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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT02374242
Registration number
NCT02374242
Ethics application status
Date submitted
9/02/2015
Date registered
27/02/2015
Titles & IDs
Public title
Anti-PD 1 Brain Collaboration for Patients With Melanoma Brain Metastases
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Scientific title
A Phase II Study of Nivolumab and Nivolumab Combined With Ipilimumab in Patients With Melanoma Brain Metastases
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Secondary ID [1]
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ACTRN12614001315606
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Secondary ID [2]
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CA209-170
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Universal Trial Number (UTN)
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Trial acronym
ABC
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Melanoma
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Brain Metastases
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Condition category
Condition code
Cancer
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Malignant melanoma
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Cancer
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Brain
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Nivolumab
Treatment: Drugs - Ipilimumab
Active comparator: Cohort 1 Nivolumab Monotherapy - Nivolumab 3mg/kg every 2 weeks, until disease progression, withdrawn consent, unacceptable toxicity or death.
Active comparator: Cohort 2 Nivolumab Monotherapy - Nivolumab 3mg/kg every 2 weeks, until disease progression, withdrawn consent, unacceptable toxicity or death.
Active comparator: Cohort 3 Nivolumab and Ipilimumab - Nivolumab 1mg/kg every 3 weeks x four doses and ipilimumab 3mg/kg every 3 weeks x four doses. After 12 weeks, nivolumab 3mg/kg alone every 2 weeks until disease progression, withdrawn consent, unacceptable toxicity or death.
Treatment: Drugs: Nivolumab
Nivolumab is a fully human monoclonal antibody directed against the negative immunoregulatory human cell surface receptor PD-1 (programmed death-1 or programmed cell death-1/PCD-1) with immunopotentiation activity.
Treatment: Drugs: Ipilimumab
Ipilimumab is a recombinant, human monoclonal antibody that binds to the cytotoxic T lymphocyte-associated antigen 4 (CTLA-4). CTLA-4 is a negative regulator of T-cell activation. Ipilimumab binds to CTLA-4 and blocks the interaction of CTLA-4 with its ligands, CD80/CD86. Blockade of CTLA-4 has been shown to augment T-cell activation and proliferation. The mechanism of action of ipilimumab's effect in patients with melanoma is indirect, possibly through T-cell mediated anti-tumour immune responses.
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Intracranial response rate
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Assessment method [1]
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Proportion of patients with a complete or partial response in intracranial metastases as measured using RECIST 1.1 criteria (modified for brain metastases - bm RECIST), from week 12.
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Timepoint [1]
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Approximately 3 years
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Secondary outcome [1]
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Extracranial response rate
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Assessment method [1]
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Proportion of patients with an overall complete or partial response in extra cranial metastases as measured using bm RECIST.
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Timepoint [1]
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Approximately 3 years
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Secondary outcome [2]
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Overall response rate
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Assessment method [2]
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Proportion of patients with an overall complete or partial response as measured using bm RECIST 1.1 criteria.
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Timepoint [2]
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Approximately 3 years
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Secondary outcome [3]
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Progression free survival in intracranial disease
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Assessment method [3]
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Time from the baseline assessment to the date of intracranial progression as measured using bm RECIST 1.1 criteria.
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Timepoint [3]
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Approximately 3 years
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Secondary outcome [4]
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Progression free survival in extracranial disease
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Assessment method [4]
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Time from the baseline assessment to the date of extracranial progression as measured using bm RECIST 1.1 criteria.
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Timepoint [4]
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Approximately 3 years
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Secondary outcome [5]
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Overall progression free survival
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Assessment method [5]
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Time from the baseline assessment to the date of local or distant progression as measured using bm RECIST 1.1 criteria. Patients dying from causes other than melanoma or treatment related toxicity will be censored at date of death. Patients alive without progression or with second primary cancers will be censored at date of last assessment.
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Timepoint [5]
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Approximately 3 years
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Secondary outcome [6]
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Overall survival
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Assessment method [6]
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Time from commencing study treatment to the date of death from any cause. Patient still alive will be censored at the date of last assessment.
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Timepoint [6]
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Up to approximately 5 years
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Secondary outcome [7]
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Safety and tolerability of nivolumab and nivolumab + ipilimumab (verse events by type, frequency and severity using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.03.)
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Assessment method [7]
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Description of adverse events by type, frequency and severity using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.03.
Number of patients who withdraw from the study due to intolerable adverse reactions.
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Timepoint [7]
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Approximately 3 years
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Secondary outcome [8]
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Patient rated quality of life
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Assessment method [8]
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The mean change from baseline quality of life scores at the time of clinical response, stable disease and progression in each cohort.
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Timepoint [8]
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Approximately 3 years
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Secondary outcome [9]
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Clinical response using immune related response criteria (irRC)
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Assessment method [9]
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Proportion of patients with an intracranial, extracranial and overall complete or partial response, stable disease or progression and progression free survival as measured using immune-related response criteria (irRC) and the proportion of concordant or discordant results compared with bm RECIST.
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Timepoint [9]
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Approximately 3 years
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Secondary outcome [10]
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Tissue and blood biomarkers of response and progression
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Assessment method [10]
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PD-L1 status, immune markers and genetics of response and resistance in tumour tissue at baseline and at disease progression. Lymphocyte, T cell subsets, myeloid derived suppressor cells and other biomarkers in blood at baseline, after 2 weeks on study treatment and then every 6 weeks, to examine if any specific subsets are predictive or response or progression.
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Timepoint [10]
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Approximately 3 years
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Secondary outcome [11]
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FET-PET response in the brain at 6 and 12 weeks on therapy (Proportion of patients with a lower standardised uptake value from baseline in intracranial metastases, following at least ONE dose of study treatment)
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Assessment method [11]
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Comparison of FET-PET to MRI findings. Proportion of patients with a lower standardised uptake value from baseline in intracranial metastases, following at least ONE dose of study treatment(s).
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Timepoint [11]
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Approximately 1 year
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Eligibility
Key inclusion criteria
Cohort 1 and 3
1. =18 years of age.
2. Written informed consent
3. AJCC Stage IV (any T, any N, M1c) histologically confirmed melanoma or unknown primary melanoma. Patients must have at least 1 radiological definitive brain metastasis that is = 5mm and =40mm measurable per RECIST version 1.1 guidelines.
4. In patients with prior BRAF inhibitor treatment, intracranial disease progression must be demonstrated (RECIST >20% or new measurable brain metastases) compared with nadir of intracranial response during BRAF inhibitor treatment, and confirmed with a second MRI brain scan at any time from the beginning of the drug washout period (dabrafenib=5 days, trametinib=14 days).
5. No prior localised treatment for brain metastases (eg. surgery or radiotherapy).
6. Neurologically asymptomatic from brain metastases.
7. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-2, and life expectancy > 30 days.
8. Able to undergo MRI with Gadolinium contrast agent.
9. Adequate haematological, hepatic and renal organ function.
10. Women of childbearing potential: negative serum pregnancy test and effective contraception from 14 days prior to study treatment until 23 weeks after the last dose.
11. Men with female partner of childbearing potential to use effective contraception from 14 days prior to study treatment until 31 weeks after the last dose.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
12. Any melanoma brain metastasis >40mm.
13. Ocular melanoma.
14. Prior treatment with an anti-PD-1 or anti-PD-L1 , anti-PD-L2, anti-CD137, or anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways.
15. Patients with active, known or suspected autoimmune disease. Patients with vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.
16. Current systemic treatment with corticosteroids, except prednisone at nonimmunosuppressive doses of = 10 mg/day (or equivalent). Past treatment for non-neurological symptoms allowed, if ceased 2 weeks prior to starting study treatment. Inhaled or intranasal corticosteroids (with minimal systemic absorption) may be continued if patient on a stable dose. Non-absorbed intraarticular steroid injections will be permitted.
17. Any investigational drug or other systemic drug therapy for melanoma within 28 days or 5 half-lives from baseline.
18. Known to be HIV positive, or a positive test for hepatitis B and C .
19. Another malignancy or concurrent malignancy unless disease-free for 3 years.
20. Serious or unstable pre-existing medical conditions or other conditions that could interfere with the patient's safety, consent, or compliance.
21. Pregnant or breastfeeding females.
22. Administration of any form of live vaccination (such as influenza vaccine) within 30 days of starting trial and anticipated use during the trial. Administration of any other vaccine is cautionary within 30 days of starting the trial and during the trial.
Cohort 2 - per Cohorts 1 & 3, except patients must have at least one of the following:
1. Failed prior local therapy for brain metastases (including surgery, stereotactic radiotherapy or whole brain radiotherapy) where disease has progressed per RECIST (>20% increase in SOD or new measurable brain metastases),
and/or;
2. Have current neurological symptoms related to brain metastases. IF they have received prior local therapy for brain metastases, the disease must have progressed per RECIST (>20% increase in SOD or new measurable brain metastases),
and/or;
3. Have leptomeningeal disease concurrently with measurable brain metastases. IF they have had failed prior local therapy for brain metastases, this must have progressed per RECIST (>20% increase in SOD or new measurable brain metastases).
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 2
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Active, not recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
4/11/2014
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/12/2028
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Actual
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Sample size
Target
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Accrual to date
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Final
76
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,VIC
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Recruitment hospital [1]
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Melanoma Institute Australia - North Sydney
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Recruitment hospital [2]
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Princess Alexandra Hospital - Woolloongabba
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Recruitment hospital [3]
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Royal Adelaide Hospital - Adelaide
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Recruitment hospital [4]
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Peter MacCallum Cancer Centre - East Melbourne
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Recruitment postcode(s) [1]
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2060 - North Sydney
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Recruitment postcode(s) [2]
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4102 - Woolloongabba
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Recruitment postcode(s) [3]
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5000 - Adelaide
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Recruitment postcode(s) [4]
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3002 - East Melbourne
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Funding & Sponsors
Primary sponsor type
Other
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Name
Melanoma Institute Australia
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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Melanoma and Skin Cancer Trials Limited
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Address [1]
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Country [1]
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Other collaborator category [2]
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Commercial sector/industry
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Name [2]
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Bristol-Myers Squibb
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Address [2]
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Country [2]
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Ethics approval
Ethics application status
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Summary
Brief summary
The purpose of this research project is to test the effectiveness of nivolumab versus nivolumab together with ipilimumab for the treatment of melanoma brain metastases. Patients are eligible to join this study if they are aged 18 years or above and have been diagnosed with melanoma with brain metastases.
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Trial website
https://clinicaltrials.gov/study/NCT02374242
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Trial related presentations / publications
Long GV, Atkinson V, Lo S, Sandhu S, Guminski AD, Brown MP, Wilmott JS, Edwards J, Gonzalez M, Scolyer RA, Menzies AM, McArthur GA. Combination nivolumab and ipilimumab or nivolumab alone in melanoma brain metastases: a multicentre randomised phase 2 study. Lancet Oncol. 2018 May;19(5):672-681. doi: 10.1016/S1470-2045(18)30139-6. Epub 2018 Mar 27.
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Public notes
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Contacts
Principal investigator
Name
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Georgina Long
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Address
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Melanoma Institute Australia
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT02374242