Sorafenib and Isolated Limb Infusion of Melphalan in Treating Patients With Stage III Melanoma of the Arm or Leg

This study has been completed.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Duke University
ClinicalTrials.gov Identifier:
NCT00565968
First received: November 29, 2007
Last updated: January 23, 2014
Last verified: January 2014
  Purpose

RATIONALE: Sorafenib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Drugs used in chemotherapy, such as melphalan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Sorafenib may also make tumor cells more sensitive to melphalan. Giving sorafenib together with an isolated limb infusion of melphalan may kill more tumor cells.

PURPOSE: This phase I trial is studying the side effects and best dose of sorafenib when given together with an isolated limb infusion of melphalan in treating patients with stage III melanoma of the arm or leg.


Condition Intervention Phase
Melanoma (Skin)
Drug: melphalan
Drug: sorafenib tosylate
Genetic: gene expression analysis
Genetic: protein expression analysis
Genetic: western blotting
Other: pharmacological study
Phase 1

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I Dose Escalation Trial to Evaluate Safety and Efficacy of Oral Sorafenib (Nexavar) With Regional Melphalan Via Normothermic Isolated Limb Infusion (ILI) in Patients With Intransit Extremity Melanoma

Resource links provided by NLM:


Further study details as provided by Duke University:

Primary Outcome Measures:
  • Maximum tolerated dose [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Safety and tolerability [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
  • Antitumor activity, as evidenced by best overall response and duration of response [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • Duration of progression-free survival [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • Pharmacokinetics of melphalan [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • Tumor gene and protein expression profiles following treatment [ Time Frame: 3 years ] [ Designated as safety issue: No ]

Enrollment: 20
Study Start Date: October 2007
Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Sorafenib dose escalation Drug: melphalan Drug: sorafenib tosylate Genetic: gene expression analysis Genetic: protein expression analysis Genetic: western blotting Other: pharmacological study

Detailed Description:

OBJECTIVES:

Primary

  • To determine the dose-limiting toxicities and maximum tolerate dose of systemic sorafenib tosylate in combination with regionally administered melphalan by isolated limb infusion in patients with stage IIIB or IIIC intransit extremity melanoma.

Secondary

  • To characterize the safety and tolerability of this regimen in these patients.
  • To assess the antitumor activity of this regimen, as evidenced by best overall response and duration of response, in these patients.
  • To characterize the duration of progression-free survival of these patients.
  • To characterize the pharmacokinetics of melphalan.
  • To assess alterations in selected gene and protein expression profiles following treatment.

OUTLINE: This is a multicenter, dose-escalation study of sorafenib tosylate.

Patients receive oral sorafenib tosylate twice daily on days 1-14 and melphalan via isolated limb infusion into the upper or lower extremities on day 8.

Patients undergo tumor biopsies at baseline and in weeks 2 and 12 for gene expression analysis and western blot analysis. Patients also undergo blood sample collection periodically for pharmacokinetic analysis of melphalan.

After completion of study treatment, patients are followed every 3 months for 1 year and then every 6 months for 2 years.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed primary or recurrent extremity melanoma

    • Stage IIIB or IIIC disease

      • Patients with stage IIIC disease must have had regional lymph nodes previously removed
  • Disease to be treated by regional therapy must be distal to the planned site of tourniquet placement
  • Bidimensionally measurable disease by caliper or radiological method

    • Must have identifiable target lesions for disease assessment

      • Patients with a single lesion must have archived tumor tissue available for research analysis
  • No stage IV disease
  • No known brain metastasis

    • Patients with neurological symptoms must have undergone a CT scan or MRI of the brain within the past 4 weeks to exclude brain metastasis

PATIENT CHARACTERISTICS:

  • ECOG or Zubrod performance status 0-1
  • Life expectancy > 6 months
  • Hemoglobin ≥ 9.0 g/dL
  • WBC ≥ 3,000/mm^3
  • ANC ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Total bilirubin ≤ 1.5 x upper limit of normal (ULN)
  • ALT and AST ≤ 2.5 x ULN
  • INR < 1.5 or PT/PTT normal
  • Creatinine ≤ 1.5 x ULN
  • Not pregnant or nursing
  • Negative serum pregnancy test
  • Fertile patients must use effective contraception
  • Must have a palpable femoral or axillary pulse in the extremity to be treated
  • No cardiac disease, including any of the following:

    • NYHA class III or IV congestive heart failure
    • Unstable angina (i.e., angina symptoms at rest) or new onset angina within the past 3 months
    • Myocardial infarction within the past 6 months
  • No cardiac ventricular arrhythmias requiring antiarrhythmic therapy
  • No uncontrolled hypertension, defined as systolic blood pressure (BP) > 150 mm Hg or diastolic BP > 90 mm Hg, despite optimal medical management
  • No known HIV infection
  • No chronic hepatitis B or C
  • No active clinically serious infection > CTCAE grade 2
  • No thrombotic or embolic events (e.g., cerebrovascular accident or transient ischemic attacks) within the past 6 months
  • No signs or symptoms of vascular insufficiency (i.e., any history of blood clots or other ischemic peripheral vascular disease)
  • No evidence or history of bleeding diathesis or coagulopathy
  • No pulmonary hemorrhage or bleeding event ≥ CTCAE grade 2 within the past 4 weeks
  • No other hemorrhage or bleeding event ≥ CTCAE grade 3 within the past 4 weeks
  • No serious nonhealing wound, ulcer, or bone fracture
  • No significant traumatic injury within the past 4 weeks
  • No condition that impairs the patient's ability to swallow whole pills
  • No malabsorption problem
  • No known history of allergic reactions and/or hypersensitivity to melphalan, sorafenib tosylate, or any other agent used in the study
  • No psychiatric condition or diminished capacity that would compromise giving informed consent, or interfere with study compliance
  • No history of other malignancies, except for any of the following:

    • Adequately treated basal cell or squamous cell carcinoma of the skin
    • Curatively treated in situ carcinoma of the uterine cervix, prostate cancer, or superficial bladder cancer
    • Other curatively treated solid tumor with no evidence of disease for ≥ 5 years

PRIOR CONCURRENT THERAPY:

  • Recovered from prior therapy
  • No prior sorafenib tosylate
  • Prior melphalan via isolated limb infusion allowed
  • No antineoplastic therapy, radiotherapy, or any other investigational drug within the past 4 weeks
  • No major surgery or open biopsy within the past 4 weeks
  • No concurrent Hypericum perforatum (St. John wort) or rifampin
  • Concurrent anti-coagulation treatment with warfarin or heparin allowed
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00565968

Locations
United States, New York
Memorial Sloan-Kettering Cancer Center
New York, New York, United States, 10065
Sponsors and Collaborators
Duke University
Investigators
Principal Investigator: Douglas S. Tyler, MD Duke Cancer Institute
  More Information

Additional Information:
No publications provided

Responsible Party: Duke University
ClinicalTrials.gov Identifier: NCT00565968     History of Changes
Other Study ID Numbers: Pro00001344, CDR0000575427
Study First Received: November 29, 2007
Last Updated: January 23, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Duke University:
stage IIIB melanoma
stage IIIC melanoma
recurrent melanoma

Additional relevant MeSH terms:
Melanoma
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Nerve Tissue
Nevi and Melanomas
Melphalan
Sorafenib
Myeloablative Agonists
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Protein Kinase Inhibitors
Enzyme Inhibitors

ClinicalTrials.gov processed this record on July 24, 2014