A Multicentre, Open Label, Phase II Study to Determine the Response to Neoadjuvant Pembrolizumab and Lenvatinib Followed by Adjuvant Treatment With Pembrolizumab and Lenvatinib in Mucosal Melanoma
Overview
- Phase
- Phase 2
- Intervention
- Pembrolizumab
- Conditions
- Mucosal Melanoma
- Sponsor
- Melanoma Institute Australia
- Locations
- 1
- Primary Endpoint
- Change in immune cell expression of HIF1 and immune cell densities
- Status
- Withdrawn
- Last Updated
- last year
Overview
Brief Summary
In many cancers, early stage diagnosis and early treatment offers the best chance of a prolonged recurrence free- and overall survival. Neoadjuvant immunotherapy involves administering immune checkpoint inhibitors before surgical resection in high-risk resectable disease, such as mucosal melanoma. In resectable cancers, immune checkpoint inhibitors can enhance anti-tumour immunity by exploiting a competent immune system prior to surgery. Activating antigen-specific T cells found in the primary or baseline tumour continue to exert anti-tumour effects on remaining neoplastic cells after the resection of the original tumour, potentially preventing recurrences from occurring.
In resectable mucosal melanoma, an opportunity exists to improve clinical outcomes with the addition of neoadjuvant and adjuvant systemic therapy with nivolumab and lenvatinib as an adjunct to surgery.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Written informed consent
- •Histologically confirmed diagnosis of fully-resectable mucosal melanoma
- •Pathological ± clinical confirmation that the presenting lesion(s) does not represent metastasis from an unknown primary cutaneous or ocular melanoma
- •Measurable disease per RECIST
- •Availability of a newly obtained core or excisional biopsy of an affected lesion which has not been previously irradiated
- •Ability to swallow and retain oral medication
- •ECOG 0 - 1
- •Adequate organ function per laboratory values
- •Adequately controlled blood pressure with or without anti-hypertensive medications, defined as ≤ 150/90 mmHg at screening
- •Anticpated life expectabcy of \> 12 months.
Exclusion Criteria
- •A diagnosis of uveal or cutaneous melanoma
- •A WOCBP who has a positive serum pregnancy test within 72 hours prior to starting study treatment
- •Prior therapy with an anti-PD-1, anti-PD-L1, or anti PD L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor for any disease
- •Prior systemic treatment for mucosal melanoma including investigational agents. Prior surgery is acceptable
- •Major surgery within 3 weeks prior to first dose of lenvatinib
- •Patients who have not recovered adequately from any toxicity from other permitted anti- cancer treatment regimens
- •Prior radiotherapy within 2 weeks of start of study treatment
- •Received a live vaccine or live-attenuated vaccine within 30 days before the first dose of study treatment
- •Patient is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study treatment
- •A diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 14 days prior to the first dose of study treatment
Arms & Interventions
Neoadjuvant and Adjuvant Therapy
Neoadjuvant pembrolizumab \& lenvatinib for 6 weeks followed by definitive surgery then adjuvant pembrolizumab alone for 46 weeks
Intervention: Pembrolizumab
Neoadjuvant and Adjuvant Therapy
Neoadjuvant pembrolizumab \& lenvatinib for 6 weeks followed by definitive surgery then adjuvant pembrolizumab alone for 46 weeks
Intervention: Lenvatinib
Outcomes
Primary Outcomes
Change in immune cell expression of HIF1 and immune cell densities
Time Frame: Baseline, week 1 week 6
Tumour and immune cell expression of HIF1a and immune cell densities will be compared between baseline and day 8 melanoma tissue biopsies.
Pathological response rate
Time Frame: 6 weeks
Proportion of patients with complete absence of residual melanoma cells in the the planned resected tumour site(s) at week 6 surgery
Secondary Outcomes
- RECIST response rate(6 weeks)