Trial With BNT111 and Cemiplimab in Combination or as Single Agents in Patients With Anti-PD-1-refractory/Relapsed, Unresectable Stage III or IV Melanoma

Sponsor

BioNTech SE (Industry)

Overall Status

Recruiting

CT.gov ID

NCT04526899

Collaborator

Regeneron Pharmaceuticals (Industry)

180

Enrollment

Locations

Arms

48.4

Anticipated Duration (Months)

3.3

Patients Per Site

0.1

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This is an open-label, randomized, multi-site, Phase II, interventional trial designed to evaluate the efficacy, tolerability, and safety of BNT111 + cemiplimab in anti-PD-1-refractory/relapsed patients with unresectable Stage III or IV melanoma. The contributions of BNT111 and cemiplimab will be delineated in single agent calibrator arms. Patients in single agent calibrator arms, who experience disease progression under single agent treatment, may be offered addition of the other compound to the ongoing treatment after re-consent.

Condition or Disease	Intervention/Treatment	Phase
Melanoma Stage III Melanoma Stage IV Unresectable Melanoma	Biological: BNT111 Biological: Cemiplimab	Phase 2

Study Design

Study Type:

Interventional

Anticipated Enrollment :

180 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Open-label, Randomized Phase II Trial With BNT111 and Cemiplimab in Combination or as Single Agents in Patients With Anti-PD-1-refractory/Relapsed, Unresectable Stage III or IV Melanoma

Actual Study Start Date :

May 19, 2021

Anticipated Primary Completion Date :

Oct 1, 2024

Anticipated Study Completion Date :

Jun 1, 2025

Arms and Interventions

Arm	Intervention/Treatment
Experimental: BNT111 + cemiplimab	Biological: BNT111 IV injection Biological: Cemiplimab IV infusion
Experimental: BNT111 monotherapy	Biological: BNT111 IV injection
Experimental: Cemiplimab monotherapy	Biological: Cemiplimab IV infusion

Arm

Intervention/Treatment

Experimental: BNT111 + cemiplimab

Biological: BNT111

IV injection

Biological: Cemiplimab

IV infusion

Experimental: BNT111 monotherapy

Biological: BNT111

IV injection

Experimental: Cemiplimab monotherapy

Biological: Cemiplimab

IV infusion

Outcome Measures

Primary Outcome Measures

Objective response rate (ORR) - Arm: BNT111 + cemiplimab [up to 24 months]
ORR defined as the proportion of patients in whom a complete response (CR) or partial response (PR) according to Response Criteria in Solid Tumors (RECIST 1.1) is observed as best overall response by blinded independent central review (BICR).

Secondary Outcome Measures

Objective response rate - Arm: BNT111 monotherapy and Arm: Cemiplimab monotherapy [up to 24 months]
ORR defined as the proportion of patients in whom a CR or PR according to RECIST 1.1 is observed as best overall response by BICR.
Duration of response (DOR) according to RECIST 1.1 [up to 24 months]
DOR defined as the time from first objective response (CR or PR) to first occurrence of objective tumor progression (progressive disease, PD) by BICR or death from any cause (whichever occurs first).
Disease control rate (DCR) according to RECIST 1.1 [up to 24 months]
DCR defined as the proportion of patients in whom a CR, PR or stable disease (SD; assessed at least 6 weeks after first dose) is observed as best overall response by BICR.
Time to response (TTR) according to RECIST 1.1 [up to 24 months]
TTR defined as the time from randomization to the first objective tumor response (CR or PR) by BICR.
Progression-free survival (PFS) according to RECIST 1.1 [up to 24 months]
PFS defined as the time from randomization to first objective tumor progression (PD) by BICR or death from any cause (whichever occurs first).
ORR according to RECIST 1.1 as assessed by the investigator [up to 24 months]
DOR according to RECIST 1.1 as assessed by the investigator [up to 24 months]
DCR according to RECIST 1.1 as assessed by the investigator [up to 24 months]
TTR according to RECIST 1.1 as assessed by the investigator [up to 24 months]
PFS according to RECIST 1.1 as assessed by the investigator [up to 24 months]
Overall survival (OS) - Arm: BNT111 + cemiplimab [up to 48 months]
OS defined as the time from randomization to death from any cause.
Occurrence of treatment-emergent adverse events (TEAE) within a patient including Grade ≥3, serious and/or fatal TEAE by relationship [up to 27 months]
Occurrence of immune-related adverse events (irAE) [up to 27 months]
Occurrence of dose reduction and discontinuation of trial treatment within a patient due to TEAE [up to 27 months]
Occurrence of abnormal laboratory parameters (hematology) within a patient [up to 25 months]
Blood samples will be collected for the assessment of hematology parameters.
Changes in laboratory parameters (hematology) compared to baseline [up to 25 months]
Occurrence of abnormal laboratory parameters (clinical chemistry) within a patient [up to 25 months]
Blood samples will be collected for the assessment of clinical chemistry parameters.
Changes in laboratory parameters (clinical chemistry) compared to baseline [up to 25 months]
Occurrence of abnormal laboratory parameters (coagulation factors) within a patient [up to 25 months]
Blood samples will be collected for the assessment of coagulation factors.
Changes in laboratory parameters (coagulation factors) compared to baseline [up to 25 months]
Occurrence of abnormal laboratory parameters (endocrine tests) within a patient [up to 25 months]
Blood samples will be collected for the assessment of endocrine tests.
Changes in laboratory parameters (endocrine tests) compared to baseline [up to 25 months]
Occurrence of abnormal laboratory parameters (serology) within a patient [up to 25 months]
Blood samples will be collected for the assessment of serology parameters.
Changes in laboratory parameters (serology) compared to baseline [up to 25 months]
Occurrence of abnormal laboratory parameters (urinalysis) within a patient [up to 25 months]
Urine samples will be collected for the assessment of urinalysis parameters.
Changes in laboratory parameters (urinalysis) compared to baseline [up to 25 months]
Occurrence of abnormal vital signs parameters (body temperature) within a patient [up to 25 months]
Body temperature (in °C) will be assessed.
Changes in vital signs parameters (body temperature) compared to baseline [up to 25 months]
Occurrence of abnormal vital signs parameters (pulse rate) within a patient [up to 25 months]
Pulse rate (in beats per minute [bpm]) will be assessed.
Changes in vital signs parameters (pulse rate) compared to baseline [up to 25 months]
Occurrence of abnormal vital signs parameters (blood pressure) within a patient [up to 25 months]
Blood pressure (systolic/diastolic, in mmHg) will be assessed.
Changes in vital signs parameters (blood pressure) compared to baseline [up to 25 months]
Occurrence of abnormal vital signs parameters (respiratory rate) within a patient [up to 25 months]
Respiratory rate will be assessed.
Changes in vital signs parameters (respiratory rate) compared to baseline [up to 25 months]
Mean changes from baseline in the global health status score of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 items (EORTC QLQ-C30) [up to 25 months]
Mean changes from baseline in scores of the EORTC QLQ C30 functional and symptoms scales [up to 25 months]
Time to first clinically meaningful deterioration in global health status score as measured by EORTC QLQ-C30 [up to 25 months]
Time to first clinically meaningful deterioration in symptoms and functioning as measured by EORTC QLQ-C30 [up to 25 months]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Patients must sign the written informed consent form (ICF) before any screening procedure.
Patients must be aged ≥ 18 years on the date of signing the informed consent.
Patients must be willing and able to comply with scheduled visits, treatment schedule, laboratory tests, and other requirements of the trial.
Patients must have histologically confirmed unresectable Stage III or IV (metastatic) cutaneous melanoma and measurable disease by RECIST 1.1.
Patients must have confirmed disease progression on/after an approved anti-PD-1 regimen for melanoma as defined by RECIST 1.1.

Previous exposure to approved anti-PD-1 containing regimen for at least 12 consecutive weeks and
Current radiological progression to be confirmed by two scans 4 to 12 weeks apart. If progression is accompanied by new symptoms, or deterioration of performance status not attributed to toxicity, one scan is sufficient and
Inclusion into this trial must be within 6 months of confirmation of disease progression on anti-PD-1 treatment, regardless of any intervening therapy.

Patients should have received pembrolizumab or nivolumab (with/without ipilimumab).
Patients should have received at least one but no more than five lines of prior therapy for advanced disease.
Patients must be able to tolerate additional anti-PD-1 therapy (i.e., did not permanently discontinue anti-PD-1 therapy due to toxicity).
Patients must have known BRAF mutation status.
Patients with BRAF V600-positive tumor(s) should have received prior treatment with a BRAF inhibitor (alone or in combination with a MEK inhibitor) in addition to treatment with pembrolizumab or nivolumab with or without ipilimumab Note: Considering the possible negative impact of a prior BRAF/MEK therapy on immune system targeting therapies, patients with BRAF V600-positive tumors with no clinically significant tumor-related symptoms or evidence of rapid PD may be eligible for participation. This should be based on investigator assessment AND provided they are ineligible for, intolerant to, or have refused BRAF V600 mutation targeted therapy after receiving the information on possible other therapies including BRAF/MEK inhibitor-based therapy during the informed consent process.
Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 1.
Adequate bone marrow function, as defined in the protocol.
Patients must have serum lactate dehydrogenase (LDH) ≤ upper limit of normal (ULN).
Patient should have adequate hepatic function, as defined in the protocol.
Patient should have adequate kidney function, assessed by the estimated glomerular filtration rate (eGFR) ≥ 30 mL/min using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation.
Patient should be stable with adequate coagulation, as defined in the protocol.
Patients must provide the following biopsy samples:

All patients: must provide a tumor tissue sample (formalin fixed paraffin-embedded [FFPE] blocks/slides) from a fresh biopsy collected before Visit C1D1, or archival tissue. The archival tissue can be an FFPE block (not older than 3 years) or freshly cut slides (special storage conditions and immediate shipment to specialty lab are required), preferably derived from advanced disease stage.
Patients at selected trial sites: After additional consent, patients must be amenable to a pre-treatment and on-treatment biopsy and must provide a mandatory biopsy which contains tumor tissue and is taken after failure/stop of last prior treatment and an on-treatment biopsy.

Women of childbearing potential (WOCBP) must have a negative serum (beta-human chorionic gonadotropin [beta-hCG]) at screening. Patients that are postmenopausal or permanently sterilized can be considered as not having reproductive potential. Female patients of reproductive potential must agree to use highly effective contraception during and for 6 months after the last trial drug administration.
WOCBP must agree not to donate eggs (ova, oocytes) for the purposes of assisted reproduction during trial starting at screening, during the trial and for 6 months after receiving the last trial treatment.
A man who is sexually active with a WOCBP and has not had a vasectomy must agree to use a barrier method of birth control, e.g., either condom with spermicidal foam/gel/film/cream/suppository or partner with occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/suppository, and all men must also not donate sperm during the trial and for 6 months after receiving the last trial treatment.

Exclusion Criteria:

Patients must not be pregnant or breastfeeding.
Patients must not have history of uveal, acral, or mucosal melanoma.
Patients must have no ongoing or recent evidence (within the last 5 years) of significant autoimmune disease that required treatment with systemic immunosuppressive treatments which may pose a risk for immune-related adverse events (irAEs). Note: Patients with autoimmune-related hyperthyroidism, autoimmune-related hypothyroidism who are in remission, or on a stable dose of thyroid-replacement hormone, vitiligo, or psoriasis may be included.
Patients must have no known primary immunodeficiencies, either cellular (e.g., DiGeorge syndrome, T cell-negative severe combined immunodeficiency [SCID]) or combined T and B cell immunodeficiencies (e.g., T and -B negative SCID, Wiskott Aldrich syndrome, ataxia telangiectasia, common variable immunodeficiency).
Patients with uncontrolled type 1 diabetes mellitus or with uncontrolled adrenal insufficiency are not eligible.
Patients must have no uncontrolled infection with human immunodeficiency virus, hepatitis B or hepatitis C infection; or diagnosis of immunodeficiency that is related to, or results in chronic infection. Mild cancer-related immunodeficiency (such as immunodeficiency treated with gamma globulin and without chronic or recurrent infection) is allowed.

Patients with known HIV who have controlled infection (undetectable viral load and CD4 count above 350 either spontaneously or on a stable anti-viral regimen) are permitted. For patients with controlled HIV infection, monitoring will be performed per local standards.
Patients with known hepatitis B virus (HBV) who have controlled infection (serum hepatitis B virus DNA PCR that is below the limit of detection AND receiving anti-viral therapy for hepatitis B) are permitted. Patients with controlled infections must undergo periodic monitoring of HBV DNA per local standards. Patients must remain on anti-viral therapy for at least 6 months beyond the last dose of trial treatment.
Patients who are known hepatitis C virus (HCV) antibody positive who have controlled infection (undetectable HCV RNA by PCR either spontaneously or in response to a successful prior course of anti-HCV therapy) are permitted.
Patients with HIV or hepatitis must have their disease reviewed by the specialist (e.g., infectious disease specialist or hepatologist) managing this disease prior to commencing and throughout the duration of their participation in the trial.

Patients with another primary malignancy that has not been in complete remission for at least 2 years, with the exception of those with a negligible risk of metastasis, progression or death (such as adequately treated carcinoma in situ of the cervix, basal or squamous cell skin cancer, localized prostate cancer, non-invasive, superficial bladder cancer or breast ductal carcinoma in situ).

Prior/concomitant therapy:

Current use or use within 3 months prior to trial enrollment of systemic immune suppression including:

use of chronic systemic steroid medication (up to 5 mg/day prednisolone equivalent is allowed); patients using physiological replacement doses of prednisone for adrenal or pituitary insufficiency are eligible,
other clinically relevant systemic immune suppression.

Treatment with other anti-cancer therapy including chemotherapy, radiotherapy, investigational, or biological cancer therapy within 3 weeks prior to the first dose of trial treatment (6 weeks for nitrosureas). Adjuvant hormonotherapy used for breast cancer in long term remission is allowed.

Other comorbidities:

Current evidence of ongoing National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0 Grade > 1 toxicity of prior therapies before the start of treatment, with the exception of hair loss, hearing loss, Grade 2 peripheral neuropathy, or laboratory abnormalities not considered clinical significant per investigator's discretion, and those Grade 2 toxicities listed as permitted in other eligibility criteria.
Patients who have a local infection (e.g., cellulitis, abscess) or systemic infection (e. g., pneumonia, septicemia) which requires systemic antibiotic treatment within 2 weeks prior to the first dose of trial treatment.
Patients who have had a splenectomy.
Patients who have had major surgery (e.g., requiring general anesthesia) within 4 weeks before screening, have not fully recovered from surgery, or have a surgery planned during the time of trial participation.
Current evidence of new or growing brain or spinal metastases during screening. Patients with leptomeningeal disease are excluded. Patients with known brain or spinal metastases may be eligible if they:

had radiotherapy or another appropriate therapy for the brain or spinal bone metastases,
have no neurological symptoms that can be attributed to the current brain lesions,
have stable brain or spinal disease on the CT or MRI scan within 4 weeks before signing the informed consent (confirmed by stable lesions on two scans at least 4 weeks apart),
do not require steroid therapy within 14 days before the first dose of trial treatment,
spinal bone metastases are allowed, unless imminent fracture or cord compression is anticipated.

History or current evidence of significant cardiovascular disease including, but not limited to:

angina pectoris requiring anti-anginal medication, uncontrolled cardiac arrhythmia(s), severe conduction abnormality, or clinically significant valvular disease,
QTc (F) prolongation > 480 ms,
arterial thrombosis or pulmonary embolism within ≤ 6 months before the start of treatment,
myocardial infarction within ≤ 6 months before the start of treatment,
pericarditis (any NCI-CTCAE grade), pericardial effusion (NCI-CTCAE Grade ≥ 2), non-malignant pleural effusion (NCI-CTCAE Grade ≥ 2) or malignant pleural effusion (NCI-CTCAE Grade ≥ 3) within ≤ 6 months before the start of treatment,
Grade ≥ 3 symptomatic congestive heart failure (CHF) or New York Heart Association (NYHA) criteria Class ≥ II within ≤ 6 months before the start of treatment.

Patients who have received a live vaccine within 28 days of planned start of trial therapy.

Other exclusions:

Known hypersensitivity to the active substances or to any of the excipients.
Presence of a severe concurrent illness or other condition (e.g., psychological, family, sociological, or geographical circumstances) that does not permit adequate follow-up and compliance with the protocol.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University Of Arizona College Of Medicine	Tucson	Arizona	United States	85724
2	University of California, San Francisco: Helen Diller Family Comprehensive Cancer Center	San Francisco	California	United States	94158-3214
3	Saint John's Health Center - John Wayne Cancer Institute (JWCI)	Santa Monica	California	United States	90404
4	Sylvester Comprehensive Cancer Center/ UMHC	Miami	Florida	United States	33136
5	Lewis Hall Singletary Oncology Center at John D. Archbold Memorial Hospital	Thomasville	Georgia	United States	31792
6	Rush University Medical Center	Chicago	Illinois	United States	60612
7	Norton Cancer Institute	Louisville	Kentucky	United States	40241
8	Oncology Hematology West P.C. dba Nebraska Cancer Specialists	Grand Island	Nebraska	United States	68893
9	Oncology Hematology West P.C. dba Nebraska Cancer Specialists	Omaha	Nebraska	United States	68310
10	Atlantic Health System / Morristown Medical Center	Morristown	New Jersey	United States	07962
11	Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center	New York	New York	United States	10029
12	Guthrie Medical Group, PC	Sayre	Pennsylvania	United States	18840
13	Tennessee Oncology Nashville / Sarah Cannon	Nashville	Tennessee	United States	37203
14	Inova Dwight and Martha Schar Cancer Institute	Fairfax	Virginia	United States	22031
15	Border Medical Oncology	East Albury		Australia	2640
16	Gold Coast Hospital	Southport		Australia	4215
17	Melanoma Institute Australia	Sydney		Australia	2060
18	Helios Klinikum Erfurt	Erfurt		Germany	99089
19	Universitaetsklinikum Essen (AoR)	Essen		Germany	45147
20	Universitaetsklinikum Freiburg, Klinik fuer Dermatologie und Venerologie	Freiburg		Germany	79104
21	Medizinische Hochschule Hannover (MHH)	Hannover		Germany	30625
22	Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel Hautkrebszentrum Kiel	Kiel		Germany	24105
23	Universitaetsklinikum Leipzig	Leipzig		Germany	04103
24	Universitaetsmedizin der Johannes Gutenberg Universitat Mainz KoeR	Mainz		Germany	55131
25	Universitaetsklinikum Mannheim GmbH	Mannheim		Germany	68167
26	Klinikum Nürnberg Nord	Nürnberg		Germany	90419
27	University Hospital Tuebingen	Tübingen		Germany	72076
28	Istituto Di Ricovero E Cura A Carattere Scientifico - Istituto Tumori Giovanni Paolo Ii	Bari		Italy	70124
29	Azienda ospedaliera universitaria Bologna	Bologna		Italy	40138
30	Fondazione del Piemonte per l'Oncologia, Istituto di Candiolo (IRCCs)	Candiolo		Italy	10060
31	Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumpori (IRST)	Meldola		Italy	47014
32	Istituto Nazionale Tumori Fondazione Pascale - IRCCS · S.C. Oncologia Medica Melanoma, Immunoterapia Oncologica e Terapie Innovative	Napoli		Italy	80131
33	Universita di Siena -Azienda Ospedaliera Universitaria Senese-Policlincio Santa Maria Alle Scotte	Siena		Italy	53100
34	AOU Citta della Salute e della Scienza di Torino	Turin		Italy	10126
35	Uniwersyteckie Centrum Kliniczne	Gdańsk		Poland	80214
36	Szpital Specjalistyczny im. Luwika Rydygiera w Krakowie Sp. z o.o.	Kraków		Poland	31-826
37	Centrum Onkologii Ziemii Lubelskiej im. sw. Jana z Dukli	Lublin		Poland	20-090
38	Zachodniopomorskie Centrum Onkologii	Szczecin		Poland	71-730
39	Specjalistyczny Szpital Onkologiczny NU-MED	Tomaszów Mazowiecki		Poland	97-200
40	Wojewodzkie Wielospecjalistyczne Centrum Onkologii i Traumatologii im. M. Kopernika w Lodzi	Łódź		Poland	93-513
41	Hospital Teresa Herrera (CHUAC)	A Coruña		Spain	15009
42	Hospital Universitari Germans Trias i Pujol (HUGTP)	Badalona		Spain	8916
43	Hospital Clinic de Barcelona	Barcelona		Spain	08036
44	Hospital De La Santa Creu I Sant Pau	Barcelona		Spain	08041
45	Institut Català d'Oncologia l'Hospitalet	Barcelona		Spain	08907
46	Hospital General Universitario Gregorio Maranon	Madrid		Spain	28007
47	MD Anderson Cancer Center	Madrid		Spain	28033
48	Hospital Universitario Puerta de Hierro - Majadahonda	Madrid		Spain	28222
49	Hospital Universitario Marques De Valdecilla	Santander		Spain	39008
50	Complejo Hospitalario Universitario De Santiago De Compostela	Santiago De Compostela		Spain	15706
51	Hospital Universitario Virgen del Rocio	Sevilla		Spain	41013
52	Universitat de Valencia - Hospital Universitari i Politecnic La Fe de Valencia (Hospital La Fe Bulevar Sur)	Valencia		Spain	46026
53	The Christie - The Christie NHS Foundation Trust	Manchester		United Kingdom	M20 4BX
54	Royal Cornwall Hospital	Truro		United Kingdom	TR1 3LJ