An Open-Label, Randomized, Controlled Multi-Center Study of The Efficacy of Daromun (L19IL2 + L19TNF) Neoadjuvant Intratumoral Treatment Followed by Surgery and Adjuvant Therapy Versus Surgery and Adjuvant Therapy in Clinical Stage IIIB/C/D Melanoma Patients
Summary
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).
Detailed description
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.
Arms & interventions
- DrugDaromun
Patients will receive intratumoral administrations into injectable cutaneous, subcutaneous, and nodal tumors of Daromun once weekly for up to 4 weeks.
- ProcedureSurgery
Patients will receive surgery.
- DrugAdjuvant therapy
Patients will receive adjuvant therapy at the investigator's discretion following the surgery.
Outcome measures
Primary
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.
Secondary
Overall survival (OS)
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
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)
Time frame: From date of randomization until the date of the first event as described above, assessed up to 60 months
Adverse Events (AE)
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)
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)
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)
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
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
Time frame: 1) day 0-14 (screening) for both arm; 2) at week 5 (Safety assessment) only for arm 1.
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
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)
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)
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)
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)
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
Time frame: Assessed at the time of surgical resection of the tumor lesions.
Eligibility criteria
Study locations (19)
Mayo Clinic Hospital
Phoenix, Arizona, 85054
UC San Diego Moores Cancer Center
La Jolla, California, 92093
UC Irvine Health-Chao Family Comprehensive Cancer Center
Orange, California, 92868-3201
Moffitt Cancer Center
Tampa, Florida, 33612
Winship Cancer Institute, Emory university
Atlanta, Georgia, 30322
Rush University Medical Center
Chicago, Illinois, 60612
University of Iowa Hospitals and Clinics
Iowa City, Iowa, 52242
Mayo Clinic
Rochester, Minnesota, 55905
Rutgers Cancer Institute, 195 Little Albany Street
New Brunswick, New Jersey, 08903
Ambulatory Care Center at NYC Langarone Health
New York, New York, 10016
Memorial Sloan Kettering Cancer Center - Main Campus
Ney York, New York, 10065
Duke University Medical Center - Duke Cancer Center
Durham, North Carolina, 27710
Ohio State University Wexner Medical Center
Columbus, Ohio, 43210
St. Luke's Cancer Center, Clinical Trial, 3rd floor, 1600 St. Luke's Blvd.
Easton, Pennsylvania, 18045
Penn State Cancer Institute
Hershey, Pennsylvania, 17033
Fox Chase Cancer Center 333 Cottman Avenue
Philadelphia, Pennsylvania, 19111
The University of Texas M.D. Anderson Cancer Center
Houston, Texas, 77030-4009
Huntsman Cancer Institute, University of Utah 2000 Circle of Hope
Salt Lake City, UT, Utah, 84112
VCU - McGlothlin Medical Education Center
Richmond, Virginia, 980037
References
- Gorry C, McCullagh L, O'Donnell H, Barrett S, Schmitz S, Barry M, Curtin K, Beausang E, Barry R, Coyne I. Neoadjuvant treatment for stage III and IV cutaneous melanoma. Cochrane Database Syst Rev. 2023 Jan 17;1(1):CD012974. doi: 10.1002/14651858.CD012974.pub2.(PubMed)
- Miura JT, Zager JS. Neo-DREAM study investigating Daromun for the treatment of clinical stage IIIB/C melanoma. Future Oncol. 2019 Nov;15(32):3665-3674. doi: 10.2217/fon-2019-0433. Epub 2019 Sep 20.(PubMed)