Melanoma, Metastatic Melanoma, Skin Cancer
Conditions
Keywords
Temozolomide, Skin cancer, Melanoma, Metastatic Melanoma, ABT-888, MM
Brief summary
The purpose of this study is to evaluate the efficacy of ABT-888 in combination with temozolomide versus temozolomide alone in subjects with metastatic melanoma.
Interventions
ABT-888 capsule administered orally twice daily for 7 days every 28 days
temozolomide capsule administered orally once daily for 5 days every 28 days
Placebo for ABT-888 capsule administered orally twice daily for 7 days every 28 days
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically (or cytologically) confirmed metastatic melanoma. * Unresectable Stage III or Stage IV metastatic melanoma. * Measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) criteria. * Subjects with no history of brain metastases demonstrated by a baseline MRI, or subjects with a history of previously treated brain metastases who have history of operable/SRS treatable brain metastases and completed surgical resection/stereotactic radiosurgery with or without adjuvant whole brain radiation at least 28 days prior to Day 1; have baseline MRI that shows no evidence of active intercranial disease; have discontinued taking medications for symptom management of brain metastases at least 7 days prior to Day 1 * 28 days since prior anti-cancer therapy. * Eastern Cooperative Oncology Group (ECOG) Performance Score of 0-1. * Adequate hematologic, renal and hepatic function. * Partial Thromboplastin Time (PTT) is \<= 1.5 x upper normal limit of institution's normal range and international normalized ratio (INR) \< 1.5. * Subject's with significant fluid retention may be allowed at the discretion of the investigator. * Life expectancy \> 12 weeks. * Females must not be pregnant. * Voluntarily signed informed consent.
Exclusion criteria
* Lactate Dehydrogenase (LDH) \> 2 x Upper Limit of Normal (ULN). * Ocular malignant melanoma. * History of central nervous system metastases or leptomeningeal disease. * Prior treatment with Dacarbazine (DTIC) or Temozolomide (TMZ). * Prior DNA damaging agents or cytotoxic chemotherapy. * Prior Whole Brain Radiation Therapy (with exceptions). * Received an investigational agent within 28 days of study. * History of seizure disorder and/or taking medication for seizure disorder. * Active malignancy within the past 5 years, except cervical cancer in situ, in situ carcinoma of the bladder or non-melanoma carcinoma of the skin. * Medical condition that would cause a high risk for toxicities.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS): Time to Event | Every Cycle (28 Days) until disease progression was observed or another reason for discontinuation of assessments was identified by the investigator. The maximum observed followup duration at the progression-free survival analysis time was 9.7 months. | PFS: the number of days from the date that the participant was randomized to the date the participant experienced a confirmed event of disease progression (radiological, as determined by the central imaging center; or clinical, as determined by the investigator), or to the date of death (all causes of mortality) if disease progression was not reached. All events were included whether the participant was still taking or had discontinued study drug. Events of death were included for participants who had not experienced a confirmed event of disease progression, provided the death occurred within 8 weeks of the last available disease progression assessment. The distribution of PFS, as determined by the central imaging center (radiological)/ investigator (clinical), was estimated for each treatment group using Kaplan-Meier methodology. Point estimates and 95% confidence intervals (95% CIs) for the quartiles for the PFS distribution are provided. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 12-Month Overall Survival (OS) Rate | Per protocol, survival was to be assessed every 4 weeks or as needed after participant is registered as off-study for up to 18 months. The maximum observed follow-up at the overall survival analysis time was 21.0 months. | The 12-month overall survival rate was defined as the percentage of participants surviving at 12 months. The distribution of 12-month OS rate was estimated using Kaplan-Meier methodology. Point estimates and 95% CIs for the quartiles for the PFS distribution are provided. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ treatment groups were statistically significantly better than the Placebo + TMZ treatment group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values. |
| 6-month Progression-Free Survival Rate | Every Cycle (28 Days) until disease progression was observed or another reason for discontinuation of assessments was identified by the investigator. The maximum observed followup duration at the progression-free survival analysis time was 9.7 months. | The 6-month progression-free survival rate was defined as the percentage of participants without disease progression at 6 months.The distribution of 6-month progression-free survival rate, as determined by the central imaging center (radiological)/ investigator (clinical), was estimated using Kaplan-Meier methodology. Point estimates and 95% CIs for the quartiles for the PFS distribution are provided. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ treatment groups were statistically significantly better than the Placebo + TMZ treatment group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values. |
| Objective Response Rate | Every 2 cycles (8 weeks) until disease progression was observed or another reason for discontinuation of assessments was identified by the investigator. The maximum observed followup duration at the progression-free survival analysis time was 9.7 months. | The objective response rate was defined as the percentage of participants with a confirmed CR or PR per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by computed tomography (CT) scan: complete response (CR), disappearance of all target lesions; partial response (PR), ≥30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ treatment groups were statistically significantly better than the Placebo + TMZ treatment group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values. |
| Overall Survival (OS): Time to Event | Per protocol, survival follow-up information was to be obtained every 3 months for up to 18 months after the final visit for the subject. The maximum observed follow-up at the overall survival analysis time was 21.0 months. | OS was defined as the number of days from the date the participant was randomized to the date of death. All deaths were included, whether the participant was still taking or had discontinued study drug. If a participant had not died and was lost to follow-up, then data were censored at the last study visit or contact date, or date the participant was last known to be alive, whichever was later; if the participant was not lost to follow-up, then data were censored at the last study visit or contact date, whichever was later. The distribution of OS was estimated for each treatment group using Kaplan-Meier methodology. Point estimates and 95% CIs for the quartiles for the OS distribution are provided. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ groups were statistically significantly better than the Placebo + TMZ group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints. |
| Disease Control Rate | Week 8 | The disease control rate was defined as the percentage of participants who had at least stable disease (complete response, partial response, or stable disease) through the end of Week 8. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ treatment groups were statistically significantly better than the Placebo + TMZ treatment group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values. |
| Time to Neurological/Brain Metastases Progression | Every 2 cycles (8 weeks) until disease progression was observed or another reason for discontinuation of assessments was identified by the investigator. The maximum observed followup duration at the progression-free survival analysis time was 9.7 months. | Time to neurological/brain metastases progression, defined as the number of days from the date of randomization to the date the participant experienced an event of neurological/brain metastases progression, was estimated using Kaplan-Meier methodology. Point estimates and 95% CIs for the quartiles for the distribution are provided. All events of progression were included, regardless of whether the event occurred while the participant was still taking study drug. If a participant did not experience an event, data were censored at the date of the last available brain CT scan. For participants with no postbaseline brain CT scans, data were censored at randomization. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ groups were statistically significantly better than the Placebo + TMZ group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values. |
| Time to Disease Progression | Every Cycle (28 Days), until disease progression was observed or another reason for discontinuation of assessments was identified by the investigator. The maximum observed followup duration at the progression-free survival analysis time was 9.7 months. | The distribution of time to disease progression, as determined by the central imaging center (radiological)/ investigator (clinical), was estimated for each treatment group using Kaplan-Meier methodology. Point estimates and 95% CIs for the quartiles for the PFS distribution are provided. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ treatment groups were statistically significantly better than the Placebo + TMZ treatment group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values. |
Participant flow
Pre-assignment details
A total of 346 subjects were randomized; 2 subjects did not receive study drug and were excluded from the safety analysis.
Participants by arm
| Arm | Count |
|---|---|
| Placebo for ABT-888 BID + TMZ QD Placebo for ABT-888 twice daily (BID) for 7 days every 28 days plus temozolomide (TMZ; by body surface area) 150 mg/m2 once daily (QD) for 5 days every 28 days. | 115 |
| ABT-888 20 mg BID + TMZ QD ABT-888 20 mg twice daily (BID) for 7 days every 28 days plus temozolomide (TMZ; by body surface area) 150 mg/m2 once daily (QD) for 5 days every 28 days. | 116 |
| ABT-888 40 mg BID + TMZ QD ABT-888 40 mg twice daily (BID) for 7 days every 28 days plus temozolomide (TMZ; by body surface area) 150 mg/m2 once daily (QD) for 5 days every 28 days. | 115 |
| Total | 346 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Other | 115 | 116 | 114 |
Baseline characteristics
| Characteristic | Placebo for ABT-888 BID + TMZ QD | ABT-888 20 mg BID + TMZ QD | ABT-888 40 mg BID + TMZ QD | Total |
|---|---|---|---|---|
| Age, Continuous | 58.4 years STANDARD_DEVIATION 14.13 | 58.6 years STANDARD_DEVIATION 12.55 | 62.3 years STANDARD_DEVIATION 13.5 | 59.8 years STANDARD_DEVIATION 13.49 |
| Sex: Female, Male Female | 36 Participants | 45 Participants | 38 Participants | 119 Participants |
| Sex: Female, Male Male | 79 Participants | 71 Participants | 77 Participants | 227 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 112 / 113 | 116 / 116 | 113 / 115 |
| serious Total, serious adverse events | 28 / 113 | 27 / 116 | 31 / 115 |
Outcome results
Progression-Free Survival (PFS): Time to Event
PFS: the number of days from the date that the participant was randomized to the date the participant experienced a confirmed event of disease progression (radiological, as determined by the central imaging center; or clinical, as determined by the investigator), or to the date of death (all causes of mortality) if disease progression was not reached. All events were included whether the participant was still taking or had discontinued study drug. Events of death were included for participants who had not experienced a confirmed event of disease progression, provided the death occurred within 8 weeks of the last available disease progression assessment. The distribution of PFS, as determined by the central imaging center (radiological)/ investigator (clinical), was estimated for each treatment group using Kaplan-Meier methodology. Point estimates and 95% confidence intervals (95% CIs) for the quartiles for the PFS distribution are provided.
Time frame: Every Cycle (28 Days) until disease progression was observed or another reason for discontinuation of assessments was identified by the investigator. The maximum observed followup duration at the progression-free survival analysis time was 9.7 months.
Population: ITT population defined as all randomized participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo for ABT-888 BID + TMZ QD | Progression-Free Survival (PFS): Time to Event | 50th Percentile | 60 days |
| Placebo for ABT-888 BID + TMZ QD | Progression-Free Survival (PFS): Time to Event | 25th Percentile | 54 days |
| Placebo for ABT-888 BID + TMZ QD | Progression-Free Survival (PFS): Time to Event | 75th Percentile | 163 days |
| ABT-888 20 mg BID + TMZ QD | Progression-Free Survival (PFS): Time to Event | 50th Percentile | 113 days |
| ABT-888 20 mg BID + TMZ QD | Progression-Free Survival (PFS): Time to Event | 25th Percentile | 56 days |
| ABT-888 20 mg BID + TMZ QD | Progression-Free Survival (PFS): Time to Event | 75th Percentile | 225 days |
| ABT-888 40 mg BID + TMZ QD | Progression-Free Survival (PFS): Time to Event | 25th Percentile | 53 days |
| ABT-888 40 mg BID + TMZ QD | Progression-Free Survival (PFS): Time to Event | 75th Percentile | 226 days |
| ABT-888 40 mg BID + TMZ QD | Progression-Free Survival (PFS): Time to Event | 50th Percentile | 110 days |
12-Month Overall Survival (OS) Rate
The 12-month overall survival rate was defined as the percentage of participants surviving at 12 months. The distribution of 12-month OS rate was estimated using Kaplan-Meier methodology. Point estimates and 95% CIs for the quartiles for the PFS distribution are provided. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ treatment groups were statistically significantly better than the Placebo + TMZ treatment group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values.
Time frame: Per protocol, survival was to be assessed every 4 weeks or as needed after participant is registered as off-study for up to 18 months. The maximum observed follow-up at the overall survival analysis time was 21.0 months.
Population: ITT population defined as all randomized participants.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo for ABT-888 BID + TMZ QD | 12-Month Overall Survival (OS) Rate | 52.6 percentage of participants |
| ABT-888 20 mg BID + TMZ QD | 12-Month Overall Survival (OS) Rate | 43.5 percentage of participants |
| ABT-888 40 mg BID + TMZ QD | 12-Month Overall Survival (OS) Rate | 54.1 percentage of participants |
6-month Progression-Free Survival Rate
The 6-month progression-free survival rate was defined as the percentage of participants without disease progression at 6 months.The distribution of 6-month progression-free survival rate, as determined by the central imaging center (radiological)/ investigator (clinical), was estimated using Kaplan-Meier methodology. Point estimates and 95% CIs for the quartiles for the PFS distribution are provided. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ treatment groups were statistically significantly better than the Placebo + TMZ treatment group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values.
Time frame: Every Cycle (28 Days) until disease progression was observed or another reason for discontinuation of assessments was identified by the investigator. The maximum observed followup duration at the progression-free survival analysis time was 9.7 months.
Population: ITT population defined as all randomized participants.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo for ABT-888 BID + TMZ QD | 6-month Progression-Free Survival Rate | 19.1 percentage of participants |
| ABT-888 20 mg BID + TMZ QD | 6-month Progression-Free Survival Rate | 32.8 percentage of participants |
| ABT-888 40 mg BID + TMZ QD | 6-month Progression-Free Survival Rate | 30.7 percentage of participants |
Disease Control Rate
The disease control rate was defined as the percentage of participants who had at least stable disease (complete response, partial response, or stable disease) through the end of Week 8. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ treatment groups were statistically significantly better than the Placebo + TMZ treatment group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values.
Time frame: Week 8
Population: ITT population defined as all randomized participants.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo for ABT-888 BID + TMZ QD | Disease Control Rate | 48.7 percentage of participants |
| ABT-888 20 mg BID + TMZ QD | Disease Control Rate | 62.9 percentage of participants |
| ABT-888 40 mg BID + TMZ QD | Disease Control Rate | 59.1 percentage of participants |
Objective Response Rate
The objective response rate was defined as the percentage of participants with a confirmed CR or PR per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by computed tomography (CT) scan: complete response (CR), disappearance of all target lesions; partial response (PR), ≥30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ treatment groups were statistically significantly better than the Placebo + TMZ treatment group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values.
Time frame: Every 2 cycles (8 weeks) until disease progression was observed or another reason for discontinuation of assessments was identified by the investigator. The maximum observed followup duration at the progression-free survival analysis time was 9.7 months.
Population: All subjects in the ITT population (defined as all randomized participants) with measurable disease.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo for ABT-888 BID + TMZ QD | Objective Response Rate | 7.0 percentage of participants |
| ABT-888 20 mg BID + TMZ QD | Objective Response Rate | 10.3 percentage of participants |
| ABT-888 40 mg BID + TMZ QD | Objective Response Rate | 9.6 percentage of participants |
Overall Survival (OS): Time to Event
OS was defined as the number of days from the date the participant was randomized to the date of death. All deaths were included, whether the participant was still taking or had discontinued study drug. If a participant had not died and was lost to follow-up, then data were censored at the last study visit or contact date, or date the participant was last known to be alive, whichever was later; if the participant was not lost to follow-up, then data were censored at the last study visit or contact date, whichever was later. The distribution of OS was estimated for each treatment group using Kaplan-Meier methodology. Point estimates and 95% CIs for the quartiles for the OS distribution are provided. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ groups were statistically significantly better than the Placebo + TMZ group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints.
Time frame: Per protocol, survival follow-up information was to be obtained every 3 months for up to 18 months after the final visit for the subject. The maximum observed follow-up at the overall survival analysis time was 21.0 months.
Population: ITT population defined as all randomized participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo for ABT-888 BID + TMZ QD | Overall Survival (OS): Time to Event | 50th percentile | 390 days |
| Placebo for ABT-888 BID + TMZ QD | Overall Survival (OS): Time to Event | 25th Percentile | 207 days |
| Placebo for ABT-888 BID + TMZ QD | Overall Survival (OS): Time to Event | 75th percentile | 559 days |
| ABT-888 20 mg BID + TMZ QD | Overall Survival (OS): Time to Event | 50th percentile | 327 days |
| ABT-888 20 mg BID + TMZ QD | Overall Survival (OS): Time to Event | 25th Percentile | 204 days |
| ABT-888 20 mg BID + TMZ QD | Overall Survival (OS): Time to Event | 75th percentile | NA days |
| ABT-888 40 mg BID + TMZ QD | Overall Survival (OS): Time to Event | 25th Percentile | 181 days |
| ABT-888 40 mg BID + TMZ QD | Overall Survival (OS): Time to Event | 75th percentile | NA days |
| ABT-888 40 mg BID + TMZ QD | Overall Survival (OS): Time to Event | 50th percentile | 412 days |
Time to Disease Progression
The distribution of time to disease progression, as determined by the central imaging center (radiological)/ investigator (clinical), was estimated for each treatment group using Kaplan-Meier methodology. Point estimates and 95% CIs for the quartiles for the PFS distribution are provided. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ treatment groups were statistically significantly better than the Placebo + TMZ treatment group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values.
Time frame: Every Cycle (28 Days), until disease progression was observed or another reason for discontinuation of assessments was identified by the investigator. The maximum observed followup duration at the progression-free survival analysis time was 9.7 months.
Population: ITT population defined as all randomized participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo for ABT-888 BID + TMZ QD | Time to Disease Progression | 50th percentile | 60 days |
| Placebo for ABT-888 BID + TMZ QD | Time to Disease Progression | 25th Percentile | 54 days |
| Placebo for ABT-888 BID + TMZ QD | Time to Disease Progression | 75th percentile | 163 days |
| ABT-888 20 mg BID + TMZ QD | Time to Disease Progression | 50th percentile | 113 days |
| ABT-888 20 mg BID + TMZ QD | Time to Disease Progression | 25th Percentile | 56 days |
| ABT-888 20 mg BID + TMZ QD | Time to Disease Progression | 75th percentile | 225 days |
| ABT-888 40 mg BID + TMZ QD | Time to Disease Progression | 25th Percentile | 53 days |
| ABT-888 40 mg BID + TMZ QD | Time to Disease Progression | 75th percentile | 226 days |
| ABT-888 40 mg BID + TMZ QD | Time to Disease Progression | 50th percentile | 110 days |
Time to Neurological/Brain Metastases Progression
Time to neurological/brain metastases progression, defined as the number of days from the date of randomization to the date the participant experienced an event of neurological/brain metastases progression, was estimated using Kaplan-Meier methodology. Point estimates and 95% CIs for the quartiles for the distribution are provided. All events of progression were included, regardless of whether the event occurred while the participant was still taking study drug. If a participant did not experience an event, data were censored at the date of the last available brain CT scan. For participants with no postbaseline brain CT scans, data were censored at randomization. Per protocol, because neither the ABT-888 20 mg BID + TMZ nor ABT-888 40 mg BID + TMZ groups were statistically significantly better than the Placebo + TMZ group for the primary endpoint of PFS, confirmatory statistical testing was not continued for any secondary endpoints, regardless of the observed P values.
Time frame: Every 2 cycles (8 weeks) until disease progression was observed or another reason for discontinuation of assessments was identified by the investigator. The maximum observed followup duration at the progression-free survival analysis time was 9.7 months.
Population: ITT population defined as all randomized participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo for ABT-888 BID + TMZ QD | Time to Neurological/Brain Metastases Progression | 50th percentile | NA days |
| Placebo for ABT-888 BID + TMZ QD | Time to Neurological/Brain Metastases Progression | 25th Percentile | 60 days |
| Placebo for ABT-888 BID + TMZ QD | Time to Neurological/Brain Metastases Progression | 75th percentile | NA days |
| ABT-888 20 mg BID + TMZ QD | Time to Neurological/Brain Metastases Progression | 50th percentile | NA days |
| ABT-888 20 mg BID + TMZ QD | Time to Neurological/Brain Metastases Progression | 25th Percentile | 119 days |
| ABT-888 20 mg BID + TMZ QD | Time to Neurological/Brain Metastases Progression | 75th percentile | NA days |
| ABT-888 40 mg BID + TMZ QD | Time to Neurological/Brain Metastases Progression | 25th Percentile | 184 days |
| ABT-888 40 mg BID + TMZ QD | Time to Neurological/Brain Metastases Progression | 75th percentile | NA days |
| ABT-888 40 mg BID + TMZ QD | Time to Neurological/Brain Metastases Progression | 50th percentile | 184 days |