which arms continued enrollment in selection part (up to 45 subjects), and (3) which arms were discontinued due to futility, considering efficacy, safety, and biomarker data. The expansion phase included enrollment of subjects only in the combination arms that met the pre-specified criteria in selection part.

In the non-randomized section, a single combination arm was opened for enrollment in selection part:

• Arm 1A: LAG525 600 mg i.v. Q4W and PDR001 400 mg i.v. Q4W, assessed in a population selected based on the LAG-3 status of their tumor.

Arm 1A would be eligible for enrollment in expansion part only if it met the pre-specified criterion for this arm.

Participants received the study treatment corresponding to their assigned arm on a 28-day cycle basis until disease progression, as determined by local assessment using RECIST v1.1 criteria, or until certain events occurred, such as unacceptable toxicity, initiation of subsequent anti-cancer therapy, withdrawal of consent, investigator's decision, loss to follow-up, death, or termination of the study by the sponsor. Following discontinuation of the study treatment, all subjects were monitored for safety evaluations for up to 150 days after their last dose of the study treatment.

Conditions

Melanoma

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Arm 1: LAG525 + PDR001 (randomized section)

Participnats randomized to receive LAG525 at a dosage of 600 mg administered intravenously every 4 weeks, in combination with PDR001 at a dosage of 400 mg administered intravenously every 4 weeks

Group Type: EXPERIMENTAL

PDR001

Intervention Type: DRUG

400 mg of PDR001 administered every 4 weeks intravenously

LAG525

Intervention Type: DRUG

600 mg of LAG525 administered every 4 weeks intravenously

Arm 2: INC280+PDR001 (randomized section)

Participants randomized to receive INC280 orally at a dosage of 400 mg twice daily, in combination with PDR001 intravenously at a dosage of 400 mg every 4 weeks

Group Type: EXPERIMENTAL

PDR001

Intervention Type: DRUG

400 mg of PDR001 administered every 4 weeks intravenously

INC280

Intervention Type: DRUG

400 mg of INC280 administered twice daily orally

Arm 3: ACZ885 + PDR001 (randomized section)

Participants randomized to receive to receive ACZ885 at a dosage of 300 mg administered subcutaneously every 4 weeks, in combination with PDR001 at a dosage of 400 mg administered intravenously every 4 weeks

Group Type: EXPERIMENTAL

PDR001

Intervention Type: DRUG

400 mg of PDR001 administered every 4 weeks intravenously

ACZ885

Intervention Type: DRUG

200 mg of ACZ885 administered every 4 weeks subcutaneosuly

Arm 4: LEE011 + PDR001 (randomized section)

Participants randomized to receive LEE011 orally at a dosage of 600 mg once daily on Days 1-21 of a 28-day cycle, in combination with PDR001 intravenously at a dosage of 400 mg every 4 weeks

Group Type: EXPERIMENTAL

PDR001

Intervention Type: DRUG

400 mg of PDR001 administered every 4 weeks intravenously

LEE011

Intervention Type: DRUG

600 mg of LEE011 orally taken once daily on Days 1-21 of a 28-day cycle

Arm 1A: LAG525 + PDR001 (non-randomized section)

LAG-3 positive participants received LAG525 at a dosage of 600 mg administered intravenously every 4 weeks, in combination with PDR001 at a dosage of 400 mg administered intravenously every 4 weeks

Group Type: EXPERIMENTAL

PDR001

Intervention Type: DRUG

400 mg of PDR001 administered every 4 weeks intravenously

LAG525

Intervention Type: DRUG

600 mg of LAG525 administered every 4 weeks intravenously

Interventions

PDR001

400 mg of PDR001 administered every 4 weeks intravenously

Intervention Type: DRUG

LAG525

600 mg of LAG525 administered every 4 weeks intravenously

Intervention Type: DRUG

INC280

400 mg of INC280 administered twice daily orally

Intervention Type: DRUG

ACZ885

200 mg of ACZ885 administered every 4 weeks subcutaneosuly

Intervention Type: DRUG

LEE011

600 mg of LEE011 orally taken once daily on Days 1-21 of a 28-day cycle

Intervention Type: DRUG

Other Intervention Names

Spartalizumab; Ieramilimab; Capmatinib; Canakinumab; Ribociclib

Eligibility Criteria

Inclusion Criteria

• Histologically confirmed unresectable or metastatic stage IIIB/C/D or IV melanoma using AJCC edition 8.
• Previously treated for unresectable or metastatic melanoma:

• Subjects with V600BRAF wild-type disease had to have received prior systemic therapy for unresectable or metastatic melanoma with anti-PD-1/PD-L1. Additionally, subjects may have received anti-CTLA-4 as a single agent or in combination with anti-PD-1/PD-L1, irrespective of the sequence. No additional systemic treatment was allowed for advanced or metastatic melanoma.

A maximum of two prior lines of systemic therapies for unresectable or metastatic melanoma were allowed.

The last dose of prior therapy (anti-PD-1, anti-PD-L1, or anti-CTLA-4) had to have been received more than four weeks before randomization.

• Subjects with V600BRAF mutant disease had to have received prior systemic therapy for unresectable or metastatic melanoma with anti-PD-1/PD-L1 and V600BRAF inhibitor. Additionally, subjects may have received anti-CTLA-4 as a single agent or in combination with anti-PD-1/PD-L1, or MEK inhibitor (in combination with V600BRAF inhibitor or as a single agent), irrespective of the sequence. No additional systemic treatment was allowed for advanced or metastatic melanoma.
• A maximum of three prior lines of systemic therapies for unresectable or metastatic melanoma were allowed.
• The last dose of prior therapy had to have been received more than 4 weeks (for anti-PD-1, anti-PD-L1, or anti-CTLA-4) or more than 2 weeks (for V600BRAF or MEK inhibitor) prior to randomization.
• All subjects (with V600BRAF wild-type disease and with V600BRAF mutant disease) had to have documented disease progression as per RECIST v1.1 while on/after the last therapy received prior to study entry and while on/after treatment with anti-PD1/PD-L1. The last progression had to have occurred within 12 weeks prior to randomization in the study.

• ECOG performance status 0-2.
• At least one measurable lesion per RECIST v1.1.
• At least one lesion, suitable for sequential mandatory tumor biopsies (screening and on-treatment) in accordance with the biopsy guidelines specified in the protocol. The same lesion had to be biopsied sequentially.
• Screening tumor biopsy had to fulfill the tissue quality criteria outlined in the protocol, as assessed by a local pathologist.

• Histologically confirmed unresectable or metastatic stage IIIB/C/D or IV melanoma according to AJCC Edition 8.
• Previously treated for unresectable or metastatic melanoma:

• All subjects had to have received anti-PD-1 checkpoint inhibitor therapy (i.e., pembrolizumab or nivolumab) either as monotherapy or in combination with ipilimumab as the last systemic therapy prior to enrollment and had to have confirmed disease progression as per RECIST v1.1 (confirmed on a subsequent scan, which could be the scan performed during screening) while on or after this therapy prior to enrollment.
• Subjects with V600BRAF wild-type disease had to have received no more than 2 prior systemic therapies, including prior anti-PD-1/PD-L1 (as monotherapy or in combination with ipilimumab).
• Subjects with V600BRAF mutant disease had to have received no more than 3 prior systemic therapies, including anti-PD-1/PD-L1 (as monotherapy or in combination with ipilimumab) and V600BRAF inhibitor (as monotherapy or in combination with a MEK inhibitor).
• The last dose of anti-PD-1-based therapy had to have been received more than four weeks prior to the first dose of study treatment.
• The last documented disease progression had to have occurred within 12 weeks prior to the first dose of study treatment.
• No additional systemic treatment was allowed for advanced or metastatic melanoma (this included, for example, tumor-infiltrating lymphocyte therapy).
• ECOG performance status 0-1.
• At least one measurable lesion per RECIST v1.1.
• Subjects had to have a baseline tumor sample that was positive for LAG-3 per central assessment.

Exclusion Criteria

• Subjects with uveal or mucosal melanoma.
• Presence of clinically active or unstable brain metastasis at the time of screening.
• Use of any live vaccines against infectious diseases within 3 months before randomization/enrollment.
• Active infection requiring systemic antibiotic therapy at the time of randomization/enrollment.
• Subjects with a condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of randomization/enrollment. Inhaled or topical steroids, and adrenal replacement steroid doses >10 mg daily prednisone equivalent, were permitted in the absence of active autoimmune disease.
• Active, known or suspected autoimmune disease or a documented history of autoimmune disease.
• Prior allogenic bone marrow or solid organ transplant.
• History of known hypersensitivity to any of the investigational drugs used in this study.
• Malignant disease, other than that being treated in this study.
• Prior systemic therapy for unresectable or metastatic melanoma with any investigational agent or with any other agent except anti-PD-1/PD-L1 and anti-CTLA-4 (and V600BRAF and MEK inhibitors if the subject has V600BRAF mutant disease). Prior neoadjuvant and/or adjuvant therapy for melanoma completed less than 6 months before the start of the study treatment.
• Medical history or current diagnosis of myocarditis.
• Cardiac Troponin T (or Troponin I) level > 2 x ULN at screening.

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

Sponsors

Novartis Pharmaceuticals

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Novartis Pharmaceuticals

Role: STUDY_DIRECTOR

Novartis Pharmaceuticals

Locations

The Angeles Clinic and Research Institute

Los Angeles, California, United States

University of California Los Angeles

Los Angeles, California, United States

UCSF Medical Center .

San Francisco, California, United States

Massachusetts General Hospital Massachusetts Gen. Hospital CC

Boston, Massachusetts, United States

NYU Laura and Isaac Perlmutter Cancer Center Perlmutter Cancer Center

New York, New York, United States

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania, United States

Novartis Investigative Site

North Sydney, New South Wales, Australia

Novartis Investigative Site

Westmead, New South Wales, Australia

Novartis Investigative Site

Toronto, Ontario, Canada

Novartis Investigative Site

Montreal, Quebec, Canada

Novartis Investigative Site

Marseille, , France

Novartis Investigative Site

Paris, , France

Novartis Investigative Site

Villejuif, , France

Novartis Investigative Site

Dresden, , Germany

Novartis Investigative Site

Essen, , Germany

Novartis Investigative Site

Hamburg, , Germany

Novartis Investigative Site

Kiel, , Germany

Novartis Investigative Site

München, , Germany

Novartis Investigative Site

Bergamo, BG, Italy

Novartis Investigative Site

Milan, MI, Italy

Novartis Investigative Site

Napoli, , Italy

Novartis Investigative Site

Amsterdam, , Netherlands

Novartis Investigative Site

Rotterdam, , Netherlands

Novartis Investigative Site

Barcelona, Catalonia, Spain

Novartis Investigative Site

L'Hospitalet de Llobregat, Catalonia, Spain

Novartis Investigative Site

Madrid, , Spain

Novartis Investigative Site

Zurich, , Switzerland

Novartis Investigative Site

Northwood, Middlesex, United Kingdom

Novartis Investigative Site

London, , United Kingdom

Novartis Investigative Site

Manchester, , United Kingdom

Countries

United States; Australia; Canada; France; Germany; Italy; Netherlands; Spain; Switzerland; United Kingdom

Provided Documents

Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

https://www.novctrd.com/ctrdweb/patientsummary/patientsummaries?patientSummaryId=1823

Patient Lay Trial Summary

Other Identifiers

2018-000610-38

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

CPDR001J2201

Identifier Type: -

Identifier Source: org_study_id