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Concurrent Dabrafenib + Trametinib With Sterotactic Radiation in BRAF Mutation-Positive Malignant Melanoma and Brain Metastases

A Phase II Study of Concurrent Dabrafenib and Trametinib With Stereotactic Radiation in the Management of Patients With BRAF Mutation-Positive Malignant Melanoma and Brain Metastases

Status
Terminated
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02974803
Enrollment
6
Registered
2016-11-28
Start date
2018-02-09
Completion date
2020-07-29
Last updated
2021-08-20

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Brain Metastases, Melanoma

Brief summary

Dabrafenib and trametinib are drugs that are usually given for the treatment of melanoma. Combinations of dabrafenib and trametinib have also been studied and when used together have shown to increase tumour shrinkage in animals compared to either drug alone. Dabrafenib and trametinib have also shown potential to penetrate the blood-brain-barrier when given together and have an effect on brain metastases. Giving these drugs at the same time and then giving brain stereotactic radiosurgery (SRS) may also be preferred in patients with brain metastases

Detailed description

The purpose of this study is to find out the effects of giving dabrafenib in combination with trametinib continuously with stereotactic radiotherapy (SRS) has on melanoma and brain metastases. Stereotactic Radiosurgery (SRS) is a non-surgical radiation therapy used to treat tumours of the brain. It can deliver precisely targeted radiation. Currently SRS alone is the usual treatment for patients with up to 4 brain lesions. This study will include 2 groups 1) patients with 1-4 brain lesions treated with SRS concurrently with dabrafenib and trametinib and 2) patients with 5-10 brain lesions treated with SRS concurrently with dabrafenib and trametinib.

Interventions

DRUGTrametinib

Trametinib 2 mg once daily until progression or unaccepted toxicity.

DRUGDabrafenib

Dabrafenib 150 mg twice a day until progression or unaccepted toxicity.

Sponsors

Novartis
CollaboratorINDUSTRY
Canadian Cancer Trials Group
Lead SponsorNETWORK

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Histologically confirmed melanoma metastatic to brain and determined to be BRAF V600 mutated. * Age ≥ 18 years. * Karnofsky Performance Status of 70-100 (Appendix I). * Patients must have a life expectancy of at least 12 weeks. * Presence of measurable disease (i.e. present with at least one measurable CNS lesion per RECIST 1.1). * Presence of 1-10 brain metastases as confirmed on a thin slice axial T1 post-gadolinium MRI sequence. The maximum diameter of a single brain lesion should be ≤ 4 cm and presence of a measurable lesion ≥ 1cm based on baseline MRI of brain. * All CNS metastases amenable to single fraction SRS and or fractionated SRS. Hemorrhagic lesions are allowed if the treating radiation oncologist deems the lesion amenable to focal SRS. * Able to swallow and retain oral medication and must not have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels. * Laboratory requirements (within 14 days prior to registration): * ANC ≥ 1.2 x 10\^9/L * Hemoglobin ≥ 90 g/L * Platelet count ≥ 100 x 10\^9/L * PT/INR & PTT ≤ 1.3 x ULN * Total bilirubin ≤ 1.5 x ULN * AST and ALT ≤ 2.5 x ULN * Serum creatinine or ≤ 1.5 x ULN or Creatinine Clearance ≥ 50 ml/min (calculated by Cockcroft and Gault) * LVEF ≥ LLN (within 28 days prior to registration) * No prior treatment with a BRAF inhibitor or MEK inhibitor. * No known ocular or primary mucosal melanoma. * No prior systemic anti-cancer treatment within the last 2 weeks preceding the frist dose of dabrafenib and trametinib. Patients must have recoved from clinical manifestations of toxicity related to prior systemic therapy and have adequate washout as follows: Longest of one of the following: * two weeks * 5 half-lives for investigational agents * Standard cycle length of standard therapies * Prior systemic treatment in the adjuvant setting is allowed. * No current use of a prohibited medication as described in section 7.2. * No history of malignancy with confirmed activating RAS mutation at any time. * No history of malignancy other than disease under study within 3 years of study enrollment. * No leptomeningeal metastases or metastases causing spinal cord compression that are symptomatic or untreated or not stable for ≥ 3 months. Subjects on stable dose of corticosteroids \> 2 weeks or who have been off of corticosteroids for at least 2 weeks can be enrolled with approval of CCTG. * No serious or unstable pre-existing medical conditions, psychiatric disorders or other conditions that could interfere with the subject's safety, obtaining informed consent or compliance with study procedures. * No history of Hepatitis B Virus or Hepatitis C Virus infection * No history or evidence of cardiovascular risk No history or current eveidence/risk of retinal vein occlusion or central serous retinopathy * No known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to the study treatments, their excipients, and/or dimethyl sulfoxide. * No pregnant or lactating women. * No hisotry of interstitial lung disease or active pneumonitis. * Presence of any one brain metastases \>4cm in maximal diameter, and/or presence of brain metastase of less than 1cm. * No prior whole brain radiation * No brainstem metastses * No contrindications to MRI and/or Gadolinimum contrast or sterotactic brain radiation therapy.

Design outcomes

Primary

MeasureTime frame
Intracranial Objective Response Rate24 months

Secondary

MeasureTime frameDescription
Extra-cranial Objective Response Rate24 monthsResponse will be assessed using RECIST v1.1
Duration of Response24 monthsResponse will be assessed using RECIST v1.1
Intracranial Progression Free Survival24 monthsResponse will be assessed using RECIST v1.1
Overall Progression Free Survival24 monthsResponse will be assessed using RECIST v1.1

Other

MeasureTime frameDescription
Overall Objective Response Rate24 monthsResponse will be assessed using RECIST v1.1

Countries

Canada

Participant flow

Participants by arm

ArmCount
Dabrafenib and Trametinib
Dabrafenib, PO, 150mg BID Continuously Trameteinib, PO 2mg OD Continuously Dabrafenib Trametinib
6
Total6

Baseline characteristics

CharacteristicDabrafenib and Trametinib
Age, Continuous63 years
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
6 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
Region of Enrollment
Canada
6 participants
Sex: Female, Male
Female
2 Participants
Sex: Female, Male
Male
4 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
0 / 0
other
Total, other adverse events
0 / 0
serious
Total, serious adverse events
0 / 0

Outcome results

Primary

Intracranial Objective Response Rate

Time frame: 24 months

Population: The study was closed early because of very slow accrual and no final analysis was performed because the collected data cannot be considered reliable since they were not verified, reviewed or cleaned.

Secondary

Duration of Response

Response will be assessed using RECIST v1.1

Time frame: 24 months

Population: The study was closed early because of very slow accrual and no final analysis was performed because the collected data cannot be considered reliable since they were not verified, reviewed or cleaned.

Secondary

Extra-cranial Objective Response Rate

Response will be assessed using RECIST v1.1

Time frame: 24 months

Population: The study was closed early because of very slow accrual and no final analysis was performed because the collected data cannot be considered reliable since they were not verified, reviewed or cleaned.

Secondary

Intracranial Progression Free Survival

Response will be assessed using RECIST v1.1

Time frame: 24 months

Population: The study was closed early because of very slow accrual and no final analysis was performed because the collected data cannot be considered reliable since they were not verified, reviewed or cleaned.

Secondary

Overall Progression Free Survival

Response will be assessed using RECIST v1.1

Time frame: 24 months

Population: The study was closed early because of very slow accrual and no final analysis was performed because the collected data cannot be considered reliable since they were not verified, reviewed or cleaned.

Other Pre-specified

Overall Objective Response Rate

Response will be assessed using RECIST v1.1

Time frame: 24 months

Population: The study was closed early because of very slow accrual and no final analysis was performed because the collected data cannot be considered reliable since they were not verified, reviewed or cleaned.

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026