To determine the safety of local palliative radiation therapy used in combination with anti-CTLA-4 immunotherapy.
This is a single institution, open-label, pilot study of palliative radiation therapy (RT) combined with ipilimumab in patients with stage IV melanoma. The primary objective of this study is to assess the safety of combining ipilimumab with palliative RT in patients with Stage IV melanoma. Secondary objectives are a) to assess the induction of anti-melanoma immune responses using laboratory correlative studies of T cell responses to melanoma antigens, and b) to compare tumor response rates and duration of response at unirradiated sites with responses in patients with Stage IV disease treated with ipilimumab alone on expanded access study CA184045. In this study, ipilimumab will be administered as recently approved by the FDA (3 mg/kg iv every 3 weeks for a total of 4 treatments). Palliative RT will start within 2 days of the first ipilimumab dose. Patients will be seen at least every 12 weeks for follow-up following completion of ipilimumab therapy until progression of disease by imaging criteria or increased symptomatology that requires another therapy. A total of 20 patients with previously treated unresectable metastatic melanoma requiring palliative radiation therapy will be treated on this pilot study over approximately 18 months. All subjects who receive study drug will be monitored for safety. Relevant tumor imaging studies will be obtained at baseline, 2-4 weeks following the 4th/last dose of ipilimumab, and then every 12 weeks until disease progression. This study will provide the safety data (and possibly early efficacy signals) needed to proceed with a randomized Phase II study for proof of principle. If compelling data is obtained supporting this IT + RT vaccine strategy, this approach will be extended to other solid tumor types.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
22
Ipilimumab will be administered as a single agent standard of care with base dose of 3 mg/kg iv over approximately 90 minutes every 3 weeks for a total of 4 treatments.
Standard of care palliative radiation therapy will start within 5 days of the first ipilimumab dose. Dose is dependent upon lesion size and is determined by the radiation oncologist.
Stanford University School of Medicine
Stanford, California, United States
Safety Measurement - Percentage of Patients Experiencing Serious Adverse Events (SAEs) in the First 4 Months of Treatment.
Serious adverse events (SAEs) defined as untoward medical occurrence that at any dose: results in death, is life-threatening (defined as an event in which the subject was at risk of death at the time of the event; it does not refer to an event which hypothetically might have caused death if it were more severe), requires in subject hospitalization or causes prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect, or is an important medical event (defined as a medical event(s) that may not be immediately life-threatening or result in death or hospitalization but, may jeopardize the subject or may require intervention to prevent one of the other serious outcomes listed in the definition above.)
Time frame: 4 months
Response Rate
Compare tumor response rate and duration of response at unirradiated sites in patients with Stage IV melanoma with historical controls. Response assessed per Response Evaluation Criteria in Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by physical measurement; magnetic resonance imaging (MRI); computed tomography (CT), positron emission tomography (PET)-CT; and/or X-rays: * Complete Response (CR) = Disappearance of all target lesions * Partial Response (PR) = ≥ 30% decrease in the sum of the longest diameter of target lesions * Overall Response (OR) = CR + PR
Time frame: 2 to 4 weeks after last ipilimumab dose then every 3 months +/- 2 weeks until progression of disease
Overall Survival
Median time to overall survival was calculated using the Kaplan-Meier algorithm.
Time frame: 2 to 4 weeks after last ipilimumab dose then every 3 months +/- 2 weeks until progression of disease
Duration of Complete Response
The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started). The duration of overall CR is measured from the time measurement criteria are first met for CR until the first date that progressive disease is objectively documented.
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Time frame: 2 to 4 weeks after last ipilimumab dose then every 3 months +/- 2 weeks until progression of disease
Duration of Partial Response.
Length of time between first dose of ipilimumab and a partial response according to RECIST v1.1 (see above) and immune response criteria
Time frame: 2 to 4 weeks after last ipilimumab and then every 3 months until disease progression.
Stable Disease
Stable disease is measured from the start of the treatment until the criteria for progression are met, taking as reference the smallest measurements recorded since the treatment started, including the baseline measurements
Time frame: 2 to 4 weeks after last ipilimumab and then every 3 months until disease progression.
Median Time to Complete Response or Partial Response
Time from the first dose of ipilimumab to the first tumor measurement showing either a complete or partial response to therapy.
Time frame: 2 to 4 weeks after last ipilimumab and then every 3 months until disease progression.
Progression-free Survival (PFS)
Median time to progression-free survival (PFS) was calculated using the Kaplan-Meier algorithm
Time frame: 2 to 4 weeks after last ipilimumab and then every 3 months until disease progression.