Patient case: 69-year-old female with melanoma; genetic feature: high serum LDH levels

Clinical trial: A Study of Intratumoral CAVATAK in Patients With Stage IIIc and Stage IV Malignant Melanoma

Summary: Approximately 63 patients with stage IIIc or stage IV melanoma will receive 10 intratumoural injections of CAVATAK (Coxsackievirus A21) over 18 weeks.
  Disease progression will be monitored by computed tomography (CT) and rated by the RECIST 1.1 assessment criteria. Patients will be monitored for 1 year from their first treatment.
  CAVATAK is an oncolytic (cancer killing) virus. Direct injection of the virus into tumors may kill cancer cells by the lytic action of the virus. This action also releases tumor cell debris that may illicit a response by the patients own immune system against the tumour. This study seeks to assess the performance of CAVATAK in both of these actions in late stage melanoma.
  Study objectives include:
  -  Immune-related Progression-Free Survival
  -  Durable Response Rate
  -  Progression Free Survival at 6 months
  -  Quality of Life


Eligibility: Inclusion Criteria:
  1. Patient with histologically proven stage IIIc or stage IV melanoma who fails to qualify for curative surgery and who bears one or more tumors that are accessible for direct injection
  2. Patient must have had no more than one previous systemic regimen for management of melanoma; however, adjuvant chemotherapy administered 6 months or longer before entering the trial does not count as a line of treatment
  3. Absence of circulating serum neutralizing antibodies to CVA21 (titer < 1:16)
  4. At least one tumor 0.5 to 10 cm in the longest diameter must be suitable for injection and at least one tumor must be equal to or greater than 1 cm and qualified to be a target lesion for RECIST 1.1 criteria
  5. Patient must have adequate hematologic, hepatic and renal function, defined as:
  -  Absolute neutrophil count (ANC) > 1.5 x 10^9/L, platelets > 100 x 10^9/L
  -  Bilirubin < 1.5 times the upper limit of normal (ULN), aspartate aminotransferase (AST) < 2.5 x ULN
  -  Serum creatinine < 1.5 x ULN; if > 1.5 x ULN, it must be confirmed that creatinine clearance > 30 mL/minute
  6. Serum lactate dehydrogenase (LDH) levels < or = 1.5 x ULN
  7. Male or female age 18 years or older
  8. Performance status (Eastern Cooperative Oncology Group [ECOG]) 0 or 1
  9. Estimated life expectancy of more than 6 months
  10. Recovered from prior therapy with at least 4 weeks since the last exposure to chemotherapy or radiotherapy
  11. Patient is able and willing to provide written informed consent to participate in the study
  12. Fertile males and females must agree to the use of an adequate form of contraception, e.g., condoms for males. A negative pregnancy test is required in female patients of childbearing potential.
  Exclusion Criteria:
  1. Mucosal or ocular primary tumors
  2. Bone metastases
  3. Greater than 3 visceral metastases
  4. Any visceral metastases > 10 cm
  5. Serum anti-CVA21 neutralizing titer of > 1:16 at baseline
  6. Presence of any central nervous system (CNS) tumor that has not been stable for at least 3 months off corticosteroids and confirmed by imaging
  7. Tumors to be injected lying in mucosal regions or close to an airway, major blood vessel or spinal cord that, in the opinion of the Investigators, could cause occlusion into a major vessel in the case of necrosis
  8. Only measurable tumor had prior local radiotherapy without subsequent nodule progression
  9. Patient has received chemotherapy within the last 4 weeks prior to first injection
  10. ECOG score greater than 1
  11. Estimated life expectancy of less than 6 months
  12. Pregnancy or breastfeeding
  13. Primary or secondary immunodeficiency, including immunosuppressive disease, and immunosuppressive doses of corticosteroids (e.g., prednisolone > 7.5 mg per day) or other immunosuppressive medications including cyclosporine, azathioprine, interferons within the past 4 weeks prior to screening
  14. Positive serology for human immunodeficiency virus (HIV), hepatitis B or C
  15. Full dose anticoagulation or a history of bleeding diathesis or poorly controlled bleeding in the last month prior to screening
  16. Previous splenectomy
  17. Presence of uncontrolled infection
  18. Presence of unstable neurological disease
  19. Any uncontrolled medical condition that, in the opinion of the investigator, is likely to place the patient at unacceptable risk during the study or reduce his/her ability to complete the study
  20. Participation in another study requiring administration of an investigational drug or biological agent within the last 4 weeks prior to screening
  21. Any other medical or psychological condition that would preclude participation in the study or compromise ability to give informed consent
  22. Participation in any previous melanoma immunotherapy trial within 1 month prior to entry to this trial or any trial of any other investigational agent within the last month prior to entry to this trial
  23. Active infections or serious general medical conditions
  24. Patients with previous malignancies should only be permitted if they have been in a continued state of "no evidence of disease" for at least 5 years with the exception of adequately treated carcinoma in situ of the cervix, ductal carcinoma in situ (DCIS) of the breast, and basal cell/squamous cell skin cancer
  25. Known allergy to treatment medication or its excipients and/or to the contrast medium

Relevance to patient case: not relevant