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NCT03567889PHASE3Recruiting

Efficacy of Daromun Neoadjuvant Intratumoral Treatment in Clinical Stage IIIB/C/D Melanoma Patients

Philogen S.p.A.

Start Date

9/20/2018

Completion Date

12/1/2031

Summary

The trial aims to evaluate the efficacy of Daromun neoadjuvant treatment followed by surgery and adjuvant therapy to improve in a statistically significant manner the recurrence-free survival (RFS) of Stage IIIB/C/D melanoma patients with respect to the standard of care (surgery and adjuvant therapy).

Detailed Description

The present study is an open-label, randomized, controlled, two-arm multi-center study of the efficacy of Daromun neoadjuvant intratumoral treatment followed by surgery and adjuvant therapy versus surgery and adjuvant therapy in clinical stage III B/C/D melanoma patients. 186 patients will be randomized in a 1:1 ratio to receive Daromun treatment followed by surgery and adjuvant therapy (Arm 1) or surgery and adjuvant therapy (Arm 2). In both arms, follow-up for assessing recurrence-free survival will be performed up to five years after randomization. Survival information will also be collected in the following year (up to six years in total after randomization). This is an open-label study, so there is no blinding. Patients who successfully complete the screening evaluations and are eligible for participation in the study will be enrolled and randomly assigned (1:1) to two parallel treatment arms: Daromun plus surgery and adjuvant therapy (Arm 1) or surgery and adjuvant therapy (Arm 2). To ensure a balance across treatment groups, stratified randomization with permuted block will be used and separate randomization list for each subgroup (stratum) will be produced. Patients will be stratified on the basis of the following prognostic factors: * Stage of disease (3 levels): Stage IIIB vs. Stage IIIC vs Stage IIID * Planned post-surgical adjuvant therapy (2 levels): anti-PD-1 and other adjuvant therapies. The primary objective of the study is to demonstrate that a neoadjuvant Daromun treatment followed by surgery and adjuvant therapy improves in a statistically significant manner the recurrence-free survival (RFS) of Stage IIIB/C/D melanoma patients with respect to the standard of care (surgery and adjuvant therapy). Primary endpoint of the study is RFS in a time-to-event analysis in the Daromun plus surgery and adjuvant therapy treatment group (Arm 1) versus the surgery plus adjuvant therapy control group (Arm 2). Analysis will be based on the "Intention To Treat" population. The key secondary objective of the study is to demonstrate that a neoadjuvant Daromun treatment followed by surgery and adjuvant therapy improves in a statistically significant manner the overall survival (OS) of patients with resectable Stage IIIB/C/D melanoma patients with respect to the standard of care (surgery and adjuvant therapy). For patients enrolled in both arms, local approved post-surgery adjuvant therapies (as part of the standard of care) are allowed and decided at the investigator's discretion. These include high-dose interferon- α2b, anti-CTLA-4 antibodies (e.g. Ipilimumab), anti-PD1 antibodies (e.g. Nivolumab, Pembrolizumab), targeted therapies (e.g. Dabrafenib + Trametinib), or other new local approved treatments.

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion Criteria: 1. Histologically or cytologically confirmed diagnosis of clinical stage IIIB, IIIC, and IIID (AJCC 8th edition) locoregional melanoma that is eligible for complete surgical resection of all metastases (surgically resectable). 2. Eligible subjects must have measurable disease and must be candidate for intralesional therapy with at least one injectable cutaneous, subcutaneous, or nodal melanoma lesion (≥ 10 mm in longest diameter) or with multiple injectable lesions that in aggregate have a longest diameter of ≥ 10 mm. 3. Prior anti-tumor treatment for the primary melanoma lesion, including surgery and approved adjuvant treatments (e.g., radiotherapy, immune checkpoint inhibitors, BRAF/MEK inhibitors, etc.) is allowed. Before enrollment in the study, a wash-out period of 6 weeks is required and toxicities from prior treatments should be resumed to Grade ≤1. 4. Males or females, age ≥ 18 years. 5. ECOG Performance Status/WHO Performance Status ≤ 1. 6. Life expectancy of \> 24 months. 7. Absolute neutrophil count \> 1.5 x 109/L. 8. Hemoglobin \> 9.0 g/dL. 9. Platelets \> 100 x 109/L. 10. Total bilirubin ≤ 30 μmol/L (or ≤ 2.0 mg/dl). 11. ALT and AST ≤ 2.5 x the upper limit of normal (ULN). 12. Serum creatinine \< 1.5 x ULN. 13. LDH serum level ≤ 1.5 x ULN. 14. Documented negative test for HIV, HBV and HCV. For HBV serology, the determination of HBsAg and anti-HBcAg Ab is required. In patients with serology documenting previous exposure to HBV (i.e. positive anti-HBsAg with not vaccination and/or positive anti-HBcAg Ab), negative serum HBV-DNA is also required. 15. All acute toxic effects (excluding alopecia) of any prior therapy must have resolved to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) (v4.03) Grade ≤ 1 unless otherwise specified above. 16. All women of childbearing potential (WOCBP) must have negative pregnancy test results at the screening. WOCBP must be using, from the screening to three months following the last study drug administration, highly effective contraception methods. WOCBP and effective contraception methods are defined by the "Recommendations for contraception and pregnancy testing in clinical trials" issued by the Head of Medicine Agencies' Clinical Trial Facilitation Group and which include, for instance, progesterone-only or combined (estrogen- and progesterone-containing) hormonal contraception associated with inhibition of ovulation, intrauterine devices, intrauterine hormone-releasing systems, bilateral tubal occlusion, vasectomized partner or sexual abstinence. Pregnancy test will be repeated at the safety visit (only WOCBP and only for patients in Arm 1). 17. Male patients with WOCBP partners must agree to use simultaneously two acceptable methods of contraception (i.e. spermicidal gel plus condom) from the screening to three months following the last study drug administration. 18. Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study. 19. Willingness and ability to comply with the scheduled visits, treatment plan, laboratory tests and other study procedures. Exclusion Criteria 1. Uveal melanoma or mucosal melanoma 2. Evidence of distant metastases at screening. 3. Previous or concurrent cancer that is distinct in primary site or histology from the cancer being evaluated in this study except: cervical carcinoma in situ, curatively treated basal cell carcinoma, superficial bladder tumors (Ta, Tis \& T1), second primary melanoma in situ or any cancer curatively treated ≥ 5 years prior to study entry. 4. Presence of active infections (e.g. requiring antimicrobial therapy) or other severe concurrent disease, which, in the opinion of the investigator, would place the patient at undue risk or interfere with the study. 5. History within the last year of acute or subacute coronary syndromes including myocardial infarction, unstable or severe stable angina pectoris. 6. Inadequately controlled cardiac arrhythmias including atrial fibrillation. 7. Heart insufficiency (\> Grade II, New York Heart Association (NYHA) criteria). 8. LVEF ≤ 50% and/or abnormalities observed during baseline ECG and Echocardiogram investigations that are considered as clinically significant by the investigator. 9. Uncontrolled hypertension. 10. Ischemic peripheral vascular disease (Grade IIb-IV). 11. Severe diabetic retinopathy. 12. Active autoimmune disease. 13. History of organ allograft or stem cell transplantation. 14. Recovery from major trauma including surgery within 4 weeks prior to enrollment. 15. Known history of allergy to IL2, TNF, or other human proteins/peptides/antibodies or any other constituent of the product. 16. Breast feeding female. 17. Anti-tumor therapy (except small surgery) within 4 weeks before enrollment. 18. Previous in vivo exposure to monoclonal antibodies for biological therapy in the 6 weeks before enrollment. 19. Planned administration of growth factors or immunomodulatory agents within 7 days before enrollment. 20. Patient requiring or taking corticosteroids or other immunosuppressant drugs on a long-term basis will be evaluated case by case with the Sponsor for inclusion/exclusion in the study. Limited use of corticosteroids to treat or prevent acute hypersensitivity reactions is not considered an exclusion criteria. 21. Any conditions that in the opinion of the investigator could hamper compliance with the study protocol. 22. Previous enrolment and randomization in the same study.

Interventions

DRUG

Daromun

PROCEDURE

Surgery

DRUG

Adjuvant therapy

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Conditions

Melanoma Stage IIIBMelanoma Stage IIICMelanoma Stage IIID

Locations

Mayo Clinic Hospital

Phoenix, Arizona 85054

United States

UC San Diego Moores Cancer Center

La Jolla, California 92093

United States

UC Irvine Health-Chao Family Comprehensive Cancer Center

Orange, California 92868-3201

United States

Moffitt Cancer Center

Tampa, Florida 33612

United States

Winship Cancer Institute, Emory university

Atlanta, Georgia 30322

United States

Rush University Medical Center

Chicago, Illinois 60612

United States

University of Iowa Hospitals and Clinics

Iowa City, Iowa 52242

United States

Mayo Clinic

Rochester, Minnesota 55905

United States

Rutgers Cancer Institute, 195 Little Albany Street

New Brunswick, New Jersey 08903

United States

Ambulatory Care Center at NYC Langarone Health

New York, New York 10016

United States

Memorial Sloan Kettering Cancer Center - Main Campus

Ney York, New York 10065

United States

Duke University Medical Center - Duke Cancer Center

Durham, North Carolina 27710

United States

Ohio State University Wexner Medical Center

Columbus, Ohio 43210

United States

St. Luke's Cancer Center, Clinical Trial, 3rd floor, 1600 St. Luke's Blvd.

Easton, Pennsylvania 18045

United States

Penn State Cancer Institute

Hershey, Pennsylvania 17033

United States

Fox Chase Cancer Center 333 Cottman Avenue

Philadelphia, Pennsylvania 19111

United States

The University of Texas M.D. Anderson Cancer Center

Houston, Texas 77030-4009

United States

Huntsman Cancer Institute, University of Utah 2000 Circle of Hope

Salt Lake City, UT, Utah 84112

United States

VCU - McGlothlin Medical Education Center

Richmond, Virginia 980037

United States

Hospital Universitari Germans Trias i Pujol

Badalona, Barcelona 08916

Spain

Hospital de la Santa Creu i Sant Pau

Barcelona, Barcelona 08025

Spain

Fir Huvh Fundacio Institut De Recerca Hospital Universitari Vall De Hebron

Barcelona, Barcelona 08035

Spain

Hospital Clinic Barcelona

Barcelona, Barcelona 08036

Spain

El Hospital Universitario De Gran Canaria Dr. Negrin

Las Palmas de Gran Canaria, Canarie 35010

Spain

Fundacion Onkologikoa Fundazioa

Donostia / San Sebastian, Gipuzkoa 20014

Spain

MD Anderson Cancer Center

Madrid, Madrid 28033

Spain

Hospital Universitario 12 de Octubre

Madrid, Madrid 28041

Spain

Hospital Universitario Regional de Málaga

Málaga, Malaga 29010

Spain

Hospital Clínico Universitario Virgen de la Arrixaca

Murcia, Murcia 30120

Spain

Hospital Universitario Virgen De La Macarena

Seville, Sevilla 41009

Spain

Hospital General Universitario de Valencia

Valencia,

Spain

Universitätsspital Basel

Basel, Basel 4031

Switzerland

Istituto Oncologico della Svizzera Italiana

Bellinzona, Bellinzona 6500

Switzerland

Insel Gruppe AG

Bern, Canton of Bern 3010

Switzerland

Hôpitaux Universitaires de Genève

Geneva, Canton of Geneva 1205

Switzerland

Kantonsspital St.Gallen

Sankt Gallen, Canton of St. Gallen 9007

Switzerland

Universitätsspital Zürich (USZ)

Zurich, Canton of Zurich 8091

Switzerland