Patient case: 47-year-old male with melanoma; genetic feature: APC loss of function

Clinical trial: Tremelimumab and CP-870,893 in Patients With Metastatic Melanoma

Summary: RATIONALE: Monoclonal antibodies, such as tremelimumab and CD40 agonist monoclonal antibody CP-870,893, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry cancer-killing substances to them. Giving tremelimumab together with CD 40 agonist monoclonal antibody CP-870, 893 may kill more tumor cells.
  PURPOSE: This phase I trial is studying the side effects and best dose of giving tremelimumab together with CD40 agonist monoclonal antibody CP-870,893 in treating patients with metastatic melanoma.

Detailed description: PRIMARY OBJECTIVES:
  I. To assess the safety, dose-limiting toxicities and maximum tolerated doses of tremelimumab (administered intravenously every 12 weeks) and CP- 870,893 (administered intravenously every 3 weeks).
  SECONDARY OBJECTIVES:
  I To seek preliminary evidence of anti-tumor efficacy of the combination of tremelimumab and CP-870,893, including objective response rate at MTD.
  II. To determine the immune pharmacodynamic changes associated with the administration of the combination of tremelimumab and CP-870,893.
  OUTLINE: Patients receive tremelimumab IV over 1 hour on day 1 and CD40 agonist monoclonal antibody CP-870,893 IV over 30 minutes on days 2, 22, 43, and 64. Treatment repeats every 12 weeks for up to 4 courses in the absence of disease progression or unacceptable toxicity.
  After completion of study treatment, patients are followed for 4 weeks.

Eligibility: Inclusion
  -  Patients with metastatic melanoma who have measurable disease
  -  ECOG PS 0 or 1
  -  Adequate bone marrow function
  -  WBC >= 3,000
  -  Hgb >= 9
  -  Plt >= 100
  -  Adequate hepatic function, defined by the following parameters:
  -  Total bilirubin WNL unless associated with hepatobiliary metastases or Gilbert syndrome, then total bilirubin =< 2 x ULN
  -  Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 x ULN unless associated with hepatic metastases, then ALT and AST =< 5 x ULN
  -  Signed, written informed consent
  Exclusion
  -  Previous treatment with any other compound that targets CD40 or CTLA4
  -  Concurrent treatment with any anticancer agent outside of this protocol
  -  Prior allogeneic bone marrow transplant
  -  History of brain metastases, even if previously treated
  -  History of autoimmune disorder, including type 1 diabetes mellitus, pemphigus vulgaris, systemic mastocytosis, systemic lupus erythromatosis, dermatomyositis/polymyositis, rheumatoid arthritis, systemic sclerosis, Sjorgen's syndrome, vasculitis/arteritis, Behcet's syndrome, autoimmune thyroiditis, multiple sclerosis, or uveitis
  -  History of chronic inflammatory bowel disease (e.g., Crohn's disease or ulcerative colitis), celiac disease, or other chronic gastrointestinal conditions associated with diarrhea, or current acute colitis or enterocolitis of any etiology
  -  History of diverticulitis (even a single episode) or evidence at baseline, including evidence limited to CT scan only. Note diverticulosis is not an exclusion criterion per se.
  -  History (within the previous year) of stroke or transient ischemic attack, unstable angina, myocardial infarction, congestive heart failure
  -  History of deep venous thrombosis or migratory thrombophlebitis (Trousseau)
  -  Hereditary or acquired coagulopathies (e.g., hemophilia, von Willebrand's disease, or cancer-associated DIC)
  -  Prior allergic reactions attributed to other monoclonal antibodies
  -  Concurrent or planned concurrent treatment with systemic high dose (immunosuppressive) corticosteroids or treatment with systemic corticosteroids within 4 weeks of baseline
  -  Treatment on another therapeutic clinical trial within 4 weeks of enrollment in this trial
  -  Concurrent or planned concurrent treatment with anticoagulants such as Coumadin or heparin, except to maintain patency of in-dwelling catheters
  -  Ongoing or active infection; treatment with systemic antibiotics or antifungals for ongoing or recurrent infection (topical use of antibiotics or antifungals is allowed)
  -  Pregnancy or breast-feeding; female patients must be surgically sterile, be postmenopausal, or must agree to use effective contraception during the period of therapy and for 12 months following the last dose of either tremelimumab or CP-870,893; all female patients with reproductive potential must have a negative pregnancy test prior to enrollment
  -  Other uncontrolled, concurrent illness that would preclude study participation; or, psychiatric illness or social challenges that would entail unreasonable risk or preclude informed consent or compliance with study procedures

Relevance to patient case: not relevant