Metastatic Melanoma
Conditions
Keywords
melanoma, malignant, metastatic
Brief summary
This is a global, Phase 2, open label, dose selection, proof-of-concept study to assess progression free survival in subjects with metastatic melanoma. Approximately 80 subjects at 29 sites in the U.S., U.K., Germany and Australia will be randomized into one of two dose groups: 2 mg/kg, 4 mg/kg. Weekly treatment will continue until disease progression. Subjects must have measurable disease by CT Scan or MRI and must have completed at least one prior round of chemotherapy. Subjects will be assessed for Efficacy, PK/PD, Overall survival, and Safety (Adverse Events/Adverse Events of Interest, Electrocardiograms (ECG's), clinical labs, physical exams/vital signs, tolerability).
Detailed description
MORAb-004 is a monoclonal antibody directed against endosialin, a cell surface glycoprotein, which is expressed on cells involved in tumor vasculature. Studies have found endosialin to play a key role in tumor growth and neovessel formation in numerous cancer types including melanoma. Preclinical pharmacological studies have shown that MORAb-004 is a potentially useful anti-cancer agent. This clinical trial is being performed to determine the efficacy of MORAb-004 at two dose levels in subjects with metastatic melanoma, as well as to establish serum pharmacokinetics and pharmacodynamics of the antibody.
Interventions
Subjects will receive one cycle of treatment with MORAb-004, administered intravenously, on Days 1, 8, 15, and 22 (4 administrations per cycle). Additional cycles will continue without interruption until disease progression occurs or clinical or symptomatic progression as suggested by an investigator.
Sponsors
Study design
Eligibility
Inclusion criteria
* Be surgically sterile or consent to use a medically acceptable method of contraception throughout the study period. * Histologically confirmed diagnosis of metastatic melanoma * At least 1 prior systemic treatment for metastatic melanoma with disease progression following treatment * Measurable disease, as defined by RECIST v1.1, assessed within 4 weeks prior to study entry * At least 3 week interval between first infusion of test article and most recent prior systemic anticancer therapy. All treatment-associated toxicity must be resolved to less than or equal to Grade 1 before the administration of MORAb-004 * Have a life expectancy of at least 3 months as estimated by the investigator * Have other significant medical conditions well-controlled and stable, in the opinion of the investigator, for at least 30 days prior to Study Day 1 * Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1 * Have sites of disease amenable to the protocol-specified biopsy (Note: All participants will have protocol-specified biopsy at Screening. The second, on-treatment biopsy will be mandatory in the first 30 randomized participants only. For all other participants, the second biopsy is optional. * Laboratory tests results prior to Study Day 1 within limits as outlined in protocol
Exclusion criteria
* Have received no prior systemic treatment for metastatic melanoma * Evidence of other active malignancy requiring treatment within the last 5 years (other than basal cell or squamous cell carcinoma of the skin), or active brain metastasis * Clinically significant heart disease (Congestive heart failure of New York Heart Association \[NYHA\] Class 3 or 4, angina not well controlled by medication, or myocardial infarction within 6 mos.), or ECGs demonstrating clinically significant arrhythmias * Have any other serious systemic disease, including active bacterial or fungal infection, or any medical condition requiring cytotoxic therapy or chronic (at least 4 consecutive weeks) systemic corticosteroid use * Have active viral hepatitis or symptomatic Human immunodeficiency virus (HIV) infection * Be breast-feeding, pregnant, or likely to become pregnant during the study * Known allergic reaction to a prior monoclonal antibody therapy * Previous treatment with MORAb-004 * Brain metastasis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Progression-free Survival (PFS) at Week 24 | Week 24 | PFS was defined as the time (in weeks) from the date of randomization to the date of the first sign of disease progression (PD) based on Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1, or date of death, regardless of cause. PD greater than or equal to (\>=) 20 percent (%) increase in the nadir of total tumor burden (TTB) (minimum 5 millimeter \[mm\]). Participants who were alive with no disease progression had their PFS time censored at the date of their last tumor assessment. Participants who received a new anti-cancer therapy before disease progression had their PFS time censored at the date of their last tumor assessment before the new anti-cancer therapy was started. PFS was analyzed using Kaplan Meier method. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With PFS at Weeks 16 and 52 | Week 16 and Week 52 | PFS was defined as the time (in weeks) from the date of randomization to the date of the first observation of PD (RECIST version 1.1) or date of death, regardless of the cause. PD \>=20% increase in the nadir of TTB (minimum 5 mm). Participants who were alive with no disease progression had their PFS time censored at the date of their last tumor assessment. Participants who received new anti-cancer therapy before disease progression had their PFS time censored at the date of their last tumor assessment before the new anti-cancer therapy was initiated. PFS was based on the Kaplan-Meier method. |
| Overall Survival (OS) | Date of first study treatment (Day 1) to date of death or up to approximately 2 years 7 months | OS was defined as the time (in weeks) from the date of randomization to the date of death, regardless of cause. In the absence of death confirmation, or for participants alive at the time of analysis, the survival time was censored at the date of the last study follow-up. OS was calculated using the Kaplan-Meier method. As per planned analysis, efficacy outcomes was planned to be analyzed until cut-off date (02 December 2013). |
| Percentage of Participants With Overall Response | Date of first study treatment (Day 1) to complete response or partial response, assessed up to approximately 2 years 7 months | ORR was defined as the percentage of participants with best overall response (BOR) of complete response (CR) or partial response (PR) that occurred (defined by RECIST version 1.1) using CT/MRI. Per RECIST 1.1, CR= disappearance of all lesions; PR greater than or equal to (\>=) 30percent (%) decrease from baseline in TTB. As per planned analysis, efficacy outcomes was planned to be analyzed until cut-off date (02 December 2013). |
| Optimal Biologic Dosing (OBD) of Morab-004 | Day 1 Cycle 1 (Cycle length = 28 days) | OBD is defined as the dose level/exposure level at which three parameters are met: 1) adequate pharmacokinetic (PK) profile with a serum half-life (t1/2) of \>=48 hours, 2) at least minimal demonstration of antitumor efficacy (50% or greater PFS rate at 16 weeks), and 3) change of 25% or greater from baseline value in any of the pharmacodynamic (PD) parameters assessed in the study in 30% of participants at that dose level. |
Countries
Australia, Germany, United Kingdom, United States
Participant flow
Recruitment details
Participants took part in the study at 29 sites in 4 countries (the United States, Australia, Germany, and the United Kingdom), 20 of which enrolled participants.
Pre-assignment details
A total of 76 participants were randomized to treatment with MORAb-004 (40 participants in the 2 milligram per kilogram \[mg/kg\] group and 36 participants in the 4 mg/kg group).
Participants by arm
| Arm | Count |
|---|---|
| MORAb-004 2 mg/kg Participants received one cycle of treatment with MORAb-004 2 mg/kg, administered intravenously on Days 1, 8, 15, and 22 of the 28-day cycle (4 administrations per cycle). Participants who completed Cycle 1 continued with additional cycles without interruption or dose escalation until disease progression, using CT/MRI or until they discontinued the study for any reason. Participants were assessed for disease progression by CT/MRI every 8 weeks from the date of first study treatment (that is, Cycle 1 Day 1), regardless of delays in treatment. | 40 |
| MORAb-004 4 mg/kg Participants received one cycle of treatment with MORAb-004 4 mg/kg, administered intravenously on Days 1, 8, 15, and 22 of the 28-day cycle (4 administrations per cycle). Participants who completed Cycle 1 continued with additional cycles without interruption or dose escalation until disease progression, using CT/MRI or until they discontinued the study for any reason. Participants were assessed for disease progression by CT/MRI every 8 weeks from the date of first study treatment (that is, Cycle 1 Day 1), regardless of delays in treatment. | 36 |
| Total | 76 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 28 | 32 |
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | Too ill to travel to study sites | 1 | 0 |
| Overall Study | Withdrawal by Subject | 1 | 1 |
Baseline characteristics
| Characteristic | MORAb-004 4 mg/kg | Total | MORAb-004 2 mg/kg |
|---|---|---|---|
| Age, Continuous | 61.2 years STANDARD_DEVIATION 12.15 | 63.3 years STANDARD_DEVIATION 12.26 | 65.1 years STANDARD_DEVIATION 12.22 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4 Participants | 5 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 32 Participants | 71 Participants | 39 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 2 Participants | 1 Participants |
| Race (NIH/OMB) White | 34 Participants | 73 Participants | 39 Participants |
| Sex: Female, Male Female | 9 Participants | 27 Participants | 18 Participants |
| Sex: Female, Male Male | 27 Participants | 49 Participants | 22 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 28 / 40 | 32 / 36 |
| other Total, other adverse events | 40 / 40 | 36 / 36 |
| serious Total, serious adverse events | 17 / 40 | 16 / 36 |
Outcome results
Percentage of Participants With Progression-free Survival (PFS) at Week 24
PFS was defined as the time (in weeks) from the date of randomization to the date of the first sign of disease progression (PD) based on Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1, or date of death, regardless of cause. PD greater than or equal to (\>=) 20 percent (%) increase in the nadir of total tumor burden (TTB) (minimum 5 millimeter \[mm\]). Participants who were alive with no disease progression had their PFS time censored at the date of their last tumor assessment. Participants who received a new anti-cancer therapy before disease progression had their PFS time censored at the date of their last tumor assessment before the new anti-cancer therapy was started. PFS was analyzed using Kaplan Meier method.
Time frame: Week 24
Population: Primary efficacy population included all participants in the safety population who meet all key eligibility criteria (including measurable disease at baseline after at least 1 systemic treatment) analyzed by the dose level to which they were randomized.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| MORAb-004 2 mg/kg | Percentage of Participants With Progression-free Survival (PFS) at Week 24 | 13.5 percentage of participants |
| MORAb-004 4 mg/kg | Percentage of Participants With Progression-free Survival (PFS) at Week 24 | 8.9 percentage of participants |
Optimal Biologic Dosing (OBD) of Morab-004
OBD is defined as the dose level/exposure level at which three parameters are met: 1) adequate pharmacokinetic (PK) profile with a serum half-life (t1/2) of \>=48 hours, 2) at least minimal demonstration of antitumor efficacy (50% or greater PFS rate at 16 weeks), and 3) change of 25% or greater from baseline value in any of the pharmacodynamic (PD) parameters assessed in the study in 30% of participants at that dose level.
Time frame: Day 1 Cycle 1 (Cycle length = 28 days)
Population: All participants in the safety population who receive at least one dose of MORAb-004 and who had at least one on-treatment PK/PD assessment performed that is sufficient to evaluate the endpoint of interest. Here overall number of participants analyzed are participants who were available for this outcome measure.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| MORAb-004 2 mg/kg | Optimal Biologic Dosing (OBD) of Morab-004 | NA milligram(s) |
| MORAb-004 4 mg/kg | Optimal Biologic Dosing (OBD) of Morab-004 | NA milligram(s) |
Overall Survival (OS)
OS was defined as the time (in weeks) from the date of randomization to the date of death, regardless of cause. In the absence of death confirmation, or for participants alive at the time of analysis, the survival time was censored at the date of the last study follow-up. OS was calculated using the Kaplan-Meier method. As per planned analysis, efficacy outcomes was planned to be analyzed until cut-off date (02 December 2013).
Time frame: Date of first study treatment (Day 1) to date of death or up to approximately 2 years 7 months
Population: Primary efficacy population included all participants in the safety population who meet all key eligibility criteria (including measurable disease at baseline after at least 1 systemic treatment) analyzed by the dose level to which they were randomized. Participants without documentation of death at the time of analysis were censored at the date last known to be alive.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| MORAb-004 2 mg/kg | Overall Survival (OS) | 40.9 weeks |
| MORAb-004 4 mg/kg | Overall Survival (OS) | 29.3 weeks |
Percentage of Participants With Overall Response
ORR was defined as the percentage of participants with best overall response (BOR) of complete response (CR) or partial response (PR) that occurred (defined by RECIST version 1.1) using CT/MRI. Per RECIST 1.1, CR= disappearance of all lesions; PR greater than or equal to (\>=) 30percent (%) decrease from baseline in TTB. As per planned analysis, efficacy outcomes was planned to be analyzed until cut-off date (02 December 2013).
Time frame: Date of first study treatment (Day 1) to complete response or partial response, assessed up to approximately 2 years 7 months
Population: ORR population included a subset of participants from the primary efficacy population who had at least 1 on-study radiologic evaluation performed (in addition to their baseline evaluation), analyzed by the dose level received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| MORAb-004 2 mg/kg | Percentage of Participants With Overall Response | NA percentage of participants |
| MORAb-004 4 mg/kg | Percentage of Participants With Overall Response | 3.1 percentage of participants |
Percentage of Participants With PFS at Weeks 16 and 52
PFS was defined as the time (in weeks) from the date of randomization to the date of the first observation of PD (RECIST version 1.1) or date of death, regardless of the cause. PD \>=20% increase in the nadir of TTB (minimum 5 mm). Participants who were alive with no disease progression had their PFS time censored at the date of their last tumor assessment. Participants who received new anti-cancer therapy before disease progression had their PFS time censored at the date of their last tumor assessment before the new anti-cancer therapy was initiated. PFS was based on the Kaplan-Meier method.
Time frame: Week 16 and Week 52
Population: Primary efficacy population included all participants in the safety population who meet all key eligibility criteria (including measurable disease at baseline after at least 1 systemic treatment) analyzed by the dose level to which they were randomized.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| MORAb-004 2 mg/kg | Percentage of Participants With PFS at Weeks 16 and 52 | Week 16 | 32.5 percentage of participants |
| MORAb-004 2 mg/kg | Percentage of Participants With PFS at Weeks 16 and 52 | Week 52 | NA percentage of participants |
| MORAb-004 4 mg/kg | Percentage of Participants With PFS at Weeks 16 and 52 | Week 16 | 20.8 percentage of participants |
| MORAb-004 4 mg/kg | Percentage of Participants With PFS at Weeks 16 and 52 | Week 52 | 8.9 percentage of participants |