DONIMI is a phase 1b trial testing the combination of domatinostat + nivolumab or nivolumab monotherapy in IFN-gamma signature high patients and of domatinostat + nivolumab or domatinostat + nivolumab + ipilimumab in IFN-gamma signature low patients with de-novo or recurrent macroscopic stage III cutaneous or unknown primary melanoma. The trial will include 45 stage III cutaneous or unknown primary melanoma patients with RECIST 1.1 measurable de-novo or recurrent disease (short axis lymph node metastasis ≥1.5cm). NanoString IFN-gamma signature high patients will be randomized to be treated pre-surgically for 6 weeks with nivolumab (arm A; 10 patients) or domatinostat + nivolumab (arm B; 10 patients). IFN-gamma signature low patients will be randomized to be treated pre-surgically for 6 weeks with domatinostat + nivolumab (arm C; 10 patients) or domatinostat + nivolumab + ipilimumab (arm D; 15 patients). Patients will be stratified according to center. Post-surgery (starting at week 12), the patients will start with adjuvant nivolumab or pembrolizumab for 52 weeks according to institute's standard. BRAF V600E/K mutation positive patients with no pathologic response after neoadjuvant therapy may also receive adjuvant BRAF + MEK inhibition if commercially available and according to the patient's and the treating physician's decision. Follow-up after the adjuvant therapy will be for 2 years, according to the institutes' standard. Toxicity and pathologic response rates will be descriptive. In case of 2/5 or 4/10 patients not undergoing their lymph node dissection at week 6 +/- 1 week due to treatment related toxicity, this arm will be declared unfeasible.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
44
Patients in arm B and C will receive domatinostat 200 mg BID, days 1-14 q3weeks. Patients in arm D will start with once daily (OD) dosing scheme of domatinostat 200mg, d1-14 q3wks. Based on safety data of the first 5 patients in this arm, the next patients will be treated with either a higher dosing scheme (200mg BID, d1-14, q3wks), a lower dosing scheme (100mg OD, d1-14, q3wks) or the same dosing scheme (200mg OD, d1-14, q3wks).
2 courses nivolumab 240 mg q3weeks
2 courses ipilimumab 80 mg q3weeks
Melanoma Institute Australia
Sydney, Wollstonecraft NSW, Australia
Antoni van Leeuwenhoek Hospital
Amsterdam, Netherlands
Safety of patients as measured by the adherence to the timelines in the study protocol
A treatment arm will be declared as not safe if 8/10 patients develop gr 3-4 adverse events or if 2/10 patients develop longlasting (\>6 months) gr 3-4 adverse events.
Time frame: 6 months
Feasability of patients as measured by the adherence to the timelines in the study protocol
A treatment arm will be declared as not feasible if 2/5 or 4/10 patients cannot adhere to the planned time of surgery (week 6 +/- 1 week) due to treatment related adverse events.
Time frame: 6 weeks
Pathologic response rates (pPR, near-pCR, and pCR).
Time frame: At 6 weeks
Frequency of treatment-related toxicities as measured according to CTCAE 5.0.
Time frame: At 6 weeks
Radiologic response rate according to RECIST 1.1 criteria
Time frame: At 6 weeks
Relapse Free Survival (RFS)
Time frame: Up to 3 years after treatment
RNA signatures associated with pathologic response and RFS for each arm (by RNAseq and NanoString gene expression analysis).
Time frame: Up to 3 years after treatment
Changes in immune infiltrates/markers at week 3 and/or 6 compared to baseline by NanoString DSP technology or alternative immunohistochemistry analysis.
Time frame: At week 3 and/or 6
Inter-arm comparison of the expansion of tumor-resident T cell clones, as measured by TCR sequencing of the baseline tumor-biopsy and PBMC samples from baseline week 3 and week 6.
Time frame: At week 3 and/or 6
Feces microbiome diversity analyses and its correlation with pathologic response and toxicities.
Time frame: Up to 3 years after treatment
Quality of life as measured by EORTC QLQ C30
Time frame: Up to 3 years after treatment
Quality of life as measured by the the Melanoma Subscale and Melanoma Surgery Subscale of FACT-M
Time frame: Up to 3 years after treatment
Quality of life as measured by the Cancer Worry Scale
Time frame: Up to 3 years after treatment
Quality of life as measured by HADS questionnaire
Time frame: Up to 3 years after treatment
Quality of life as measured by EQ-5D-5L
Time frame: Up to 3 years after treatment
Quality of life as measured by the immunotherapy-specific questionnaire
Time frame: Up to 3 years after treatment
Quality of life as measured by an assessment of work performance.
Time frame: Up to 3 years after treatment
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