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

Clinical trial: Docetaxel With or Without AZD6244 in Melanoma

Summary: This is a randomised, double-blind placebo controlled phase 2 trial. Patient will be randomly assigned 1:1 between 2 treatment arms. They will receive either docetaxel 75mg/m2 IV and placebo given bd, or AZD6244 75mg bd daily with docetaxel 75mg/m2 IV. Docetaxel will be administered every 3 weeks for a maximum 6 cycles, but AZD6244/placebo may be continued beyond this, until disease progression. The objective is to assess whether the combination of AZD6244 with docetaxel is worthy of evaluation in a definitive randomised study, with the null hypothesis being that the combination has activity similar to that of docetaxel alone in this population. After consent has been obtained mutational analysis of tumour BRAF will be performed on archival tumour tissue, where this information is not already known, to assess eligibility for the study. If there is no archival tissue a fresh biopsy will be requested from the patient. A blood sample will also be taken for future genetic analysis. Once taking part in the trial patients will need to attend their oncology unit regularly for monitoring and the delivery of treatment. Patients will undergo complete physical examination at screening, on C1D1, C1D8, C1D15, C2D1, C2D8 and day 1 of every subsequent cycle. Blood for haematology, biochemistry and clotting will be taken at each of these visits. A 12 lead ECG will be performed at screening . Disease assessment will be by CT scanning using modified RECIST criteria after 9 and 18 weeks, then every 3 months until disease progression.

Detailed description: No further information in addition to what has been provided in the brief summary

Eligibility: Inclusion Criteria:
  -  Aged >/= 16 years
  -  Able to provide evidence from an accredited laboratory of wt BRAF status for their melanoma, or ascertainment of wt BRAF status from a sample of melanoma provided for mutational analysis in Oxford.
  -  Unresectable stage 3 or 4, histologically proven cutaneous or unknown primary melanoma
  -  At least 1 lesion, not previously irradiated, that can be accurately measured on CT or MRI as defined by modified RECIST criteria
  -  ECOG performance score of 0 or 1.
  -  Life expectancy of at least 12 weeks.
  -  The patient is willing to give consent to the main study and able to comply with the protocol for the duration of the study, including scheduled follow-up visits and examinations.
  -  Haematological and biochemical indices within the ranges shown below. Lab Test Value required Haemoglobin (Hb) >10g/dL White Blood Count (WBC) > 3x109/L Platelet count > 100,000/μL Absolute Neutrophil count > 1.5x109/L; Serum bilirubin ≤ 1.2 x ULN AST (SGOT) or ALT ≤ 2.5 x ULN LDH ≤ 2 x ULN Creatinine clearance (Cockcroft-Gault) >50 ml/min
  Exclusion Criteria:
  -  Any anti-cancer therapy (including radiotherapy and participation in other clinical trials) within 28 days prior to Day 1.
  -  Prior DNA damaging agents or cytotoxic chemotherapy for metastatic melanoma.
  -  Any unresolved toxicity from prior anti-cancer therapy that is greater than CTCAE grade 2.
  -  Pregnancy or breastfeeding women. Female patients must have a negative urinary or serum pregnancy test or have evidence of post-menopausal status (defined as absence of menstruation for > 12 months, bilateral oophrectomy or hysterectomy).
  -  Grade ≥2 peripheral neuropathy at study entry.
  -  Patients of reproductive potential who are not willing to use adequate contraceptive measures for the duration of the study (both male and female patients)
  -  Known severe hypersensitivity reactions to docetaxel or other drugs formulated in polysorbate 80
  -  Ocular or mucosal malignant melanoma
  -  Another active malignancy within the past five years.
  -  Evidence of brain metastases, unless surgically resected/stereotactic radiosurgery treated brain metastasis with no evidence of relapse on cerebral MRI, or treated brain metastasis and stable off treatment, including steroids, for 3 months.
  -  Clinically significant and uncontrolled major medical condition(s): such as active infection, bleeding diathesis.
  -  Patients who are known to be serologically positive for Hepatitis B, Hepatitis C or HIV.
  -  Cardiac conditions, including uncontrolled hypertension (BP>160/100 despite treatment), heart failure NYHA class 2 or above, prior or current cardiomyopathy, myocardial infarction within 6 months or angina requiring nitrate therapy more than once a week.
  -  Previous treatment with EGFR, ras, raf or MEK inhibitors.
  -  Inability to swallow capsules, refractory nausea and vomiting, chronic gastrointestinal diseases (eg, inflammatory bowel disease) or significant bowel resection that would preclude adequate absorption.
  -  Taking medication that significantly induces or inhibits CYP3A4.

Relevance to patient case: not relevant