Melanoma (Skin Cancer), Advanced Melanoma, Metastatic Melanoma, Skin Cancer
Conditions
Keywords
Melanoma, advanced melanoma, cancer vaccine, skin cancer
Brief summary
This Phase 3 clinical trial is evaluating whether adding iSCIB1+, an investigational DNA-based cancer vaccine, to standard immunotherapy with nivolumab and ipilimumab can improve outcomes for people with advanced unresectable melanoma. Participants will be randomly assigned to receive either iSCIB1+ or a placebo, in addition to standard treatment with nivolumab and ipilimumab. Neither participants nor study doctors will know which treatment has been assigned. The study will compare how long participants live without their cancer worsening, overall survival, tumor response, safety, and quality of life. iSCIB1+ is designed to stimulate the immune system to recognize and attack melanoma cells by targeting proteins commonly found on melanoma tumors. Earlier studies have shown encouraging signs of immune activation and anti-tumor activity when iSCIB1+ was combined with checkpoint inhibitor immunotherapy. This study aims to determine whether adding iSCIB1+ to standard immunotherapy provides additional benefit compared with standard immunotherapy alone
Detailed description
This is a multicenter, randomized, double-blind, placebo-controlled Phase 3 study evaluating the efficacy and safety of iSCIB1+ in combination with nivolumab and ipilimumab as first-line treatment for adults with advanced unresectable Stage III or Stage IV melanoma who express specific human leukocyte antigen (HLA) types. Checkpoint inhibitor therapy has significantly improved outcomes for patients with advanced melanoma; however, many patients still experience disease progression. iSCIB1+ is a DNA-based therapeutic cancer vaccine designed to enhance immune recognition of melanoma-associated antigens and may improve the depth and durability of anti-tumor responses when used alongside checkpoint inhibition. Approximately 550 participants will be randomized in a 1:1 ratio to receive either: iSCIB1+ plus nivolumab and ipilimumab, or Placebo plus nivolumab and ipilimumab. The primary objective is to determine whether the addition of iSCIB1+ improves progression-free survival (PFS) compared with placebo when both are administered in combination with nivolumab and ipilimumab. Secondary objectives include evaluation of: Overall survival (OS) Objective response rate (ORR) Duration of response (DoR) Disease control rate (DCR) Safety and tolerability Patient-reported quality of life outcomes The study will also explore immune and biomarker responses in selected participants to better understand the relationship between vaccine-induced immune responses and clinical outcomes. Participants will continue to be followed for disease progression, survival, safety, and other outcomes for up to four years after randomization.
Interventions
BIOLOGICALiSCIB1+
iSCIB1+ is a DNA-based therapeutic cancer vaccine designed to enhance T-cell immune responses against melanoma-associated antigens. The vaccine encodes epitopes derived from glycoprotein 100 (gp100) and tyrosinase-related protein 2 (TRP-2) that are delivered using Scancell's ImmunoBody® platform. In this study, iSCIB1+ is administered by intramuscular injection with electroporation in combination with nivolumab and ipilimumab for the treatment of advanced unresectable melanoma. The intervention is intended to augment anti-tumor immune responses and improve clinical outcomes when added to standard checkpoint inhibitor therapy.
Nivolumab is a programmed death-1 (PD-1) immune checkpoint inhibitor monoclonal antibody administered according to the protocol-defined treatment regimen. Ipilimumab is a cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) immune checkpoint inhibitor monoclonal antibody administered according to the protocol-defined treatment regimen.
OTHERPlacebo
The placebo is a Dulbecco's Phosphate-Buffered Saline (D-PBS) solution for intramuscular injection that contains no iSCIB1+ plasmid DNA. It is formulated to be visually and physically indistinguishable from iSCIB1+ and is administered using the same procedures to maintain study blinding. The placebo serves as the comparator in this trial when administered in combination with nivolumab and ipilimumab.
Sponsors
Scancell Ltd
PPD, Part of Thermo Fisher Scientific
Egeen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Masking Description If there are other parties who are masked in the clinical trial besides those listed above, use this space to describe those parties.
Intervention model description
This study uses a randomized, double-blind, placebo-controlled, parallel-group design. Eligible participants will be assigned in a 1:1 ratio to receive either iSCIB1+ plus nivolumab and ipilimumab or placebo plus nivolumab and ipilimumab. Randomization will be stratified according to protocol-defined factors to ensure balanced treatment groups. The study is designed to evaluate whether the addition of iSCIB1+ to standard first-line immunotherapy improves clinical outcomes in participants with advanced unresectable melanoma. Both participants and study personnel involved in study conduct and assessment will remain blinded to treatment assignment throughout the study, except where unblinding is required for participant safety or other protocol-defined reasons. All participants will receive standard-of-care nivolumab and ipilimumab induction treatment followed by nivolumab maintenance therapy in accordance with the protocol. Efficacy, safety, patient-reported outcomes, survival, and bio
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
5.1.Inclusion Criteria 1. Participant has histologically confirmed, unresectable Stage III or Stage IV melanoma as defined by the AJCC (Gershenwald et al., 2017). Participants with a diagnosis of melanoma of unknown primary are eligible. 2. Participant is positive for at least one of the following HLA alleles: HLA- with an HLA type of any one of HLA MHC class I: A2, A3, A31, Bw4, B44 and B35. 3. Participant has been clinically evaluated, and checkpoint inhibition has been determined to be an appropriate treatment for their advanced disease. 4. Participant's BRAF status must be known; participants with BRAF mutation positive disease may be enrolled without BRAF-inhibitor treatment at the discretion of the Study Investigator. 5. Participant has at least one measurable lesion per RECIST 1.1 criteria by computed tomography CT scan or MRI. 6. Participant is at least 18 years of age. 7. Participant has a life expectancy of more than 6 months. 8. Participant has an ECOG performance status of 0 or 1. 9. Participant has adequate organ function as determined by the following laboratory values: Absolute neutrophil count ≥ 1.5 x 109/L Lymphocyte count ≥0.5 x 109/L Platelet count ≥100 x 109/L Hemoglobin \>9 g/dL (\> 5.6 mmol/L) Serum creatinine or creatinine clearance ≤1.5x ULN \>50 mL/min Serum total bilirubin ≤1.5 x ULN or \<3.0 mg/dL if participant has Gilbert's syndrome Serum transaminases, AST and ALT ≤2.5 x ULN or ≤5.0 x ULN if liver metastases present 10. Participant must be able and willing to provide written IRB/REC-approved informed consent prior to any study-related procedure. 11. Women of childbearing potential must agree to use highly effective contraceptive methods prior to study entry, for the whole duration of study treatment, and for at least 5 months following the last dose or in accordance with the SmPC of the IC SOC CPI (whichever is most conservative). See Appendix D: Guidance on Acceptable Contraceptive Methods for full guidance.. 12. Women of childbearing potential must have a negative serum pregnancy test at screening and within two days before IMP (or placebo) administration. 13. Participant must be willing and able to comply with scheduled visits, treatment plan, laboratory tests and other study procedures. 5.2.
Exclusion criteria
1. Participant has a diagnosis of mucosal, ocular or acral melanoma. 2. Participant has received prior systemic anti-PD1 treatment for advanced disease. 3. Participant has received prior adjuvant treatment, defined as treatment following resection of all detectable disease, within 6 weeks of Day 1 (first dose of IMP). 4. Participant has BRAF mutation positive disease with evidence of rapid PD. 5. Participant has symptomatic brain metastases or carcinomatous meningitis. Symptomatic brain metastases are defined as brain metastases causing neurological signs or symptoms attributable to intracranial disease and/or requiring corticosteroid therapy for the management of brain metastasis-related symptoms. Participant is expected to require and elect any other form of systemic or localized anticancer therapy while receiving study treatment. 6. Participants receive treatment with any investigational product within 28 days (or five half-lives of the treatment concerned if longer than 28 days) prior to Day 1. 7. Participant has had a previous or current malignancy within 5 years, with the exception of melanoma and curatively treated local tumors. 8. Participant has a concurrent illness/diagnosis which are uncontrolled and/or would preclude study conduct and assessment. 9. Participant has NYHA class III or IV heart disease. 10. Participant has a history of severe hypersensitivity reaction to treatment with a mAb. 11. Participant has an active autoimmune disease or a documented history of autoimmune disease or syndrome that requires systemic steroids or immunosuppressive agents above physiological dosing. 12. Received a live vaccine or non-live vaccine (including COVID-19 vaccines) within 7 days prior to first dose of study treatment. 13. Participant has received systemic steroids or is receiving any other form of immune suppressant medication above physiological dosing within 7 days of Day 1. 14. Participant is positive for HIV-1/2 infection or is positive for HBsAg or HCV antigen consistent with active infection. 15. Participant has a known current or recent history (within the last year) of substance abuse including illicit drugs or alcohol to the extent where it would negatively affect compliance with the trial protocol based on Study Investigator's decision. 16. Participant has received a solid organ transplant. 17. Participant is breastfeeding during the study treatment phase, and for at least five months following the last dose or in accordance with the SmPC of I/N (whichever is most conservative).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) | Up to 4 years after randomization. | Progression-free survival (PFS), defined as the time from randomization to the earliest occurrence of disease progression per RECIST v1.1 as assessed by Blinded Independent Central Review (BICR) or death from any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Up to approximately 4 years months after randomization. | Overall survival, defined as the time from randomization to death from any cause. |
| Objective Response Rate (ORR) | Up to 4 years after randomization. | Objective response rate, defined as the proportion of participants achieving a confirmed complete response (CR) or partial response (PR) according to RECIST v1.1 as assessed by BICR. |
| Duration of Response (DoR) | Up to 4 years after randomization. | Duration of response, defined as the time from first documented objective response (CR or PR) until disease progression per RECIST v1.1 or death from any cause. |
| Disease Control Rate (DCR) | Up to 4 years after randomization. | Disease control rate, defined as the proportion of participants achieving complete response, partial response, or stable disease according to RECIST v1.1 as assessed by BICR. |
| Incidence of Treatment-Emergent Adverse Events (TEAEs) | From informed consent and up to 4 years from randomization | Incidence, nature, severity, and relationship of treatment-emergent adverse events, graded according to NCI CTCAE. |
| Incidence of Serious Adverse Events (SAEs) | From informed consent and up to 4 years from randomization | Incidence of serious adverse events. |
| Change from baseline in EORTC QLQ-C30 Global Health Status/Quality of Life score | From informed consent and up to 4 years from randomization | The EORTC QLQ-C30 Global Health Status/Quality of Life scale ranges from 0 to 100, with higher scores indicating better quality of life. |
| Change from baseline in EQ-5D-5L Health Utility Index Score | From informed consent and up to 4 years from randomization | EQ-5D-5L index values are derived from participant responses across five health dimensions. |
| Number of participants reporting symptomatic adverse events according to PRO-CTCAE items | From informed consent and up to 4 years from randomization | Participant-reported symptom burden will be assessed using selected PRO-CTCAE symptom items. Individual responses are scored according to the PRO-CTCAE scoring manual. |
Countries
United Kingdom, United States
Contacts
CONTACTJoe Thornton
CONTACTOlivia Howard
Outcome results
None listed