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Bevacizumab and Temozolomide or Bevacizumab and Paclitaxel Albumin-Stabilized Nanoparticle Formulation and Carboplatin in Treating Patients With Stage IV Malignant Melanoma That Cannot Be Removed by Surgery

A Randomized Phase II Trial of Temozolomide (TMZ) and Bevacizumab or ABI-007 (ABX)/Carboplatin (CBDCA) and Bevacizumab in Patients With Unresectable Stage IV Malignant Melanoma

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00626405
Enrollment
95
Registered
2008-02-29
Start date
2008-08-31
Completion date
2012-11-30
Last updated
2018-05-01

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, paclitaxel albumin-stabilized nanoparticle formulation, and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. It is not yet known whether bevacizumab is more effective when given together with temozolomide or paclitaxel albumin-stabilized nanoparticle formulation and carboplatin in killing malignant melanoma cells. PURPOSE: This randomized phase II trial is studying the side effects of giving temozolomide together with bevacizumab and to see how well it works compared with giving bevacizumab together with paclitaxel albumin-stabilized nanoparticle formulation and carboplatin in treating patients with stage IV malignant melanoma that cannot be removed by surgery.

Detailed description

OBJECTIVES: Primary * To assess the anti-tumor activity, in terms of the percentage of patients who are treated with these regimens and who are progression-free at 6 months. * To assess the safety profile of each treatment regimen. Secondary * To estimate the response rate in patients treated with these regimens. * To estimate the distribution of progression-free survival time and overall survival time of patients treated with these regimens. Tertiary * To examine the impact of therapy on angiogenesis and immune homeostasis. OUTLINE: Patients are stratified according to ECOG performance status (0 vs 1) and location of metastatic disease (M1a \[skin or subcutaneous tissue or lymph node only\] vs M1b \[lung\] vs M1c \[other visceral sites\]) and randomized to 1 of 2 treatment arms. * Arm I: Patients receive oral temozolomide on days 1-5 and bevacizumab IV over 30-90 minutes on days 1 and 15. (closed to accrual 8/21/09) * Arm II: Patients receive bevacizumab IV over 30-90 minutes on days 1 and 15, paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes on days 1, 8, and 15, and carboplatin IV over 30 minutes on day 1. In both arms, treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection periodically for VEGF plasma levels and analysis of changes in immune homeostasis. Beginning at study entry, patients are followed up every 3 months for 2 years and then every 6 months for up to 3 years.

Interventions

BIOLOGICALbevacizumab

Given IV over 30-90 minutes

DRUGcarboplatin

Given IV over 30 minutes

DRUGpaclitaxel albumin-stabilized nanoparticle formulation

Given IV over 30 minutes

DRUGtemozolomide

Oral temozolomide on days 1-5

Sponsors

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

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)

Eligibility

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

Inclusion criteria

* Histologic confirmed diagnosis of malignant melanoma * Stage IV disease * Not amenable tosurgery * Measurable disease with at least one lesion whose longest diameter canbe measured as ≥ 20 mm by CT or MRI scans OR ≥ 10 mm by spiral CT * No disease that is measurable by physical examination only * No brain metastases per MRI or CT * No radiographically documented invasion of adjacent organs(duodenum, stomach, etc.) or tumor invading major blood vessels * ECOG performance status 0-1 * Life expectancy ≥ 4 months * ANC ≥ 1,500/mm³ * Platelet count ≥ 100,000/mm³ * Hemoglobin ≥ 9 g/dL (transfusion allowed) * Creatinine ≤ 1.5 times upper limit of normal (ULN) * Total bilirubin ≤ 1.5 mg/dL (unless Gilbert syndrome) * AST ≤ 2.5 times ULN * Alkaline phosphatase ≤ 2.5 times ULN * Urine protein:creatinine ratio \< 1.0 at screening ORproteinuria \< 2+ by urine dipstick or protein ≤ 1 g by 24-hour urine collection * Negative serum pregnancy test * Not pregnant or nursing * Fertile patients must use effective contraception * Active infection requiring parenteral antibiotics * Poorly controlled high blood pressure (≥ 150 mm Hg systolic and/or100 mm Hg diastolic) despite treatment * NYHA class II-IV congestive heart failure * Serious cardiac arrhythmia requiring medication * Myocardial infarction or unstable angina within the past 6 months * Clinically significant peripheral vascular disease * Deep venous thrombosis or pulmonary embolus within the past year * Active bleeding or pathological conditions that carry high risk of bleeding (e.g., known esophageal varices) * Serious, non-healing wound (including wounds healing by secondary intention), ulcer or bone fracture * Abdominal fistula, gastrointestinal perforation, or intraabdominal abscess within the past 6 months * History of CNS disease (e.g., primary brain tumor, vascular abnormalities, etc.) * Clinically significant stroke or TIA within the past 6 months * Seizures not controlled with standardmedical therapy * Peripheral neuropathy ≥ grade 2 * History of other malignancy within the past 5 years except basal cell or squamous cell carcinoma of the skin treatable with local resection only or carcinoma in situ of the cervix * Significant traumatic injury within the past 4 weeks * History of hypertensive crisis or hypertensive encephalopathy * Active or recent (≤ 30 days) history of hemoptysis (≥ ½ teaspoon of bright red blood per episode) * Known hypersensitivity to any of the components of bevacizumab * Known to be HIV positive * Current or known history of hepatitis * Prior adjuvant chemotherapy and/or immunotherapy for this cancer allowed * No prior treatment with agents disrupting VEGF activity (i.e., bevacizumab,VEGF-trap, anti-VEGFR Mab) * No ongoing need for full-dose oral or parenteral anticoagulation * No ongoing anti-platelet treatment other than low-dose aspirin(i.e., aspirin 81 mg daily) * No other investigational agents within the past 4 weeks * No major surgical procedure or open biopsy within the past 4 weeks * No fine needle aspirations or core biopsies within the past 7 days * No prior chemotherapy in the metastatic setting * No prior treatment with sunitinib malate or sorafenib * No prior treatment with any taxane-based chemotherapy * Patients who have had \> 25% of their functional bone marrow irradiated are not eligible for this trial * No adjuvant radiation therapy within the past 4 weeks * More than 2 weeks since prior and no concurrent palliative radiation therapy * No concurrent major surgical procedure * No concurrent participation in another clinical study for procedures or agents that treat the same primary study malignancy

Design outcomes

Primary

MeasureTime frameDescription
Progression-free Survival at 6 Monthsat 6 monthsThe primary endpoint is the 6 month post registration Progression-free survival (PFS) rate. Progression-free survival time is defined as the time from registration to documentation of disease progression using the RECIST criteria. Patients who died without documentation of disease progression will be considered to have progressed at death unless there is sufficient documented evidence to conclude no progression occurred prior to death. All patients, who meet the eligibility criteria, sign a consent form, and start treatment will be included in the evaluation of the 6 month PFS rate.

Secondary

MeasureTime frameDescription
Tumor Response Rate, Calculated as a Percentage Along With it's 95% Confidence IntervalUp to 5 yearsA confirmed tumor response is defined to be a Complete Response or Partial Response noted \> as the objective status on 2 consecutive evaluations at least 8 \> weeks apart. The proportion of tumor responses will be \> estimated by the number of confirmed tumor responses divided \> by the total number of evaluable patients. \> Complete Response (CR): Disappearance of all target lesions \> Partial Response (PR): At least a 30% decrease in the sum of the LD of target lesions taking as reference the baseline sum LD. \> Progression (PD): At least a 20% increase in the sum of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. \> Stable Disease (SD): Neither sufficient shrinkage to Qualify for PR nor sufficient increase to Qualify for PD taking as reference the smallest sum LD. responses will be calculated assuming that the number of \> confirmed tumor responses follows a binomial distribution.
Overall SurvivalUp to 5 yearsOverall 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.

Countries

United States

Participant flow

Participants by arm

ArmCount
Arm I
Patients receive oral temozolomide on days 1-5 and bevacizumab IV over 30-90 minutes on days 1 and 15.\> \> bevacizumab: Given IV over 30-90 minutes\> \> temozolomide: Oral temozolomide on days 1-5
42
Arm II
Patients receive bevacizumab IV over 30-90 minutes on days 1 and 15, paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes on days 1, 8, and 15, and carboplatin IV over 30 minutes on day 1.\> \> bevacizumab: Given IV over 30-90 minutes\> \> carboplatin: Given IV over 30 minutes\> \> paclitaxel albumin-stabilized nanoparticle formulation: Given IV over 30 minutes
51
Total93

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeemed Ineligible10
Overall StudyWithdrawal by Subject01

Baseline characteristics

CharacteristicArm IArm IITotal
Age, Continuous57 Years57 Years57 Years
Sex: Female, Male
Female
18 Participants22 Participants40 Participants
Sex: Female, Male
Male
24 Participants29 Participants53 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
43 / 4351 / 51
serious
Total, serious adverse events
7 / 4318 / 51

Outcome results

Primary

Progression-free Survival at 6 Months

The primary endpoint is the 6 month post registration Progression-free survival (PFS) rate. Progression-free survival time is defined as the time from registration to documentation of disease progression using the RECIST criteria. Patients who died without documentation of disease progression will be considered to have progressed at death unless there is sufficient documented evidence to conclude no progression occurred prior to death. All patients, who meet the eligibility criteria, sign a consent form, and start treatment will be included in the evaluation of the 6 month PFS rate.

Time frame: at 6 months

Population: The first 41 eligible patients randomized to each treatment arm.

ArmMeasureValue (NUMBER)
Arm IProgression-free Survival at 6 Months32.8 % of patients alive and progression free
Arm IIProgression-free Survival at 6 Months56.1 % of patients alive and progression free
Secondary

Overall Survival

Overall 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: Up to 5 years

ArmMeasureValue (MEDIAN)
Arm IOverall Survival12.3 Months
Arm IIOverall Survival13.9 Months
Secondary

Tumor Response Rate, Calculated as a Percentage Along With it's 95% Confidence Interval

A confirmed tumor response is defined to be a Complete Response or Partial Response noted \> as the objective status on 2 consecutive evaluations at least 8 \> weeks apart. The proportion of tumor responses will be \> estimated by the number of confirmed tumor responses divided \> by the total number of evaluable patients. \> Complete Response (CR): Disappearance of all target lesions \> Partial Response (PR): At least a 30% decrease in the sum of the LD of target lesions taking as reference the baseline sum LD. \> Progression (PD): At least a 20% increase in the sum of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. \> Stable Disease (SD): Neither sufficient shrinkage to Qualify for PR nor sufficient increase to Qualify for PD taking as reference the smallest sum LD. responses will be calculated assuming that the number of \> confirmed tumor responses follows a binomial distribution.

Time frame: Up to 5 years

ArmMeasureValue (NUMBER)
Arm ITumor Response Rate, Calculated as a Percentage Along With it's 95% Confidence Interval23.8 percentage of patients with response
Arm IITumor Response Rate, Calculated as a Percentage Along With it's 95% Confidence Interval33.3 percentage of patients with response

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