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).
The present study is an open-label, randomized, controlled, two-arm multi-center study of the efficacy of Daromun neoadjuvant intratumoral treatment followed by surgery and adjuvant therapy versus surgery and adjuvant therapy in clinical stage III B/C/D melanoma patients. 186 patients will be randomized in a 1:1 ratio to receive Daromun treatment followed by surgery and adjuvant therapy (Arm 1) or surgery and adjuvant therapy (Arm 2). In both arms, follow-up for assessing recurrence-free survival will be performed up to five years after randomization. Survival information will also be collected in the following year (up to six years in total after randomization). This is an open-label study, so there is no blinding. Patients who successfully complete the screening evaluations and are eligible for participation in the study will be enrolled and randomly assigned (1:1) to two parallel treatment arms: Daromun plus surgery and adjuvant therapy (Arm 1) or surgery and adjuvant therapy (Arm 2). To ensure a balance across treatment groups, stratified randomization with permuted block will be used and separate randomization list for each subgroup (stratum) will be produced. Patients will be stratified on the basis of the following prognostic factors: * Stage of disease (3 levels): Stage IIIB vs. Stage IIIC vs Stage IIID * Planned post-surgical adjuvant therapy (2 levels): anti-PD-1 and other adjuvant therapies. The primary objective of the study is to demonstrate that a neoadjuvant Daromun treatment followed by surgery and adjuvant therapy improves 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). Primary endpoint of the study is RFS in a time-to-event analysis in the Daromun plus surgery and adjuvant therapy treatment group (Arm 1) versus the surgery plus adjuvant therapy control group (Arm 2). Analysis will be based on the "Intention To Treat" population. The key secondary objective of the study is to demonstrate that a neoadjuvant Daromun treatment followed by surgery and adjuvant therapy improves in a statistically significant manner the overall survival (OS) of patients with resectable Stage IIIB/C/D melanoma patients with respect to the standard of care (surgery and adjuvant therapy). For patients enrolled in both arms, local approved post-surgery adjuvant therapies (as part of the standard of care) are allowed and decided at the investigator's discretion. These include high-dose interferon- α2b, anti-CTLA-4 antibodies (e.g. Ipilimumab), anti-PD1 antibodies (e.g. Nivolumab, Pembrolizumab), targeted therapies (e.g. Dabrafenib + Trametinib), or other new local approved treatments.
Patients will receive intratumoral administrations into injectable cutaneous, subcutaneous, and nodal tumors of Daromun once weekly for up to 4 weeks.
Patients will receive surgery.
Patients will receive adjuvant therapy at the investigator's discretion following the surgery.
Recurrence Free Survival (RFS)
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.
Time frame: 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.
Overall survival (OS)
Overall survival (OS) in the Daromun plus surgery and adjuvant therapy treatment group (Arm 1) versus surgery and adjuvant therapy (Arm 2), which will be evaluated in time to event analysis as key secondary endpoint.
Time frame: From date of randomization until the date of the first recurrence or date of death from any cause, whichever occurs first, assessed up to 72 months.
Recurrence free survival (RFS) as determined by the local investigator
A sensitivity analysis to assess ascertainment bias will be performed on recurrence free survival. For this analysis the primary analysis definition of recurrence will be split into its two components and each will be analyzed separately. The first component/definition will be based on the unblinded assessment performed at the site - any new lesion detected by clinical evaluation which is confirmed by histopathology (biopsy or surgical specimen) and the second component/definition will be based on the assessment of a new lesion detected by allowed imaging modalities in a Blinded Independent Central Review and confirmed, wherever possible, by histological analysis. Each of these components will be analyzed separately using the same statistical model as the primary endpoint. Results from the two component analyses will be compared.
Time frame: 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.
Event-free survival (EFS)
Event-free survival (EFS) defined as time from randomization to melanoma progression (irresectable stage III or stage IV disease), melanoma recurrence, treatment-related toxicity precluding surgery, treatment-related death, or melanoma-related death, whichever occurs first.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
186
Mayo Clinic Hospital
Phoenix, Arizona, United States
RECRUITINGUC San Diego Moores Cancer Center
La Jolla, California, United States
ACTIVE_NOT_RECRUITINGUC Irvine Health-Chao Family Comprehensive Cancer Center
Orange, California, United States
ACTIVE_NOT_RECRUITINGMoffitt Cancer Center
Tampa, Florida, United States
RECRUITINGWinship Cancer Institute, Emory university
Atlanta, Georgia, United States
RECRUITINGRush University Medical Center
Chicago, Illinois, United States
ACTIVE_NOT_RECRUITINGUniversity of Iowa Hospitals and Clinics
Iowa City, Iowa, United States
ACTIVE_NOT_RECRUITINGMayo Clinic
Rochester, Minnesota, United States
RECRUITINGRutgers Cancer Institute, 195 Little Albany Street
New Brunswick, New Jersey, United States
RECRUITINGAmbulatory Care Center at NYC Langarone Health
New York, New York, United States
ACTIVE_NOT_RECRUITING...and 27 more locations
Time frame: From date of randomization until the date of the first event as described above, assessed up to 60 months
Adverse Events (AE)
Percentage of Patients in Each Treatment Group with AEs, AEs with CTCAE grade ≥3
Time frame: From the inclusion in the study (signature of the informed consent form - ICF) until the first follow-up visit (up to approximately 5 months).
Immune-related Adverse Events (irAEs)
Occurrence of immune-related Adverse Events (irAEs)
Time frame: From the inclusion in the study (signature of the informed consent form - ICF) until the end of follow-up (up to approximately 60 months).
Drug-Induced Liver Injury (DILI)
Number of patients with Drug-Induced Liver Injury (DILI)
Time frame: From the inclusion in the study (signature of the informed consent form - ICF) until the end of follow-up (up to approximately 60 months).
Adverse Events of Special Interest (AESI)
Number of patients with Adverse Events of Special Interest (AESI)
Time frame: From the inclusion in the study (signature of the informed consent form - ICF) until the end of follow-up (up to approximately 60 months).
Haematological/chemical Laboratory Abnormalities
Percentage of Subjects with Haematological/chemical Laboratory Abnormalities
Time frame: From the inclusion in the study (signature of the informed consent form - ICF) until the end of follow-up (up to approximately 60 months).
Electrocardiogram (ECG) and echocardiogram (ECHO) abnormalities
Percentage of participants with Electrocardiogram (ECG) and echocardiogram (ECHO) abnormality findings. Data about QT/QTc intervals will be collected and analysed for QT/QTc prolongation potentially caused by treatment.
Time frame: 1) day 0-14 (screening) for both arm; 2) at week 5 (Safety assessment) only for arm 1.
Physical examination
Number of subjects with a clinically significant change from baseline in physical examination
Time frame: From the inclusion in the study (signature of the informed consent form - ICF) until the end of follow-up (up to approximately 60 months)
Concomitant medication
Number of subject with concomitant medication
Time frame: From the inclusion in the study (signature of the informed consent form - ICF) until the end of follow-up (up to approximately 60 months)
Human anti-fusion protein antibodies (HAFA)
Assessment of the formation of human anti-fusion protein antibodies (HAFA) against L19IL2 and L19TNF
Time frame: 1) day 0-14 (screening) for arm 1; 2) at week 5 (Safety assessment) for Arm 1; 3) at week 12 (only first follow-up) for Arm 1.
Vital signs (blood pressure)
Number of subjects with a clinically significant change from baseline in vital signs (blood pressure) by visit
Time frame: From the inclusion in the study (signature of the informed consent form - ICF) until the end of follow-up (up to approximately 60 months).
Vital signals (heart rate)
Number of subjects with a clinically significant change from baseline in vital signs (heart rate) by visit
Time frame: From the inclusion in the study (signature of the informed consent form - ICF) until the end of follow-up (up to approximately 60 months)
Vital signals (body temperature)
Number of subjects with a clinically significant change from baseline in vital signs (body temperature) by visit
Time frame: From the inclusion in the study (signature of the informed consent form - ICF) until the end of follow-up (up to approximately 60 months)
Pathological responses
Pathological responses (categorized into pCR, near-pCR, pPR, pNR, according to INMC criteria) assessed at time of surgical resection.
Time frame: Assessed at the time of surgical resection of the tumor lesions.