Metastatic Melanoma, Unresectable Melanoma
Conditions
Brief summary
The primary purpose of this study is to compare the objective response rate, as determined by investigators, of Nivolumab combined with Ipilimumab versus Ipilimumab monotherapy in patients with untreated, unresectable, or metastatic melanoma
Interventions
Matching nivolumab
Sponsors
Study design
Eligibility
Inclusion criteria
For more information regarding BMS clinical trial participation, please visit www.BMSStudyConnect.com Key Inclusion Criteria: * Eastern Cooperative Oncology Group performance status of 0 or 1 * Histologically confirmed unresectable Stage III or Stage IV melanoma * No prior systemic anticancer therapy for unresectable or metastatic melanoma. Note that prior adjuvant or neoadjuvant melanoma therapy is permitted if it was completed at least 6 weeks prior to date of first dose, and all related adverse events have either returned to baseline or stabilized * Tumor tissue obtained in the metastatic setting or from an unresectable site must be provided for biomarker analyses and sent to the central laboratory. Biopsy should be excisional, incisional punch, or core needle. Fine needle aspirates or other cytology samples are insufficient * Known BRAF V600 mutation status as determined by an FDA-approved test. Patients with either V600 wild-type or V600 mutation-positive melanoma are eligible. Key
Exclusion criteria
* Active brain metastases or leptomeningeal metastases. Patients with treated brain metastases are eligible if there is no evidence of progression on magnetic resonance imaging scan for at least 8 weeks after completion of treatment and within 28 days prior to first dose of study drug administration. There must also be no requirement for high doses of systemic corticosteroids that could result in immunosuppression (\>10 mg/day prednisone equivalents) for at least 2 weeks prior to study drug administration * Ocular melanoma * Patients with active, known, or suspected autoimmune disease. Those with vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR) - BRAF Wild-type (WT) Participants | From 12 weeks after Randomization, assessed every 6 weeks up to Week 49 of study treatment and then every 12 weeks until disease progression (up to approximately 76 months) | Objective Response Rate is defined as the percentage of participants with a best overall response of Complete Response (CR) or Partial Response (PR), assessed by the investigator by using RECIST 1.1 criteria. CR=all target and nontarget lesions have disappeared. Lymph nodes selected must have returned to normal size (\<10 mm). PR=at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) - BRAF Wild-type (WT) Participants | From randomization to progression or death (up to approximately 88 months) | PFS is defined as the time between the date of randomization and the first date of documented progression, as assessed by the investigator, or death due to any cause, whichever occurs first. Participants who died without a reported progression were considered to have progressed on the date of their death. Participants who did not progress or died were censored on the date of their last evaluable tumor assessment. PFS values are based on Kaplan-Meier Estimates. |
| Objective Response Rate (ORR) - BRAF Mutant Participants | From 12 weeks after Randomization, assessed every 6 weeks up to Week 49 of study treatment and then every 12 weeks until disease progression (up to approximately 76 months) | Objective Response Rate is defined as the percentage of participants with a best overall response of Complete Response (CR) or Partial Response (PR), assessed by the investigator by using RECIST 1.1 criteria. CR=all target and nontarget lesions have disappeared. Lymph nodes selected must have returned to normal size (\<10 mm). PR=at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD. |
| Progression-Free Survival (PFS) - BRAF Mutant Participants | From randomization to progression or death (up to approximately 88 months) | PFS is defined as the time between the date of randomization and the first date of documented progression, as assessed by the investigator, or death due to any cause, whichever occurs first. Participants who died without a reported progression were considered to have progressed on the date of their death. Participants who did not progress or died were censored on the date of their last evaluable tumor assessment. PFS values are based on Kaplan-Meier Estimates. |
| Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | From Baseline (prior to start of study treatment) to Week 25 after first dose | The EORTC QLQ-C30 version 3 is a questionnaire developed to assess the QOL of cancer patients. The questionnaire is a 30-item tool, and it comprises 6 functional subscales (physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning and global quality of life) as well as 9 symptom subscales (fatigue, pain, nausea/vomiting, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Scores for each subscale range from 0 to 100. For the 6 functional subscales, a higher score represents a better level of functioning/health status. For the 9 symptom subscales, a lower score represents a better outcome (low level of symptomatology). Scores for the 15 subscales are presented individually. |
Countries
France, United States
Participant flow
Pre-assignment details
142 participants were randomized, and 140 participants received treatment.
Participants by arm
| Arm | Count |
|---|---|
| Nivolumab + Ipilimumab Participants received 1 mg/kg of nivolumab + 3 mg/kg of ipilimumab solution intravenously every 3 weeks for 4 doses (4 cycles), then 3 mg/kg of nivolumab intravenously every 2 weeks until documented disease progression, toxicity, withdrawal of consent, or study completion. | 95 |
| Ipilimumab Participants received placebo-matching nivolumab + 3 mg/kg of ipilimumab solution intravenously every 3 weeks for 4 doses (4 cycles), then placebo-matching nivolumab solution intravenously every 2 weeks until documented disease progression, toxicity, withdrawal of consent, or study completion. | 47 |
| Total | 142 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Pre-Treatment Period | Adverse event unrelated to study drug | 0 | 1 |
| Pre-Treatment Period | Participants no longer meeting study criteria | 1 | 0 |
| Treatment Period | Adverse event unrelated to study drug | 6 | 3 |
| Treatment Period | Death | 0 | 1 |
| Treatment Period | Disease progression | 17 | 20 |
| Treatment Period | Maximum Clinical Benefit | 6 | 2 |
| Treatment Period | Not Reported | 1 | 1 |
| Treatment Period | Other reasons | 3 | 4 |
| Treatment Period | Participant request to discontinue | 12 | 4 |
| Treatment Period | Study drug toxicity | 48 | 10 |
| Treatment Period | Withdrawal by Subject | 1 | 1 |
Baseline characteristics
| Characteristic | Nivolumab + Ipilimumab | Ipilimumab | Total |
|---|---|---|---|
| Age, Continuous | 63.3 Years STANDARD_DEVIATION 11 | 64.5 Years STANDARD_DEVIATION 10.2 | 63.7 Years STANDARD_DEVIATION 10.7 |
| Age, Customized 65 years and older to younger than 75 years | 35 Participants | 22 Participants | 57 Participants |
| Age, Customized 75 years and older | 12 Participants | 5 Participants | 17 Participants |
| Age, Customized Younger than 65 years | 48 Participants | 20 Participants | 68 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 0 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 82 Participants | 43 Participants | 125 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 12 Participants | 4 Participants | 16 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 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 | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) White | 92 Participants | 47 Participants | 139 Participants |
| Sex: Female, Male Female | 32 Participants | 15 Participants | 47 Participants |
| Sex: Female, Male Male | 63 Participants | 32 Participants | 95 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 44 / 94 | 29 / 46 |
| other Total, other adverse events | 90 / 94 | 45 / 46 |
| serious Total, serious adverse events | 69 / 94 | 27 / 46 |
Outcome results
Objective Response Rate (ORR) - BRAF Wild-type (WT) Participants
Objective Response Rate is defined as the percentage of participants with a best overall response of Complete Response (CR) or Partial Response (PR), assessed by the investigator by using RECIST 1.1 criteria. CR=all target and nontarget lesions have disappeared. Lymph nodes selected must have returned to normal size (\<10 mm). PR=at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD.
Time frame: From 12 weeks after Randomization, assessed every 6 weeks up to Week 49 of study treatment and then every 12 weeks until disease progression (up to approximately 76 months)
Population: All randomized BRAF wild-type participants .
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Nivolumab + Ipilimumab | Objective Response Rate (ORR) - BRAF Wild-type (WT) Participants | 60.3 Percentage of participants |
| Ipilimumab | Objective Response Rate (ORR) - BRAF Wild-type (WT) Participants | 10.8 Percentage of participants |
Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score
The EORTC QLQ-C30 version 3 is a questionnaire developed to assess the QOL of cancer patients. The questionnaire is a 30-item tool, and it comprises 6 functional subscales (physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning and global quality of life) as well as 9 symptom subscales (fatigue, pain, nausea/vomiting, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Scores for each subscale range from 0 to 100. For the 6 functional subscales, a higher score represents a better level of functioning/health status. For the 9 symptom subscales, a lower score represents a better outcome (low level of symptomatology). Scores for the 15 subscales are presented individually.
Time frame: From Baseline (prior to start of study treatment) to Week 25 after first dose
Population: All randomized participants with available measurements at baseline and week 25
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Nausea and Vomiting | -3.03 Score on a scale | Standard Deviation 12.211 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Emotional Functioning | 8.33 Score on a scale | Standard Deviation 10.603 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Pain | -2.27 Score on a scale | Standard Deviation 12.905 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Fatigue | -3.54 Score on a scale | Standard Deviation 21.52 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Dyspnea | -9.09 Score on a scale | Standard Deviation 23.417 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Insomnia | -12.12 Score on a scale | Standard Deviation 31.782 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Cognitive Functioning | -1.52 Score on a scale | Standard Deviation 15.352 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Appetite Loss | -13.64 Score on a scale | Standard Deviation 30.271 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Role Functioning | -1.52 Score on a scale | Standard Deviation 22.95 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Constipation | -3.03 Score on a scale | Standard Deviation 20.339 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Social Functioning | 2.27 Score on a scale | Standard Deviation 22.593 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Diarrhea | -3.03 Score on a scale | Standard Deviation 14.213 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Global Health Status | 3.79 Score on a scale | Standard Deviation 11.422 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Financial Difficulties | -3.03 Score on a scale | Standard Deviation 22.792 |
| Nivolumab + Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Physical Functioning | 2.12 Score on a scale | Standard Deviation 17.625 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Financial Difficulties | -2.78 Score on a scale | Standard Deviation 22.285 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Fatigue | -0.85 Score on a scale | Standard Deviation 17.836 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Dyspnea | -7.69 Score on a scale | Standard Deviation 27.735 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Physical Functioning | 1.03 Score on a scale | Standard Deviation 9.367 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Role Functioning | 5.13 Score on a scale | Standard Deviation 21.926 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Emotional Functioning | 10.26 Score on a scale | Standard Deviation 17.063 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Cognitive Functioning | -2.56 Score on a scale | Standard Deviation 11.479 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Global Health Status | -0.64 Score on a scale | Standard Deviation 29.357 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Nausea and Vomiting | -2.56 Score on a scale | Standard Deviation 6.259 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Pain | -8.97 Score on a scale | Standard Deviation 21.099 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Insomnia | -12.82 Score on a scale | Standard Deviation 16.879 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Appetite Loss | -2.56 Score on a scale | Standard Deviation 16.452 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Constipation | 0.00 Score on a scale | Standard Deviation 13.608 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Diarrhea | 5.13 Score on a scale | Standard Deviation 12.518 |
| Ipilimumab | Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Overall Quality of Life (QOL) C30 Score | Social Functioning | 0.00 Score on a scale | Standard Deviation 16.667 |
Objective Response Rate (ORR) - BRAF Mutant Participants
Objective Response Rate is defined as the percentage of participants with a best overall response of Complete Response (CR) or Partial Response (PR), assessed by the investigator by using RECIST 1.1 criteria. CR=all target and nontarget lesions have disappeared. Lymph nodes selected must have returned to normal size (\<10 mm). PR=at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD.
Time frame: From 12 weeks after Randomization, assessed every 6 weeks up to Week 49 of study treatment and then every 12 weeks until disease progression (up to approximately 76 months)
Population: All randomized BRAF mutant participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Nivolumab + Ipilimumab | Objective Response Rate (ORR) - BRAF Mutant Participants | 54.5 Percentage of participants |
| Ipilimumab | Objective Response Rate (ORR) - BRAF Mutant Participants | 10.0 Percentage of participants |
Progression-Free Survival (PFS) - BRAF Mutant Participants
PFS is defined as the time between the date of randomization and the first date of documented progression, as assessed by the investigator, or death due to any cause, whichever occurs first. Participants who died without a reported progression were considered to have progressed on the date of their death. Participants who did not progress or died were censored on the date of their last evaluable tumor assessment. PFS values are based on Kaplan-Meier Estimates.
Time frame: From randomization to progression or death (up to approximately 88 months)
Population: All randomized BRAF mutant participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab + Ipilimumab | Progression-Free Survival (PFS) - BRAF Mutant Participants | 8.61 Months |
| Ipilimumab | Progression-Free Survival (PFS) - BRAF Mutant Participants | 2.73 Months |
Progression-Free Survival (PFS) - BRAF Wild-type (WT) Participants
PFS is defined as the time between the date of randomization and the first date of documented progression, as assessed by the investigator, or death due to any cause, whichever occurs first. Participants who died without a reported progression were considered to have progressed on the date of their death. Participants who did not progress or died were censored on the date of their last evaluable tumor assessment. PFS values are based on Kaplan-Meier Estimates.
Time frame: From randomization to progression or death (up to approximately 88 months)
Population: All randomized BRAF wild-type participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab + Ipilimumab | Progression-Free Survival (PFS) - BRAF Wild-type (WT) Participants | 58.41 Months |
| Ipilimumab | Progression-Free Survival (PFS) - BRAF Wild-type (WT) Participants | 4.30 Months |