Study of ADI-PEG 20 in Patients With Advanced Melanoma

Phase 1

Completed

Brief Summary: This was a phase 1/2, open-label, dose-escalation study of arginine deiminase linked via succinimidyl succinate to polyethylene glycol of 20,000 molecular weight (ADI-PEG 20) in subjects with advanced melanoma. ADI-PEG 20 was administered intramuscularly (IM) at escalating doses weekly for 9 weeks (cycle 1) or 8 weeks (subsequent cycles). The primary objectives were to the establish the safety, tolerability, and clinical efficacy of ADI-PEG 20. Secondary objectives included evaluation of the metabolic activity by \[18F\]-fluorodeoxyglucose positron emission tomography (FDG PET), pharmacodynamics, correlation of immunogenicity with clinical response, and correlation of argininosuccinate synthetase (ASS) tumor expression with clinical response.

Detailed Description: A 3+3 design was implemented during phase 1, in which 3 to 6 subjects were enrolled sequentially into the following escalating dose cohorts:

* Cohort 1 (40 IU/m\^2)

* Cohort 2 (80 IU/m\^2)

* Cohort 3 (160 IU/m\^2)

Subjects were monitored for dose-limiting toxicity (DLT) during the first 2 weeks of cycle 1, with DLT defined as any grade 3 or higher toxicity. The maximum tolerated dose (MTD) was defined as the cohort in which \< 33% of subjects (ie, 0/3 or 1/6 subjects in a cohort) experienced DLT. In phase 2, the MTD cohort was expanded in up to 25 patients.

Subjects who completed treatment in cycle 1 without DLT were eligible to initiate cycle 2 at week 10 provided that a computed tomography (CT) scan showed either enlargement of existing disease without accompanying symptoms OR stable disease or improvement with no unacceptable toxicity. The same radiologic criteria applied for initiation of subsequent cycles. Subjects could continue to receive study treatment until disease progression.

Recruitment & Eligibility

Inclusion Criteria

Histologically confirmed malignant melanoma, American Joint Committee on Cancer (AJCC) stage III (unresectable) or IV. Subjects with uveal and mucosal melanomas were eligible.
Measurable disease using the Response Evaluation Criteria in Solid Tumors (RECIST).
Pathology slides reviewed by the Memorial Hospital Department of Pathology or New York University (NYU) Department of Pathology for confirmation of melanoma diagnosis.
Karnofsky performance status of 80% or more.
Adequate organ and marrow function, as defined below:
- white blood cell count ≥ 3000/µL
- absolute neutrophil count ≥ 1500/µL
- platelet count ≥ 100,000/µL
- total bilirubin ≤ 2.5 x institutional upper limit of normal (ULN)
- lactate dehydrogenase ≤ 1.5 x institutional ULN
- albumin ≥ 3.0 mg/dL
- creatinine ≤ 2.0 mg/dL
Expected survival of at least 3 months.
Age ≥ 18 years.
Able and willing to give valid written informed consent.

Exclusion Criteria

Receipt of chemotherapy, immunotherapy, or radiotherapy within 3 weeks prior to first dosing of study agent or lack of recovery from adverse events (AEs) due to agents administered more than 3 weeks earlier. For nitrosoureas, at least 6 weeks must have elapsed.
Any other malignancy that required concomitant therapy.
Any medical condition that could have made it difficult for the subject to complete the full course of treatments, at the discretion of the Principal Investigator or co-Principal Investigators.
Metastatic disease to the central nervous system, unless treated and stable.
Known human immunodeficiency virus (HIV) positivity.
Mental impairment that may have compromised the ability to give informed consent and comply with the requirements of the study.
Lack of availability for clinical follow-up assessments.
Participation in any other clinical trial involving another investigational agent within 3 weeks prior to enrollment.
Pregnant women or women who were nursing. Women of child-bearing potential and sexually active men must have used appropriate contraception during the course of this study. Women of child-bearing potential must not have been pregnant (negative β human chorionic gonadotropin within 2 weeks of treatment) or nursing during treatment.
History of seizure disorder.

Arm && Interventions

Group	Intervention	Description
Cohort 2	ADI PEG 20	Subjects received ADI-PEG 20 at a dose of 80 IU/m\^2
Cohort 1	ADI PEG 20	Subjects received ADI-PEG 20 at a dose of 40 IU/m\^2
Cohort 3	ADI PEG 20	Subjects received ADI-PEG 20 at a dose of 160 IU/m\^2

Primary Outcome Measures

Name	Time	Method
Assessment of Safety and Tolerability of ADI-PEG 20	Every 1 to 2 weeks for up to 12 months	Analysis of treatment-emergent adverse events (TEAEs) reported from clinical laboratory tests, physical examinations, and vital signs.
Best Overall Clinical Tumor Response	Every 8 to 9 weeks for up to 12 months	Clinical tumor responses were evaluated using disease imaging (CT preferred) performed at baseline and at the end of every cycle. Responses were categorized according to RECIST. Per RECIST for target lesions and assessed by MRI: Complete Response (CR): Disappearance of all target lesions \[no evidence of disease\]; Partial Response (PR): ≥ 30% decrease in the sum of the longest diameter of target lesions; Progressive Disease (PD): ≥ 20% increase in the sum of the longest diameter of target lesions; Stable Disease (SD): small changes that do not meet above criteria.

Secondary Outcome Measures

Name	Time	Method
Summary of Plasma Arginine Levels Over Time	Up to 9 months	Blood samples were collected at baseline, day 1 (pre-injection), day 4, day 8, and every 7 days thereafter for plasma arginine levels.
Correlation Between ASS Tumor Expression and Clinical Response	Up to 12 months	Expression of ASS was analyzed by immunohistochemistry in tumor samples (archived or biopsy) at baseline and compared with overall best clinical response per RECIST. ASS tumor expression is categorized as either negative or ≤ 5% positive tumor cells.
Metabolic Tumor Response	Every 8 to 9 weeks for up to 12 months	Metabolic tumor responses were evaluated using fluorodeoxyglucose (FDG) positron emission tomography (PET) at baseline, on day 4, and at the end of every cycle.
Summary of Plasma Citrulline Levels Over Time	Up to 9 months	Blood samples were collected at baseline, day 1 (pre-injection), day 4, day 8, and every 7 days thereafter for plasma citrulline levels.
Summary of ADI-PEG 20 Immunogenicity Over Time	Up to 12 months	Blood samples were collected at baseline, day 1 (pre-injection), day 4, day 8, and every 7 days thereafter for detection of anti-ADI antibodies.
Summary of ADI-PEG 20 Plasma Concentrations Over Time	Up to 12 months	Blood samples were collected on day 1 (pre-injection), day 4, day 8, and every 7 days thereafter for ADI-PEG 20 plasma concentrations.

Locations (2): NYU Cancer Institute
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New York, New York, United States
Memorial Sloan-Kettering Cancer Center
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New York, New York, United States