Recruiting
Phase 3
Efficacy of Daromun Neoadjuvant Intratumoral Treatment in Clinical Stage IIIB/C/D Melanoma Patients
Condition(s) studied
Melanoma Stage IIIBMelanoma Stage IIICMelanoma Stage IIID
Investigational drug(s) / intervention(s)
DaromunSurgeryAdjuvant therapy
Daromun: Patients will receive intratumoral administrations into injectable cutaneous, subcutaneous, and nodal tumors of Daromun once weekly for up to 4 weeks.
Surgery: Patients will receive surgery.
Adjuvant therapy: Patients will receive adjuvant therapy at the investigator's discretion following the surgery.
Study summary
The trial aims to evaluate the efficacy of Daromun neoadjuvant treatment followed by surgery and adjuvant therapy to improve in a statistically significant manner the recurrence-free survival (RFS) of Stage IIIB/C/D melanoma patients with respect to the standard of care (surgery and adjuvant therapy).
Eligibility
Inclusion Criteria:
1. Histologically or cytologically confirmed diagnosis of clinical stage IIIB, IIIC, and IIID (AJCC 8th edition) locoregional melanoma that is eligible for complete surgical resection of all metastases (surgically resectable).
2. Eligible subjects must have measurable disease and must be candidate for intralesional therapy with at least one injectable cutaneous, subcutaneous, or nodal melanoma lesion (≥ 10 mm in longest diameter) or with multiple injectable lesions that in aggregate have a longest diameter of ≥ 10 mm.
3. Prior anti-tumor treatment for the primary melanoma lesion, including surgery and approved adjuvant treatments (e.g., radiotherapy, immune checkpoint inhibitors, BRAF/MEK inhibitors, etc.) is allowed. Before enrollment in the study, a wash-out period of 6 weeks is required and toxicities from prior treatments should be resumed to Grade ≤1.
4. Males or females, age ≥ 18 years.
5. ECOG Performance Status/WHO Performance Status ≤ 1.
6. Life expectancy of \> 24 months.
7. Absolute neutrophil count \> 1.5 x 109/L.
8. Hemoglobin \> 9.0 g/dL.
9. Platelets \> 100 x 109/L.
10. Total bilirubin ≤ 30 μmol/L (or ≤ 2.0 mg/dl).
11. ALT and AST ≤ 2.5 x the upper limit of normal (ULN).
12. Serum creatinine \< 1.5 x ULN.
13. LDH serum level ≤ 1.5 x ULN.
14. Documented negative test for HIV, HBV and HCV. For HBV serology, the determination of HBsAg and anti-HBcAg Ab is required. In patients with serology documenting previous exposure to HBV (i.e. positive anti-HBsAg with not vaccination and/or positive anti-HBcAg Ab), negative serum HBV-DNA is also required.
15. All acute toxic effects (excluding alopecia) of any prior therapy must have resolved to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) (v4.03) Grade ≤ 1 unless otherwise specified above.
16. All women of childbearing potential (WOCBP) must have negative pregnancy test results at the screening. WOCBP must be using, from the screening to three months following the last study drug administration, highly effective contraception methods. WOCBP and effective contraception methods are defined by the "Recommendations for contraception and pregnancy testing in clinical trials" issued by the Head of Medicine Agencies' Clinical Trial Facilitation Group and which include, for instance, progesterone-only or combined (estrogen- and progesterone-containing) hormonal contraception associated with inhibition of ovulation, intrauterine devices, intrauterine hormone-releasing systems, bilateral tubal occlusion, vasectomized partner or sexual abstinence. Pregnancy test will be repeated at the safety visit (only WOCBP and only for patients in Arm 1).
17. Male patients with WOCBP partners must agree to use simultaneously two acceptable methods of contraception (i.e. spermicidal gel plus condom) from the screening to three months following the last study drug administration.
18. Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study.
19. Willingness and ability to comply with the scheduled visits, treatment plan, laboratory tests and other study procedures.
Exclusion Criteria
1. Uveal melanoma or mucosal melanoma
2. Evidence of distant metastases at screening.
3. Previous or concurrent cancer that is distinct in primary site or histology from the cancer being evaluated in this study except: cervical carcinoma in situ, curatively treated basal cell carcinoma, superficial bladder tumors (Ta, Tis \& T1), second primary melanoma in situ or any cancer curatively treated ≥ 5 years prior to study entry.
4. Presence of active infections (e.g. requiring antimicrobial therapy) or other severe concurrent disease, which, in the opinion of the investigator, would place the patient at undue risk or interfere with the study.
5. History within the last year of acute or subacute coronary syndromes including myocardial infarction, unstable or severe stable angina pectoris.
6. Inadequately controlled cardiac arrhythmias including atrial fibrillation.
7. Heart insufficiency (\> Grade II, New York Heart Association (NYHA) criteria).
8. LVEF ≤ 50% and/or abnormalities observed during baseline ECG and Echocardiogram investigations that are considered as clinically significant by the investigator.
9. Uncontrolled hypertension.
10. Ischemic peripheral vascular disease (Grade IIb-IV).
11. Severe diabetic retinopathy.
12. Active autoimmune disease.
13. History of organ allograft or stem cell transplantation.
14. Recovery from major trauma including surgery within 4 weeks prior to enrollment.
15. Known history of allergy to IL2, TNF, or other human proteins/peptides/antibodies or any other constituent of the product.
16. Breast feeding female.
17. Anti-tumor therapy (except small surgery) within 4 weeks before enrollment.
18. Previous in vivo exposure to monoclonal antibodies for biological therapy in the 6 weeks before enrollment.
19. Planned administration of growth factors or immunomodulatory agents within 7 days before enrollment.
20. Patient requiring or taking corticosteroids or other immunosuppressant drugs on a long-term basis will be evaluated case by case with the Sponsor for inclusion/exclusion in the study. Limited use of corticosteroids to treat or prevent acute hypersensitivity reactions is not considered an exclusion criteria.
21. Any conditions that in the opinion of the investigator could hamper compliance with the study protocol.
22. Previous enrolment and randomization in the same study.
Primary outcome measure(s)
- Recurrence Free Survival (RFS) — From date of randomization until the date of the first recurrence or date of death from any cause, whichever occurs first assessed up to 60 months.
Recurrence Free Survival (RFS) in a time-to-event analysis in the Daromun plus surgery and adjuvant therapy treatment group (Arm 1) versus the surgery and adjuvant therapy control group (Arm 2). Analysis will be performed for the "Intention To Treat" population.
Trial sites (37)
| Facility | City | Region | Status |
| Mayo Clinic Hospital |
Phoenix |
Arizona |
Recruiting |
| UC San Diego Moores Cancer Center |
La Jolla |
California |
Active Not Recruiting |
| UC Irvine Health-Chao Family Comprehensive Cancer Center |
Orange |
California |
Active Not Recruiting |
| Moffitt Cancer Center |
Tampa |
Florida |
Recruiting |
| Winship Cancer Institute, Emory university |
Atlanta |
Georgia |
Recruiting |
| Rush University Medical Center |
Chicago |
Illinois |
Active Not Recruiting |
| University of Iowa Hospitals and Clinics |
Iowa City |
Iowa |
Active Not Recruiting |
| Mayo Clinic |
Rochester |
Minnesota |
Recruiting |
| Rutgers Cancer Institute, 195 Little Albany Street |
New Brunswick |
New Jersey |
Recruiting |
| Ambulatory Care Center at NYC Langarone Health |
New York |
New York |
Active Not Recruiting |
| Memorial Sloan Kettering Cancer Center - Main Campus |
Ney York |
New York |
Recruiting |
| Duke University Medical Center - Duke Cancer Center |
Durham |
North Carolina |
Recruiting |
| Ohio State University Wexner Medical Center |
Columbus |
Ohio |
Recruiting |
| St. Luke's Cancer Center, Clinical Trial, 3rd floor, 1600 St. Luke's Blvd. |
Easton |
Pennsylvania |
Active Not Recruiting |
| Penn State Cancer Institute |
Hershey |
Pennsylvania |
Recruiting |
| Fox Chase Cancer Center 333 Cottman Avenue |
Philadelphia |
Pennsylvania |
Recruiting |
| The University of Texas M.D. Anderson Cancer Center |
Houston |
Texas |
Recruiting |
| Huntsman Cancer Institute, University of Utah 2000 Circle of Hope |
Salt Lake City, UT |
Utah |
Recruiting |
| VCU - McGlothlin Medical Education Center |
Richmond |
Virginia |
Recruiting |
| Hospital Universitari Germans Trias i Pujol |
Badalona |
Barcelona |
Recruiting |
| Hospital de la Santa Creu i Sant Pau |
Barcelona |
Barcelona |
Recruiting |
| Fir Huvh Fundacio Institut De Recerca Hospital Universitari Vall De Hebron |
Barcelona |
Barcelona |
Recruiting |
| Hospital Clinic Barcelona |
Barcelona |
Barcelona |
Recruiting |
| El Hospital Universitario De Gran Canaria Dr. Negrin |
Las Palmas de Gran Canaria |
Canarie |
Recruiting |
| Fundacion Onkologikoa Fundazioa |
Donostia / San Sebastian |
Gipuzkoa |
Recruiting |
| MD Anderson Cancer Center |
Madrid |
Madrid |
Active Not Recruiting |
| Hospital Universitario 12 de Octubre |
Madrid |
Madrid |
Recruiting |
| Hospital Universitario Regional de Málaga |
Málaga |
Malaga |
Recruiting |
| Hospital Clínico Universitario Virgen de la Arrixaca |
Murcia |
Murcia |
Recruiting |
| Hospital Universitario Virgen De La Macarena |
Seville |
Sevilla |
Active Not Recruiting |
| Hospital General Universitario de Valencia |
Valencia |
Spain |
Recruiting |
| Universitätsspital Basel |
Basel |
Basel |
Active Not Recruiting |
| Istituto Oncologico della Svizzera Italiana |
Bellinzona |
Bellinzona |
Recruiting |
| Insel Gruppe AG |
Bern |
Canton of Bern |
Active Not Recruiting |
| Hôpitaux Universitaires de Genève |
Geneva |
Canton of Geneva |
Active Not Recruiting |
| Kantonsspital St.Gallen |
Sankt Gallen |
Canton of St. Gallen |
Recruiting |
| Universitätsspital Zürich (USZ) |
Zurich |
Canton of Zurich |
Recruiting |
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