Melanoma
Conditions
Brief summary
The purpose of this study is to determine whether giving Ipilimumab at a dose of 10mg/kg will extend the lives of subjects with unresectable or metastatic melanoma more than giving Ipilimumab at a dose of 3 mg/kg
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
For more information regarding BMS clinical trial participation, please visit www.BMSStudyConnect.com. Inclusion Criteria: * Unresectable Stage III or Stage IV melanoma * Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
Exclusion criteria
* Brain metastases with symptoms or requiring treatment * History of autoimmune disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Approximately 48 months (assessed up to February 2016) | OS is defined for each participant as the time between randomization date and death due to any cause. The survival time for participants who had not died was censored at the last known alive date. Median and associated 2-sided 95% confidence intervals were calculated using the method of Brookmeyer and Crowley. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Best Overall Response Rate (BORR) by mWHO Criteria | From date of randomization until 540 death events occurred (approximately 48 months) | BORR by treatment arm was defined as the total number of randomized participants in the arm whose BOR is CR or PR, divided by the total number of randomized participants in the arm. Any participant who was unevaluable for BOR, e.g. on account of missing or not evaluable assessments, was included in the denominator of the calculation (i.e. was considered a non-responder with respect to the BORR endpoint). 95% 2-sided exact confidence intervals were computed using the method of Clopper and Pearson. |
| Disease Control Rate (DCR) by mWHO Criteria | From date of randomization until 540 death events occurred (approximately 48 months) | DCR by treatment arm was defined as the total number of randomized participants in the arm whose BOR is CR, PR or SD, divided by the total number of randomized participants in the arm. Any participant who was unevaluable for Disease Control (DC), (e.g. on account of missing or not evaluable assessments), was included in the denominator of the calculation (i.e. was considered a non-responder with respect to the DCR endpoint). 95% 2-sided exact confidence intervals were computed using the Clopper and Pearson method. |
| Duration of Response (DOR) by mWHO Criteria | From date of randomization until 540 death events occurred (approximately 48 months) | Duration of response for participants whose BOR was CR or PR was defined as the time between the date measurement criteria were first met for overall response of PR or CR (whichever status was recorded first) and the date of disease progression or death (whichever occurred first). For participants who underwent tumor resection following response but prior to disease progression, duration of response was censored on the date of last evaluable tumor assessment prior to resection. For participants who had BOR of SD, PR or CR at Week 12, or a confirmed response of PR or CR before Week 12, the date of PD following thereafter (where available) was used in the analysis of duration of response. For those participants who remained alive and had not progressed following response, duration of response was censored on the date of last evaluable tumor assessment. Median and associated 2-sided 95% confidence intervals were calculated using the Brookmeyer Crowley method. |
| Progression Free Survival (PFS) by mWHO Criteria | From date of randomization until 540 death events occurred (approximately 48 months) | PFS was defined as the time between randomization date and the date of progression or death, whichever occurred first. A participant who died without reported prior progression was considered to have progressed on the date of death. For a participant who underwent resection post randomization, PFS was censored on last tumor assessment date prior to resection. For those who remained alive and had not progressed, PFS was censored on last evaluable tumor assessment date. Participants who had not died and had no recorded post-baseline tumor assessment were censored at the day of randomization. For participants who had Progressive Disease (PD) prior to Week 12 and a subsequent assessment of Stable Disease (SD), Partial Response (PR), or Complete Response (CR), the date of PD following response was used in the analysis of PFS; otherwise these participants were censored on the date of their last tumor assessment. Median and 2-sided 95% CIs were calculated with Brookmeyer Crowley method. |
| Rate of Overall Survival | Approximately 66 months | OS is defined for each participant as the time between randomization date and death due to any cause. The survival time for participants who had not died was censored at the last known alive date. Survival rates were calculated based on Kaplan-Meier estimation with log-log transformed confidence intervals. The survival rate at x year(s) is defined as the probability that a subject is alive at x year(s) following randomization. |
| Overall Survival of Participants With Brain Metastases at Baseline | From date of randomization until 540 death events occurred (approximately 48 months) | OS for each participant with brain metastases at baseline was measured as the time between randomization date and death due to any cause. The survival time for participants who had not died was censored at the last known alive date. Median OS, and associated 2-sided 95% confidence intervals were calculated using the Brookmeyer and Crowley method. |
| Duration of Stable Disease by mWHO Criteria | From date of randomization until 540 death events occurred (approximately 48 months) | Duration of stable disease was defined for participants whose BOR was SD as the time between when SD was first documented and the date of PD or death (whichever occurred first). For a participant who underwent tumor resection following Week 12 but prior to disease progression, duration of stable disease was censored on the date of the last evaluable tumor assessment prior to resection. For participants who had BOR of SD at Week 12, the date of PD following thereafter (where available) was used in the analysis of duration of stable disease. For participants with BOR of SD who had not subsequently progressed and who remained alive, duration of stable disease was censored on the date of last evaluable tumor assessment. Median and associated 2-sided 95% confidence intervals were calculated using the Brookmeyer and Crowley method. |
Countries
Argentina, Australia, Austria, Belgium, Canada, Czechia, Denmark, France, Germany, Hungary, Israel, Italy, Mexico, Netherlands, Norway, Poland, South Africa, Spain, Sweden, Switzerland, United Kingdom, United States
Participant flow
Pre-assignment details
831 participants were enrolled; 727 were randomized to a treatment group; 726 received at least one dose of study treatment. Of the 105 participants not treated, 81 no longer met study criteria, 11 withdrew consent, 4 suffered an Adverse Event, 4 died, and 5 were not treated due to investigator decision or other reasons.
Participants by arm
| Arm | Count |
|---|---|
| Ipilimumab (10 mg/kg) Ipilimumab 10 mg/kg solution intravenously once every 3 weeks for 4 doses or until disease progression or unacceptable toxicity | 365 |
| Ipilimumab (3 mg/kg) Ipilimumab 3 mg/kg solution intravenously once every 3 weeks for 4 doses or until disease progression or unacceptable toxicity | 362 |
| Total | 727 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| First Re-Induction Phase | Disease progression | 6 | 14 |
| First Re-Induction Phase | No longer meets study criteria | 1 | 0 |
| First Re-Induction Phase | Other | 1 | 0 |
| First Re-Induction Phase | Study drug toxicity | 5 | 0 |
| First Re-Induction Phase | Withdrawal by Subject | 1 | 1 |
| Induction | Adverse Event | 14 | 9 |
| Induction | Death | 24 | 17 |
| Induction | Disease Progression | 109 | 155 |
| Induction | Lost to Follow-up | 1 | 0 |
| Induction | No longer meets study criteria | 0 | 2 |
| Induction | Other | 0 | 4 |
| Induction | Study drug toxicity | 86 | 36 |
| Induction | Withdrawal by Subject | 3 | 9 |
Baseline characteristics
| Characteristic | Ipilimumab (10 mg/kg) | Ipilimumab (3 mg/kg) | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 141 Participants | 154 Participants | 295 Participants |
| Age, Categorical Between 18 and 65 years | 224 Participants | 208 Participants | 432 Participants |
| Age, Continuous | 58.6 years STANDARD_DEVIATION 14.52 | 60.7 years STANDARD_DEVIATION 13.22 | 59.7 years STANDARD_DEVIATION 13.92 |
| Sex: Female, Male Female | 146 Participants | 131 Participants | 277 Participants |
| Sex: Female, Male Male | 219 Participants | 231 Participants | 450 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 319 / 364 | 302 / 362 |
| serious Total, serious adverse events | 245 / 364 | 194 / 362 |
Outcome results
Overall Survival (OS)
OS is defined for each participant as the time between randomization date and death due to any cause. The survival time for participants who had not died was censored at the last known alive date. Median and associated 2-sided 95% confidence intervals were calculated using the method of Brookmeyer and Crowley.
Time frame: Approximately 48 months (assessed up to February 2016)
Population: All randomized participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ipilimumab (10 mg/kg) | Overall Survival (OS) | 15.70 months |
| Ipilimumab (3 mg/kg) | Overall Survival (OS) | 11.53 months |
Best Overall Response Rate (BORR) by mWHO Criteria
BORR by treatment arm was defined as the total number of randomized participants in the arm whose BOR is CR or PR, divided by the total number of randomized participants in the arm. Any participant who was unevaluable for BOR, e.g. on account of missing or not evaluable assessments, was included in the denominator of the calculation (i.e. was considered a non-responder with respect to the BORR endpoint). 95% 2-sided exact confidence intervals were computed using the method of Clopper and Pearson.
Time frame: From date of randomization until 540 death events occurred (approximately 48 months)
Population: All randomized participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Ipilimumab (10 mg/kg) | Best Overall Response Rate (BORR) by mWHO Criteria | 15.3 percentage of participants with BORR |
| Ipilimumab (3 mg/kg) | Best Overall Response Rate (BORR) by mWHO Criteria | 12.2 percentage of participants with BORR |
Disease Control Rate (DCR) by mWHO Criteria
DCR by treatment arm was defined as the total number of randomized participants in the arm whose BOR is CR, PR or SD, divided by the total number of randomized participants in the arm. Any participant who was unevaluable for Disease Control (DC), (e.g. on account of missing or not evaluable assessments), was included in the denominator of the calculation (i.e. was considered a non-responder with respect to the DCR endpoint). 95% 2-sided exact confidence intervals were computed using the Clopper and Pearson method.
Time frame: From date of randomization until 540 death events occurred (approximately 48 months)
Population: All randomized participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Ipilimumab (10 mg/kg) | Disease Control Rate (DCR) by mWHO Criteria | 31.5 percentage of participants with DC |
| Ipilimumab (3 mg/kg) | Disease Control Rate (DCR) by mWHO Criteria | 27.9 percentage of participants with DC |
Duration of Response (DOR) by mWHO Criteria
Duration of response for participants whose BOR was CR or PR was defined as the time between the date measurement criteria were first met for overall response of PR or CR (whichever status was recorded first) and the date of disease progression or death (whichever occurred first). For participants who underwent tumor resection following response but prior to disease progression, duration of response was censored on the date of last evaluable tumor assessment prior to resection. For participants who had BOR of SD, PR or CR at Week 12, or a confirmed response of PR or CR before Week 12, the date of PD following thereafter (where available) was used in the analysis of duration of response. For those participants who remained alive and had not progressed following response, duration of response was censored on the date of last evaluable tumor assessment. Median and associated 2-sided 95% confidence intervals were calculated using the Brookmeyer Crowley method.
Time frame: From date of randomization until 540 death events occurred (approximately 48 months)
Population: All randomized participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ipilimumab (10 mg/kg) | Duration of Response (DOR) by mWHO Criteria | 16.33 months |
| Ipilimumab (3 mg/kg) | Duration of Response (DOR) by mWHO Criteria | 15.90 months |
Duration of Stable Disease by mWHO Criteria
Duration of stable disease was defined for participants whose BOR was SD as the time between when SD was first documented and the date of PD or death (whichever occurred first). For a participant who underwent tumor resection following Week 12 but prior to disease progression, duration of stable disease was censored on the date of the last evaluable tumor assessment prior to resection. For participants who had BOR of SD at Week 12, the date of PD following thereafter (where available) was used in the analysis of duration of stable disease. For participants with BOR of SD who had not subsequently progressed and who remained alive, duration of stable disease was censored on the date of last evaluable tumor assessment. Median and associated 2-sided 95% confidence intervals were calculated using the Brookmeyer and Crowley method.
Time frame: From date of randomization until 540 death events occurred (approximately 48 months)
Population: All randomized participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ipilimumab (10 mg/kg) | Duration of Stable Disease by mWHO Criteria | 5.55 months |
| Ipilimumab (3 mg/kg) | Duration of Stable Disease by mWHO Criteria | 3.19 months |
Overall Survival of Participants With Brain Metastases at Baseline
OS for each participant with brain metastases at baseline was measured as the time between randomization date and death due to any cause. The survival time for participants who had not died was censored at the last known alive date. Median OS, and associated 2-sided 95% confidence intervals were calculated using the Brookmeyer and Crowley method.
Time frame: From date of randomization until 540 death events occurred (approximately 48 months)
Population: All randomized participants with brain metastases at baseline
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ipilimumab (10 mg/kg) | Overall Survival of Participants With Brain Metastases at Baseline | 7.00 months |
| Ipilimumab (3 mg/kg) | Overall Survival of Participants With Brain Metastases at Baseline | 5.67 months |
Progression Free Survival (PFS) by mWHO Criteria
PFS was defined as the time between randomization date and the date of progression or death, whichever occurred first. A participant who died without reported prior progression was considered to have progressed on the date of death. For a participant who underwent resection post randomization, PFS was censored on last tumor assessment date prior to resection. For those who remained alive and had not progressed, PFS was censored on last evaluable tumor assessment date. Participants who had not died and had no recorded post-baseline tumor assessment were censored at the day of randomization. For participants who had Progressive Disease (PD) prior to Week 12 and a subsequent assessment of Stable Disease (SD), Partial Response (PR), or Complete Response (CR), the date of PD following response was used in the analysis of PFS; otherwise these participants were censored on the date of their last tumor assessment. Median and 2-sided 95% CIs were calculated with Brookmeyer Crowley method.
Time frame: From date of randomization until 540 death events occurred (approximately 48 months)
Population: All randomized participants.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ipilimumab (10 mg/kg) | Progression Free Survival (PFS) by mWHO Criteria | 2.83 months |
| Ipilimumab (3 mg/kg) | Progression Free Survival (PFS) by mWHO Criteria | 2.79 months |
Rate of Overall Survival
OS is defined for each participant as the time between randomization date and death due to any cause. The survival time for participants who had not died was censored at the last known alive date. Survival rates were calculated based on Kaplan-Meier estimation with log-log transformed confidence intervals. The survival rate at x year(s) is defined as the probability that a subject is alive at x year(s) following randomization.
Time frame: Approximately 66 months
Population: All randomized participants
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Ipilimumab (10 mg/kg) | Rate of Overall Survival | Survival rate at 2 years | 38.46 percentage of participants |
| Ipilimumab (10 mg/kg) | Rate of Overall Survival | Survival rate at 4 years | 26.63 percentage of participants |
| Ipilimumab (10 mg/kg) | Rate of Overall Survival | Survival rate at 3 years | 31.16 percentage of participants |
| Ipilimumab (10 mg/kg) | Rate of Overall Survival | Survival rate at 5 years | 24.90 percentage of participants |
| Ipilimumab (10 mg/kg) | Rate of Overall Survival | Survival rate at 1 year | 54.28 percentage of participants |
| Ipilimumab (3 mg/kg) | Rate of Overall Survival | Survival rate at 5 years | 18.78 percentage of participants |
| Ipilimumab (3 mg/kg) | Rate of Overall Survival | Survival rate at 1 year | 47.62 percentage of participants |
| Ipilimumab (3 mg/kg) | Rate of Overall Survival | Survival rate at 2 years | 30.97 percentage of participants |
| Ipilimumab (3 mg/kg) | Rate of Overall Survival | Survival rate at 3 years | 23.15 percentage of participants |
| Ipilimumab (3 mg/kg) | Rate of Overall Survival | Survival rate at 4 years | 20.25 percentage of participants |