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    Clinical Trial Results:
    A Phase II Two Cohort Study Evaluating the Safety and Efficacy of Cobimetinib plus Atezolizumab in BRAFV600 Wild-type melanoma with central nervous system metastases and cobimetinib plus atezolizumab and vemurafenib in BRAFV600 mutation-positive melanoma with central nervous system metastases

    Summary
    EudraCT number
    2018-000759-41
    Trial protocol
    LV   HU   ES   DE   IT  
    Global end of trial date
    13 Apr 2023

    Results information
    Results version number
    v3(current)
    This version publication date
    21 Apr 2024
    First version publication date
    21 Jul 2022
    Other versions
    v1 , v2
    Version creation reason

    Trial information

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    Trial identification
    Sponsor protocol code
    MO39136
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03625141
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    F. Hoffmann-La Roche AG
    Sponsor organisation address
    Grenzacherstrasse 124, Basel, Switzerland, CH-4070
    Public contact
    F. Hoffmann-La Roche AG, F. Hoffmann-La Roche AG, 41 616878333, global.trial_information@roche.com
    Scientific contact
    F. Hoffmann-La Roche AG, F. Hoffmann-La Roche AG, 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
    13 Apr 2023
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    13 Apr 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The objective of this trial was to evaluate the efficacy and safety of cobimetinib plus atezolizumab in participants with BRAFV600 wild-type melanoma with central nervous system (CNS) metastases and of cobimetinib plus atezolizumab and vemurafenib in BRAFV600 mutation-positive melanoma patients with CNS metastases.
    Protection of trial subjects
    All study subjects were required to read and sign and Informed Consent Form.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    13 Dec 2018
    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
    Brazil: 18
    Country: Number of subjects enrolled
    France: 8
    Country: Number of subjects enrolled
    Germany: 2
    Country: Number of subjects enrolled
    Hungary: 5
    Country: Number of subjects enrolled
    Italy: 34
    Country: Number of subjects enrolled
    Spain: 8
    Country: Number of subjects enrolled
    Switzerland: 5
    Worldwide total number of subjects
    80
    EEA total number of subjects
    57
    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)
    56
    From 65 to 84 years
    24
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The study was conducted at 21 centers in 7 countries.

    Pre-assignment
    Screening details
    A total of 80 participants were enrolled at 21 centers.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Cohort 1- cobimetinib and atezolizumab
    Arm description
    Participants with BRAFV600 wild-type disease will be administered cobimetinib on Days 1−21 of each 28-day cycle; and atezolizumab on Days 1 and 15 of each treatment cycle.
    Arm type
    Experimental

    Investigational medicinal product name
    Atezolizumab
    Investigational medicinal product code
    Other name
    Tecentriq
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Atezolizumab was given at a fixed dose of 840 mg by intravenous (IV) infusion on Days 1 and 15 of each 28-day cycle

    Investigational medicinal product name
    Cobimetinib
    Investigational medicinal product code
    Other name
    Cotellic
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    60 mg (three tablets of 20 mg each) orally (PO) once a day (QD) on Days 1−21 of each 28-day cycle.

    Arm title
    Cohort 2 - cobimetinib, atezolizumab and vemurafenib
    Arm description
    Participants with BRAFV600 mutation-positive disease will be administered cobimetinib, atezolizumab and vemurafenib in 28-day treatment cycles. Treatment includes a 28-day run-in period where participants will receive cobimetinib and vemurafenib only. Upon completion of the 28-day run-in period, atezolizumab will be added to their treatment regimen
    Arm type
    Experimental

    Investigational medicinal product name
    Cobimetinib
    Investigational medicinal product code
    Other name
    Cotellic
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    60 mg (three tablets of 20 mg each) PO QD on Days 1−21 of each 28-day cycle.

    Investigational medicinal product name
    Vemurafenib
    Investigational medicinal product code
    Other name
    Zelboraf
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Participants received vemurafenib 960 mg (four 240 mg tablets) PO twice daily (BID) on days 1-21 of the run-in period (cycle 1); thereafter, they received vemurafenib 720 mg dose (three 240 mg tablets) PO BID on days 22-28 of cycle 1 and on days 1-28 of all subsequent cycles.

    Investigational medicinal product name
    Atezolizumab
    Investigational medicinal product code
    Other name
    Tecentriq
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Atezolizumab was given at a fixed dose of 840 mg by IV infusion on Days 1 and 15 of each 28-day cycle. Only for cohort 2, no dose of atezolizumab was given during the run-in period (cycle 1).

    Number of subjects in period 1
    Cohort 1- cobimetinib and atezolizumab Cohort 2 - cobimetinib, atezolizumab and vemurafenib
    Started
    15
    65
    Completed
    0
    0
    Not completed
    15
    65
         Consent withdrawn by subject
    3
    -
         Adverse Event
    -
    2
         Death
    11
    47
         Study terminated by sponsor
    1
    13
         Withdrawal of consent
    -
    1
         Progressive disease
    -
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Cohort 1- cobimetinib and atezolizumab
    Reporting group description
    Participants with BRAFV600 wild-type disease will be administered cobimetinib on Days 1−21 of each 28-day cycle; and atezolizumab on Days 1 and 15 of each treatment cycle.

    Reporting group title
    Cohort 2 - cobimetinib, atezolizumab and vemurafenib
    Reporting group description
    Participants with BRAFV600 mutation-positive disease will be administered cobimetinib, atezolizumab and vemurafenib in 28-day treatment cycles. Treatment includes a 28-day run-in period where participants will receive cobimetinib and vemurafenib only. Upon completion of the 28-day run-in period, atezolizumab will be added to their treatment regimen

    Reporting group values
    Cohort 1- cobimetinib and atezolizumab Cohort 2 - cobimetinib, atezolizumab and vemurafenib Total
    Number of subjects
    15 65 80
    Age Categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    8 48 56
        From 65-84 years
    7 17 24
        85 years and over
    0 0 0
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    60.9 ± 12.5 54.4 ± 13.9 -
    Gender Categorical
    Units: Subjects
        Female
    9 24 33
        Male
    6 41 47
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    0 9 9
        Not Hispanic or Latino
    11 50 61
        Not Stated
    0 5 5
        Unknown
    4 1 5
    Race (NIH/OMB)
    Units: Subjects
        White
    11 61 72
        Unknown
    4 4 8

    End points

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    End points reporting groups
    Reporting group title
    Cohort 1- cobimetinib and atezolizumab
    Reporting group description
    Participants with BRAFV600 wild-type disease will be administered cobimetinib on Days 1−21 of each 28-day cycle; and atezolizumab on Days 1 and 15 of each treatment cycle.

    Reporting group title
    Cohort 2 - cobimetinib, atezolizumab and vemurafenib
    Reporting group description
    Participants with BRAFV600 mutation-positive disease will be administered cobimetinib, atezolizumab and vemurafenib in 28-day treatment cycles. Treatment includes a 28-day run-in period where participants will receive cobimetinib and vemurafenib only. Upon completion of the 28-day run-in period, atezolizumab will be added to their treatment regimen

    Subject analysis set title
    PRO-evaluable Population: Cohort 1
    Subject analysis set type
    Per protocol
    Subject analysis set description
    All participants who received any amount of any study medication (e.g., atezolizumab, cobimetinib, or vemurafenib) and had a baseline and at least one post baseline PRO assessment in the questionnaire of interest (EORTC QLQ-C30 or EORTC QLQBN20)

    Subject analysis set title
    PRO-evaluable Population: Cohort 2
    Subject analysis set type
    Per protocol
    Subject analysis set description
    All participants who received any amount of any study medication (e.g., atezolizumab, cobimetinib, or vemurafenib) and had a baseline and at least one post baseline PRO assessment in the questionnaire of interest (EORTC QLQ-C30 or EORTC QLQBN20)

    Subject analysis set title
    Safety-evaluable Population: Cohort 1
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The safety population included all participants who received at least one dose of study treatment.

    Subject analysis set title
    Safety-evaluable Population: Cohort 2
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The safety population included all participants who received at least one dose of study treatment.

    Subject analysis set title
    Safety-evaluable Population: Cohort 2 (no atezolizumab)
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    There were 5 participants in Cohort 2 administered with cobimetinib and vemurafenib only as they dropped out during the run-in period.

    Subject analysis set title
    Evaluable Population: Cohort 1
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The evaluable population included all enrolled participants who received study medication and had at least two post-baseline intracranial tumour assessments for response evaluation.

    Subject analysis set title
    Evaluable Population: Cohort 2
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The evaluable population included all enrolled participants who received study medication and had at least two post-baseline intracranial tumour assessments for response evaluation.

    Primary: Intracranial Objective Response Rate (ORR)

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    End point title
    Intracranial Objective Response Rate (ORR) [1]
    End point description
    Intracranial ORR is defined as the percentage of participants with either a complete response (CR) or a partial response (PR) in their intracranial disease based on two consecutive assessments >= 4 weeks apart. Disease status for this endpoint will be determined by an Independent Review Committee (IRC) in accordance with Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1) with modified measurability definition for intracranial lesions (>= 0.5 cm by MRI) and allowing up to five intracranial target lesions. CR is defined as disappearance of all lesions. PR is defined as >=30% decrease in tumor burden, in the absence of CR. The primary endpoint is analyzed on the BRAFV600 mutation positive (Cohort 2) only as the Sponsor had discontinued enrolment into Cohort 1. The evaluable population included all enrolled participants who received study medication and had at least two post-baseline intracranial tumour assessments for response evaluation.
    End point type
    Primary
    End point timeframe
    Baseline up to cut of date (approximately 2.5 years)
    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 statistical analyses were performed for this endpoint.
    End point values
    Evaluable Population: Cohort 2
    Number of subjects analysed
    56
    Units: Percentage of participants
        number (confidence interval 95%)
    46.4 (32.99 to 60.26)
    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
    Intracranial, extracranial and overall PFS defined as the time from study treatment initiation to the first occurrence of disease progression or death from any cause, whichever occurs first, as determined by the investigator according to RECIST v1.1. The safety population included all participants who received at least one dose of study treatment.
    End point type
    Secondary
    End point timeframe
    Baseline up to cut of date (approximately 2.5 years)
    End point values
    Cohort 1- cobimetinib and atezolizumab Cohort 2 - cobimetinib, atezolizumab and vemurafenib
    Number of subjects analysed
    15
    65
    Units: Months
    median (confidence interval 95%)
        Intracranial
    2.17 (1.74 to 7.98)
    5.78 (5.36 to 7.43)
        Extracranial
    4.21 (1.84 to 12.65)
    10.68 (7.85 to 13.67)
        Overall
    1.81 (1.71 to 3.71)
    5.49 (5.13 to 7.43)
    No statistical analyses for this end point

    Secondary: Overall ORR

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    End point title
    Overall ORR
    End point description
    Overall ORR, defined as the percentage of participants with either a CR or PR in their overall disease (i.e. including intracranial and extracranial disease) based on two consecutive assessments >= 4 weeks apart, as determined by the investigator according to RECIST v1.1. CR was defined as disappearance of all target and non-target lesions and (if applicable) normalization of tumor marker levels. PR was defined as at least a 30 percent (%) decrease in sum of diameters of all target lesions, taking as reference the baseline sum of diameters, in the absence of CR. The safety population included all participants who received at least one dose of study treatment.
    End point type
    Secondary
    End point timeframe
    Baseline up to cut of date (approximately 2.5 years)
    End point values
    Cohort 1- cobimetinib and atezolizumab Cohort 2 - cobimetinib, atezolizumab and vemurafenib
    Number of subjects analysed
    15
    65
    Units: Percentage of participants
        number (confidence interval 95%)
    26.7 (7.79 to 55.10)
    52.3 (39.54 to 64.85)
    No statistical analyses for this end point

    Secondary: Extracranial ORR

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    End point title
    Extracranial ORR
    End point description
    Extracranial ORR, defined as the percentage of participants with either a CR or PR in their extracranial disease based on two consecutive assessments >=4 weeks apart, as determined by the investigator according to RECIST v1.1. The safety population included all participants who received at least one dose of study treatment.
    End point type
    Secondary
    End point timeframe
    Baseline up to cut of date (approximately 2.5 years)
    End point values
    Cohort 1- cobimetinib and atezolizumab Cohort 2 - cobimetinib, atezolizumab and vemurafenib
    Number of subjects analysed
    15
    65
    Units: Percentage of participants
        number (confidence interval 95%)
    20.0 (4.33 to 48.09)
    56.9 (44.04 to 69.15)
    No statistical analyses for this end point

    Secondary: Disease Control Rate (DCR)

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    End point title
    Disease Control Rate (DCR) [2]
    End point description
    Intracranial, extracranial and overall DCR, defined as the percentage of participants with a CR or PR or stable disease (SD) at 16 weeks from study treatment initiation, as determined by the investigator according to RECIST v1.1. CR was defined as disappearance of all target and non-target lesions and (if applicable) normalization of tumor marker levels. PR was defined as at least a 30 percent (%) decrease in sum of diameters of all target lesions, taking as reference the baseline sum of diameters, in the absence of CR. SD is defined as neither sufficient shrinkage to qualify for CR or PR nor sufficient increase to qualify for disease progression. Disease progression is defined as >=20% increase in tumor burden. This endpoint is analyzed on the BRAFV600 mutation positive (Cohort 2) only as the Sponsor had discontinued enrolment into Cohort 1. The safety population included all participants who received at least one dose of study treatment.
    End point type
    Secondary
    End point timeframe
    At 16 weeks
    Notes
    [2] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: This endpoint is analyzed on the BRAFV600 mutation positive (Cohort 2) only as the Sponsor had discontinued enrolment into Cohort 1. Data for Cohort 1 was not collected nor analyzed for this outcome measure.
    End point values
    Cohort 2 - cobimetinib, atezolizumab and vemurafenib
    Number of subjects analysed
    65
    Units: Percentage of participants
    number (confidence interval 95%)
        Intracranial
    50.8 (38.07 to 63.40)
        Extracranial
    50.8 (38.07 to 63.40)
        Overall
    50.8 (38.07 to 63.40)
    No statistical analyses for this end point

    Secondary: Duration of Response (DOR)

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    End point title
    Duration of Response (DOR) [3]
    End point description
    Intracranial, extracranial and overall DOR, defined as the time from the first occurrence of a documented objective response based on two consecutive assessments ≥ 4 weeks apart to disease progression or death from any cause (whichever occurs first), as determined by the investigator according to RECIST v1.1. This endpoint is analyzed on the BRAFV600 mutation positive (Cohort 2) only as the Sponsor had discontinued enrolment into Cohort 1. Data for Cohort 1 was not collected nor analyzed for this outcome measure. The safety population included all participants who received at least one dose of study treatment.
    End point type
    Secondary
    End point timeframe
    Baseline up to cut of date (approximately 2.5 years)
    Notes
    [3] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: This endpoint is analyzed on the BRAFV600 mutation positive (Cohort 2) only as the Sponsor had discontinued enrolment into Cohort 1. Data for Cohort 1 was not collected nor analyzed for this outcome measure.
    End point values
    Cohort 2 - cobimetinib, atezolizumab and vemurafenib
    Number of subjects analysed
    65
    Units: Months
    median (confidence interval 95%)
        Intracranial (n=32)
    6.7 (5.6 to 9.5)
        Extracranial (n=37)
    11.6 (9.2 to 13.0)
        Overall (n=34)
    7.4 (5.5 to 9.5)
    No statistical analyses for this end point

    Secondary: Overall Survival (OS)

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    End point title
    Overall Survival (OS) [4]
    End point description
    OS is defined as the time from study treatment initiation to death from any cause. The safety population included all participants who received at least one dose of study treatment.
    End point type
    Secondary
    End point timeframe
    Baseline up to 4 years, 4 months
    Notes
    [4] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: This endpoint is analyzed on the BRAFV600 mutation positive (Cohort 2) only as the Sponsor had discontinued enrolment into Cohort 1. Data for Cohort 1 was not collected nor analyzed for this outcome measure.
    End point values
    Cohort 2 - cobimetinib, atezolizumab and vemurafenib
    Number of subjects analysed
    65
    Units: Months
        median (confidence interval 95%)
    13.40 (10.68 to 16.92)
    No statistical analyses for this end point

    Secondary: Time to Cognitive Symptom Deterioration

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    End point title
    Time to Cognitive Symptom Deterioration
    End point description
    Time from study treatment initiation to cognitive symptom deterioration, defined as a change (≥ 10 points on a 0-100 scale) on selected scales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-BN20) (visual disorder, motor dysfunction, communication deficit, headaches, seizures and drowsiness). 9999999 = Insufficient number of participants with event. The PRO-evaluable population included all participants who received any amount of any study medication (e.g., atezolizumab, cobimetinib, or vemurafenib) and had a baseline and at least one post baseline PRO assessment in the questionnaire of interest (EORTC QLQ-C30 or EORTC QLQBN20).
    End point type
    Secondary
    End point timeframe
    Up to 48 months
    End point values
    PRO-evaluable Population: Cohort 1 PRO-evaluable Population: Cohort 2
    Number of subjects analysed
    13
    63
    Units: Months
    median (confidence interval 95%)
        Visual Disorder
    3.75 (1.87 to 9999999)
    2.99 (1.41 to 8.74)
        Motor Dysfunction
    1.87 (1.08 to 19.84)
    6.70 (3.94 to 13.90)
        Communication Deficit
    6.44 (2.83 to 9999999)
    13.90 (6.54 to 21.13)
        Headaches
    9999999 (1.08 to 9999999)
    10.84 (5.55 to 9999999)
        Seizures
    8.31 (8.31 to 9999999)
    9999999 (17.74 to 9999999)
        Drowsiness
    2.83 (1.08 to 9999999)
    7.16 (1.94 to 9999999)
    No statistical analyses for this end point

    Secondary: Time to Symptom and Function Deterioration

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    End point title
    Time to Symptom and Function Deterioration
    End point description
    Time from study treatment initiation to symptom and function deterioration defined as a change (≥ 10 points on a 0-100 scale) in fatigue, physical functioning, cognitive functioning, or role functioning as measured by the Fatigue, Physical, Cognitive, Role Functioning scales of the EORTC QLQ-C30. 9999999 = Insufficient number of participants with event The PRO-evaluable population included all participants who received any amount of any study medication (e.g., atezolizumab, cobimetinib, or vemurafenib) and had a baseline and at least one post baseline PRO assessment in the questionnaire of interest (EORTC QLQ-C30 or EORTC QLQBN20).
    End point type
    Secondary
    End point timeframe
    Up to 48 months
    End point values
    PRO-evaluable Population: Cohort 1 PRO-evaluable Population: Cohort 2
    Number of subjects analysed
    13
    63
    Units: Months
    median (confidence interval 95%)
        Physical Functioning
    9999999 (0.99 to 9999999)
    11.56 (5.55 to 9999999)
        Cognitive Functioning
    11.99 (1.91 to 9999999)
    8.25 (5.55 to 9999999)
        Role Functioning
    2.83 (1.35 to 6.47)
    4.07 (1.61 to 6.47)
        Fatigue
    1.35 (0.95 to 9999999)
    1.45 (1.38 to 6.47)
    No statistical analyses for this end point

    Secondary: Duration of Stable/Improved Health-related Quality of Life (HRQoL) Scores

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    End point title
    Duration of Stable/Improved Health-related Quality of Life (HRQoL) Scores
    End point description
    Duration of Stable/Improved HRQoL scores as assessed through use of the two-item Global Health Status (GHS)/HRQoL subscale (Questions 29 and 30) of the EORTC QLQ-C30. 9999999 = Insufficient number of participants with event. The PRO-evaluable population included all participants who received any amount of any study medication (e.g., atezolizumab, cobimetinib, or vemurafenib) and had a baseline and at least one post baseline PRO assessment in the questionnaire of interest (EORTC QLQ-C30 or EORTC QLQBN20).
    End point type
    Secondary
    End point timeframe
    Baseline up to cut of date (approximately 2.5 years)
    End point values
    PRO-evaluable Population: Cohort 1 PRO-evaluable Population: Cohort 2
    Number of subjects analysed
    13
    63
    Units: Months
        median (confidence interval 95%)
    9999999 (15.21 to 9999999)
    6.14 (3.68 to 10.32)
    No statistical analyses for this end point

    Secondary: Percentage of Participants with Adverse Events

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    End point title
    Percentage of Participants with Adverse Events
    End point description
    The safety profile of Cobimetinib plus Atezolizumab and Cobimetinib plus Atezolizumab plus Vemurafenib is evaluated in terms of occurrence and severity of AEs. Severity will be determined according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 4.0 (NCI CTCAE v4.0) The safety population included all participants who received at least one dose of study treatment.
    End point type
    Secondary
    End point timeframe
    Baseline up to 4 years, 4 months
    End point values
    Safety-evaluable Population: Cohort 1 Safety-evaluable Population: Cohort 2 Safety-evaluable Population: Cohort 2 (no atezolizumab)
    Number of subjects analysed
    15
    60
    5
    Units: Percentage of participants
    number (not applicable)
        Occurrence (n=15,60,5)
    100
    100
    100
        Grade 1 (n=1,1,0)
    6.7
    1.7
    0
        Grade 2 (n=3,13,1)
    20.0
    21.7
    20.0
        Grade 3 (n=9,35,2)
    60.0
    58.3
    40.0
        Grade 4 (n=1,10,0)
    6.7
    16.7
    0
        Grade 5 (n=1,1,2)
    6.7
    1.7
    40.0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Baseline up to 4 years, 4 months
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    26.0
    Reporting groups
    Reporting group title
    Cohort 1- Cobimetinib and Atezolizumab
    Reporting group description
    Participants with BRAFV600 wild-type disease will be administered cobimetinib on Days 1-21 of each 28-day cycle; and atezolizumab on Days 1 and 15 of each treatment cycle.

    Reporting group title
    Cohort 2 - Cobimetinib and Vemurafenib
    Reporting group description
    There were 5 participants in Cohort 2 administered with cobimetinib and vemurafenib only as they dropped out during the run-in period.

    Reporting group title
    Cohort 2 - Cobimetinib, Atezolizumab and Vemurafenib
    Reporting group description
    Participants with BRAFV600 mutation-positive disease will be administered cobimetinib, atezolizumab and vemurafenib in 28-day treatment cycles. Treatment includes a 28-day run-in period where participants will receive cobimetinib and vemurafenib only. Upon completion of the 28-day run-in period, atezolizumab will be added to their treatment regimen

    Serious adverse events
    Cohort 1- Cobimetinib and Atezolizumab Cohort 2 - Cobimetinib and Vemurafenib Cohort 2 - Cobimetinib, Atezolizumab and Vemurafenib
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 15 (40.00%)
    5 / 5 (100.00%)
    21 / 60 (35.00%)
         number of deaths (all causes)
    11
    3
    47
         number of deaths resulting from adverse events
    0
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Malignant melanoma
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Colorectal adenoma
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Thrombophlebitis
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Influenza like illness
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Death
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Oedema
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immune system disorders
    Cytokine release syndrome
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pulmonary embolism
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Aspartate aminotransferase increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Transaminases increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac failure
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myocarditis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Seizure
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cerebral haemorrhage
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Limbic encephalitis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Epilepsy
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Brain oedema
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Pancytopenia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Disseminated intravascular coagulation
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Eye disorders
    Retinal detachment
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Vomiting
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pancreatitis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Upper gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Hepatitis toxic
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gallbladder rupture
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Drug-induced liver injury
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Rash morbilliform
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rash maculo-papular
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Photosensitivity reaction
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pustular psoriasis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rash
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Drug reaction with eosinophilia and systemic symptoms
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Muscular weakness
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myositis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Sepsis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diverticulitis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    2 / 60 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Postoperative wound infection
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bacterial diarrhoea
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Septic shock
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Appendicitis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Cohort 1- Cobimetinib and Atezolizumab Cohort 2 - Cobimetinib and Vemurafenib Cohort 2 - Cobimetinib, Atezolizumab and Vemurafenib
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    15 / 15 (100.00%)
    4 / 5 (80.00%)
    60 / 60 (100.00%)
    Vascular disorders
    Lymphoedema
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences all number
    1
    0
    1
    Hypertension
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    10 / 60 (16.67%)
         occurrences all number
    2
    0
    12
    Deep vein thrombosis
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Hypotension
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    4 / 15 (26.67%)
    0 / 5 (0.00%)
    19 / 60 (31.67%)
         occurrences all number
    5
    0
    23
    Mass
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Chills
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    2 / 60 (3.33%)
         occurrences all number
    1
    0
    3
    Mucosal inflammation
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    6 / 60 (10.00%)
         occurrences all number
    1
    0
    12
    Malaise
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences all number
    1
    0
    1
    Pyrexia
         subjects affected / exposed
    3 / 15 (20.00%)
    1 / 5 (20.00%)
    26 / 60 (43.33%)
         occurrences all number
    5
    1
    56
    Fatigue
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    1
    0
    4
    Oedema peripheral
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    8 / 60 (13.33%)
         occurrences all number
    3
    0
    9
    Xerosis
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences all number
    0
    1
    0
    Immune system disorders
    Contrast media allergy
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    1
    0
    4
    Pneumonitis
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    6 / 60 (10.00%)
         occurrences all number
    1
    0
    6
    Oropharyngeal pain
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences all number
    2
    0
    1
    Cough
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    2
    0
    4
    Epistaxis
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Psychiatric disorders
    Confusional state
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Anxiety
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Insomnia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    5 / 60 (8.33%)
         occurrences all number
    0
    0
    6
    Investigations
    Blood magnesium decreased
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Ejection fraction decreased
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences all number
    1
    0
    1
    Blood alkaline phosphatase increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    11 / 60 (18.33%)
         occurrences all number
    0
    0
    13
    Aspartate aminotransferase increased
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    14 / 60 (23.33%)
         occurrences all number
    2
    0
    21
    Amylase increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    19 / 60 (31.67%)
         occurrences all number
    0
    0
    27
    Blood creatinine increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    9 / 60 (15.00%)
         occurrences all number
    0
    0
    12
    Blood creatine phosphokinase increased
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    28 / 60 (46.67%)
         occurrences all number
    31
    0
    78
    Thyroxine free increased
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Blood lactate dehydrogenase increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    5 / 60 (8.33%)
         occurrences all number
    0
    0
    5
    Lipase increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    23 / 60 (38.33%)
         occurrences all number
    0
    0
    45
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    13 / 60 (21.67%)
         occurrences all number
    1
    0
    26
    Tri-iodothyronine free decreased
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Blood cholesterol increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    4
    Transaminases increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    0
    0
    5
    Lymphocyte count decreased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Blood bilirubin increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Injury, poisoning and procedural complications
    Infusion related reaction
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    1
    0
    9
    Cardiac disorders
    Left ventricular dysfunction
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Mitral valve incompetence
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Myocardial infarction
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    8 / 60 (13.33%)
         occurrences all number
    6
    0
    13
    Dizziness
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    2 / 60 (3.33%)
         occurrences all number
    1
    0
    2
    Dysgeusia
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    6 / 60 (10.00%)
         occurrences all number
    1
    0
    6
    Seizure
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    4
    Sciatica
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    2
    0
    0
    Tremor
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Blood and lymphatic system disorders
    Thrombocytopenia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Anaemia
         subjects affected / exposed
    4 / 15 (26.67%)
    1 / 5 (20.00%)
    11 / 60 (18.33%)
         occurrences all number
    5
    1
    11
    Eosinophilia
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences all number
    0
    1
    0
    Lymphopenia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Eye disorders
    Retinal detachment
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    2 / 60 (3.33%)
         occurrences all number
    0
    1
    2
    Vision blurred
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    5 / 60 (8.33%)
         occurrences all number
    0
    0
    5
    Keratitis
         subjects affected / exposed
    1 / 15 (6.67%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    1
    0
    Visual impairment
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences all number
    1
    0
    1
    Eye pain
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences all number
    0
    1
    0
    Uveitis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    4
    Serous retinopathy
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    8 / 60 (13.33%)
         occurrences all number
    0
    0
    9
    Detachment of retinal pigment epithelium
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    5
    Serous retinal detachment
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    1
    0
    3
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    6 / 60 (10.00%)
         occurrences all number
    1
    0
    7
    Mouth ulceration
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences all number
    0
    1
    0
    Diarrhoea
         subjects affected / exposed
    6 / 15 (40.00%)
    0 / 5 (0.00%)
    29 / 60 (48.33%)
         occurrences all number
    17
    0
    60
    Abdominal pain
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    7 / 60 (11.67%)
         occurrences all number
    1
    0
    8
    Vomiting
         subjects affected / exposed
    2 / 15 (13.33%)
    1 / 5 (20.00%)
    10 / 60 (16.67%)
         occurrences all number
    4
    1
    15
    Stomatitis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    5 / 60 (8.33%)
         occurrences all number
    0
    0
    5
    Gastritis
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Odynophagia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    4
    Gastrooesophageal reflux disease
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    2 / 60 (3.33%)
         occurrences all number
    1
    0
    2
    Nausea
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    14 / 60 (23.33%)
         occurrences all number
    2
    0
    22
    Dry mouth
         subjects affected / exposed
    1 / 15 (6.67%)
    1 / 5 (20.00%)
    4 / 60 (6.67%)
         occurrences all number
    1
    1
    4
    Abdominal pain upper
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    5 / 60 (8.33%)
         occurrences all number
    1
    0
    6
    Dyspepsia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    6 / 60 (10.00%)
         occurrences all number
    0
    0
    6
    Gastrointestinal disorder
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Hepatobiliary disorders
    Hepatic cytolysis
         subjects affected / exposed
    1 / 15 (6.67%)
    1 / 5 (20.00%)
    1 / 60 (1.67%)
         occurrences all number
    1
    1
    1
    Skin and subcutaneous tissue disorders
    Photosensitivity reaction
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    11 / 60 (18.33%)
         occurrences all number
    0
    0
    16
    Rash
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    20 / 60 (33.33%)
         occurrences all number
    1
    0
    29
    Vitiligo
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    0
    0
    4
    Alopecia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    5 / 60 (8.33%)
         occurrences all number
    0
    0
    5
    Rash follicular
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences all number
    1
    0
    1
    Rash maculo-papular
         subjects affected / exposed
    2 / 15 (13.33%)
    1 / 5 (20.00%)
    17 / 60 (28.33%)
         occurrences all number
    2
    1
    20
    Dermatitis
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    2 / 60 (3.33%)
         occurrences all number
    1
    0
    2
    Erythema
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    1
    0
    5
    Scab
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Dermatitis acneiform
         subjects affected / exposed
    4 / 15 (26.67%)
    0 / 5 (0.00%)
    18 / 60 (30.00%)
         occurrences all number
    9
    0
    21
    Pruritus
         subjects affected / exposed
    2 / 15 (13.33%)
    1 / 5 (20.00%)
    9 / 60 (15.00%)
         occurrences all number
    2
    1
    9
    Hyperkeratosis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    0
    0
    5
    Dermatitis allergic
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Renal and urinary disorders
    Dysuria
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Endocrine disorders
    Hyperthyroidism
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    1
    0
    3
    Hypothyroidism
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    8 / 60 (13.33%)
         occurrences all number
    1
    0
    8
    Musculoskeletal and connective tissue disorders
    Myalgia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    11 / 60 (18.33%)
         occurrences all number
    0
    0
    16
    Arthralgia
         subjects affected / exposed
    2 / 15 (13.33%)
    1 / 5 (20.00%)
    19 / 60 (31.67%)
         occurrences all number
    2
    1
    24
    Pain in extremity
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    1
    0
    4
    Sjogren's syndrome
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Back pain
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    6 / 60 (10.00%)
         occurrences all number
    0
    0
    6
    Infections and infestations
    COVID-19
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    1
    0
    3
    Fungal skin infection
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Hordeolum
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences all number
    0
    1
    0
    Conjunctivitis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    0
    0
    4
    Furuncle
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Influenza
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Gastroenteritis
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences all number
    1
    0
    1
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    0
    0
    5
    Rhinitis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Urinary tract infection
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences all number
    1
    0
    1
    Rash pustular
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    2 / 60 (3.33%)
         occurrences all number
    2
    0
    3
    Respiratory tract infection
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences all number
    1
    0
    1
    Folliculitis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Metabolism and nutrition disorders
    Hypoalbuminaemia
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 5 (0.00%)
    2 / 60 (3.33%)
         occurrences all number
    2
    0
    2
    Hypoproteinaemia
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Vitamin D deficiency
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    4 / 60 (6.67%)
         occurrences all number
    1
    0
    4
    Iron deficiency
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    0 / 60 (0.00%)
         occurrences all number
    1
    0
    0
    Decreased appetite
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    5 / 60 (8.33%)
         occurrences all number
    0
    0
    5
    Cell death
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 5 (20.00%)
    0 / 60 (0.00%)
         occurrences all number
    0
    1
    0
    Hypokalaemia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    6 / 60 (10.00%)
         occurrences all number
    0
    0
    6
    Hyperglycaemia
         subjects affected / exposed
    1 / 15 (6.67%)
    1 / 5 (20.00%)
    7 / 60 (11.67%)
         occurrences all number
    1
    1
    11
    Hyponatraemia
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 5 (0.00%)
    3 / 60 (5.00%)
         occurrences all number
    0
    0
    3
    Hyperkalaemia
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 5 (0.00%)
    1 / 60 (1.67%)
         occurrences all number
    1
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    06 Nov 2018
    The following updates were made: [1] The Roche Medical Responsible was identified as the Roche Medical Monitor; [2] Descriptions of the roles and responsibilities on the Internal Monitoring Committee were added; [3] Requirements for re-screening were added and/or clarified; [4] Eligibility requirement for woman of childbearing potential to refrain from donating eggs was added; [5] Text clarifying that the eligibility requirements for men refraining from donating sperm were added; [6] Text identifying acetaminophen as CYP1A2 was added to clarify its interaction with vemurafenib; [7] Text describing and allowing screening window extensions was added; [8] Text describing Next-generation sequencing of study participant samples was revised; [9] Timing of destruction of samples collected from participants who have not consented to optional donation was modified; [10] Nephritis was added as a known risk to be associated with atezolizumab; [11] The length of time atezolizumab treatment was suspended was revised; [12] Submission of tumor tissue biomarker analyses was moved from screening to Cycle 1, Day 1; [13] [9] Additional minor changes were made to improve clarity and consistency.
    12 Aug 2019
    The following updates were made: [1] The Sponsor communicated the decision to discontinue enrollment in Cohort 1 in a Dear Investigator Letter dated 9 July 2019; [2] Benefit-Risk assessment was updated; [3] Sample size calculations were revised; [4] Primary efficacy analysis was revised to only include participants enrolled in Cohort 2; [5] Intracranial ORR as assessed by the investigator according to RECIST v1.1 was added as a secondary efficacy endpoint; [6] Inclusion criteria was revised; [7] Study Treatment Dosage for Cohort 1 was updated; [8] Permitted Therapy section was updated; [9] Guidelines for managing patients who experienced atezolizumab-associated adverse events were revised; [10] Management Guidelines for Cohort 1 and Emergency Medical Contacts were updated; [11] Abortions section was revise to clarify new safety reporting requirements; [12] Immune-related was changed to 'immune-mediated' throughout the protocol; [13] Additional minor changes were made to improve the clarity and consistency.
    26 Feb 2020
    The following updates were made: [1] The definition of the endpoint of intracranial ORR by investigator was clarified to align with the IRC-determined definition; [2] Proteinuria inclusion criteria was removed; [3] The rationale for the dose of atezolizumab was updated; [4] Clarity was introduced on the recommendation for vemurafenib interruption in the event of planned stereotactic radiotherapy; [5] Clarification that intracranial and extracranial tumour assessments do not need to be done for study purposes; [6] In the event of disease progression, a confirmatory tumour assessment was to be performed approximately four weeks later; [7] Added "Management of Study Quality" section and updated the "Publication of Data and Protection of Trade Secrets" section; [8] Safety updates from the atezolizumab Investigator's Brochure were added; [9] Additional minor changes were made to improve clarity and consistency.
    04 Mar 2022
    The following updates were made: [1] List of approved indications for atezolizumab was updated; [2] Provisions related to performing the study in the setting of the coronavirus disease 2019 (COVID-19) pandemic were added; [3] Benefit-risk assessment and guidance on concomitant administration of COVID-19 vaccines with atezolizumab was added; [4] AE management guidelines were updated; [5] The responsibilities of the investigator and the role of the Medical Monitor were clarified; [6] Language was added to indicate that sites could confirm that appropriate temperature conditions were maintained during investigational medicinal product (IMP) transit; [7] Immunosuppressive medications have been removed from the prohibited therapy section and added to the cautionary therapy section; [8] Updates related to the risks associated with atezolizumab; [9] Hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) replaced systemic inflammatory response syndrome on the list of atezolizumab-associated adverse events ofspecial interest (AESI); [10] Language was added to the ICF to instruct female participants to inform the investigator if they became pregnant; [11] language regarding investigator reporting of pregnancies was clarified; [12] Management guidelines for Grade 4 myositis were removed; [13] The management guidelines for HLH and MAS have been modified to indicate that HLH were to be considered when CRS presentation was atypical or prolonged, to add anticytokine therapy as an option for treating HLH or MAS, and suggest that published guidelines be followed for HLH or MAS events that did not respond to treatment within 24 hours; [14] Minor updates to the management guidelines for Suspected Hemophagocytic Lymphohistiocytosis or Macrophage Activation Syndrome; [15] The medical term “primary biliary cirrhosis” was replaced by the term “primary biliary cholangitis;” [16] Additional minor changes were made to improve clarity and consistency.

    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.
    The Sponsor decided to discontinue enrollment into Cohort 1, which was communicated in a Dear Investigator Letter dated 9 July 2019.
    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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