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    Clinical Trial Results:
    A Single Arm, Open Label, Phase II, Multicenter Study to Assess the Detection of the BRAF V600 Mutation on cfDNA from Plasma in Patients with Advanced Melanoma

    Summary
    EudraCT number
    2015-001731-20
    Trial protocol
    BE   PL  
    Global end of trial date
    16 Jul 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    26 Jul 2020
    First version publication date
    26 Jul 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ML29741
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02768207
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Hoffmann-La Roche
    Sponsor organisation address
    Grenzacherstrasse 124, Basel, Switzerland, 4070
    Public contact
    Medical Communications, Hoffmann-La Roche, +41 616878333, global.trial_information@roche.com
    Scientific contact
    Medical Communications, Hoffmann-La Roche, +41 616878333, global.trial_information@roche.com
    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
    16 Jul 2019
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    16 Jul 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main trial objective was to estimate the frequency of the BRAFV600 mutation in a new mutation analysis in response to a mutant plasma cfDNA test result in participants with BRAF wild-type status based on a prior tissue test result.
    Protection of trial subjects
    All participants were required to sign an Informed Consent form.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    02 May 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Belgium: 78
    Country: Number of subjects enrolled
    Poland: 94
    Worldwide total number of subjects
    172
    EEA total number of subjects
    172
    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)
    95
    From 65 to 84 years
    72
    85 years and over
    5

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Adult participants with unresectable or metastatic melanoma. Participants possessing a BRAF V600 mutation were eligible to move to the second study phase (treatment phase).

    Period 1
    Period 1 title
    Pre-Screening Phase
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Pre-Screening Phase (mITT population)
    Arm description
    Participants in the modified intention to treat (mITT) population were tested for the presence of the BRAFV600 mutation using plasma cfDNA.
    Arm type
    No Intervention

    Investigational medicinal product name
    Blood draw for plasma sample
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Anticoagulant and preservative solution for blood
    Routes of administration
    Unknown use
    Dosage and administration details
    No intervention was administered in this arm. Samples were collected to determine the presence of the BRAFV600 mutation using plasma cfDNA. The EudraCT platform will not allow for the proper recording of this arm as "no intervention."

    Number of subjects in period 1
    Pre-Screening Phase (mITT population)
    Started
    172
    Completed
    40
    Not completed
    132
         Physician decision
    6
         Consent withdrawn by subject
    6
         Did not meet inclusion criteria
    1
         Not eligible
    1
         Unspecified
    4
         Not eligible for treatment phase
    113
         Met exclusion criteria
    1
    Period 2
    Period 2 title
    Treatment Phase
    Is this the baseline period?
    No
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Treatment Phase (STITT population)
    Arm description
    Participants in the study treatment intention to treat (STITT) population with the BRAF V600 mutation received vemurafenib tablets at the recommended dose of 960 milligrams (mg) orally twice daily (BID) on Days 1-28 of each 28-day treatment cycle. Participants also received cobimetinib tablets at the recommended dose of 60 mg orally once daily (QD) on Days 1-21 of each 28-day cycle until disease progression, withdrawal of consent, or the development of unacceptable toxicity.
    Arm type
    Experimental

    Investigational medicinal product name
    Cobimetinib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Three 20 mg tablets taken orally QD on Days 1-21 of each 28-day cycle.

    Investigational medicinal product name
    Vemurafenib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Four tablets totaling 960 mg BID on Days 1-28 of each 28-day cycle.

    Number of subjects in period 2
    Treatment Phase (STITT population)
    Started
    40
    Completed
    0
    Not completed
    40
         End of follow-up after 18 months
    5
         Consent withdrawn by subject
    1
         Disease progression
    24
         Adverse event, non-fatal
    9
         Lost to follow-up
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Pre-Screening Phase
    Reporting group description
    Participants were tested for the presence of the BRAFV600 mutation using plasma cfDNA.

    Reporting group values
    Pre-Screening Phase Total
    Number of subjects
    172 172
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    95 95
        From 65-84 years
    72 72
        85 years and over
    5 5
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    60.0 ± 15.5 -
    Gender categorical
    Units: Subjects
        Female
    88 88
        Male
    84 84

    End points

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    End points reporting groups
    Reporting group title
    Pre-Screening Phase (mITT population)
    Reporting group description
    Participants in the modified intention to treat (mITT) population were tested for the presence of the BRAFV600 mutation using plasma cfDNA.
    Reporting group title
    Treatment Phase (STITT population)
    Reporting group description
    Participants in the study treatment intention to treat (STITT) population with the BRAF V600 mutation received vemurafenib tablets at the recommended dose of 960 milligrams (mg) orally twice daily (BID) on Days 1-28 of each 28-day treatment cycle. Participants also received cobimetinib tablets at the recommended dose of 60 mg orally once daily (QD) on Days 1-21 of each 28-day cycle until disease progression, withdrawal of consent, or the development of unacceptable toxicity.

    Primary: Number of Participants with BRAF V600 Mutation as Assessed Using the Idylla^TM Diagnostic Platform

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    End point title
    Number of Participants with BRAF V600 Mutation as Assessed Using the Idylla^TM Diagnostic Platform [1]
    End point description
    End point type
    Primary
    End point timeframe
    Days -56 to -1 (Pre-screening period)
    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: No formal statistical analyses were planned for this endpoint.
    End point values
    Pre-Screening Phase (mITT population)
    Number of subjects analysed
    172
    Units: Participants
    42
    No statistical analyses for this end point

    Primary: Concentration of BRAF V600 Mutation as Determined on Plasma cfDNA

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    End point title
    Concentration of BRAF V600 Mutation as Determined on Plasma cfDNA [2]
    End point description
    End point type
    Primary
    End point timeframe
    Days -56 to -1 (Pre-screening period)
    Notes
    [2] - 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: No formal statistical analyses were planned for this endpoint.
    End point values
    Pre-Screening Phase (mITT population)
    Number of subjects analysed
    172
    Units: Cycle quantification (Cq) value
        arithmetic mean (confidence interval 95%)
    39.70 (37.96 to 41.43)
    No statistical analyses for this end point

    Primary: Number of Participants by BRAF Mutation Status

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    End point title
    Number of Participants by BRAF Mutation Status [3]
    End point description
    End point type
    Primary
    End point timeframe
    Days -56 to -1 (Pre-screening period)
    Notes
    [3] - 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: No formal statistical analyses were planned for this endpoint.
    End point values
    Pre-Screening Phase (mITT population)
    Number of subjects analysed
    42
    Units: Participants
        BRAF V600 Mutation Subtype E/D
    37
        BRAF V600 Mutation Subtype K/R/M
    5
    No statistical analyses for this end point

    Primary: Number of Participants with BRAF V600 Mutation as Assessed Using the Idylla^TM Diagnostic Platform in Participants With BRAF Wild-Type Based on a Prior Tissue Test Result

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    End point title
    Number of Participants with BRAF V600 Mutation as Assessed Using the Idylla^TM Diagnostic Platform in Participants With BRAF Wild-Type Based on a Prior Tissue Test Result [4]
    End point description
    End point type
    Primary
    End point timeframe
    Days -56 to -1 (Pre-screening period)
    Notes
    [4] - 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: No formal statistical analyses were planned for this endpoint.
    End point values
    Pre-Screening Phase (mITT population)
    Number of subjects analysed
    113
    Units: Participants
    7
    No statistical analyses for this end point

    Secondary: Percentage of Participants with Objective Response as Assessed by the Investigator According to Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1)

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    End point title
    Percentage of Participants with Objective Response as Assessed by the Investigator According to Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1)
    End point description
    End point type
    Secondary
    End point timeframe
    Baseline up to disease progression or death whichever occurs first (up to 38 months)
    End point values
    Treatment Phase (STITT population)
    Number of subjects analysed
    40
    Units: Percentage of Participants
        number (confidence interval 95%)
    80.6 (64.0 to 91.8)
    No statistical analyses for this end point

    Secondary: Progression-Free Survival (PFS)

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    End point title
    Progression-Free Survival (PFS)
    End point description
    End point type
    Secondary
    End point timeframe
    Baseline up to disease progression or death whichever occurs first (up to 38 months)
    End point values
    Treatment Phase (STITT population)
    Number of subjects analysed
    40
    Units: Months
        median (confidence interval 95%)
    13.6 (9.5 to 16.5)
    No statistical analyses for this end point

    Secondary: Duration of Response as Assessed by Investigator According to RECIST v1.1

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    End point title
    Duration of Response as Assessed by Investigator According to RECIST v1.1
    End point description
    End point type
    Secondary
    End point timeframe
    Baseline up to disease progression or death whichever occurs first (Up to 38 months)
    End point values
    Treatment Phase (STITT population)
    Number of subjects analysed
    40 [5]
    Units: Months
        median (confidence interval 95%)
    11.0 (9.2 to 9999)
    Notes
    [5] - 9999 = value not available due to insufficient number of participants with the event
    No statistical analyses for this end point

    Secondary: Overall Survival

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    End point title
    Overall Survival
    End point description
    End point type
    Secondary
    End point timeframe
    Baseline up to death (up to 38 months)
    End point values
    Treatment Phase (STITT population)
    Number of subjects analysed
    40 [6]
    Units: Months
        median (confidence interval 95%)
    9999 (9999 to 9999)
    Notes
    [6] - 9999 = value not available due to insufficient number of participants with the event
    No statistical analyses for this end point

    Secondary: Number of Participants with Adverse Events (AEs) and Serious Adverse Events (SAEs)

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    End point title
    Number of Participants with Adverse Events (AEs) and Serious Adverse Events (SAEs)
    End point description
    End point type
    Secondary
    End point timeframe
    Day 1 Cycle 1 up to 4 weeks after end of treatment or until initiation of another anti-cancer therapy, whichever occurs first (up to 38 months)
    End point values
    Treatment Phase (STITT population)
    Number of subjects analysed
    40
    Units: Participants
        AE
    39
        SAE
    15
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Approximately 3 years
    Adverse event reporting additional description
    Adverse events are reported for the study treatment safety analysis population (STSAP), which contains all enrolled participants treated with at least one dose of cobimetinib or vemurafenib.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    21.1
    Reporting groups
    Reporting group title
    Treatment Phase
    Reporting group description
    Participants with the BRAF V600 mutation received vemurafenib tablets at the recommended dose of 960 milligrams (mg) orally twice daily (BID) on Days 1-28 of each 28-day treatment cycle. Participants also received cobimetinib tablets at the recommended dose of 60 mg orally once daily (QD) on Days 1-21 of each 28-day cycle until disease progression, withdrawal of consent, or the development of unacceptable toxicity.

    Serious adverse events
    Treatment Phase
    Total subjects affected by serious adverse events
         subjects affected / exposed
    15 / 40 (37.50%)
         number of deaths (all causes)
    4
         number of deaths resulting from adverse events
    Investigations
    Blood creatine phosphokinase increased
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Ejection fraction decreased
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Transaminases increased
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Cardiac failure
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Coronary artery disease
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Loss of consciousness
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Paraesthesia
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Mucosal inflammation
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pyrexia
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Eye disorders
    Chorioretinopathy
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    3 / 40 (7.50%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Abdominal pain
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal obstruction
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Purpura
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Rash maculo-papular
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Nephrolithiasis
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Infection
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory tract infection
         subjects affected / exposed
    1 / 40 (2.50%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Treatment Phase
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    39 / 40 (97.50%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Keratoacanthoma
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Tumour pain
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Vascular disorders
    Hypertension
         subjects affected / exposed
    5 / 40 (12.50%)
         occurrences all number
    6
    Flushing
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    11 / 40 (27.50%)
         occurrences all number
    12
    Fatigue
         subjects affected / exposed
    8 / 40 (20.00%)
         occurrences all number
    12
    Oedema peripheral
         subjects affected / exposed
    5 / 40 (12.50%)
         occurrences all number
    10
    Face oedema
         subjects affected / exposed
    3 / 40 (7.50%)
         occurrences all number
    3
    Mucosal inflammation
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Peripheral swelling
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Investigations
    Blood creatinine phosphokinase increased
         subjects affected / exposed
    13 / 40 (32.50%)
         occurrences all number
    17
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    5 / 40 (12.50%)
         occurrences all number
    6
    C-reactive protein increased
         subjects affected / exposed
    4 / 40 (10.00%)
         occurrences all number
    5
    Ejection fraction decreased
         subjects affected / exposed
    3 / 40 (7.50%)
         occurrences all number
    4
    Blood alkaline phosphatase increased
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Blood creatinine increased
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    4
    Nervous system disorders
    Headache
         subjects affected / exposed
    6 / 40 (15.00%)
         occurrences all number
    9
    Dizziness
         subjects affected / exposed
    3 / 40 (7.50%)
         occurrences all number
    3
    Paraesthesia
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Eye disorders
    Vision blurred
         subjects affected / exposed
    6 / 40 (15.00%)
         occurrences all number
    6
    Chorioretinopathy
         subjects affected / exposed
    4 / 40 (10.00%)
         occurrences all number
    4
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    13 / 40 (32.50%)
         occurrences all number
    23
    Vomiting
         subjects affected / exposed
    6 / 40 (15.00%)
         occurrences all number
    7
    Nausea
         subjects affected / exposed
    5 / 40 (12.50%)
         occurrences all number
    6
    Stomatitis
         subjects affected / exposed
    3 / 40 (7.50%)
         occurrences all number
    3
    Abdominal pain
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    3
    Dyspepsia
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    19 / 40 (47.50%)
         occurrences all number
    21
    Photosensitivity reaction
         subjects affected / exposed
    11 / 40 (27.50%)
         occurrences all number
    13
    Rash maculo-papular
         subjects affected / exposed
    9 / 40 (22.50%)
         occurrences all number
    11
    Alopecia
         subjects affected / exposed
    4 / 40 (10.00%)
         occurrences all number
    4
    Dermatitis acneiform
         subjects affected / exposed
    3 / 40 (7.50%)
         occurrences all number
    9
    Dry skin
         subjects affected / exposed
    3 / 40 (7.50%)
         occurrences all number
    3
    Palmar-plantar erythrodysaesthaesia syndrome
         subjects affected / exposed
    3 / 40 (7.50%)
         occurrences all number
    3
    Rash popular
         subjects affected / exposed
    3 / 40 (7.50%)
         occurrences all number
    3
    Erythema nodosum
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Pruritis
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    11 / 40 (27.50%)
         occurrences all number
    14
    Musculoskeletal pain
         subjects affected / exposed
    4 / 40 (10.00%)
         occurrences all number
    4
    Myalgia
         subjects affected / exposed
    4 / 40 (10.00%)
         occurrences all number
    4
    Pain in extremity
         subjects affected / exposed
    4 / 40 (10.00%)
         occurrences all number
    5
    Back pain
         subjects affected / exposed
    3 / 40 (7.50%)
         occurrences all number
    4
    Infections and infestations
    Upper respiratory tract infection
         subjects affected / exposed
    8 / 40 (20.00%)
         occurrences all number
    11
    Conjunctivitis
         subjects affected / exposed
    6 / 40 (15.00%)
         occurrences all number
    6
    Urinary tract infection
         subjects affected / exposed
    4 / 40 (10.00%)
         occurrences all number
    4
    Rash pustular
         subjects affected / exposed
    2 / 40 (5.00%)
         occurrences all number
    2
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    4 / 40 (10.00%)
         occurrences all number
    5
    Hypokalaemia
         subjects affected / exposed
    4 / 40 (10.00%)
         occurrences all number
    11

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    22 Jun 2016
    Updates to eligibility criteria.
    20 Oct 2016
    Updates to safety information.
    29 Mar 2017
    Updated recruitment period and end of study.

    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
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