Stage II patients with primary surgical treatment of cuMM are often at risk for recurrence of their disease. This risk may be reduced by adjuvant systemic treatment. Due to toxicities of adjuvant therapies the aim is to identify patients at high risk for relapse and to administer adjuvant treatment only to these patients. Thus an optimal balance between insufficient treatment vs. overtreatment has to be found. To define these patients a prognostic biomarker test will be used in addition to conventional AJCC staging. AJCC staging takes into account several prognostic factors. However, to subdivide stage II melanoma patients into having a low or high risk for relapse further methods are needed. This clinical trial will evaluate whether adjuvant nivolumab treatment will improve relapse-free survival (RFS) in patients with stage II high-risk melanoma as compared to observation only. The randomized approach of this trial offers the most objective method with the least influence of bias. Since patients with stage II melanoma are usually not receiving adjuvant treatment, no patient will be undertreated in case of randomization into observational arm.
The NivoMela trial is a randomized, controlled, prospective, multi-center national phase III trial with biomarker-based risk stratification. Stage II melanoma patients having undergone surgery of the malignant melanoma will be screened using the MelaGenix GEP score to identify patients at high risk for relapse. It is expected, that 61% of screened patients will belong to this group. Patients with a risk score of \> 0.0 (HR 1.48, 1.11-1.98) corresponding to high risk of relapse will be randomized at a ratio of 2:1 to receive either nivolumab as adjuvant treatment (arm A) or observation only (arm B). Stratification factors for randomization are: 1. Tumor stage: IIA versus IIB versus IIC 2. Gender: Female versus Male 3. Site of primary tumor: extremities versus trunk versus head \&neck All screened patients with a risk score of ≤ 0.0 who are not eligible for randomization will be followed for RFS, DMFS and OS for at least 5 years according to German Follow-up guidelines (Arm C). Various factors that could potentially predict clinical response and incidence of AEs to treatment with nivolumab will be investigated in peripheral blood and tumor specimen taken at baseline. Data from these investigations will be evaluated for associations with clinical efficacy (eg, ORR, PFS, OS) and safety/toxicity (AE). The samples may also be used for exploratory analyses to assess biomarkers associated with melanoma and/or with immunotherapy treatment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
374
480 mg nivolumab fixed dose given as 60-minute iv infusion every 4 weeks for 12 doses over 1 year
Universitätsklinikum Würzburg - Klinik für Dermatologie, Venerologie und Allergologie
Würzburg, Bavaria, Germany
Universitätsmedizin Rostock -Klinik und Poliklinik für Dermatologie und Venerologie
Rostock, Mecklenburg-Vorpommern, Germany
Universitätsklinikum Augsburg, Campus Süd
Augsburg, Germany
St. Josef-Hospital - Dermatologische Studienambulanz
Bochum, Germany
Klinikum Dortmund gGmbH - Dermatologie
Dortmund, Germany
Universitätsklinik Carl Gustav Carus der Technischen Universität Dresden - Klinik und Poliklinik für Dermatologie
Dresden, Germany
HELIOS Klinikum Erfurt
Erfurt, Germany
University Hospital Essen, Department of Dermatology, Skin Cancer Center
Essen, Germany
Universitätsklinikum Freiburg - Klinik für Dermatologie und Venerologie
Freiburg im Breisgau, Germany
Universitätsklinikum Gießen und Marburg GmbH - Klinik für Dermatologie und Allergologie
Giessen, Germany
...and 10 more locations
Relapse-Free Survival (RFS) rates
Determination of efficacy of nivolumab in a biomarker-selected high-risk-enriched stage II melanoma patient population in comparison to control receiving observation only in a 2 (Arm A=nivolumab) : 1 (Arm B=observation) randomization, as measured by Relapse-Free Survival (RFS) rates at 36 and 60 months. RFS is defined as the time from date of registration until documented tumor progression date or date of death of any cause, whichever occurs first in all patients tested with the MelaGenix gene expression profiling (GEP).
Time frame: 5 years
Distant metastasis-free survival (DMFS) rates
DMFS rates at 36 and 60 months
Time frame: 5 years
Melanoma-specific survival (MSS) rates
MSS rates at 36 and 60 months
Time frame: 5 years
Overall survival (OS) rates
OS rates at 36 and 60 months
Time frame: 5 years
Adverse events ≥ Grade 3 according to CTCAE Version 5.0 criteria (Safety / Toxicity)
All adverse events ≥ Grade 3 according to CTCAE Version 5.0 criteria, that are definitely, probably, or possibly related to the administration of the investigational agent
Time frame: Arm A: Until 100 days after discontinuation of dosing of the investigational product; Arm B: Until 1 year after patient´s written consent
Clinical utility/decision impact of the MelaGenix Gene Expression Profiling (GEP) Score in stratifying patients for adjuvant therapy
Patients with a risk score of \> 0.0 (HR 1.48, 1.11-1.98) will be classified as high risk for relapse. It is expected, that 61% of screened patients will belong to this group. Patients with a risk score of score of ≤ 0.0 will be classified as low risk for relapse.
Time frame: 5 years
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.