Melanoma
Conditions
Keywords
BRAF inhibitor, Metastatic Melanoma, Cancer, MEK inhibitor
Brief summary
This was a two-arm, open-label, randomized, Phase III study comparing dabrafenib (GSK2118436) and trametinib (GSK1120212) combination therapy with vemurafenib.
Detailed description
Screening/Subject eligibility: Subjects with histologically confirmed cutaneous melanoma that was either unresectable or metastatic (Stages IIIC or IV), were screened for eligibility. Eligible subjects were BRAF V600E or V600K mutation positive. Subjects who had prior systemic anti-cancer treatment in the advanced or metastatic setting were not eligible although prior systemic treatment in the adjuvant setting was allowed. Randomization: A total of 704 subjects were randomized in a ratio of 1:1 to receive combination therapy (352 subjects) or vemurafenib treatment (352 subjects). Subjects were stratified by LDH level (\> the ULN versus =\< ULN) and BRAF mutation (V600E versus V600K). Study treatment: Dabrafenib and trametinib were administered orally at their recommended doses of 150 mg b.i.d. and 2.0 mg once daily, respectively. Subjects randomized in the combination therapy arm received both the agents. Subjects randomized in the vemurafenib arm received vemurafenib at the recommended dose of 960 mg orally b.i.d. Subjects in both the arms continued treatment until disease progression, death, unacceptable toxicity, or withdrawal of consent. The protocol was amended on 07-Aug-2014 which allowed subjects who were still receiving vemurafenib to cross over to the dabrafenib and trametinib combination arm, including those subjects who were still receiving vemurafenib monotherapy treatment after disease progression. A washout period of a minimum of 7 days was considered prior to initiating dabrafenib in combination with trametinib. Subjects who experienced disease progression on the vemurafenib monotherapy arm, discontinued vemurafenib monotherapy, and subsequently received another anticancer therapy were ineligible for cross over to the dabrafenib and trametinib combination arm. Follow-up/Study closure: After study treatment discontinuation, subjects were followed for survival and disease progression as applicable. This study completed once all the subjects had at least the 5-years of follow-up.
Interventions
Dabrafenib 150 mg twice daily orally
Vemurafenib 960 mg twice daily orally
Trametinib 2 mg once daily orally
Sponsors
Study design
Eligibility
Inclusion criteria
Key Inclusion Criteria: * \>= 18 years of age * Stage IIIc or Stage IV BRAF V600E/K cutaneous melanoma * Measurable disease according to RECIST 1.1 * Women of childbearing potential with negative serum pregnancy test prior to randomisation * Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1 * Adequate baseline organ function Key
Exclusion criteria
* Any prior use of a BRAF or MEK inhibitor * Prior systemic anti-cancer treatment in the advanced or metastatic setting; prior systemic treatment in the adjuvant setting is allowed * History of another malignancy (except subjects who have been disease free for 3 years or with a history of completely resected non-melanoma skin cancer) * Known HIV, HBV, HCV infection (except chronic or cleared HBV and HCV infection which will be allowed) * Brain metastases (except if all known lesions were previously treated with surgery or stereotactic radiosurgery and lesions, if still present, are confirmed stable for \>= 12 weeks prior to randomisation or if no longer present are confirmed no evidence of disease for \>= 12 weeks, and are asymptomatic with no corticosteroid requirements for \>= 4 weeks prior to randomisation, and no enzyme inducing anticonvulsants for \>= 4 weeks prior to randomisation * History or evidence of cardiovascular risk (LVEF \< LLN; QTcB \>= 480 msec; blood pressure or systolic \>=140 mmHg or diastolic \>= 90 mmHg which cannot be controlled by anti-hypertensive therapy) * History or current evidence/risk of retinal vein occlusion (RVO) or central serous retinopathy (CSR)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | From the date of randomization until date of death due to any cause (up to approximately 6 years) | Overall Survival (OS) was defined as the interval of time between the date of randomization and the date of death due to any cause. For patients who did not die, OS was censored at the date of last contact. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS), as Assessed by the Investigator | From randomization until the earliest date of disease progression (PD) or death due to any cause (up to approximately 6 years) | Progression-free survival (PFS) was defined as the interval of time between the date of randomization and the first documented occurrence of disease progression or death due to any cause. PFS for investigator-assessed response was summarized per Response Evaluation Criteria in Solid Tumors (RECIST), Version 1.1, which is a set of published rules defining when cancer patients improve (respond), stay the same (stabilize), or worsen (progress) during treatment. Disease progression was defined as at least a 20% increase in the sum of the diameters of target lesions with an absolute increase of at least 5 millimeters (mm) or the appearance of at least 1 new lesion, or the worsening of non-target lesions significant enough to require study treatment discontinuation. |
| Overall Response Rate (ORR) During Randomized Phase, as Assessed by the Investigator | From randomization until the first documented complete response or partial response (up to approximately 6 years) | Overall response was defined as the percentage of confirmed responders (complete response \[CR\] + partial response \[PR\] per RECIST, Version 1.1) as summarized by Investigator assessment. CR was defined as the disappearance of all evidence of target lesions. PR was defined as at least a 30% reduction from Baseline in the sum of the longest diameter (LD) of all target lesions. Data were reported as those participants with measureable disease at Baseline. |
| Duration of Response (DOR), as Assessed by the Investigator | From the time of the first documented response (CR or PR) until disease progression (up to approximately 6 years) | Duration of Response (DOR) was defined as the time from the first documented evidence of a CR (disappearance of all evidence of target lesions) or a PR (at least a 30% reduction from Baseline in the sum of the longest diameter of all target lesions) until disease progression or death due to any cause. PD was defined as at least a 20% increase in the sum of the diameters of target lesions with an absolute increase of at least 5 mm or the appearance of at least1 new lesion, or the worsening of non-target lesions significant enough to require study treatment discontinuation. Data were summarized per RECIST, Version 1.1. |
Countries
Argentina, Australia, Austria, Belgium, Brazil, Canada, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Israel, Italy, Netherlands, New Zealand, Norway, Poland, Russia, South Korea, Spain, Sweden, Switzerland, Taiwan, Ukraine, United Kingdom, United States
Participant flow
Recruitment details
This study was conducted at 207 centers in 28 countries worldwide (Argentina, Australia, Austria, Belgium, Brazil, Canada, Czech Republic, Denmark, Finland, France, Germany, Hungary, Ireland, Israel, Italy, South Korea, Netherlands, New Zealand, Norway, Poland, Russian Federation, Spain, Sweden,Switzerland, Taiwan, Ukraine, UK and USA).
Pre-assignment details
694 subjects were planned and 704 subjects (352 each in combination therapy arm and vemurafenib monotherapy arm) were actually randomized and analyzed. Subjects were stratified by LDH level (\> the ULN versus ≤ ULN) and BRAF mutation (V600E versus V600K).
Participants by arm
| Arm | Count |
|---|---|
| Dabrafenib Plus Trametinib Dabrafenib 150 milligrams (mg) orally twice daily (BID) and Trametinib 2 mg orally once daily until disease progression, death, unacceptable toxicity, or withdrawal of consent. | 352 |
| Vemurafenib Vemurafenib 960 mg orally BID until disease progression, death, unacceptable toxicity, or withdrawal of consent. | 352 |
| Total | 704 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Crossover Phase | Death | 0 | 0 | 11 |
| Crossover Phase | Sponsor Decision | 0 | 0 | 20 |
| Crossover Phase | Withdrawal by Subject | 0 | 0 | 3 |
| Randomized Phase | Crossover to Dabrafenib&Trametinib | 0 | 34 | 0 |
| Randomized Phase | Death | 217 | 238 | 0 |
| Randomized Phase | Lost to Follow-up | 9 | 16 | 0 |
| Randomized Phase | Physician Decision | 6 | 3 | 0 |
| Randomized Phase | Sponsor Decision | 93 | 39 | 0 |
| Randomized Phase | Withdrawal by Subject | 26 | 22 | 0 |
Baseline characteristics
| Characteristic | Vemurafenib | Total | Dabrafenib Plus Trametinib |
|---|---|---|---|
| Age, Continuous | 54.3 Years STANDARD_DEVIATION 14.06 | 54.2 Years STANDARD_DEVIATION 13.94 | 54.1 Years STANDARD_DEVIATION 13.83 |
| Race/Ethnicity, Customized African American/African Heritage | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized American Indian or Alaskan Native | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian - East Asian Heritage | 8 Participants | 16 Participants | 8 Participants |
| Race/Ethnicity, Customized Mixed Race | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized White - Arabic/North African Heritage | 2 Participants | 6 Participants | 4 Participants |
| Race/Ethnicity, Customized White - Mixed Race | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized White - White/Caucasian/European Heritage | 339 Participants | 678 Participants | 339 Participants |
| Sex: Female, Male Female | 172 Participants | 316 Participants | 144 Participants |
| Sex: Female, Male Male | 180 Participants | 388 Participants | 208 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 216 / 350 | 238 / 349 | 11 / 34 | 465 / 699 |
| other Total, other adverse events | 338 / 350 | 341 / 349 | 32 / 34 | 679 / 699 |
| serious Total, serious adverse events | 172 / 350 | 139 / 349 | 15 / 34 | 319 / 699 |
Outcome results
Overall Survival (OS)
Overall Survival (OS) was defined as the interval of time between the date of randomization and the date of death due to any cause. For patients who did not die, OS was censored at the date of last contact.
Time frame: From the date of randomization until date of death due to any cause (up to approximately 6 years)
Population: Intent-to-Treat (ITT) Population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Dabrafenib Plus Trametinib | Overall Survival (OS) | 26.0 Months |
| Vemurafenib | Overall Survival (OS) | 17.8 Months |
Duration of Response (DOR), as Assessed by the Investigator
Duration of Response (DOR) was defined as the time from the first documented evidence of a CR (disappearance of all evidence of target lesions) or a PR (at least a 30% reduction from Baseline in the sum of the longest diameter of all target lesions) until disease progression or death due to any cause. PD was defined as at least a 20% increase in the sum of the diameters of target lesions with an absolute increase of at least 5 mm or the appearance of at least1 new lesion, or the worsening of non-target lesions significant enough to require study treatment discontinuation. Data were summarized per RECIST, Version 1.1.
Time frame: From the time of the first documented response (CR or PR) until disease progression (up to approximately 6 years)
Population: Intent-to-Treat (ITT) Population. Only participants with confirmed response by RECIST version 1.1 were included.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Dabrafenib Plus Trametinib | Duration of Response (DOR), as Assessed by the Investigator | 13.8 Months |
| Vemurafenib | Duration of Response (DOR), as Assessed by the Investigator | 8.5 Months |
Overall Response Rate (ORR) During Randomized Phase, as Assessed by the Investigator
Overall response was defined as the percentage of confirmed responders (complete response \[CR\] + partial response \[PR\] per RECIST, Version 1.1) as summarized by Investigator assessment. CR was defined as the disappearance of all evidence of target lesions. PR was defined as at least a 30% reduction from Baseline in the sum of the longest diameter (LD) of all target lesions. Data were reported as those participants with measureable disease at Baseline.
Time frame: From randomization until the first documented complete response or partial response (up to approximately 6 years)
Population: Intent-to-Treat (ITT) Population. Only participants with measurable disease at baseline were included.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dabrafenib Plus Trametinib | Overall Response Rate (ORR) During Randomized Phase, as Assessed by the Investigator | 68 Percentage of Participants |
| Vemurafenib | Overall Response Rate (ORR) During Randomized Phase, as Assessed by the Investigator | 53 Percentage of Participants |
Progression-Free Survival (PFS), as Assessed by the Investigator
Progression-free survival (PFS) was defined as the interval of time between the date of randomization and the first documented occurrence of disease progression or death due to any cause. PFS for investigator-assessed response was summarized per Response Evaluation Criteria in Solid Tumors (RECIST), Version 1.1, which is a set of published rules defining when cancer patients improve (respond), stay the same (stabilize), or worsen (progress) during treatment. Disease progression was defined as at least a 20% increase in the sum of the diameters of target lesions with an absolute increase of at least 5 millimeters (mm) or the appearance of at least 1 new lesion, or the worsening of non-target lesions significant enough to require study treatment discontinuation.
Time frame: From randomization until the earliest date of disease progression (PD) or death due to any cause (up to approximately 6 years)
Population: Intent-to-Treat (ITT) Population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Dabrafenib Plus Trametinib | Progression-Free Survival (PFS), as Assessed by the Investigator | 12.1 Months |
| Vemurafenib | Progression-Free Survival (PFS), as Assessed by the Investigator | 7.3 Months |
All Collected Deaths
Pre-treatment deaths were collected from screening visit up to the first day of treatment, for a maximum duration of 28 days. Patients who died during the screening period are considered as screen failure. On treatment deaths were collected from FPFT up to 30 days after study drug discontinuation, for a maximum duration of 81.1 months (treatment duration ranged from 0.1 to 80.1 months). Deaths post treatment survival follow up were collected after the on- treatment period, up to approximately 6 years. Patients who didn't die during the on-treatment period and had not stopped study participation at the time of data cut-off (end of study) were censored.
Time frame: up to 28 days before Day 1 (Screening), up to 81.1 months (on-treatment), up to approximately 6 years (study duration)
Population: Clinical database population; all treated patients and patients who died during screening.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Dabrafenib Plus Trametinib | All Collected Deaths | Pre-treatment deaths | 1 Participants |
| Dabrafenib Plus Trametinib | All Collected Deaths | On-treatment deaths | 44 Participants |
| Dabrafenib Plus Trametinib | All Collected Deaths | Post-treatment deaths | 172 Participants |
| Dabrafenib Plus Trametinib | All Collected Deaths | All deaths | 216 Participants |
| Vemurafenib | All Collected Deaths | All deaths | 238 Participants |
| Vemurafenib | All Collected Deaths | Pre-treatment deaths | 0 Participants |
| Vemurafenib | All Collected Deaths | Post-treatment deaths | 191 Participants |
| Vemurafenib | All Collected Deaths | On-treatment deaths | 47 Participants |
| Crossover Dabrafenib + Trametinib | All Collected Deaths | All deaths | 11 Participants |
| Crossover Dabrafenib + Trametinib | All Collected Deaths | On-treatment deaths | 2 Participants |
| Crossover Dabrafenib + Trametinib | All Collected Deaths | Post-treatment deaths | 9 Participants |
| Crossover Dabrafenib + Trametinib | All Collected Deaths | Pre-treatment deaths | 0 Participants |