E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Melanoma is a type of skin cancer that develops from the pigment-containing cells known as melanocytes. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10027481 |
E.1.2 | Term | Metastatic melanoma |
E.1.2 | System Organ Class | 100000004864 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
- To evaluate intracranial ORR with cobimetinib plus atezolizumab in BRAFV600 wild-type melanoma as assessed by an IRC
- To evaluate intracranial ORR with cobimetinib plus atezolizumab and vemurafenib in BRAFV600 mutation-positive melanoma as assessed by an IRC
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E.2.2 | Secondary objectives of the trial |
- To evaluate the efficacy of cobimetinib plus atezolizumab in BRAFV600 wild-type melanoma with CNS metastases
- To evaluate the efficacy of cobimetinib plus atezolizumab and vemurafenib in BRAFV600 mutation-positive melanoma with CNS metastases
- To evaluate the safety of cobimetinib plus atezolizumab in BRAFV600 wild-type melanoma with CNS metastases
- To evaluate the safety of cobimetinib plus atezolizumab and vemurafenib in BRAFV600 mutation-positive melanoma with CNS metastases
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Disease-specific criteria:
- Histologically confirmed melanoma with radiologically confirmed brain metastases
- Documented BRAFV600 mutation status of melanoma tumour tissue using a validated genetic test
- Measurable brain metastases
- Prior anti-cancer therapy for metastatic melanoma is allowed with the following exceptions
- Prior BRAF or methyl ethyl ketone (MEK) inhibitors are not allowed in either the metastatic or adjuvant settings
- Prior immunotherapy is not allowed. As an exception, for patients in Cohort 1 (BRAFv600 wild-type) prior immunotherapy is allowed in the adjuvant setting if completed >= 90 days prior to study treatment initiation. Examples of immunotherapy include, but are not limited to, nivolumab, pembrolizumab and ipilimumab
- Any anti-cancer therapy, including chemotherapy, hormonal therapy and radiotherapy, is prohibited within two weeks prior to initiation of study treatment
- Prior SRT or surgical therapy of <=10 brain metastases is allowed but prior WBRT is not allowed
- Adverse effects of all prior systemic or local treatment must have either returned to baseline or become stable and manageable prior to initiation of study treatment General criteria
- Age >= 18 years
- Able to comply with the study protocol, in the investigator's judgment
- ECOG Performance Status <= 2
- Life expectancy of > 3 months
- Willing and able to complete health and quality of life questionnaires required by the protocol
- Adequate hematologic and end-organ function
- Female patients of childbearing potential and male patients with partners of childbearing potential must agree to always use two effective forms of contraception including at least one method with a failure rate of <= 1% per year during the course of this study and for at least six months after completion of study therapy
- Female patients of childbearing potential must agree to refrain from donating eggs during the course of the study and for at least 5 months after their final dose of atezolizumab
- Male patients must agree to refrain from donating sperm during the course of the study and for at least six months after the last dose of cobimetinib |
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E.4 | Principal exclusion criteria |
Cancer-related criteria:
- Ocular melanoma
- Leptomeningeal involvement
- Uncontrolled tumour-related pain
- Uncontrolled pleural effusion, pericardial effusion, or ascites requiring repeated drainage more than once every 28 days
- Prior WBRT treatment for CNS disease
- Increasing corticosteroid dose during the seven days prior to initiation of study treatment or current dexamethasone or equivalent dose of > 8 mg/day
- Prior treatment with a BRAF or MEK inhibitor
- For patients assigned to Cohort 1 only: prior immunotherapy in the metastatic setting is not allowed. Prior immunotherapy is allowed in the adjuvant setting, provided it is completed >= 90 days prior to study treatment initiation
For patients assigned to Cohort 2 only: prior immunotherapy in either the adjuvant or metastatic setting is not allowed
- Major surgical procedure other than for diagnosis within four weeks prior to initiation of study treatment, or anticipation of need for a major surgical procedure during the course of the study
- Known hypersensitivity to biopharmaceutical agents produced in Chinese hamster ovary cells or to any formulation component of cobimetinib or atezolizumab or, for patients assigned to Cohort 2 only, vemurafenib
- Any anti-cancer therapy, including chemotherapy, hormonal therapy and radiotherapy, within two weeks prior to initiation of study treatment
- Patients assigned to Cohort 2 only: Concomitant treatment with anticonvulsants other than gabapentin, vigabatrin and levetiracetam
- Patients assigned to Cohort 2 only: acetaminophen is prohibited within seven days prior to initiation of study treatment unless the patient has an absolute contraindication to the use of non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin
- Active malignancy (other than melanoma) or a prior malignancy within the past three years
General criteria:
- Known risk factors for ocular toxicity
- History of clinically significant cardiac dysfunction
- Inability to swallow medications
- Malabsorption condition that would alter the absorption of orally administered medications
- Traumatic injury within two weeks prior to initiation of study treatment
- Prior allogeneic stem cell or solid organ transplantation
- Active or history of autoimmune disease or immune deficiency
- History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography (CT) scan
- Uncontrolled diabetes or symptomatic hyperglycaemia
- Any Grade>= 3 haemorrhage or bleeding event within 28 days of study treatment initiation
- History of stroke, reversible ischemic neurological defect, or transient ischemic attack within six months prior to study treatment initiation
- Positive human immunodeficiency virus (HIV) test at screening
- Hepatitis B virus (HBV) infection (chronic or acute)
- Active hepatitis C virus (HCV) infection
- Active tuberculosis
- History of severe allergic, anaphylactic or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
- Severe infection within four weeks prior to initiation of study treatment
- Signs or symptoms of infection within two weeks prior to initiation of study treatment
- Any serious medical condition or abnormality in clinical laboratory tests that, in the investigator’s judgment, precludes the patient’s safe participation in, and completion of, the study
- Any psychological, familial, sociological, or geographical condition that may hamper compliance with the protocol and follow-up after treatment discontinuation
- Treatment with therapeutic oral or IV antibiotics within two weeks prior to initiation of study treatment
- Patients receiving prophylactic antibiotics are eligible for the study
- Administration of a live, attenuated vaccine within four weeks prior to initiation of study treatment or anticipation of need for such a vaccine during the study
- Treatment with systemic immunostimulatory agents within 28 days or 5 half-lives of the drug, whichever is shorter, prior to study treatment initiation
- Treatment with systemic immunosuppressive medications within two weeks prior to study treatment initiation
- Treatment with investigational drug within 28 days or 5 half-lives of the drug, whichever is longer, prior to initiation of study treatment
- For patients to be assigned to Cohort 2 only: anticipated use of any concomitant medication during or within seven days prior to initiation of study treatment that is known to cause QT prolongation
- Consumption of foods, supplements, or drugs that are strong or moderate CYP3A4 enzyme inducers or inhibitors at least seven days prior to initiation of study treatment
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E.5 End points |
E.5.1 | Primary end point(s) |
Intracranial objective response rate (ORR) as determined by the independent review committee |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
1. Intracranial ORR as determined by the investigator
2. Extracranial ORR as determined by the investigator
3. Overall ORR as determined by the investigator
4. Intracranial, extracranial and overall progression-free survival (PFS) as determined by the investigator
5. Intracranial, extracranial and overall duration of response (DOR) as determined by the investigator
6. Intracranial, extracranial and overall disease control rate (DCR) as determined by the investigator
7. Overall survival
8. Time from study treatment initiation to cognitive symptom deterioration
9. Time from study treatment initiation to symptom and function deterioration
10. Duration of Stable/Improved health-related quality of life (HRQoL) scores
11. Occurrence and severity of adverse events, with severity determined according to NCI CTCAE v4.0
12. Change from baseline in targeted vital signs
13. Change from baseline in targeted clinical laboratory test results |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 26 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Brazil |
France |
Germany |
Hungary |
Italy |
Latvia |
Spain |
Switzerland |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The study will end when all patients enrolled have either completed the study (been followed for at least 24 months), died, withdrawn consent, or been lost to follow-up; or the Sponsor decides to end the trial; whichever occurs first. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |