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Temozolomide and Everolimus in Treating Patients With Stage IV Melanoma That Cannot be Removed by Surgery

A Phase II Study of Temozolomide and Everolimus (RAD001) Therapy for Metastatic Melanoma

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00521001
Enrollment
49
Registered
2007-08-27
Start date
2008-01-31
Completion date
2010-12-31
Last updated
2017-08-14

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

Conditions

Melanoma (Skin)

Keywords

stage IV melanoma

Brief summary

RATIONALE: Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Everolimus may stop the growth of tumor cells by blocking blood flow to the tumor and by blocking some of the enzymes needed for cell growth. Giving everolimus together with temozolomide may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving everolimus together with temozolomide works in treating patients with stage IV melanoma that cannot be removed by surgery

Detailed description

OBJECTIVES: Primary * Estimate the 9-week progression-free survival rate for patients with stage IV malignant melanoma treated with everolimus and temozolomide. Secondary * Evaluate overall survival time. * Evaluate time to disease progression. * Evaluate confirmed response rate. OUTLINE: This is a multicenter study. Patients receive oral everolimus once a day on days 1-5, 8-12, 15-19, 22-26, and 29-33 and oral temozolomide once a day on days 8-12 for course 1 only. For course 2 and all subsequent courses, patients receive oral everolimus once a day on days 1-5, 8-12, 15-19, and 22-26 and oral temozolomide once a day on days 1-5. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. All patients undergo blood sample collection periodically for correlative studies. Samples are analyzed for relative numbers of T, B, and NK cells via flow cytometry, quantitative immunoglobulin levels (IgG, IgM, and IgA), Tetramer/ELISPOT CTL frequencies to CMV/EBV immunodominant antigens, V beta T cell spectratyping, and VEGF levels via ELISA. After completion of study treatment, patients are followed every 8 weeks.

Interventions

DRUGeverolimus
DRUGtemozolomide

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Alliance for Clinical Trials in Oncology
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically confirmed melanoma with manifestations of metastatic disease. * Unresectable stage IV malignant melanoma with measurable disease * Measurable disease defined as at least one lesion with the longest diameter measured as ≥ 20 mm by CT scan or MRI scan OR ≥ 10 mm by spiral CT * No previously untreated or unstable active brain metastases within the past 3 months * No known standard therapy for this disease that is potentially curative or proven capable of extending life expectancy PATIENT CHARACTERISTICS: * ECOG performance status 0-2 * Life expectancy ≥ 12 weeks * ANC ≥ 1,500/μL * Platelet count ≥ 100,000/μL * Hemoglobin ≥ 9.0 g/dL * Alkaline phosphatase ≤ 3 times institutional upper limit of normal (ULN) * Creatinine ≤ 1.5 times ULN * AST ≤ 3 times ULN * INR ≤ 1.5 * Not pregnant or nursing * Negative pregnancy test * Fertile patients and their partners must use effective contraception during and for ≥ 8 weeks after completion of study treatment * Able to return to a NCCTG institution for follow-up * Able to forego foods high in fat content 2 hours prior to and 2 hours after administration of everolimus therapy * Able to provide blood samples for research purposes * No hypersensitivity to temozolomide, dacarbazine, or any analog of sirolimus * No history of malignancy within the past 5 years except for basal cell or squamous cell carcinoma of the skin treated with local resection only * No immunosuppression from any cause, including known HIV infection or chronic immunosuppressive therapy * No impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of everolimus (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, or malabsorption syndrome) * No serious medical condition that may make it unsafe for a patient to enroll in study, including any of the following: * Severely impaired lung function (FEV1 \< 1 liter), unstable angina pectoris (ongoing symptoms), ongoing symptomatic congestive heart failure (i.e., NYHA class I-IV) refractory to appropriate therapy, or myocardial infarction within the past 6 months, or serious uncontrolled cardiac arrhythmia * Uncontrolled diabetes in spite of optimal therapy (i.e., a history of fasting serum glucose \> 150 mg/dL) * Any active (acute or chronic) or uncontrolled infection/disorders * Nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the study treatment * Liver disease (i.e., uncompensated cirrhosis or active hepatitis with elevated liver enzymes) * No bleeding diathesis * No concurrent severe condition that would make it undesirable for the patient to participate in this trial or that would jeopardize compliance with the trial PRIOR CONCURRENT THERAPY: * Must have recovered from effects of prior antineoplastic therapy * At least 4 weeks since prior chemotherapy (6 weeks for mitomycin C or nitrosoureas) * At least 4 weeks since prior immunotherapy * At least 4 weeks since prior biologic therapy * At least 4 weeks since prior radiosurgery * At least 4 weeks since prior investigational therapy for melanoma * No prior small bowel resection that may significantly alter the absorption of everolimus * No prior sirolimus or its analogues * No prior radiotherapy to \> 30% of bone marrow * No concurrent drugs that may induce CYP3A4 activity * No concurrent warfarin * No concurrent grapefruit or grapefruit juice * No concurrent use or planned use of vaccines containing live virus

Design outcomes

Primary

MeasureTime frameDescription
9-week Progression-free Survival Rateat 9 weeksThe primary endpoint of this trial is the 9 week PFS rate. A patient is a success if they are progression free at their cycle 2 evaluation (approximately 9 weeks post registration). All patients, who meet the eligibility criteria, sign a consent form, and start treatment will be included in the evaluation of the 9-week PFS rate (evaluable patients). The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Confidence intervals for the true success proportion will be calculated using the properties of the binomial distribution. If some patients are lost to follow up prior to their cycle 2 evaluation, the Kaplan-Meier method will be used to estimate the 9 week PFS rate. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.

Secondary

MeasureTime frameDescription
Survival TimeTime from registration to death due to any cause; Up to 5 yearsSurvival time is defined as the time from registration to death due to any cause. The distribution of survival time will be estimated using the method of Kaplan-Meier.
Time to Disease ProgressionTime from registration to the earliest date documentation of disease progression; Up to 5 yearsTime to disease progression is defined as the time from registration to the earliest date documentation of disease progression. If a patient dies without a documentation of disease progression the patient will be considered to have had tumor progression at the time of their death unless there is sufficient documented evidence to conclude no progression occurred prior to death. The distribution of time to progression will be estimated using the method of Kaplan-Meier. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.
Confirmed Response Rate (Complete Response and Partial Response)Up to 5 yearsConfirmed response rates will be evaluated by dividing the number of confirmed responders (i.e. patients that achieve a CR or PR on consecutive evaluations) by the total number of evaluable patients. Confidence intervals for the true response rate will be calculated using the properties of the binomial distribution.

Countries

United States

Participant flow

Participants by arm

ArmCount
Everolimus + Temozolomide
Patients receive 10 mg everolimus orally once a day on days 1-5, 8-12, 15-19, 22-26, and 29-33 and 200 mg/m\^2 temozolomide orally once a day on days 8-12 for cycle 1 only (where cycle length is 35 days). For cycle 2 and all subsequent cycles, patients receive 10 mg everolimus orally once a day on days 1-5, 8-12, 15-19, and 22-26 and 200 mg/m\^2 temozolomide orally once a day on days 1-5. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
48
Total48

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyIneligible1

Baseline characteristics

CharacteristicEverolimus + Temozolomide
Age, Continuous60 years
Region of Enrollment
United States
48 Participants
Sex: Female, Male
Female
16 Participants
Sex: Female, Male
Male
32 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
48 / 48
serious
Total, serious adverse events
6 / 48

Outcome results

Primary

9-week Progression-free Survival Rate

The primary endpoint of this trial is the 9 week PFS rate. A patient is a success if they are progression free at their cycle 2 evaluation (approximately 9 weeks post registration). All patients, who meet the eligibility criteria, sign a consent form, and start treatment will be included in the evaluation of the 9-week PFS rate (evaluable patients). The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Confidence intervals for the true success proportion will be calculated using the properties of the binomial distribution. If some patients are lost to follow up prior to their cycle 2 evaluation, the Kaplan-Meier method will be used to estimate the 9 week PFS rate. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.

Time frame: at 9 weeks

ArmMeasureValue (NUMBER)
Everolimus + Temozolomide9-week Progression-free Survival Rate0.44 proportion of patients
Secondary

Confirmed Response Rate (Complete Response and Partial Response)

Confirmed response rates will be evaluated by dividing the number of confirmed responders (i.e. patients that achieve a CR or PR on consecutive evaluations) by the total number of evaluable patients. Confidence intervals for the true response rate will be calculated using the properties of the binomial distribution.

Time frame: Up to 5 years

ArmMeasureValue (NUMBER)
Everolimus + TemozolomideConfirmed Response Rate (Complete Response and Partial Response)8.3 percentage of confirmed responses
Secondary

Survival Time

Survival time is defined as the time from registration to death due to any cause. The distribution of survival time will be estimated using the method of Kaplan-Meier.

Time frame: Time from registration to death due to any cause; Up to 5 years

ArmMeasureValue (MEDIAN)
Everolimus + TemozolomideSurvival Time8.6 months
Secondary

Time to Disease Progression

Time to disease progression is defined as the time from registration to the earliest date documentation of disease progression. If a patient dies without a documentation of disease progression the patient will be considered to have had tumor progression at the time of their death unless there is sufficient documented evidence to conclude no progression occurred prior to death. The distribution of time to progression will be estimated using the method of Kaplan-Meier. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.

Time frame: Time from registration to the earliest date documentation of disease progression; Up to 5 years

ArmMeasureValue (MEDIAN)
Everolimus + TemozolomideTime to Disease Progression2.4 months

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