Immunotherapy for Melanoma

Overseen By Lina Moreno

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: H. Lee Moffitt Cancer Center and Research Institute

Must not be taking: Corticosteroids, Immunosuppressive drugs

Disqualifiers: Pregnancy, Cardiovascular disease, Brain metastases, Autoimmune disease, others

Stay on Your Current Meds You can continue your current medications while participating

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Breakthrough Therapy This drug has been fast-tracked for approval by the FDA given its high promise

Compensation: Varies

Number of Visits: 4

90 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores the effectiveness of immunotherapy given before surgery for individuals with certain types of melanoma, a serious skin cancer. The study consists of two parts, testing different combinations of drugs such as ipilimumab (Yervoy) and nivolumab (Opdivo) to determine which works best based on specific tumor markers. It is suitable for participants with melanoma that can be surgically removed and may have spread to nearby lymph nodes or other areas. As a Phase 2 trial, the research focuses on measuring the treatment's effectiveness in an initial, smaller group of people.

Will I have to stop taking my current medications?

The trial protocol does not specify if you must stop taking your current medications. However, you cannot have certain treatments like investigational drugs or systemic interventions for melanoma within 4 weeks before starting the study drugs.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that the treatments tested in this study have been used before and have demonstrated varying levels of safety. Here are the main treatments:

1. **Nivolumab plus Ipilimumab**: Studies have found that most people tolerate this combination well, although about 2.5% of melanoma patients experienced reactions during infusion. Medical care can usually manage these reactions.

2. **Nivolumab plus Relatlimab**: Previous studies have not identified any new safety concerns with this combination. However, around 43% of patients experienced serious side effects when using it for advanced melanoma.

3. **Ipilimumab plus Nivolumab-Relatlimab**: This combination has been used to treat melanoma, with some reports of serious reactions affecting the heart and nervous system. Although rare, these reactions require prompt attention.

Researchers continue to study these treatments to improve outcomes for melanoma patients. While side effects can occur, clinical trials closely monitor them to ensure patient safety. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about these treatments for melanoma because they explore innovative combinations of immunotherapy drugs. Unlike current standard treatments, which often involve single-agent therapies, these trials combine drugs like nivolumab, ipilimumab, and relatlimab to potentially boost the immune system's ability to fight cancer. One key feature is the combination of nivolumab and relatlimab, which targets both PD-1 and LAG-3 pathways, offering a dual blockade that might enhance the immune response against melanoma cells. Additionally, the triplet combination therapy adds ipilimumab to the mix, which could further amplify the immune attack on cancer. These novel combinations aim to improve outcomes for patients with advanced melanoma, especially those who are resistant to existing treatments.

What evidence suggests that this trial's treatments could be effective for melanoma?

Research has shown that using nivolumab with ipilimumab, one of the treatment options in this trial, is promising for treating advanced melanoma. A study found that after five years, 52% of patients who received this combination were still alive, a much higher rate than those who only received ipilimumab. Another treatment option in this trial is the combination of nivolumab with relatlimab, which studies have shown helps patients live longer without their cancer worsening. When used together, these two drugs consistently controlled tumor growth better than nivolumab alone. Adding relatlimab to the nivolumab-ipilimumab combination, another arm in this trial, has demonstrated similar effectiveness, suggesting it might work as well as the two-drug combo in managing melanoma. These treatments harness the body's immune system to fight cancer, aiming to improve long-term survival and quality of life. ^{3 5 6 7 8}

Who Is on the Research Team?

Ahmad Tarhini, MD, PhD

Principal Investigator

Moffitt Cancer Center

Are You a Good Fit for This Trial?

This trial is for adults with a specific stage of melanoma, which involves regional lymph nodes or distant metastases that are potentially removable by surgery. Participants must not have had previous systemic therapy for melanoma and should be able to provide informed consent.

Inclusion Criteria

Women of childbearing potential (WOCBP) must have a negative pregnancy test and agree to use contraception

My organs are working well.

I have not received any systemic therapy for melanoma.

Exclusion Criteria

I have been diagnosed with melanoma in my eye.

Pregnancy or lactation

Recent treatment with another investigational drug or systemic intervention for melanoma

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Neoadjuvant Treatment

Participants receive neoadjuvant immunotherapy treatment based on tumor biomarkers

8 weeks

2 cycles, each cycle every 4 weeks

Surgery

Participants undergo surgery following neoadjuvant treatment

1 week

Adjuvant Treatment

Participants receive adjuvant immunotherapy treatment post-surgery

8 weeks

2 cycles, each cycle every 4 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

36 months

What Are the Treatments Tested in This Trial?

Interventions

• Ipilimumab
• Nivolumab
• Nivolumab + Relatlimab

Trial Overview

The study tests if using immunotherapy drugs like Ipilimumab, Nivolumab, or their combination before surgery can improve outcomes in melanoma patients. The treatment choice is based on tumor biomarkers.

How Is the Trial Designed?

Group I: Part 2, Arm B2: Doublet Combination Therapy Nivolumab-Relatlimab-rmbw Experimental Treatment 1 Intervention

Patients with locoregionally advanced melanoma that is refractory to systemic adjuvant therapy will be given the fixed dose combination of 480 mg of nivolumab with 160 mg of relatlimab I.V. over 60 minutes (-/+ 10 minutes) every 4 weeks (every cycle) for a total of 2 cycles.

Group II: Part 2, Arm B1: Triplet Combination Therapy Ipilmumab + Nivolumab-Relatlimab-rmbw Experimental Treatment 2 Interventions

Patients with locoregionally advanced melanoma that is refractory to systemic adjuvant therapy will be given the fixed dose combination of 480 mg of nivolumab with 160 mg or relatlimab I.V. over 60 minutes (-/+ 10 minutes) every 4 weeks (every cycle) for a total of 2 cycles. In addition, a single dose of 1 mg/kg ipilimumab I.V. will be given on C1D1.

Group III: Part 2, Arm A: Ipilimumab + Nivolumab-Relatimab-rmbw Experimental Treatment 2 Interventions

Systemic therapy naïve locoregionally advanced melanoma patients will be given the fixed dose combination of 480 mg of nivolumab with 160 mg of relatlimab I.V. over 60 minutes (-/+ 10 minutes) every 4 weeks (every cycle) for a total of 2 cycles. In addition, a single dose of 1 mg/kg ipilimumab I.V. will be given on C1D1.

Group IV: Part 1, Arm C: Nivolumab plus ipilimumab Experimental Treatment 2 Interventions

PD-L1 negative patients will be given 3 mg/kg of Nivolumab plus 1 mg/kg of Ipilimumab I.V. each given over 30 minutes (-/+ 10 minutes) every 4 weeks (every cycle) for a total of 2 cycles.

Group V: Part 1, Arm B: Nivolumab- Relatlimab-rmbw Experimental Treatment 1 Intervention

PD-L1 negative patients will be given a combination of Nivolumab 480 mg with Relatlimab 160 mg I.V. over 60 minutes (-/+ 10 minutes) every 4 weeks (every cycle) for a total of 2 cycles.

Group VI: Part 1, Arm A: Nivolumab Experimental Treatment 1 Intervention

PD-L1 positive patients will be given Nivolumab 480 mg I.V. over 30 minutes (-/+ 10 minutes) every 4 weeks (every cycle) for 2 a total of 2 cycles.

Who Is Running the Clinical Trial?

H. Lee Moffitt Cancer Center and Research Institute

Lead Sponsor

Trials

576

Recruited

145,000+

Bristol-Myers Squibb

Industry Sponsor

Trials

2,731

Recruited

4,127,000+

Headquarters

New York City, USA

Known For

Oncology & Cardiovascular

Top Products

Eliquis, Opdivo, Revlimid, Orencia

Christopher Boerner

Bristol-Myers Squibb

Chief Executive Officer since 2023

PhD in Business Administration from the Haas School of Business, University of California, Berkeley; BA in Economics and History from Washington University in St. Louis

Deepak L. Bhatt

Bristol-Myers Squibb

Chief Medical Officer since 2024

MD from Yale University; MSc in Clinical Epidemiology from the University of Pennsylvania

Published Research Related to This Trial

In a study of 945 patients with untreated metastatic melanoma, the combination of nivolumab and ipilimumab significantly improved progression-free survival to a median of 11.5 months compared to just 2.9 months with ipilimumab alone.

For patients with PD-L1-negative tumors, the combination therapy was particularly effective, showing a progression-free survival of 11.2 months compared to 5.3 months with nivolumab alone, highlighting the potential of dual checkpoint inhibition in this subgroup.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma. Larkin, J., Chiarion-Sileni, V., Gonzalez, R., et al.[2023]

In a study analyzing over 91,000 adverse events from patients receiving immune checkpoint inhibitors, 10,933 cases of cutaneous immune-related adverse events (cirAEs) were identified, highlighting the prevalence and diversity of skin complications associated with immunotherapy.

The onset of cirAEs varies significantly by subtype, with some, like erythema multiforme and Stevens-Johnson syndrome, appearing around one month after treatment, while others, such as bullous pemphigoid and vitiligo, may take five to six months to develop.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cutaneous Toxicities Associated with Immune Checkpoint Inhibitors: An Observational, Pharmacovigilance Study. Le, TK., Brown, I., Goldberg, R., et al.[2023]

In a study analyzing 2,088 individual case safety reports (ICSRs) related to immune checkpoint inhibitors (ICIs) in Italy, 801 reports documented serious immune-related adverse drug reactions (irADRs), primarily affecting male patients with gastrointestinal and skin toxicities.

Among the ICIs, nivolumab and pembrolizumab were most frequently associated with irADRs, with significant risks identified for pembrolizumab and ipilimumab, highlighting the need for oncologists to recognize and manage these serious side effects effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immune Checkpoint Inhibitors and Immune-Related Adverse Drug Reactions: Data From Italian Pharmacovigilance Database. Ruggiero, R., Fraenza, F., Scavone, C., et al.[2022]

Ipilimumab, an FDA-approved immunotherapy for advanced melanoma, effectively blocks CTLA-4 to enhance anti-tumor immune responses, but it is associated with a range of immune-related adverse events (irAEs) such as colitis, dermatologic issues, and endocrine dysfunction.

The article discusses the potential for combination therapies to mitigate these irAEs and emphasizes the need for further research to identify biomarkers that could predict patient responses to ipilimumab treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immune-mediated adverse events of anticytotoxic T lymphocyte-associated antigen 4 antibody therapy in metastatic melanoma. Quirk, SK., Shure, AK., Agrawal, DK.[2019]

In a phase 2 trial involving 142 patients with untreated advanced melanoma, the combination of nivolumab and ipilimumab resulted in a 2-year overall survival rate of 63.8%, compared to 53.6% for those receiving ipilimumab alone, suggesting improved survival outcomes with the combination therapy.

However, the combination treatment was associated with a higher incidence of severe side effects, with 54% of patients experiencing grade 3-4 adverse events compared to 20% in the ipilimumab-only group, indicating a trade-off between efficacy and safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Combined nivolumab and ipilimumab versus ipilimumab alone in patients with advanced melanoma: 2-year overall survival outcomes in a multicentre, randomised, controlled, phase 2 trial. Hodi, FS., Chesney, J., Pavlick, AC., et al.[2022]

The combination of ipilimumab and nivolumab is more effective in treating advanced melanoma compared to ipilimumab alone, leading to better patient responses.

However, this two-drug combination significantly increases the likelihood of side effects compared to using ipilimumab as a single treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab + ipilimumab ups melanoma response. [2018]

Nivolumab plus relatlimab is a combination immunotherapy that targets immune checkpoints, specifically PD-1 and LAG-3, and has been approved for treating unresectable or metastatic melanoma in adults and adolescents weighing at least 40 kg.

This combination therapy represents a significant advancement in cancer treatment, as it utilizes two different mechanisms to enhance the immune response against cancer cells.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab Plus Relatlimab: First Approval. Paik, J.[2022]

Nivolumab, a monoclonal antibody targeting the programmed death receptor-1, has shown promising efficacy in treating advanced malignant melanoma, with nearly 25% of patients achieving a partial tumor response in a phase II trial involving previously treated stage III/IV patients.

The treatment demonstrated a durable clinical benefit, with a median progression-free survival of 172 days and an acceptable safety profile, as less than 18% of patients experienced severe adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab: a review of its use in patients with malignant melanoma. Deeks, ED.[2021]

Combining nivolumab and ipilimumab shows improved effectiveness in treating metastatic melanoma compared to using either drug alone, based on a retrospective analysis of approximately 7700 patients.

The combination therapy presents a safety profile that includes immune-related adverse events from both drugs, indicating that while the combination is effective, it also carries a heightened risk of toxicity that needs further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Retrospective Side Effect Profiling of the Metastatic Melanoma Combination Therapy Ipilimumab-Nivolumab Using Adverse Event Data. Soldatos, TG., Dimitrakopoulou-Strauss, A., Larribere, L., et al.[2022]

In a study of 93 Chinese patients with advanced melanoma treated with PD-1 inhibitors, those who developed immune-related adverse events (irAEs) had significantly higher overall response rates (ORR) and disease control rates (DCR) compared to those without irAEs.

Patients experiencing three or more irAEs showed even better clinical outcomes, including longer progression-free survival and overall survival, suggesting that the presence of irAEs may indicate a more effective immune response to PD-1 therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between immune-related adverse events and efficacy of PD-1 inhibitors in Chinese patients with advanced melanoma. Zhao, JJ., Wen, XZ., Ding, Y., et al.[2021]

In a study of 142 patients with advanced melanoma, the combination of nivolumab and ipilimumab resulted in a significantly higher objective response rate of 61% compared to 11% for ipilimumab alone, indicating that the combination therapy is much more effective for treating this type of cancer.

While the combination therapy showed promising efficacy, it also had a higher incidence of severe adverse events (54% vs. 24% for monotherapy), but most of these side effects were manageable with immune-modulating medications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab and ipilimumab versus ipilimumab in untreated melanoma. Postow, MA., Chesney, J., Pavlick, AC., et al.[2022]

The combination of nivolumab and ipilimumab, two immune checkpoint inhibitors, is a promising treatment for advanced melanoma, enhancing the body's immune response against the cancer.

Adding denosumab to this treatment may further improve anti-tumor effects by counteracting the immunosuppressive environment created by CD8+ T cells, as suggested by recent reports.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Successful Treatment of Multiple Metastatic Melanoma with Nivolumab, Ipilimumab plus Denosumab Combined Therapy. Yoshida, S., Fujimura, T., Kambayashi, Y., et al.[2020]

Nivolumab (Opdivo®) is a human monoclonal antibody that enhances the immune response against melanoma by blocking the PD-1 receptor on tumor cells, allowing T cells to better target the cancer.

Clinical trials have shown that nivolumab is more effective than standard chemotherapy for treating advanced melanoma, offering a safer alternative with improved patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab for Metastatic Melanoma. Gupta, AK., Daigle, D.[2018]

In a phase 1 trial involving 53 patients with advanced melanoma, the combination of nivolumab and ipilimumab resulted in a 40% objective response rate, with 65% of patients showing clinical activity, indicating significant effectiveness in tumor reduction.

The concurrent treatment had a manageable safety profile, with 53% of patients experiencing grade 3 or 4 adverse events, which were similar to those seen with monotherapy and generally reversible, suggesting that this combination therapy is a viable option for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab plus ipilimumab in advanced melanoma. Wolchok, JD., Kluger, H., Callahan, MK., et al.[2022]

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