Patient case: 86-year-old female with melanoma; genetic feature: high tumor mutational burden

Clinical trial: XL888 + Vemurafenib + Cobimetinib for Unresectable BRAF Mutated Stage III/IV Melanoma

Summary: The main purpose of this study is to determine the maximum tolerated dose (MTD) and recommended phase II dose (RP2D) of XL888 when administered orally with vemurafenib plus cobimetinib in participants with BRAF V600 mutated melanoma and to evaluate the safety and tolerability of this combination.


Eligibility: Inclusion Criteria:
  -  Must be 18 years of age or above. All races and ethnicities are eligible and no upper limit of age is specified.
  -  Must have cytologically or histologically-confirmed unresectable melanoma that harbors a BRAF V600 E or K mutation determined by pyrosequencing assay or equivalent genotyping assay in a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory, meeting one of the following AJCC staging criteria: 1.) American Joint Committee on Cancer (AJCC) stage IV (Tany, Nany, M1a, b, or c); 2.) AJCC stage IIIB or IIIC with unresectable nodal/locoregional involvement.
  -  Adequate hepatic, renal, and bone marrow function with parameters obtained within 2 weeks prior to initiation of study treatment.
  -  Eastern Cooperative Oncology Group (ECOG) performance status of ≤2.
  -  Willing to give written informed consent per institutional guidelines and must be able to adhere to dose and visit schedules.
  -  Negative serum pregnancy test within 7 days prior to commencement of dosing in premenopausal women. Women of non-childbearing potential may be included without serum pregnancy test if they are either surgically sterile or have been postmenopausal for ≥1 year.
  -  Fertile men and women must use an effective method of contraception during treatment and for at least 6 months after completion of treatment as directed by their physician.
  -  Treatment-naïve and previously treated patients will be included; however, patients may not have received a BRAF, Mitogen Activated Kinase (MEK) or HSP90 inhibitor in the past.
  -  May have received prior systemic and/or radiation therapy. All adverse events associated with prior systemic therapy or radiation therapy must have resolved to ≤ Grade 1 prior to start of study.
  -  Must have measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.
  Exclusion Criteria:
  -  Women who are pregnant, intend to become pregnant or are nursing.
  -  Previously treated with BRAF, MEK or HSP90 inhibitor therapy.
  -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, or psychiatric illness/social situations that would limit compliance with study requirements.
  -  HIV-positive patients on combination antiretroviral therapy.
  -  Potential participants with untreated or uncontrolled brain metastases or evidence of leptomeningeal disease. Patients with asymptomatic brain metastases or previously treated brain metastases that are stable (i.e., not requiring corticosteroids) at the time of study start will be eligible.
  -  Previous malignancy is not an exclusion provided that the other malignancy is considered under control, patient is not on concomitant anti-cancer drug therapy, and target lesions from melanoma are clearly defined for response assessment.
  -  History of malabsorption or other condition that would interfere with absorption of study drugs.
  -  The following foods/supplements are prohibited at least 7 days prior to initiation of and during study treatment: St. John's wort or hyperforin (potent cytochrome P450 CYP3A4 enzyme inducer); Grapefruit juice (potent cytochrome P450 CYP3A4 enzyme inhibitor).
  -  Ocular: History of or evidence of retinal pathology on ophthalmologic examination that is considered a risk factor for neurosensory retinal detachment, retinal vein occlusion (RVO), or neovascular macular degeneration.
  -  Cardiac: History of clinically significant cardiac dysfunction.

Relevance to patient case: not relevant