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S0008: Chemotherapy Plus Biological Therapy in Treating Patients With Melanoma

Phase III Trial of High Dose Interferon Alfa 2-b Versus Cisplatin, Vinblastine, DTIC Plus IL-2 and Interferon in Patients With High Risk Melanoma

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00006237
Enrollment
432
Registered
2003-01-27
Start date
2000-08-31
Completion date
2012-07-31
Last updated
2015-03-25

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Melanoma (Skin)

Keywords

stage III melanoma, recurrent melanoma

Brief summary

RATIONALE: Interferon alfa may interfere with the growth of cancer cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Interleukin-2 may stimulate a person's white blood cells to kill melanoma cells. It is not yet known whether interferon alfa is more effective with or without combination chemotherapy and interleukin-2 for melanoma. PURPOSE: Randomized phase III trial to compare the effectiveness of interferon alfa with or without combination chemotherapy consisting of cisplatin, vinblastine, and dacarbazine, plus interleukin-2, in treating patients who have melanoma.

Detailed description

OBJECTIVES: * Compare the overall survival and disease-free survival of patients with high-risk melanoma treated with interferon alfa vs cisplatin, vinblastine, and dacarbazine plus interferon alfa and interleukin-2. * Compare the toxic effects of these treatment regimens in these patients. * Determine the relationship between minimal residual disease (MRD) status at 12 weeks and 52 weeks and overall survival of patients treated with these regimens. * Compare the effects of these treatment regimens on the MRD status of these patients. * Determine the relationship between clinical characteristics (number of involved lymph nodes, ulcerated primary, and extracapsular extension) and MRD in patients treated with these regimens. OUTLINE: This is a randomized, multicenter study. Patients are stratified according to nodal status (N1 or N2 vs N3), degree of lymph node involvement (micrometastases only vs any macrometastases, including satellite/in-transit metastases), and ulceration of the primary tumor (yes vs no vs unknown primary). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients receive interferon alfa IV on days 1-5 of weeks 1-4 followed by interferon alfa subcutaneously (SC) on days 1, 3, and 5 of weeks 5-52 in the absence of disease progression or unacceptable toxicity. * Arm II: Patients receive cisplatin IV over 30 minutes followed by vinblastine IV on days 1-4. Patients also receive dacarbazine IV over 1 hour on day 1, interleukin-2 IV over 96 hours on days 1-4, and interferon alfa SC on days 1-5, 8, 10, and 12. In addition, patients receive filgrastim (G-CSF) SC on days 6-15. Treatment repeats every 3 weeks for 3 courses in the absence of disease progression or unacceptable toxicity. Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually for 5 years. PROJECTED ACCRUAL: A total of 410 patients (205 per treatment arm) will be accrued for this study within 3 years.

Interventions

BIOLOGICALinterleukin-2

Given IV

BIOLOGICALfilgrastim

Given subcutaneously

BIOLOGICALinterferon alfa

Given IV and subcutaneously

DRUGcisplatin

Given IV

DRUGdacarbazine

Given IV

DRUGvinblastine

Given IV

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Eastern Cooperative Oncology Group
CollaboratorNETWORK
Cancer and Leukemia Group B
CollaboratorNETWORK
Children's Oncology Group
CollaboratorNETWORK
SWOG Cancer Research Network
Lead SponsorNETWORK

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically proven melanoma of cutaneous origin or from unknown primary at initial presentation of primary or first clinically detected nodal or satellite/in-transit recurrence * No distant metastases * No melanoma of ocular, mucosal, or other non-cutaneous origin * One of the following criteria must apply for patients with newly diagnosed melanoma OR a previously diagnosed primary with current subsequent, clinical, regional nodal disease and/or satellite/in-transit disease: * Ulcerated primary melanoma with 1 or more involved lymph nodes (micro/occult or macro/clinically overt) * Non-ulcerated or unknown primary melanoma with one macro/clinically overt lymph node metastasis, including a single matted nodal mass * No non-ulcerated or unknown primary tumor and a single micrometastatic lymph node * Non-ulcerated melanoma with two or more lymph node metastases (micro/occult or macro/clinically overt) and/or matted nodes * Any satellite/in transit metastasis with or without lymph node involvement * Patients with recurrent disease must have recurrent disease in the regional nodal basin of a prior complete lymphadenectomy * Multiple regional nodal basin involvement allowed if they are appropriate anatomic drainage basins for primary site * Patients must be disease free at time of enrollment based on the following surgical criteria: * Patients at initial presentation of melanoma must undergo adequate wide excision of primary lesion * Patients with previously diagnosed melanoma must have all disease resected with pathologically negative margins and no disease at primary site or second resection of primary * Full lymphadenectomy required of all patients including those with positive sentinel nodes or positive satellite/in-transit metastasis * No more than 56 days since prior lymphadenectomy OR surgery to remove recurrent disease after prior complete lymphadenectomy * Must be willing to participate in minimal residual disease studies if registered on the study on 3/1/2003 or later PATIENT CHARACTERISTICS: Age: * 18 and over Performance status: * Zubrod 0-1 Life expectancy: * Not specified Hematopoietic: * Absolute granulocyte count at least 1,500/mm\^3 * Platelet count at least 100,000/mm\^3 Hepatic: * Bilirubin no greater than 1.5 times upper limit of normal (ULN) * SGOT or SGPT no greater than 2 times ULN * LDH and alkaline phosphatase no greater than 2 times ULN (above normal value requires a contrast-enhanced CT scan or MRI of liver) * No known recent hepatitis positivity by PCR Renal: * Creatinine no greater than 1.5 mg/dL OR * Creatinine clearance at least 75 mL/min Cardiovascular: * No congestive heart failure * No coronary artery disease * No serious cardiac arrhythmia * No prior myocardial infarction * Normal cardiac stress test required if any of the following are present: * Over age 50 * Abnormal EKG * History of cardiac disease Pulmonary: * No symptomatic pulmonary disease Other: * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * No autoimmune disorders or conditions of immunosuppression * No other prior malignancy within the past 5 years except the following: * Adequately treated basal cell or squamous cell skin cancer * Carcinoma in situ of the cervix * Adequately treated stage I or II cancer in remission * HIV negative * No known AIDS or HIV-1 associated complex PRIOR CONCURRENT THERAPY: Biologic therapy: * No prior immunotherapy, including interferon, interleukin, levamisole, or other biologic response modifiers * No other concurrent biologic therapy Chemotherapy: * No prior chemotherapy (including infusion or perfusion therapy) * No other concurrent chemotherapy Endocrine therapy: * No concurrent systemic corticosteroids or topical steroid creams * Concurrent steroid antihistamines allowed if no alternative * No concurrent hormonal therapy Radiotherapy: * No prior radiotherapy * Prior postlumpectomy radiotherapy for breast cancer allowed * No concurrent radiotherapy Surgery: * See Disease Characteristics * No concurrent surgery Other: * No concurrent anti-hypertensive medications (arm II only) * No concurrent immunosuppressive agents * No other concurrent anticancer therapy * Antihistamines allowed if no alternative medication suitable

Design outcomes

Primary

MeasureTime frameDescription
5-year Overall SurvivalEvery three months for a year, every six months for years 2-5, annual for years 5-10Overall survival was measured from the date of registration to study until death from any cause with observations censored at the date of last contact for patients last known to be alive.
5-year Relapse-Free SurvivalEvery three months for the first year, every 6 months for years 2-5, annually for years 6-10Measured from date of registration to date of first observation of progressive disease or death due to any cause.

Secondary

MeasureTime frameDescription
ToxicityWhile on treatment, patients on the HDIFN arm were assessed weekly for the 1st month, then every 2 weeks for the 2nd month, then every 3 months therafter; patients on the biochemo arm were assessed daily for the 1st 5 days, then weekly thereafter.Number of patients with Grade 3-5 adverse events that are related to study drug by given type of adverse event

Countries

Australia, United States

Participant flow

Participants by arm

ArmCount
Interferon
interferon alfa
203
Biochemotherapy
cisplatin, dacarbazine, interleukin-2, interferon alfa SC, filgrastim
199
Total402

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event3929
Overall StudyDeath10
Overall StudyNot eligible920
Overall StudyNot protocol specified145
Overall StudyProgression/relapse542
Overall StudyRefusal unrelated to adverse effects84
Overall StudyWithdrawal by Subject01

Baseline characteristics

CharacteristicInterferonBiochemotherapyTotal
Age, Continuous47 years46 years47 years
Region of Enrollment
United States
203 participants199 participants402 participants
Sex: Female, Male
Female
62 Participants58 Participants120 Participants
Sex: Female, Male
Male
141 Participants141 Participants282 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
132 / 193144 / 185
serious
Total, serious adverse events
2 / 1934 / 185

Outcome results

Primary

5-year Overall Survival

Overall survival was measured from the date of registration to study until death from any cause with observations censored at the date of last contact for patients last known to be alive.

Time frame: Every three months for a year, every six months for years 2-5, annual for years 5-10

ArmMeasureValue (NUMBER)
Interferon5-year Overall Survival56 Percent of population
Biochemotherapy5-year Overall Survival56 Percent of population
p-value: 0.49Log Rank
Primary

5-year Relapse-Free Survival

Measured from date of registration to date of first observation of progressive disease or death due to any cause.

Time frame: Every three months for the first year, every 6 months for years 2-5, annually for years 6-10

ArmMeasureValue (NUMBER)
Interferon5-year Relapse-Free Survival47 Percentage of population
Biochemotherapy5-year Relapse-Free Survival38 Percentage of population
p-value: 0.02Log Rank
Secondary

Toxicity

Number of patients with Grade 3-5 adverse events that are related to study drug by given type of adverse event

Time frame: While on treatment, patients on the HDIFN arm were assessed weekly for the 1st month, then every 2 weeks for the 2nd month, then every 3 months therafter; patients on the biochemo arm were assessed daily for the 1st 5 days, then weekly thereafter.

Population: Eligible patients who started therapy

ArmMeasureGroupValue (NUMBER)
InterferonToxicityHypoxia0 Participants
InterferonToxicityDizziness/vertigo, NOS0 Participants
InterferonToxicityInfection w/o 3-4 neutropenia0 Participants
InterferonToxicityPersonality/behavioral change1 Participants
InterferonToxicityInfection with 3-4 neutropenia0 Participants
InterferonToxicityDouble vision0 Participants
InterferonToxicityInfection, unk ANC1 Participants
InterferonToxicityCerebrovascular ischemia1 Participants
InterferonToxicityInsomnia1 Participants
InterferonToxicityEryth/rash/eruption/desq, NOS1 Participants
InterferonToxicityLeukopenia12 Participants
InterferonToxicitySensory neuropathy0 Participants
InterferonToxicityLipase increase1 Participants
InterferonToxicityEsophagitis/dysphagia0 Participants
InterferonToxicityLocal injection site reaction1 Participants
InterferonToxicityColitis0 Participants
InterferonToxicityLymphopenia0 Participants
InterferonToxicityEye-other1 Participants
InterferonToxicityMood/consciousness change, NOS0 Participants
InterferonToxicityPancreatitis0 Participants
InterferonToxicityMuscle weakness (not neuro)0 Participants
InterferonToxicityFatigue/malaise/lethargy38 Participants
InterferonToxicityMyalgia7 Participants
InterferonToxicityConfusion2 Participants
InterferonToxicityNausea10 Participants
InterferonToxicityFebrile neutropenia1 Participants
InterferonToxicityNeutropenia/granulocytopenia25 Participants
InterferonToxicityBilirubin increase0 Participants
InterferonToxicityPRBC transfusion0 Participants
InterferonToxicityFever without neutropenia1 Participants
InterferonToxicityConstipation/bowel obstruction0 Participants
InterferonToxicityPlatelet transfusion0 Participants
InterferonToxicityFever, NOS0 Participants
InterferonToxicityPruritus1 Participants
InterferonToxicityPetechiae/purpura0 Participants
InterferonToxicityRash/desquamation4 Participants
InterferonToxicityHallucinations1 Participants
InterferonToxicityRenal failure0 Participants
InterferonToxicityCranial neuropathy1 Participants
InterferonToxicityReportable adverse event, NOS1 Participants
InterferonToxicityHeadache9 Participants
InterferonToxicityRespiratory infect w/ neutrop0 Participants
InterferonToxicityBone pain0 Participants
InterferonToxicityRigors/chills2 Participants
InterferonToxicityHemorrhage w/ 3-4 thrombocyt0 Participants
InterferonToxicitySGOT (AST) increase18 Participants
InterferonToxicityCreatinine increase0 Participants
InterferonToxicityArthralgia4 Participants
InterferonToxicityHyperglycemia2 Participants
InterferonToxicityAbdominal pain/cramping1 Participants
InterferonToxicitySGPT (ALT) increase32 Participants
InterferonToxicityAcidosis0 Participants
InterferonToxicityHyperkalemia0 Participants
InterferonToxicityAcute vascular leak syndrome0 Participants
InterferonToxicityDehydration1 Participants
InterferonToxicityAlkaline phosphatase increase0 Participants
InterferonToxicityHypermagnesemia1 Participants
InterferonToxicityAllergic reaction1 Participants
InterferonToxicityCPK increase0 Participants
InterferonToxicityAnal incontinence0 Participants
InterferonToxicityHypertension0 Participants
InterferonToxicityAnemia0 Participants
InterferonToxicityDelusions0 Participants
InterferonToxicityAnorexia1 Participants
InterferonToxicityHypertriglyceridemia1 Participants
InterferonToxicityAnxiety/agitation4 Participants
InterferonToxicityDyspnea1 Participants
InterferonToxicityApnea1 Participants
InterferonToxicityHypocalcemia0 Participants
InterferonToxicityArrhythmia, NOS2 Participants
InterferonToxicityDepression14 Participants
InterferonToxicityStomatitis/pharyngitis0 Participants
InterferonToxicityHypokalemia1 Participants
InterferonToxicitySurgery-wound infection3 Participants
InterferonToxicityCardiovascular-other1 Participants
InterferonToxicitySyncope2 Participants
InterferonToxicityHypomagnesemia0 Participants
InterferonToxicityThrombocytopenia1 Participants
InterferonToxicityDiarrhea without colostomy2 Participants
InterferonToxicityThrombosis/embolism1 Participants
InterferonToxicityHyponatremia0 Participants
InterferonToxicityTyphlitis0 Participants
InterferonToxicitySeizures0 Participants
InterferonToxicityVertigo1 Participants
InterferonToxicityHypophosphatemia0 Participants
InterferonToxicityVomiting9 Participants
InterferonToxicityDizziness/light headedness2 Participants
InterferonToxicityWeakness (motor neuropathy)1 Participants
InterferonToxicityHypotension0 Participants
InterferonToxicityWeight loss3 Participants
InterferonToxicityCatheter related infection0 Participants
BiochemotherapyToxicityWeight loss0 Participants
BiochemotherapyToxicityPancreatitis1 Participants
BiochemotherapyToxicityPersonality/behavioral change0 Participants
BiochemotherapyToxicitySGPT (ALT) increase8 Participants
BiochemotherapyToxicitySeizures2 Participants
BiochemotherapyToxicitySensory neuropathy2 Participants
BiochemotherapyToxicityBilirubin increase1 Participants
BiochemotherapyToxicityBone pain4 Participants
BiochemotherapyToxicityCPK increase1 Participants
BiochemotherapyToxicityCardiovascular-other0 Participants
BiochemotherapyToxicityCatheter related infection2 Participants
BiochemotherapyToxicityCerebrovascular ischemia0 Participants
BiochemotherapyToxicityColitis2 Participants
BiochemotherapyToxicityConfusion3 Participants
BiochemotherapyToxicityConstipation/bowel obstruction4 Participants
BiochemotherapyToxicityCranial neuropathy0 Participants
BiochemotherapyToxicityCreatinine increase4 Participants
BiochemotherapyToxicityDehydration7 Participants
BiochemotherapyToxicityDelusions1 Participants
BiochemotherapyToxicityDepression4 Participants
BiochemotherapyToxicityDiarrhea without colostomy6 Participants
BiochemotherapyToxicityDizziness/light headedness1 Participants
BiochemotherapyToxicityDizziness/vertigo, NOS1 Participants
BiochemotherapyToxicityDyspnea2 Participants
BiochemotherapyToxicityEryth/rash/eruption/desq, NOS3 Participants
BiochemotherapyToxicityEsophagitis/dysphagia2 Participants
BiochemotherapyToxicityEye-other0 Participants
BiochemotherapyToxicityFatigue/malaise/lethargy22 Participants
BiochemotherapyToxicityFebrile neutropenia9 Participants
BiochemotherapyToxicityFever without neutropenia5 Participants
BiochemotherapyToxicityFever, NOS1 Participants
BiochemotherapyToxicityHallucinations1 Participants
BiochemotherapyToxicityHeadache5 Participants
BiochemotherapyToxicityHemorrhage w/ 3-4 thrombocyt1 Participants
BiochemotherapyToxicityHyperglycemia3 Participants
BiochemotherapyToxicityHyperkalemia1 Participants
BiochemotherapyToxicityHypermagnesemia1 Participants
BiochemotherapyToxicityHypertension1 Participants
BiochemotherapyToxicityHypertriglyceridemia0 Participants
BiochemotherapyToxicityHypocalcemia18 Participants
BiochemotherapyToxicityHypokalemia7 Participants
BiochemotherapyToxicityHypomagnesemia5 Participants
BiochemotherapyToxicityHyponatremia6 Participants
BiochemotherapyToxicityHypophosphatemia4 Participants
BiochemotherapyToxicityHypotension16 Participants
BiochemotherapyToxicityHypoxia1 Participants
BiochemotherapyToxicityInfection w/o 3-4 neutropenia3 Participants
BiochemotherapyToxicityInfection with 3-4 neutropenia9 Participants
BiochemotherapyToxicityInfection, unk ANC2 Participants
BiochemotherapyToxicityInsomnia1 Participants
BiochemotherapyToxicityLeukopenia38 Participants
BiochemotherapyToxicityLipase increase2 Participants
BiochemotherapyToxicityLocal injection site reaction0 Participants
BiochemotherapyToxicityLymphopenia2 Participants
BiochemotherapyToxicityMood/consciousness change, NOS1 Participants
BiochemotherapyToxicityMuscle weakness (not neuro)1 Participants
BiochemotherapyToxicityMyalgia4 Participants
BiochemotherapyToxicityNausea51 Participants
BiochemotherapyToxicityNeutropenia/granulocytopenia61 Participants
BiochemotherapyToxicityPRBC transfusion3 Participants
BiochemotherapyToxicityPetechiae/purpura1 Participants
BiochemotherapyToxicityPlatelet transfusion5 Participants
BiochemotherapyToxicityPruritus3 Participants
BiochemotherapyToxicityRash/desquamation10 Participants
BiochemotherapyToxicityRenal failure1 Participants
BiochemotherapyToxicityReportable adverse event, NOS1 Participants
BiochemotherapyToxicityRespiratory infect w/ neutrop2 Participants
BiochemotherapyToxicityRigors/chills1 Participants
BiochemotherapyToxicitySGOT (AST) increase7 Participants
BiochemotherapyToxicityArthralgia3 Participants
BiochemotherapyToxicityAbdominal pain/cramping1 Participants
BiochemotherapyToxicityAcidosis1 Participants
BiochemotherapyToxicityAcute vascular leak syndrome1 Participants
BiochemotherapyToxicityAlkaline phosphatase increase3 Participants
BiochemotherapyToxicityAllergic reaction0 Participants
BiochemotherapyToxicityAnal incontinence1 Participants
BiochemotherapyToxicityAnemia8 Participants
BiochemotherapyToxicityAnorexia9 Participants
BiochemotherapyToxicityAnxiety/agitation5 Participants
BiochemotherapyToxicityApnea0 Participants
BiochemotherapyToxicityArrhythmia, NOS0 Participants
BiochemotherapyToxicityStomatitis/pharyngitis1 Participants
BiochemotherapyToxicitySurgery-wound infection0 Participants
BiochemotherapyToxicitySyncope0 Participants
BiochemotherapyToxicityThrombocytopenia50 Participants
BiochemotherapyToxicityThrombosis/embolism1 Participants
BiochemotherapyToxicityTyphlitis1 Participants
BiochemotherapyToxicityVertigo0 Participants
BiochemotherapyToxicityVomiting37 Participants
BiochemotherapyToxicityWeakness (motor neuropathy)2 Participants
BiochemotherapyToxicityDouble vision1 Participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026