Ipilimumab or High-Dose Interferon Alfa-2b in Treating Patients With High-Risk Stage III-IV Melanoma That Has Been Removed by Surgery

Not Recruiting

Trial ID: NCT01274338


This randomized phase III trial studies ipilimumab to see how well it works compared to high-dose interferon alfa-2b in treating patients with high-risk stage III-IV melanoma that has been removed by surgery. Immunotherapy with monoclonal antibodies, such as ipilimumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Interferon alfa-2b may interfere with the growth of tumor cells and slow the growth of melanoma and other cancers. It is not yet known whether ipilimumab is more effective than interferon alfa-2b in treating patients with melanoma.

Official Title

A Phase III Randomized Study of Adjuvant Ipilimumab Anti-CTLA4 Therapy Versus High-Dose Interferon a-2b for Resected High-Risk Melanoma

Stanford Investigator(s)

Harlan Pinto
Harlan Pinto

Associate Professor of Medicine (Oncology) and of Otolaryngology - Head & Neck Surgery

Sunil Arani Reddy
Sunil Arani Reddy

Clinical Associate Professor, Medicine - Oncology

Susan M. Swetter, MD
Susan M. Swetter, MD

Professor of Dermatology


Inclusion Criteria:

   - All patients must have disease-free status documented by a complete physical
   examination and imaging studies within 4 weeks prior to randomization; imaging studies
   must include a total body positron emission tomography (PET)-computed tomography (CT)
   scan (with or without brain) and brain magnetic resonance imaging (MRI) or CT (if MRI
   is contraindicated); if PET-CT cannot be done, CT of neck, chest, abdomen, and pelvis
   should be done

      - If for some reason a CT cannot be done, an MRI may be done instead; any other
      imaging studies if performed (eg, bone scan) must show no evidence of disease

   - Patients must have primary cutaneous melanoma that belong to one of the following
   American Joint Commission on Cancer (AJCC) stages (2009 AJCC Melanoma Staging System):

      - Stage IIIB

         - T1-4b N1a M0

         - T1-4b N2a M0

         - T1-4b N1b M0

         - T1-4b N2b M0

         - T1-4b N2c M0

      - Stage IIIC

         - T1-4b N1b M0

         - T1-4b N2b M0

         - T1-4b N2c M0

         - Any T N3 M0

      - Stage IV

         - M1a

         - M1b

         - NOTE: patients with stage IV melanoma must have normal lactate dehydrogenase
         (LDH) and either distant skin, subcutaneous, lymph node, or lung metastases,
         but no other visceral metastases in order to be eligible; for patients with
         resected stage IV melanoma, LDH within the institutional upper limit of
         normal (ULN) must be documented within 4 weeks prior to randomization

   - Patients with disease recurrence after adequate surgical excision of the original
   primary cutaneous/unknown primary melanoma are allowed even if they don't fit the
   strict staging criteria, but only as follows:

      - Recurrence in a regional lymph node basin after a prior complete lymph node
      dissection; relapsed disease must be completely surgically resected with free

      - Recurrence in the form of in-transit or satellite metastases or distant
      skin/subcutaneous, nodal, or lung metastases that are completely surgically
      resected with free margins

      - Recurrence in a regional lymph node basin; relapsed disease must be completely
      surgically resected with free margins

   - Patients with unknown primary melanoma (Tx) who present with cutaneous, subcutaneous,
   nodal and/or lung metastases that are completely surgically resected with free margins
   are allowed; these patients are allowed even if they don't fit the strict staging
   criteria; for stage IV patients LDH within the institutional ULN must be documented
   within 4 weeks prior to randomization (M1c is not eligible)

      - NOTE: all subjects should be classified as IIIB, IIIC, M1a or M1b including
      subjects with disease recurrence after adequate surgical excision of the original
      primary melanoma; that is the treating team/physician investigator should review
      an overall TNM status (that includes primary tumor presentation and disease
      recurrence status) and provide a designation of IIIB, IIIC, M1a or M1b

   - Patients must be randomized within 84 days (12 weeks) of surgical resection; if more
   than one surgical procedure is required to render the patient disease-free, the
   patient must be randomized within 12 weeks of the last surgery

      - NOTE: patients with clinically positive lymph nodes for melanoma involvement or
      those with positive lymph nodes identified through lymphoscintigraphic and/or dye
      lymphographic techniques in the groin, axilla, or neck should have additional
      lymphadenectomy in those sites; the complete lymph node dissection procedure
      would be considered as the last surgery in counting the 84 days unless a
      subsequent surgical procedure(s) was clinically required to ensure the disease
      free status

   - Patients must have Eastern Cooperative Oncology Group (ECOG) performance status of 0-1

   - Given that serious adverse events may occur with ipilimumab and IFN-alpha and that
   these may impact a patient's wellbeing, it is possible that the occurrence of other
   serious adverse events (SAEs) may seriously impact an underlying state of mental
   depression and lead to suicidal ideation; therefore, patients should be carefully
   screened for depression at baseline and if there are indications or a history of
   depression it is strongly recommended that these patients be closely followed together
   with behavioral health or psychiatric medical support; patients with an established
   diagnosis of depression that, in the assessment of the investigator may make the
   administration of IFN-alpha or ipilimumab hazardous, should not be enrolled on this
   protocol; the risks and benefits of being treated with standard adjuvant IFN-alpha
   should be weighed very carefully in consultation with behavioral health or psychiatry

   - Due to the possible effect of treatment with ipilimumab on the immunologic response to
   infectious disease vaccines, patients must not have had any infectious disease
   vaccination (e.g., standard influenza, H1N1 influenza, pneumococcal, meningococcal,
   tetanus toxoid) within 4 weeks prior to randomization

   - WOCBP must be using an adequate method of contraception to avoid pregnancy throughout
   the study and for up to 26 weeks after the last dose of ipilimumab or HDI, in such a
   manner that the risk of pregnancy is minimized; women who are using oral
   contraceptives, other hormonal contraceptives (vaginal products, skin patches, or
   implanted or injectable products), or mechanical products such as an intrauterine
   device or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy, or
   are practicing abstinence or where their partner is sterile (e.g., vasectomy) should
   be considered to be of childbearing potential

      - Men of fathering potential and WOCBP must be using an adequate method of
      contraception to avoid conception/pregnancy throughout the study and for up to 26
      weeks after the last dose of ipilimumab or HDI in such a manner that the risk of
      pregnancy is minimized; men or WOCBP who are unwilling or unable to strictly
      follow this requirement are not eligible

      - WOCBP are not eligible if they satisfy any of the following:

         - A positive pregnancy test at baseline

         - Pregnant or breastfeeding

   - White blood cell (WBC) >= 3,000/uL (obtained within 4 weeks prior to randomization)

   - Absolute neutrophil count (ANC) >= 1,500/uL (obtained within 4 weeks prior to

   - Platelets >= 100 x 10^3/uL (obtained within 4 weeks prior to randomization)

   - Hemoglobin >= 10 g/dL (obtained within 4 weeks prior to randomization)

   - Serum creatinine =< 1.5 mg/dL (obtained within 4 weeks prior to randomization)

   - Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.5 x ULN (obtained
   within 4 weeks prior to randomization)

   - Serum bilirubin =< 1.5 x ULN, (except patients with Gilbert's syndrome, who must have
   a total bilirubin less than 3.0 mg/dL) (obtained within 4 weeks prior to

   - No active or chronic infection with human immunodeficiency virus (HIV), hepatitis B,
   or hepatitis C due to the unknown effects of ipilimumab; patients must have negative
   testing for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV) within 4 weeks prior
   to randomization

Exclusion Criteria:

   - Patients must not have received any adjuvant treatment (chemotherapy, biotherapy, or
   limb perfusion) after the resection(s) that make(s) them eligible for this trial

      - NOTE: previous radiation therapy, including after the surgical resection, is
      allowed as long as 21 days have elapsed between the radiation and initiation of
      this adjuvant systemic therapy

   - Prior treatment with anti-cytotoxic T-lymphocyte antigen 4 (CTLA4) monoclonal
   antibodies or prior CTLA-4 inhibitor or agonist or prior clusters of differentiation
   (CD)137 agonist or prior interferon-alfa is not allowed; other forms of prior
   treatment for melanoma (e.g., aldesleukin [IL-2], anti-tumor vaccine, chemotherapy)
   are allowed if given before the resection(s) that make(s) the patient eligible for
   this trial, but these must have been completed at least 4 weeks prior to randomization

   - Patients must not have an active infection requiring current treatment with parenteral

   - Patients must not have other significant medical, surgical, or psychiatric conditions
   or require any medication or treatment that in the opinion of the investigator may
   interfere with compliance, make the administration of ipilimumab or HDI hazardous or
   obscure the interpretation of adverse events (AEs), such as a condition associated
   with frequent diarrhea; patients with a baseline of frequent diarrhea (e.g. irritable
   bowel syndrome) are not eligible because of the difficulty in interpreting later
   expected GI toxicities that may lead to suboptimal management and complications

   - Patients must not have a documented history of inflammatory bowel disease (including
   ulcerative colitis and Crohn's disease) or diverticulitis (history of diverticulosis
   is allowed)

   - Patients must not have autoimmune disorders or conditions of immunosuppression that
   require current ongoing treatment with systemic corticosteroids (or other systemic
   immunosuppressants), including oral steroids (i.e., prednisone, dexamethasone) or
   continuous use of topical steroid creams or ointments or ophthalmologic steroids; a
   history of occasional (but not continuous) use of steroid inhalers is allowed;
   replacement doses of steroids for patients with adrenal insufficiency are allowed;
   patients who discontinue use of these classes of medication for at least 2 weeks prior
   to randomization are eligible if, in the judgment of the treating physician
   investigator, the patient is not likely to require resumption of treatment with these
   classes of drugs during the study

      - Exclusion from this study also includes patients with a history of symptomatic
      autoimmune disease (e.g., rheumatoid arthritis, systemic progressive sclerosis
      [scleroderma], systemic lupus erythematosus, Sjogren's syndrome, autoimmune
      vasculitis [e.g., Wegener's granulomatosis]); motor neuropathy considered of
      autoimmune origin (e.g., Guillain-Barre syndrome and Myasthenia Gravis); other
      central nervous system (CNS) autoimmune disease (e.g., poliomyelitis, multiple

      - Patients with autoimmune hypothyroid disease or type I diabetes on replacement
      treatment are eligible

   - Patients must not be prisoners or subjects who are compulsorily detained
   (involuntarily incarcerated) for treatment of either a psychiatric or physical (e.g.,
   infectious) illness; this is due to concerns about subject safety and compliance with
   study procedures

   - Patients who have other current malignancies are not eligible; patients with other
   malignancies are eligible if they have been continuously disease free for > 5 years
   prior to the time of randomization; patients with prior history at any time of any in
   situ cancer, lobular carcinoma of the breast in situ, cervical cancer in situ,
   atypical melanocytic hyperplasia or melanoma in situ are eligible; patients with prior
   history of basal or squamous skin cancer are eligible; patients who have had multiple
   primary melanomas are eligible

   - Women must not be pregnant or breast-feeding due to the unknown effects of ipilimumab
   and HDI on conception and the fetus; all females of childbearing potential must have a
   blood test or urine study during screening to rule out pregnancy

      - NOTE: a woman of childbearing potential (WOCBP) is any woman, regardless of
      sexual orientation or whether they have undergone tubal ligation, who meets the
      following criteria: 1) has not undergone a hysterectomy or bilateral
      oophorectomy; or 2) has not been naturally postmenopausal for at least 24
      consecutive months (i.e., has had menses at any time in the preceding 24
      consecutive months); post-menopause is defined as:

         - Amenorrhea >= 12 consecutive months without another cause, or

         - For women with irregular menstrual periods and taking hormone replacement
         therapy (HRT), a documented serum follicle stimulating hormone (FSH) level
         >= 35 mIU/mL


biological: ipilimumab

other: Quality-of-Life Assessment

biological: Recombinant Interferon Alfa-2b

Not Recruiting

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305

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