This is a Phase II, open-label, single arm study. The study will consist of an assessment of the safety and tolerability of tocilizumab administered concurrently at 4 mg/kg every 6 weeks for 5 doses in combination with ipilimumab and nivolumab for four induction doses to week 12, then maintenance nivolumab alone up to one year to patients with advanced melanoma. Treatment will be divided into induction and maintenance phases. It is anticipated that this clinical study will inform the use of this 3-drug combination for further phase II and/or phase III clinical testing. The trial will include an assessment of the pharmacodynamic activity of tocilizumab administered in combination with ipilimumab and nivolumab.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
71
4 induction doses (during the 2 treatment cycles) at a dose of 1 mg/kg intravenously (IV) every 3 weeks, 4 times during the 12-week induction period, concurrent with nivolumab at 3 mg/kg administered at the same interval
Nivolumab (3 mg/kg) will be administered IV on Days 1 and 22 of each 42-day induction treatment cycle. Nivolumab will continue to be administered IV at 240 mg flat dose every 2 weeks; i.e., at Days 1, 15, 29, 43, 57, and 71 of the 84-day treatment cycle for the first maintenance cycle until week 24, then nivolumab will be administered at 480 mg flat dose every 4 weeks to a maximum of 2 years
Administered intravenously for each 42-day induction treatment cycle. After 12 weeks of therapy, starting at Week 13, subjects enter the maintenance phase. Tocilizumab will be administered intravenously every 6 weeks during the first 84 day maintenance treatment cycle only at 4 mg/kg
The Angeles Clinic
Los Angeles, California, United States
Massachusetts General Hospital
Boston, Massachusetts, United States
Dana Farber Cancer Institute
Boston, Massachusetts, United States
NYU Langone Health
New York, New York, United States
Percentage of Participants With Grades 3-5 Treatment Related Immune Related Adverse Events (irAEs)
Adverse events are graded according to the NCI CTCAE version 5.0. Immune-related adverse events (irAEs) are specific events occurring within 100 days of the last dose (which includes pneumonitis, diarrhea/colitis, hepatitis, nephritis/renal dysfunction, rash, and endocrine abnormalities \[adrenal insufficiency, hypothyroidism/thyroiditis, hyperthyroidism, diabetes mellitus, and hypophysitis\]), regardless of causality, for which patients received immunosuppressive medication for treatment of the event. The exception to the immunosuppressive medication criteria for irAEs is endocrine events (e.g., hypothyroidism/thyroiditis, hyperthyroidism, hypophysitis, diabetes mellitus, adrenal insufficiency), which are included regardless of treatment since these events are often managed without immunosuppression.
Time frame: From start of treatment up to 100 days post treatment, *up to 18 months*
Objective Response Rate (ORR)
Objective Response Rate (ORR) is defined as the total number of patients whose best response outcome is a CR or PR by week 24 divided by the total number of evaluable patients. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: 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: Week 24
Disease Control Rate (DCR)
Disease Control Rate (DCR) is defined as the total number of patients whose best response outcome is a complete response (CR) or partial response (PR), or SD divided by the total number of evaluable patients.
Time frame: From beginning of treatment until the first observation of disease progression (up to 5 years)
Progression-Free Survival (PFS)
Progression-Free Survival (PFS) is defined for each patient as the time from first dosing to the first observation of disease progression or death due to any cause. If a patient has not progressed or died at the time of analysis, PFS will be censored on the date of the last disease assessment. Patients who do not have any tumor assessment on treatment will be censored on the day of the first dose.
Time frame: From start of treatment until the first observation of disease progression or death due to any cause, whichever came first (up to 5 years)
Duration of Overall Response
Duration of Overall Response will be computed for all patients whose best response is either a PR or CR and is calculated from the time the measurement criteria are met for PR or CR, whichever is recorded first, until the date of documented PD or death.
Time frame: From date of best overall response until the first observation of disease progression or death due to any cause, whichever came first (up to 5 years)
Duration of Disease Control
Duration of Disease Control will be computed for the patients who had ORR outcome of CR, PR, or SD and is calculated from the beginning of treatment until the time of documented disease progression.
Time frame: From start of treatment until the first observation of disease progression (up to 5 years)
Immune-related Response Rate (irRR)
Immune-related Response Rate (irRR) is defined as the proportion of response evaluable patients whose Immune Related Best Overall Response (irBOR) outcome is irPR, irCR.
Time frame: From beginning of treatment until the first observation of disease progression (up to 5 years)
Immune-related Disease Control Rate
Immune-related Disease Control Rate is defined as the proportion of the response evaluable patients whose irBOR outcome is irPR, irCR, or immune-related stable disease (irSD).
Time frame: From beginning of treatment until the first observation of disease progression (up to 5 years)
Immune-related Progression-Free Survival (irPFS)
Immune-related Progression-Free Survival (irPFS) is defined as the time between the first dosing date and the date of immune-related progressive disease (irPD) or death, whichever occurs first. For patients with no recorded post-baseline tumor assessment, irPFS will be censored at the day of first dose. A patient who dies without reported irPD will be considered to have progressed on the date of death. For those who remain alive and have no irPD, irPFS will be censored on the date of last evaluable tumor assessment. Patients who do not have any tumor assessment on treatment will be censored on the day of the first dose.
Time frame: From start of treatment until the first observation of disease progression or death due to any cause, whichever came first (up to 5 years)
Duration of Immune-related Overall Response
Duration of Immune-related Overall Response will be computed for all patients whose irBOR outcome is either an irPR or irCR and is calculated from the time the measurement criteria are met for irPR or irCR, whichever is recorded first, until the date of documented PD or death by irRC.
Time frame: From time irPR or irCR was met until the first observation of disease progression or death due to any cause, whichever came first (up to 5 years)
Duration of Immune-related Disease Control
Duration of Immune-related Disease Control will be computed for the patients who had irBOR outcome of irCR, irPR, or irSD and is calculated from the beginning of treatment until the time of documented disease progression by irRC.
Time frame: From beginning of treatment until the first observation of disease progression (up to 5 years)
Overall Survival (OS)
Overall Survival is defined for each patient as the time from first dosing to death due to any cause. If a patient has not died at the time of analysis, OS will be censored as of their last known date alive (i.e. last time patient was contacted for any reason in the study). Patients who do not have any tumor assessment on treatment be followed up for OS, and their date of death will be incorporated into the OS analysis.
Time frame: From start of treatment until the date of death from any cause (up to 5 years)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.