The study is an open-label, single arm multicenter Phase II study to evaluate the safety and efficacy of the combination of Abraxane and Avastin as first-line therapy for patients with unresectable metastatic malignant melanoma. The patient sample will be approximately 50 individuals, males and females 18 years of age or older with measurable metastatic melanoma. Patients will be treated with Abraxane administered weekly for 3 weeks via a 30-minute IV infusion at150 mg/m2 followed by 1 week rest (28-day cycle). Avastin will be administered in a dose of 10 mg/kg every 2 weeks (without rest period). Patients will be evaluated for disease progression every 2 months and those who do not have disease progression or unacceptable toxicity will be offered ongoing therapy until they have progressive disease or unacceptable toxicity.
It has been suggested that chemotherapy administration may be synergistic with the effects of an antiangiogenic agent such as Avastin. A "Proof of Principal" of the concept of the synergistic effects of chemotherapy and antiangiogenic therapy has been shown in the favorable results reported with temozolomide administered in combination with thalidomide in melanoma, the favorable results reported for the use of FOLFOX4 in combination with Avastin in previously treated patients with advanced or metastatic colorectal cancer, and the approval of the combination of Avastin with 5-fluorouracil-based chemotherapy in the treatment of patients with metastatic carcinoma of the colon or rectum. A number of lines of evidence suggest that the combination of Abraxane and Avastin may be effective as first-line therapy for melanoma: * Taxanes are active agents in melanoma: 1. In a clinical trial in patients who had failed combination chemotherapy (the Dartmouth regimen, there was a 24% response rate in patients treated with paclitaxel (in combination with tamoxifen). 2. Paclitaxel is being used in a Phase III trial with carboplatin and Sorafenib in patients with metastatic melanoma who have failed no more than one previous systemic chemotherapeutic treatment. 3. In a phase II trial of docetaxel in patients with metastatic melanoma, objective responses lasting more than 2 years were observed. * Abraxane is a taxane that has efficacy superior to that of Taxol for the treatment of metastatic breast cancer. Abraxane was evaluated as first- and second-line therapy for patients with metastatic melanoma. Results were encouraging. In this study, Abraxane will be combined with Avastin in an effort to improve the clinical benefit and prolong the time to disease progression. The primary end-point of the study is progression-free survival (PFS) at 4 months. Secondary end-points include progression-free survival, overall survival (OS), objective Response Rate (RR) in patients with measurable lesions, time to objective response, duration of objective response in patients with measurable lesions, and safety and tolerability of this combination.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Northern California Melanoma Center
San Francisco, California, United States
The Angeles Clinic and Research Institute
Santa Monica, California, United States
Progression-free Survival (PFS) at 4 Months
Progression-free survival at 4 months from first treatment as determined by RECIST 1.0
Time frame: 4 months.
Progression-free Survival
Median time of progression-free survival from first treatment according to RECIST 1.0
Time frame: From start of treatment to disease progressin; median duration of follow-up for surviving patients was 41.6 months.
Overall Survival (OS)
The duration of overall survival was defined as the number of months between the start date of protocol treatment and the date of death (irrespective of cause), and was right-censored at the date of last contact for patients who were alive as of the data cutoff.
Time frame: April 2007 through December 2010
Objective Response Rate (RR) in Patients With Measurable Lesions Time to Objective Response
The objective response rate is defined as the percentage of patients showing complete or partial response.
Time frame: The median duration of follow-up for surviving patients was 41.6 months.
Safety and Tolerability of This Combination
See adverse events Table
Time frame: April 2007 through December 2010
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