- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03563729
Melanoma Metastasized to the Brain and Steroids (MEMBRAINS)
Efficacy of Immunotherapy in Melanoma Patients With Brain Metastases Treated With Steroids
Study Overview
Status
Conditions
Detailed Description
Cancer immunotherapy with checkpoint inhibitors (CPI) has demonstrated significant response rates, with clinical responses of exceptional duration observed in pivotal clinical trials for multiple types of solid tumors. Results from clinical trials demonstrate a considerable survival benefit of CPI over standard treatments, leading to registration of CPI for lung-, head and neck-, bladder-, renal cancer, lymphomas and metastatic melanoma (MM). To date, CPI appear to hold the key for longterm survival - at least for patients treated in clinical trials.
Patients enrolled in pivotal clinical trials for immunotherapy of MM are highly selected and does not include patients with brain metastases. Small phase II studies lend support to CPI to yield responses in melanoma that has metastasized to the brain. However, a large proportion of patients that develop brain metastasis will require continued systemic treatment with steroids to alleviate symptoms from the central nervous system (CNS). This group of patients are not offered treatment with CPI, as it is generally assumed that steroid treatment hamper their clinical efficacy. Thus, this group of patients face a large unmet need.
Due to the immune inhibiting effects, steroids are used to manage immune-related adverse events (irAEs) induced by CPI treatment. However, patients receiving steroids in this context are still able to achieve and maintain clinical benefit even after stopping treatment.
It is not known whether steroid treatment at the time of initiation of CPI treatment diminishes the treatment effect, as patients in need of steroid treatment are generally excluded from clinical trials.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Inge M Svane, Professor
- Phone Number: 004538683868
- Email: inge.marie.svane@regionh.dk
Study Contact Backup
- Name: Troels H Borch, PhD
- Phone Number: 004538683868
- Email: troels.holz.borch@regionh.dk
Study Locations
-
-
Hovedstaden
-
Herlev, Hovedstaden, Denmark, 2730
- Recruiting
- Herlev Universityhospital
-
Contact:
- Inge M Svane, Professor
- Phone Number: 004538683868
- Email: inge.marie.svane@regionh.dk
-
Contact:
- Troels H Borch, PhD
- Phone Number: 004538683868
- Email: troels.holz.borch@regionh.dk
-
Principal Investigator:
- Troels H Borch, PhD
-
Sub-Investigator:
- Marco Donia, PhD
-
-
Midt
-
Aarhus, Midt, Denmark, 8000
- Not yet recruiting
- Aarhus Universityhospital
-
Contact:
- Henrik Schmidt, PhD
-
Principal Investigator:
- Henrik Schmidt, PhD
-
-
Syd
-
Odense, Syd, Denmark, 5000
- Not yet recruiting
- Odense Universityhospital
-
Contact:
- Lars Bastholt
-
Principal Investigator:
- Lars Bastholt
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Histologically confirmed metastatic melanoma with radiologically verified brain metastasis
- Need for systemic steroid treatment (prednisolone > 10 mg daily; dexamethasone > 1.6 mg daily, hydrocortisone > 40 mg daily or equivalent) due to brain metastasis
- At least one measurable lesion according to RECIST version 1.1 guidelines
- Evaluable intracranial disease
- 18 years of age or older
- Performance status 0-2
- Able to undergo MRI with gadolinium contrast agent
- Adequate hematological and organ function
- No significant toxicity from previous cancer treatments (CTC<1)
- Women of childbearing potential: Negative serum pregnancy test and must use effective contraception. This applies from screening and until 6 months after treatment. Birth control pills, spiral, depot injection with gestagen, subdermal implantation, hormonal vaginal ring and transdermal depot patch are all considered effective contraceptives
- Men with female partner of childbearing potential must use effective contraception from screening and until 6 months after treatment. Effective contraceptives are as described above for the female partner. In addition documented vasectomy and sterility or double barrier contraception are considered effective contraceptives
- Signed statement of consent after receiving oral and written study information.
- Willingness to participate in the planned treatment and follow-up and capable of handling toxicities.
- For arm E specifically: Tumor cells must harbor BRAF mutation.
Exclusion Criteria:
- Another malignancy or concurrent malignancy unless disease-free for 3 years
- Ocular melanoma
- Neurological symptoms from brain metastases present at baseline despite steroid treatment, unless symptoms are related to prior surgery
- Known hypersensitivity to one of the active drugs or excipients
- Acute or chronic infections with HIV or hepatitis
- Any medical condition that will interfere with patient compliance or safety
- Prior treatment with anti-PD-1/PD-L1/PD-L2/CTLA-4 antibodies in the metastatic setting
- Prior systemic treatment with anti-PD-1/PD-L1/PD-L2/CTLA-4 antibodies in the adjuvant setting, unless completed more than 6 months before enrolment in this study
- Simultaneous treatment with other experimental drugs or other anti-cancer drugs
- Pregnant or breastfeeding females.
- For arm E specifically: Prior treatment with BRAF/MEK inhibitors.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: B: Pembrolizumab (Prednisolone >10 mg)
Intravenous infusion of pembrolizumab 2 mg/kg every third week for up to two years.
|
Alone
|
Experimental: C: Ipilimumab/nivolumab (Prednisolone 11-25 mg)
Intravenous infusion of ipilimumab 3 mg/kg and nivolumab 1 mg/kg four times every three weeks in the induction phase and nivolumab 480 mg every four weeks in the maintenance phase for up to two years.
|
In combination with nivolumab.
In combination with ipilimumab.
|
Experimental: D: Ipilimumab/nivolumab (Prednisolone >25 mg)
Intravenous infusion of ipilimumab 3 mg/kg and nivolumab 1 mg/kg four times every three weeks in the induction phase and nivolumab 480 mg every four weeks in the maintenance phase for up to two years.
|
In combination with nivolumab.
In combination with ipilimumab.
|
Experimental: E: BRAF/MEK -> ipi/nivo (prednisolone >10 mg)
Induction treatment with BRAF/MEK inhibitors (either the combination of encorafenib/binimetinib or dabrafenib/trametinib) orally for 28 days followed by intravenous infusion of ipilimumab 3 mg/kg and nivolumab 1 mg/kg four times every three weeks in the induction phase and nivolumab 480 mg every four weeks in the maintenance phase for up to two years.
|
In combination with nivolumab.
In combination with ipilimumab.
In combination with binimetinib
In combination with encorafenib
In combination with dabrafenib
In combination with trametinib
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
6 months progression-free survival rate
Time Frame: 6 months
|
Proportion of patients who did not progress or die within 6 months from commencing study treatment.
|
6 months
|
6 months overall survival rate
Time Frame: 6 months
|
Proportion of patients who did not die within 6 months from commencing study treatment.
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall progression-free survival
Time Frame: 4 years
|
Time from commencing study treatment to the date of progression or death.
|
4 years
|
Overall survival
Time Frame: 4 years
|
Time from commencing study treatment to the date of death from any cause.
|
4 years
|
Overall response rate
Time Frame: 4 years
|
Proportion of patients with an overall complete or partial response according to modified RECIST 1.1.
|
4 years
|
Extracranial response rate
Time Frame: 4 years
|
Proportion of patients with an overall complete or partial response in extracranial lesions according to modified RECIST 1.1.
|
4 years
|
Intracranial response rate
Time Frame: 4 years
|
Proportion of patients with an overall complete or partial response in intracranial lesions according to modified RECIST 1.1.
|
4 years
|
Intracranial clinical benefit rate
Time Frame: 4 years
|
Proportion of patients with an overall complete, partial response or stable disease > 6 months according to modified RECIST 1.1.
|
4 years
|
Blood and tissue biomarkers of response and progression
Time Frame: 5 years
|
Correlation of the baseline PD-L1 status, immune markers, genomics and other biomarkers in tumour tissue and blood with complete or partial response and at subsequent disease progressionanalyses of potential specific biomarkers predictive of response or progression.
|
5 years
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Troels H Borch, PhD, Center for Cancer Immune Therapy, Department of Hematology and Department of Oncology
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Neoplasms by Histologic Type
- Neoplasms
- Neuroectodermal Tumors
- Neoplasms, Germ Cell and Embryonal
- Neoplasms, Nerve Tissue
- Neuroendocrine Tumors
- Nevi and Melanomas
- Melanoma
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antineoplastic Agents
- Antineoplastic Agents, Immunological
- Protein Kinase Inhibitors
- Immune Checkpoint Inhibitors
- Nivolumab
- Pembrolizumab
- Trametinib
- Dabrafenib
- Ipilimumab
Other Study ID Numbers
- MM1807
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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