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Study to Evaluate the Safety/ Efficacy of T-VEC in Japanese Subjects With Unresectable Stage IIIB-IV Malignant Melanoma

A Phase 1, Multi-center, Open-Label, Dose De-escalation Study to Evaluate the Safety and Efficacy of Talimogene Laherparepvec in Japanese Subjects With Unresectable Stage IIIB-IV Malignant Melanoma

Status
Completed
Phases
Phase 1
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03064763
Enrollment
18
Registered
2017-02-27
Start date
2017-03-07
Completion date
2023-01-12
Last updated
2023-08-09

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

Conditions

Unresectable Stage IIIB-IV Malignant Melanoma

Keywords

Unresectable Stage IIIB-IV Malignant Melanoma

Brief summary

There are 2 fold of purposes for this study. 1 is to evaluate safety and tolerability and the other is to study the anti-tumor effects of talimogene laherparepvec in Japanese participants with unresectable stage IIIB-IV malignant melanoma.

Detailed description

This is a phase 1, multicenter, open-label study of talimogene laherparepvec in Japanese participants with unresectable stage IIIB-IVM1c malignant melanoma that are candidates for intralesional therapy. The Screening period is 28 days prior to study enrollment. There will be a Treatment period, Safety Follow-up period and a Long Term Follow-up period. The Screening Period: Informed consent will be obtained prior to screening procedures. Screening procedures to determine eligibility include: medical history (including concomitant medications, prior therapy for melanoma and BRAF status (if known)), physical exam, vital signs, assessment of Eastern Cooperative Oncology Group (ECOG) performance level status, electrocardiogram (ECG), laboratory assessments (including hepatitis serology), baseline tumor assessments, and adverse events assessment. Treatment Period: Initially, 6 Dose Limiting Toxicity (DLT)-evaluable participants will be enrolled and treated at 100% dose regimen of talimogene laherparepvec (Up to 4.0 mL of 10\_6 PFU/mL followed by a dose of up to 4.0 mL of 10\_8 PFU/mL). Upon demonstration of safety based on DLT incidence in the first 6 participants, an additional 12 participants will be enrolled and treated at Dose 1 to obtain additional safety data. If dose de-escalation is needed based on the DLT evaluation of first 6 participants, then additional 6 participants will be treated at lower dose (up to 4.0 mL of 10\_6 PFU/mL followed by a dose of up to 4.0 mL of 10\_7PFU/mL). The duration of treatment will vary for each participants. Participants will be treated until the participant has a DLT during the DLT evaluation period, participant has achieved a Complete Response, no injectable lesions, clinically relevant (resulting in clinical deterioration or requiring change in therapy) disease progression beyond 24-weeks of treatment, or safety concern, whichever occurs first. Maximum treatment duration will be 48 months. The total study duration for an individual participant can be up to 4 years. Drug Administration: If the participants are found to be eligible to take part in this study, they will receive talimogene laherparepvec by intralesional injection only into injectable cutaneous, subcutaneous, and nodal tumors, with or without image ultrasound guidance. The first injection of talimogene laherparepvec will take place on day 1 (week 0). The second injection should be administered 3 weeks (+ 5 days) after the initial injection. Subsequent injections should be given every 2 weeks (± 3 days). Study Visits: The participant will have a physical exam along with vital signs and ECOG. At any study visit blood may be collected to monitor health and safety, and effects of talimogene laherparepvec. Adverse events and medications taken will be reviewed at each study visit. The tumor assessment, physical exams, and ECOG performance status will be completed after 12 (± 1) weeks on treatment (ie, day 1 of week 11), and then every 12 (± 1) weeks (eg, weeks 23, 35, 47 etc.), or more frequently if clinically indicated, until Progressive disease beyond 6 months of treatment or until the start of a new anticancer therapy. Central Lab tests: Blood for herpes simplex virus type-1 (HSV-1) Antibody Serostatus will collected within 3 days prior to dose at day 1 (week 0) and at week 5. Throughout the trial any participant developing a lesion of suspected herpetic origin will have a swab of the lesion for presence of talimogene laherparepvec DNA obtained within 3 days of the event. Exposure to talimogene laherparepvec by the healthcare providers of the participant and/or close contacts will be assessed. Safety Follow Visit: A safety follow-up visit will be performed 30 (+7) days after the last dose. The participant will have a physical exam, have vital signs taken, assessment of ECOG status and have weight measured. Adverse events will be assessed as well as the concomitant medications. Routine bloodwork and tumor response assessments will be performed. Long-Term Follow-up Visits: Follow-up for survival status and, if applicable, commencement of any subsequent anticancer melanoma therapy will occur every 12 weeks (± 28 days) by phone or clinic visit for all participants who permanently discontinue talimogene laherparepvec for any reason other than withdrawal of full consent for up to 24 months after the last participant is enrolled in the study. For participants that discontinue talimogene laherparepvec for reason other than disease progression, the following additional procedures will be conducted during the long-term follow-up: radiographic tumor imaging, clinical tumor assessments, ECOG Performance Status assessments, reporting of pregnancy or lactation, assessment of swabs of lesions of suspected herpetic origin for presence of talimogene laherparepvec DNA, and tumor response assessments until documented disease progression beyond 24-weeks of treatment, until the start of a new anticancer therapy, or end of study, whichever is earliest. If a participant discontinues therapy more than 24 months after the last participant was enrolled in the study, when the long-term follow-up period ends, they will not enter long-term follow-up.

Interventions

DRUGTalimogene laherparepvec

Talimogene laherparepvec will be administered as an intralesional injection.

Sponsors

Amgen
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No

Inclusion criteria

* Histologically confirmed diagnosis of melanoma * Participants with stage IIIB to IVM1c melanoma that is not surgically resectable * Participant who is treatment naive and is determined by the physician to be not suitable or eligible for the approved systemic anticancer drug therapy in Japan. Participant may also have received prior systemic anticancer treatment consisting of chemotherapy, immunotherapy, or targeted therapy. Treatment for melanoma must have been completed at least 28 days prior to enrollment. * Candidate for intralesional therapy (ie, disease is appropriate for direct injection or through the use of ultrasound guidance, where appropriate) defined as one or more of the following: * at least 1 injectable cutaneous, subcutaneous, or nodal melanoma lesion greater or equal to 10 mm in longest diameter, OR * multiple injectable melanoma lesions that in aggregate have a longest diameter of greater or equal to 10 mm * Measurable disease defined as one or more of the following: * at least 1 melanoma lesion that can be accurately and serially measured in at least 2 dimensions and for which the greatest diameter is greater or equal to 10 mm as measured by contrast-enhanced or spiral computed tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound for nodal/soft tissue disease (including lymph nodes) * at least 1 greater or equal to 10 mm longest diameter superficial cutaneous or subcutaneous melanoma lesion as measured by calipers * multiple superficial melanoma lesions which in aggregate have a total diameter of greater or equal to 10 mm * Serum lactate dehydrogenase (LDH) levels less than or equal to 1.5 X upper limit of normal (ULN) within 28 days prior to enrollment * Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 * Other Inclusion Criteria May Apply.

Exclusion criteria

* Clinically active cerebral metastases. Participants with up to 3 cerebral metastases may be enrolled, provided that all lesions have been adequately treated with stereotactic radiation therapy (including Gamma Knife) or craniotomy, with no evidence of progression and have not required steroids for at least 2 months prior to enrollment. * Greater than 3 visceral metastases (this does not include lung metastases or nodal metastases associated with visceral organs). For participants with less than or equal to 3 visceral metastases, no lesion greater than 3 cm in longest dimension and liver lesions must be stable for at least 1 month prior to enrollment. * Bone metastases * Primary ocular or mucosal melanoma * History or evidence of symptomatic autoimmune disease (eg, pneumonitis, glomerulonephritis, vasculitis, or other), or history of autoimmune disease that required systemic treatment (ie, use of corticosteroids, immunosuppressive drugs or biological agents used for treatment of autoimmune diseases) in past 2 months prior to enrollment. * Active herpetic skin lesions or prior complications of herpetic infection (eg, herpetic keratitis or encephalitis). * Requires intermittent or chronic systemic (intravenous or oral) treatment with an antiherpetic drug (eg, acyclovir), other than intermittent topical use. * Previous treatment with talimogene laherparepvec * Other investigational procedures while participating in this study are excluded. * Known to have acute or chronic active hepatitis B infection, acute or chronic active hepatitis C infection or human immunodeficiency virus (HIV) infection * Participant has known sensitivity to bovine- or porcine derived components or to any of the products or components to be administered during dosing. * History of other malignancy within the past 3 years * Other

Design outcomes

Primary

MeasureTime frameDescription
Number of Participants Who Experienced One or More Dose Limiting Toxicities (DLTs)Day 1 to Day 35DLTs were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 4 Events were considered DLTs, if judged by the investigator to be related to study treatment: Grade 4 non-hematologic toxicity Grade 3 non-hematologic toxicity lasting \> 3 days despite optimal supportive care (grade 3 fatigue not a DLT) Grade 3 or higher non-hematologic laboratory value reported as an adverse event if: medical intervention is required, or abnormality leads to hospitalization, or abnormality persists for \> 1 week (Laboratory values that persist for \> 1 week but are deemed not clinically important per both investigator and sponsor were not considered DLTs) Febrile neutropenia grade 3 or 4 Thrombocytopenia \< 25 x 10\^9/L associated with bleeding event requiring intervention Serious herpetic event (eg, herpetic encephalitis, encephalomyelitis, or disseminated herpetic infection) Grade 5 toxicity Any other intolerable toxicity leading to permanent discontinuation of study treatment
Durable Response Rate (DRR) Using Modified World Health Organization (WHO) Response CriteriaDay 1 up to the maximum time on treatment or follow-up at primary data cutoff date (03 August 2020): 89.1 weeks of treatment and 37 months of follow-upDRR using WHO response criteria was defined as the percentage of participants who experienced objective response (complete response \[CR\] or partial response \[PR\]) lasting continuously for ≥ 6 months that starting any time within 12 months of initiating treatment. CR: Complete disappearance of all index lesions, including any new tumors which might have appeared. PR: Achieving a 50% or greater reduction in the SPD of the perpendicular diameters of all index lesions at the time of assessment as compared to the sum of the products of the perpendicular diameters of all index lesions at baseline (Day 1).

Secondary

MeasureTime frameDescription
Duration of Response (DOR) Using Using Modified World Health Organization (WHO) Response CriteriaDay 1 to end of study, maximum time to end of study was 212.6 weeksDOR was defined as the time from the date of an initial response (CR or PR) to the earlier of progressive disease (PD) or death. Participants who had not ended their response at the time of analysis were censored at their last evaluable tumor assessment. PD: A \> 25% increase in the sum of the products of the perpendicular diameters of all index tumors since baseline, or the unequivocal appearance of a new tumor since the last response assessment time point. DOR was estimated using Kaplan-Meier (KM) method.
Overall Response Rate (ORR) Using Modified World Health Organization (WHO) Response CriteriaDay 1 to end of study, maximum time to end of study was 212.6 weeksORR was defined as the percentage of participants who experienced an objective response of CR or PR per modified WHO response criteria among the set of participants analyzed.
Overall Survival (OS)Day 1 to end of study, maximum time to end of study was 212.6 weeksOS was defined as the interval from first dose to the event of death from any cause; otherwise, OS was censored at the date the participant was last known to be alive. OS was estimated using Kaplan-Meier (KM) method.
Progression Free Survival (PFS) Using Using Modified World Health Organization (WHO) Response CriteriaDay 1 to end of study, maximum time to end of study was 212.6 weeksPFS was defined as the interval from the first dose to the earlier of PD per modified WHO response criteria or death from any cause; otherwise, PFS was censored at the last evaluable tumor assessment. PFS was estimated using Kaplan-Meier (KM) method.
Time to Response (TTR) Using Modified World Health Organization (WHO) Response CriteriaDay 1 to end of study, maximum time to end of study was 212.6 weeksTTR was defined as the time from the first treatment administration to the first incidence of a confirmed CR or PR according to modified WHO response criteria among the set of participants analyzed. TTR was estimated using Kaplan-Meier (KM) method.

Countries

Japan

Participant flow

Recruitment details

A total of 18 participants were enrolled at 8 centers in Japan from March 2017 until January 2023.

Participants by arm

ArmCount
Talimogene Laherparepvec
Participants received talimogene laherparepvec administered by intralesional injection only into injectable cutaneous, subcutaneous, and nodal tumors, with or without image ultrasound guidance. On Day 1 (Week 0), the initial dose of talimogene laherparepvec was up to 4.0 mL of 10\^6 Plaque forming units per millilitre (PFU/mL). Subsequent doses of talimogene laherparepvec were up to 4.0 mL of 10\^8 or 10\^7 PFU/mL. The second dose was administered 3 weeks (+ 5 days) after the initial dose, and subsequent doses were given every 2 weeks (+ 3 days). Participants could receive talimogene laherparepvec for a maximum treatment duration of 48 months.
18
Total18

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyDeath8
Overall StudyLost to Follow-up1

Baseline characteristics

CharacteristicTalimogene Laherparepvec
Age, Continuous57.2 years
STANDARD_DEVIATION 18.3
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
18 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
18 Participants
Race (NIH/OMB)
Black or African American
0 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
White
0 Participants
Sex: Female, Male
Female
13 Participants
Sex: Female, Male
Male
5 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
8 / 18
other
Total, other adverse events
17 / 18
serious
Total, serious adverse events
6 / 18

Outcome results

Primary

Durable Response Rate (DRR) Using Modified World Health Organization (WHO) Response Criteria

DRR using WHO response criteria was defined as the percentage of participants who experienced objective response (complete response \[CR\] or partial response \[PR\]) lasting continuously for ≥ 6 months that starting any time within 12 months of initiating treatment. CR: Complete disappearance of all index lesions, including any new tumors which might have appeared. PR: Achieving a 50% or greater reduction in the SPD of the perpendicular diameters of all index lesions at the time of assessment as compared to the sum of the products of the perpendicular diameters of all index lesions at baseline (Day 1).

Time frame: Day 1 up to the maximum time on treatment or follow-up at primary data cutoff date (03 August 2020): 89.1 weeks of treatment and 37 months of follow-up

Population: Safety Analysis Set: all enrolled participants who received at least 1 dose of talimogene laherparepvec.

ArmMeasureValue (NUMBER)
Talimogene LaherparepvecDurable Response Rate (DRR) Using Modified World Health Organization (WHO) Response Criteria11.1 Percentage of participants
Primary

Number of Participants Who Experienced One or More Dose Limiting Toxicities (DLTs)

DLTs were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 4 Events were considered DLTs, if judged by the investigator to be related to study treatment: Grade 4 non-hematologic toxicity Grade 3 non-hematologic toxicity lasting \> 3 days despite optimal supportive care (grade 3 fatigue not a DLT) Grade 3 or higher non-hematologic laboratory value reported as an adverse event if: medical intervention is required, or abnormality leads to hospitalization, or abnormality persists for \> 1 week (Laboratory values that persist for \> 1 week but are deemed not clinically important per both investigator and sponsor were not considered DLTs) Febrile neutropenia grade 3 or 4 Thrombocytopenia \< 25 x 10\^9/L associated with bleeding event requiring intervention Serious herpetic event (eg, herpetic encephalitis, encephalomyelitis, or disseminated herpetic infection) Grade 5 toxicity Any other intolerable toxicity leading to permanent discontinuation of study treatment

Time frame: Day 1 to Day 35

Population: The DLT Analysis Set: all participants who had the opportunity to be followed for at least 35 days on treatment from the initial dosing (unless discontinued due to DLT) and received at least 1 dose of talimogene laherparepvec.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Talimogene LaherparepvecNumber of Participants Who Experienced One or More Dose Limiting Toxicities (DLTs)0 Participants
Secondary

Duration of Response (DOR) Using Using Modified World Health Organization (WHO) Response Criteria

DOR was defined as the time from the date of an initial response (CR or PR) to the earlier of progressive disease (PD) or death. Participants who had not ended their response at the time of analysis were censored at their last evaluable tumor assessment. PD: A \> 25% increase in the sum of the products of the perpendicular diameters of all index tumors since baseline, or the unequivocal appearance of a new tumor since the last response assessment time point. DOR was estimated using Kaplan-Meier (KM) method.

Time frame: Day 1 to end of study, maximum time to end of study was 212.6 weeks

Population: Responders among Safety Analysis Set: all enrolled participants who received at least 1 dose of talimogene laherparepvec who experienced a response of either CR or PR.

ArmMeasureValue (MEDIAN)
Talimogene LaherparepvecDuration of Response (DOR) Using Using Modified World Health Organization (WHO) Response CriteriaNA Months
Secondary

Overall Response Rate (ORR) Using Modified World Health Organization (WHO) Response Criteria

ORR was defined as the percentage of participants who experienced an objective response of CR or PR per modified WHO response criteria among the set of participants analyzed.

Time frame: Day 1 to end of study, maximum time to end of study was 212.6 weeks

Population: Safety Analysis Set: all enrolled participants who received at least 1 dose of talimogene laherparepvec.

ArmMeasureValue (NUMBER)
Talimogene LaherparepvecOverall Response Rate (ORR) Using Modified World Health Organization (WHO) Response Criteria11.1 Percentage of participants
Secondary

Overall Survival (OS)

OS was defined as the interval from first dose to the event of death from any cause; otherwise, OS was censored at the date the participant was last known to be alive. OS was estimated using Kaplan-Meier (KM) method.

Time frame: Day 1 to end of study, maximum time to end of study was 212.6 weeks

Population: Safety Analysis Set: all enrolled participants who received at least 1 dose of talimogene laherparepvec.

ArmMeasureValue (MEDIAN)
Talimogene LaherparepvecOverall Survival (OS)NA Months
Secondary

Progression Free Survival (PFS) Using Using Modified World Health Organization (WHO) Response Criteria

PFS was defined as the interval from the first dose to the earlier of PD per modified WHO response criteria or death from any cause; otherwise, PFS was censored at the last evaluable tumor assessment. PFS was estimated using Kaplan-Meier (KM) method.

Time frame: Day 1 to end of study, maximum time to end of study was 212.6 weeks

Population: Safety Analysis Set: all enrolled participants who received at least 1 dose of talimogene laherparepvec.

ArmMeasureValue (MEDIAN)
Talimogene LaherparepvecProgression Free Survival (PFS) Using Using Modified World Health Organization (WHO) Response Criteria3.07 Months
Secondary

Time to Response (TTR) Using Modified World Health Organization (WHO) Response Criteria

TTR was defined as the time from the first treatment administration to the first incidence of a confirmed CR or PR according to modified WHO response criteria among the set of participants analyzed. TTR was estimated using Kaplan-Meier (KM) method.

Time frame: Day 1 to end of study, maximum time to end of study was 212.6 weeks

Population: Safety Analysis Set: all enrolled participants who received at least 1 dose of talimogene laherparepvec.

ArmMeasureValue (MEDIAN)
Talimogene LaherparepvecTime to Response (TTR) Using Modified World Health Organization (WHO) Response CriteriaNA Months

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