Melanoma (Skin)
Conditions
Keywords
recurrent melanoma, stage IV melanoma
Brief summary
RATIONALE: Interleukin-21 may stimulate white blood cells, including natural killer cells, to kill melanoma cells. PURPOSE: This phase II trial is studying the side effects and how well interleukin-21 works in treating patients with metastatic or recurrent malignant melanoma.
Detailed description
OBJECTIVES: Primary * To assess the efficacy, in terms of objective response rate, nonprogression rate, time to progression, and response duration, in patients with metastatic or recurrent malignant melanoma treated with recombinant human interleukin-21 (rIL-21). * To assess the toxicity and safety of rIL-21 in patients with previously untreated metastatic or recurrent malignant melanoma. * To characterize the pharmacokinetics of rIL-21. * To characterize the effects of rIL-21 on lymphocyte cell count and soluble CD25 (sCD25) in serum as potential biomarkers for drug activity. * To evaluate the immunogenicity of rIL-21, specifically preexisting immunogenicity to the drug and antibody induction during treatment. * To assess melanoma antigenic markers for response and nonprogression on archival tissue from patients enrolled on the study. Secondary * To investigate whether rIL-21 induced sCD25 release is independent of the level of circulating sCD25. * To investigate the effect of rIL-21 on antibody induction during treatment and preexisting immunogenicity. * To assess lymphocyte cell-count changes over time in relation to rIL-21 therapy. OUTLINE: This is a multicenter study. Patients receive recombinant human interleukin-21 (rIL-21) IV on days 1-5 of weeks 1, 3 and 5. Treatment repeats every 8 weeks in the absence of disease progression or unacceptable toxicity. Patients achieving a complete response (CR) or partial response (PR) receive 2 courses beyond CR or PR. Patients with stable disease receive a maximum of 3 courses of rIL-21. Previously archived tumor tissue and blood samples are collected from patients for correlative studies. Samples are analyzed for soluble CD25, rIL-21 antibodies, circulating lymphocyte counts, preexisting immonogenicity to rIL-21 for antibody induction, and expression of common melanoma tumor antigen markers via IHC. After completion of study treatment, patients are followed at 4 weeks.
Interventions
Patients enrolled in Part A will receive treatment daily x 5 on weeks 1, 3, and 5 of an 8 week cycle. Patients enrolled in Part B will receive treatment daily x 5 on weeks 1, and 3 of a 6 week cycle
Cycle 1 Day 1 and Cycle 1 Day 29
slides will be blocked for 15 minutes in 20% normal goat serum and then incubated in primary antibody
Starting dose of 50μg/kg/day as an IV push
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed cutaneous malignant melanoma * Recurrent or metastatic disease that is not curable by surgical or other means * Clinically and/or radiologically documented disease defined as at least one site of disease unidimensionally measurable ≥ 20 mm by x-ray, physical exam, or nonspiral CT scan OR ≥ 10 mm by spiral CT scan * Must have nonbulky metastatic disease defined as the largest measurable lesion ≤ 50 mm in maximum diameter * Must have primary diagnosis tumor tissue or previously resected metastatic melanoma tissue available (i.e., paraffin block or unstained slides) * No known brain metastases PATIENT CHARACTERISTICS: * ECOG performance status 0-2 * Life expectancy ≥ 12 weeks * Absolute granulocytes count ≥ 1,500/mm\^3 * Platelet count ≥ 100,000/mm\^3 * Bilirubin normal * Serum creatinine ≤ 1.5 times upper limit of normal (ULN) * AST and ALT ≤ 2.5 times ULN * Negative pregnancy test * Not pregnant or nursing * Fertile patients must use effective contraception during study therapy * No uncontrolled intercurrent illness or condition including, but not limited to, any of the following: * Ongoing or active infection * Symptomatic congestive heart failure * Unstable angina pectoris * Cardiac arrhythmia * Psychiatric illness or social situation that would limit compliance with study requirements * No history of hemolysis or a hemolytic disorder including, but not limited to, any of the following: * Sickle cell anemia * Thalassemia * Autoimmune hemolytic anemia * No history of other malignancies within the past 5 years except adequately treated nonmelanoma skin cancer, curatively treated carcinoma in situ of the cervix, or other solid tumors curatively treated with no evidence of disease * No known HIV, hepatitis B, or hepatitis C infection * Patients must reside within a 2-hour drive from a participating center PRIOR CONCURRENT THERAPY: * No previous systemic therapy for metastatic disease * At least 3 months since prior adjuvant immunotherapy for recurrent melanoma * No prior immunotherapy for metastatic disease * No prior immunotherapy outside the adjuvant setting * At least 4 weeks since prior major surgery * At least 4 weeks since prior radiotherapy except low-dose, nonmyelosuppressive radiotherapy and recovered * More than 4 weeks since prior and no concurrent investigational agents or anticancer therapy * No prior chemotherapy including regional therapy * No concurrent systemic corticosteroids (e.g., prednisone or dexamethasone) * Concurrent topical steroids are allowed
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Objective tumor response as assessed by RECIST | after completion of treatment |
| Overall response rate (complete and partial) | after completion of study |
| Stable disease rate | after completion of study |
| Progressive disease rate | after completion of study |
| Median time to progression | after completion of study |
| Response duration (median and range) | after completion of study |
Countries
Canada