Anti-CSF1R Monoclonal Antibody IMC-CS4, Vemurafenib, and Cobimetinib in Treating Patients with Melanoma That is Metastatic or Cannot Be Removed by Surgery
This phase I/II trial studies the side effects and best dose of anti-CSF1R monoclonal antibody IMC-CS4 when given together with vemurafenib and cobimetinib and to see how well they work in treating patients with melanoma that has spread to other places in the body or cannot be removed by surgery. Monoclonal antibodies, such as anti-CSF1R monoclonal antibody IMC-CS4, may interfere with the ability of tumor cells to grow and spread. Vemurafenib and cobimetinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving anti-CSF1R monoclonal antibody IMC-CS4, vemurafenib, and cobimetinib may work better in treating patients with melanoma.
Inclusion Criteria
- For enrollment to the phase I portion: participants must have a histologically confirmed melanoma with a BRAF V600E or BRAF V600K mutation (identified via next generation [NextGen] sequencing using the Dana-Farber Cancer Institute [DFCI]/Brigham and Women's Hospital [BWH] OncoPanel or any Clinical Laboratory Improvement Act [CLIA]-certified method) that is metastatic or unresectable and for which standard curative measures do not exist or are no longer effective
- For enrollment to the phase II portion: participants must have a histologically confirmed melanoma with a BRAF V600E or BRAF V600K mutation (identified via NextGen sequencing using the DFCI/BWH OncoPanel or any CLIA-certified method) and cannot have received prior BRAF or MEK inhibitor therapy
- Participants enrolling to the phase I portion of the trial must have evaluable or measurable disease
- Participants enrolling to the phase II portion of the trial must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as >= 10 mm with spiral computed tomography (CT) scan, magnetic resonance imaging (MRI), or calipers by clinical exam
- Eastern Cooperative Oncology Group (ECOG) performance status 0 - 1
- Absolute neutrophil count >= 1.5 K/uL
- Platelets >= 100 K/uL
- Hemoglobin >= 9 g/dL
- Total bilirubin =< 1.5 x institutional upper limit of normal (ULN)
- Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional ULN
- Serum creatinine =< 1.5 x institutional ULN
- Prothrombin time (PT)-international normalized ratio (INR) =< 1.5 x institutional ULN (for participants on anticoagulation therapy, =< 1.5 x their baseline value)
- Activated partial thromboplastin time (aPTT) =< 1.5 x institutional ULN (for participants on anticoagulation therapy, =< 1.5 x their baseline value)
- Participants must have a left ventricular ejection fraction (LVEF) >= 50%
- Participants must have a corrected QT (QTc) of =< 470 msec on the screening electrocardiography (EKG)
- Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately; men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 4 months after completion of LY3022855 administration
- Ability to understand and the willingness to sign a written informed consent document
- Participants must have archival tumor tissue available; participants without archival tissue may be enrolled at the discretion of the principal investigator
Exclusion Criteria
- Participants who have had chemotherapy, radiotherapy, biologic therapy, major surgery, or another investigational agent within 3 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study
- For enrollment to the phase I portion: there is no required washout period for BRAF or MEK inhibitor therapy
- Participants who have not recovered to =< Common Terminology Criteria for Adverse Events (CTCAE) grade 1 or baseline from toxicity as a result of previous cancer treatment prior to entering the study (with the exception of alopecia and peripheral neuropathy which can be =< grade 2)
- For enrollment to the phase II portion: participants who have received prior BRAF or MEK inhibitor therapy
- Participants with known untreated brain metastases should be excluded from this clinical trial; participants with a history of brain metastases that have been treated, are no longer taking corticosteroids, and have been stable on imaging for >= 4 weeks following the last date of treatment are permitted
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to LY3022855, vemurafenib, or cobimetinib
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
- Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with LY3022855; these potential risks may also apply to the other agents used in this study
- Participants with a known history of human immunodeficiency virus (HIV) are ineligible; appropriate studies will be undertaken in participants receiving combination antiretroviral therapy when indicated
- Participants with a personal or family history of long QT syndrome
- Participants with a history of a second primary malignancy; exceptions include: patients with a history of malignancies that were treated curatively and have not recurred within 3 years prior to study entry; resected basal and squamous cell carcinomas of the skin, and completely resected carcinoma in situ of any type
- Participants with impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of vemurafenib and cobimetinib in the opinion of the treating investigator (e.g., ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, small bowel resection)
- Participants who are unable to swallow or retain oral medication
- Participants that require co-administration of strong or moderate CYP3A inhibitors, as these medications may alter vemurafenib and cobimetinib concentrations
- Participants who require treatment with medications that are strong or moderate CYP3A inducers, as these medications may alter the concentration of cobimetinib
- Participants with evidence of retinal pathology on ophthalmologic examination that is considered a risk factor for neurosensory retinal detachment/central serous chorioretinopathy (CSCR), retinal vein occlusion (RVO), or neovascular macular degeneration
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT03101254.
PRIMARY OBJECTIVES:
I. To determine the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of the combination of anti-CSF1R monoclonal antibody IMC-CS4 (LY3022855) with vemurafenib and cobimetinib. (Phase I)
II. To evaluate the progression-free survival (PFS) rate in patients with BRAF V600E or V600K mutated melanoma. (Phase II)
SECONDARY OBJECTIVES:
I. To evaluate the preliminary overall response rate (ORR) and PFS rate of LY3022855 with vemurafenib and cobimetinib in patients with melanoma harboring BRAF V600E or V600K mutations. (Phase I)
II. To evaluate the ORR of the combination of LY3022855 with vemurafenib and cobimetinib in patients with BRAF V600E or V600K mutated melanoma. (Phase II)
III. To evaluate the overall survival (OS) in patients with BRAF V600E or V600K melanoma to the combination of LY3022855 with vemurafenib and cobimetinib. (Phase II)
IV. To continue to evaluate the safety and tolerability of LY3022855 in combination with vemurafenib and cobimetinib. (Phase II)
TERTIARY OBJECTIVES:
I. To investigate the effect of the combination of LY3022855 with vemurafenib and cobimetinib on mitogen-activated protein kinase (MAPK) pathway signaling and the immune tumor microenvironment via collection of blood, archival tumor tissue, and optional pre and on-treatment tissue biopsies obtained during both phases of the trial.
II. To investigate the relationship between the levels of tumor deoxyribonucleic acid (DNA) in serially collected plasma samples and the observed clinical outcomes during both phases of the trial.
OUTLINE: This is a phase I, dose-escalation study of anti-CSF1R monoclonal antibody IMC-CS4 followed by a phase II study.
Patients receive anti-CSF1R monoclonal antibody IMC-CS4 intravenously (IV) over 30-90 minutes on days 1, 8, 15, and 22, vemurafenib orally (PO) twice daily (BID) on days 1-28, and cobimetinib PO once daily (QD) on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up ever 3-4 months.
Trial PhasePhase I/II
Trial Typetreatment
Lead OrganizationDana-Farber Harvard Cancer Center
Principal InvestigatorElizabeth Iannotti Buchbinder
- Primary ID17-030
- Secondary IDsNCI-2017-01198
- ClinicalTrials.gov IDNCT03101254