This is a Phase 2 trial consisting of 24 patients receiving the combination of dabrafenib + trametinib + pembrolizumab in 3 different dosing schemes and 8 patients receiving pembrolizumab standard monotherapy. All patients start with pembrolizumab standard therapy for 6 weeks and will then be randomized to continue pembrolizumab monotherapy or to receive additional intermitted/short-term dabrafenib + trametinib. Stratification will be baseline LDH level and baseline PD-L1 expression.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
32
Biopsies will be taken during screening, before randomization, at week 8 (only arm 2-4) after 12 weeks, at week 18 and if PD.
Antoni van Leeuwenhoek ziekenhuis
Amsterdam, North Holland, Netherlands
RECRUITINGSafety of different schemes of continuous/intermittent dabrafenib+trametinib during treatment with pembrolizumab as compared to pembrolizumab monotherapy as measured by SUSARs.
Safety as measured by SUSARs during treatment week 0 till week 18.
Time frame: 18 weeks from baseline
Feasibility of different schemes of continuous/intermittent dabrafenib+trametinib during treatment with pembrolizumab as compared to pembrolizumab monotherapy as measured by adherence to the timelines in the study protocol.
Feasibility as measured by adherence to the timelines in the study protocol (week 0 till week 18).
Time frame: 18 weeks from baseline.
The immune-activating capacity of different schemes of continuous/intermittent dabrafenib+trametinib during treatment with pembrolizumab as compared to pembrolizumab monotherapy
Readout will be the alterations in magnitude or breadth of the self-antigen specific T cell responses in the time interval pre-treatment to week 18 intrapatient, and interpatient, pembrolizumab only (cohort 1) versus pembrolizumab plus intermittent dabrafenib/ trametinib (cohorts 2-4). To this purpose, we will analyze melanoma antigen-specific T cells responses by HLA-A2-restricted MHC-tetramer staining.
Time frame: 18 weeks from baseline.
To determine rates of response at week 6, 12, week 18.
Rates of response at week 6, week 12, week 18 according to RECIST 1.1 criteria
Time frame: Screening, week 6, 12 and 18
To determine progression-free survival starting from randomization.
Progression-free survival (PFS) starting from randomization to progression using RECIST 1.1 criteria.
Time frame: From randomisation until PD, median 10 months.
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Blood will be taken for PBMCs during screening (twice), before randomization, at weeks 12 at week 18 and if PD.
Long-term toxicities of intermittent dabrafenib + trametinib during treatment with pembrolizumab as compared to pembrolizumab monotherapy
Rate and type of late adverse events
Time frame: From beyond week 18, up to 2 years follow-up.