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    Clinical Trial Results:
    A Phase II Trial of PLX3397 in the Treatment of KIT Mutated Advanced Acral and Mucosal Melanoma (PIANO)

    Summary
    EudraCT number
    2013-002073-22
    Trial protocol
    GB  
    Global end of trial date
    01 Mar 2021

    Results information
    Results version number
    v1(current)
    This version publication date
    27 Sep 2024
    First version publication date
    27 Sep 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    11_DOG12_56
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02071940
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    clinicaltrials.gov: NCT02071940
    Sponsors
    Sponsor organisation name
    The Christie NHS Foundation Trust
    Sponsor organisation address
    550 Wilmslow Road, Manchester, United Kingdom, M20 4BX
    Public contact
    Clare Griffin, The Christie NHS Foundation Trust, +44 01619187771, the-christie.sponsoredresearch@nhs.net
    Scientific contact
    Clare Griffin, The Christie NHS Foundation Trust, +44 01619187771, the-christie.sponsoredresearch@nhs.net
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    27 Jul 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    01 Mar 2021
    Global end of trial reached?
    Yes
    Global end of trial date
    01 Mar 2021
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The primary objective of this study is to evaluate the efficacy and safety of PLX3397 in patients with KIT mutated advanced mucosal and acral melanoma. Response to the treatment is measured by tumour progression free survival at 6 months and overall patient survival rate are key objectives of the study.
    Protection of trial subjects
    Patients are assigned a unique trial ID via the MCTU trials line which was used throughout their participation in the trial. Any personal data recorded will is regarded as confidential, and any information which would allow individual patients to be identified have not be released into the public domain. Each investigator should keep a separate Trial ID and screening log of all participants consented and screen status. The investigator must maintain this screening log and all other trial documents (including participant’s written consent forms) which are to be held at the participating centres, in strictest confidence. The investigator must ensure the patients’ confidentiality is maintained. The MCTU will maintain the confidentiality of all patients and will not reproduce or disclose any information by which patients could be identified. The Investigator and trial site staff involved with this trial may not disclose or use for any purpose other than performance of the trial, any data, record, or other unpublished, confidential information disclosed to those individuals for the purpose of the trial. All Investigators and trial site staff involved with the trial must comply with the requirements of the Data Protection Act 1998 with regard to the collection, storage, processing and disclosure of personal information and will uphold the Act’s core principles. Patient notes and trial files at site must be kept in a secure storage area with limited access. Computers used to collate the data will have limited access measures via user names and passwords. Published results will not contain any personal data that could allow identification of individual patients.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Jun 2015
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 9
    Worldwide total number of subjects
    9
    EEA total number of subjects
    0
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    4
    From 65 to 84 years
    5
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 9 participants with histologically proven KIT mutated advanced mucosal or acral melanoma not associated with PLX3397 resistance were recruited over the course of the trial. Patients were recruited from outpatient oncology clinics and were required to have given written informed consent after a period of time.

    Pre-assignment
    Screening details
    Once eligibility was established, screening assessments included demographic details, medical and surgical history, RECIST v1.1 tumour evaluation, current medications, vital signs and standard physical examination, ECOG performance status, lab investigations including full blood count and liver function tests, pregnancy testing and ECG.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    The PIANO trial is an open-label, single-arm, multicentre phase II trial.

    Arms
    Arm title
    Single-arm PLX3397
    Arm description
    Following consent and successful screening, patients will receive PLX3397 capsules 1000mg/day as monotherapy, and will remain on therapy as long as they are deriving clinical benefit. Patients will be seen every 4 weeks during treatment to monitor response and toxicity.
    Arm type
    Experimental

    Investigational medicinal product name
    PLX3397
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Patients will be started on treatment of PLX3397, 1000mg/day divided into two doses: one dose in the morning (three 200 mg capsules) and a dose in the evening (two 200mg capsules)

    Number of subjects in period 1
    Single-arm PLX3397
    Started
    9
    Completed
    9

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall Trial
    Reporting group description
    -

    Reporting group values
    Overall Trial Total
    Number of subjects
    9 9
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    4 4
        From 65-84 years
    5 5
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    5 5
        Male
    4 4

    End points

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    End points reporting groups
    Reporting group title
    Single-arm PLX3397
    Reporting group description
    Following consent and successful screening, patients will receive PLX3397 capsules 1000mg/day as monotherapy, and will remain on therapy as long as they are deriving clinical benefit. Patients will be seen every 4 weeks during treatment to monitor response and toxicity.

    Primary: Evaluation of overall survival rate

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    End point title
    Evaluation of overall survival rate [1]
    End point description
    Survival status at point of end of trial.
    End point type
    Primary
    End point timeframe
    Patients are kept on treatment as soon as they are consented and eligible to participate for the duration of the trial (4 years). Patients will be offered the trial drug until closure of the trial or until confirmation of disease progression.
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Because of the slow recruitment, we tried unsuccessfully to extend the study to other countries in Europe. In the meantime, the pharmaceutical company Plexxicon was aquired by another company which made a decision not to progress development of the drug for this disease. In addition, the preliminary data did not indicate a strong signal to extend the trial.
    End point values
    Single-arm PLX3397
    Number of subjects analysed
    9
    Units: Number of participants
        Alive at End of Trial
    2
        Died on Trial
    7
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    All AEs, both related and unrelated to the drug, and whether observed by the Investigator or patient reported during the study period, must be recorded up to and including those which occurred one month after study drug administration.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    27.0
    Reporting groups
    Reporting group title
    Single arm intervention
    Reporting group description
    -

    Serious adverse events
    Single arm intervention
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 9 (44.44%)
         number of deaths (all causes)
    1
         number of deaths resulting from adverse events
    1
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Progressive Malignant Melanoma
    Additional description: Progressive Malignant Melanoma
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Pyrexia
    Additional description: Pyrexia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Small Intestinal Obstruction
    Additional description: Small Intestinal Obstruction
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Musculoskeletal and connective tissue disorders
    Suspected Spinal Cord Compression
    Additional description: Suspected Spinal Cord Compression
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Single arm intervention
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    9 / 9 (100.00%)
    Vascular disorders
    Hypertension
    Additional description: Hypertension
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    General disorders and administration site conditions
    Face oedema
    Additional description: Face oedema
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Fatigue
    Additional description: Fatigue
         subjects affected / exposed
    7 / 9 (77.78%)
         occurrences all number
    7
    Oedema peripheral
    Additional description: Oedema peripheral
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Pain
    Additional description: Pain
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Pyrexia
    Additional description: Pyrexia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Reproductive system and breast disorders
    Vaginal Spotting
    Additional description: Vaginal Spotting
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
    Additional description: Dyspnoea
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Cough
    Additional description: Cough
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Psychiatric disorders
    Depression
    Additional description: Depression
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Insomnia
    Additional description: Insomnia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Investigations
    Alkaline Phosphatase Increased
    Additional description: Alkaline Phosphatase Increased
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Alanine Aminotransferase Increased
    Additional description: Alanine Aminotransferase Increased
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Blood creatinine increased
    Additional description: Blood creatinine increased
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Aspartate Aminotransferase Increased
    Additional description: Aspartate Aminotransferase Increased
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Electrocardiogram QT prolonged
    Additional description: Electrocardiogram QT prolonged
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Eosinophil count decreased
    Additional description: Eosinophil count decreased
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Gamma-glutamyltransferase increased
    Additional description: Gamma-glutamyltransferase increased
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Hepatic Enzymes Increased
    Additional description: Hepatic Enzymes Increased
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Lymphocyte count decreased
    Additional description: Lymphocyte count decreased
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Weight decreased
    Additional description: Weight decreased
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Contusion
    Additional description: Contusion
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Stoma site haemorrhage
    Additional description: Stoma site haemorrhage
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Nervous system disorders
    Ataxia
    Additional description: Ataxia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Dysgeusia
    Additional description: Dysgeusia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Dysesthesia
    Additional description: Dysesthesia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Dizziness
    Additional description: Dizziness
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Anaemia
    Additional description: Anaemia
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Eye disorders
    Periorbital oedema
    Additional description: Periorbital oedema
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Visual Loss
    Additional description: Visual Loss
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Gastrointestinal disorders
    Abdominal Pain
    Additional description: Abdominal Pain
         subjects affected / exposed
    3 / 9 (33.33%)
         occurrences all number
    3
    Abdominal distension
    Additional description: Abdominal distension
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Dysphagia
    Additional description: Dysphagia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Dyspepsia
    Additional description: Dyspepsia
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    3
    Diarrhoea
    Additional description: Diarrhoea
         subjects affected / exposed
    4 / 9 (44.44%)
         occurrences all number
    4
    Gastroesophageal reflux disease
    Additional description: Gastroesophageal reflux disease
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Intestina stoma leak
    Additional description: Intestina stoma leak
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Mucositis Oral
    Additional description: Mucositis Oral
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Nausea
    Additional description: Nausea
         subjects affected / exposed
    6 / 9 (66.67%)
         occurrences all number
    6
    Vomiting
    Additional description: Vomiting
         subjects affected / exposed
    3 / 9 (33.33%)
         occurrences all number
    3
    Skin and subcutaneous tissue disorders
    Erythema Multiforme
    Additional description: Erythema Multiforme
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Erythema nodosum
    Additional description: Erythema nodosum
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Hair Depigmented
    Additional description: Hair Depigmented
         subjects affected / exposed
    3 / 9 (33.33%)
         occurrences all number
    3
    Hyperhidrosis
    Additional description: Hyperhidrosis
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Rash Maculo-Papular
    Additional description: Rash Maculo-Papular
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Skin ulceration
    Additional description: Skin ulceration
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Renal and urinary disorders
    Proteinuria
    Additional description: Proteinuria
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Back Pain
    Additional description: Back Pain
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    Anorexia
    Additional description: Anorexia
         subjects affected / exposed
    5 / 9 (55.56%)
         occurrences all number
    5
    Hyperkalaemia
    Additional description: Hyperkalaemia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Hyponatremia
    Additional description: Hyponatremia
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    16 Jul 2015
    Pregnancy testing frequency was changed from monthly to every visit due to costing issues.
    11 May 2016
    PI change - Christine Parkinson (Addenbrookes Hospital)
    13 Dec 2016
    ?Various updates to protocol including minor changes to contact details, protocol updated to show that LFTs should be repeated every week for the first 8 weeks, minor update separating blood samples for PK/PD tests, updated with information from the most recent IB, upated drug distributor details and changes in SAEs being reported from registration rather than from consent.
    04 Oct 2017
    Immediate halt of patient recruitment as of 4th October 2017 due to pending safety review by Daiichi Sankyo, the parent company of the IMP manufacturer.
    12 Jan 2018
    Updated Protocol, IB and corresponding patient documents to reopen the study to recruitment.
    02 Oct 2019
    Updates to multiple trial documents including; updated IB to v10.0, updated Protocol to reference updated IB v10.0, updated PIS to v7.0 to include updated risk language and updated ICF to v6.0 to reference updated PIS

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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