Ipilimumab With or Without High-Dose Recombinant Interferon Alfa-2b in Treating Patients With Stage III-IV Melanoma That Cannot Be Removed by Surgery
Condition: Recurrent Melanoma; Stage IIIA Cutaneous Melanoma AJCC v7; Stage IIIB Cutaneous Melanoma AJCC v7; Stage IIIC Cutaneous Melanoma AJCC v7; Stage IV Cutaneous Melanoma AJCC v6 and v7
MeSH terms: Melanoma; Skin Neoplasms
Intervention: Ipilimumab; Laboratory Biomarker Analysis; Recombinant Interferon Alfa-2b
Intervention description: Given IV; Correlative studies; Given IV or SC
Intervention MeSH terms: Interferons; Interferon-alpha; Interferon alpha-2; Ipilimumab
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 88.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This randomized phase II trial studies how well ipilimumab with or without high-dose
      recombinant interferon alpha-2b works in treating patients with stage III-IV melanoma that
      cannot be removed by surgery. Monoclonal antibodies, such as ipilimumab, may block tumor
      growth by targeting certain cells. Recombinant interferon alfa-2b may interfere with the
      growth of tumor cells. It is not yet known whether ipilimumab is more effective with or
      without high-dose recombinant interferon alfa-2b in treating melanoma.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have unresectable stage III or stage IV melanoma, either initial
             presentation or recurrent, that is of cutaneous origin or unknown primary origin and
             that is histologically diagnosed

          -  No more than one prior systemic therapeutic regimen for unresectable stage III or
             stage IV melanoma; this includes chemotherapy, biologic therapy, biochemotherapy, or
             investigational treatment; this does not include any therapies given in the adjuvant
             setting; however, patients are excluded if they have a history of prior treatment for
             melanoma (either adjuvant or metastatic disease) with ipilimumab or other cytotoxic
             T-lymphocyte antigen 4 (CTLA-4) inhibitor, or prior interferon-alpha treatment for
             metastatic disease (history of adjuvant interferon-alpha is allowed); there should be
             a 4-week washout period between last treatment administration and initiation of study
             therapy

          -  Patients must have Eastern Cooperative Oncology Group (ECOG) performance status of 0-1

          -  Patients must not have other significant medical, surgical, or psychiatric conditions
             or require any medication or treatment that in the opinion of the investigator may
             interfere with compliance, make the administration of ipilimumab or HDI hazardous or
             obscure the interpretation of adverse events (AEs), such as a condition associated
             with frequent diarrhea; patients must not have an active infection requiring current
             treatment with parenteral antibiotics

          -  Patients must not have a history of inflammatory bowel disease or diverticulitis
             (history of diverticulosis is allowed)

          -  Patients who have other current malignancies are not eligible; patients with other
             malignancies are eligible if they have been continuously disease free for > 5 years
             prior to the time of randomization; one exception are patients treated with a curative
             intent and are continuously disease free for > 3 years; these patients would be
             considered eligible:

               -  Patients with prior history at any time of any in situ cancer, lobular carcinoma
                  of the breast in situ, cervical cancer in situ, atypical melanocytic hyperplasia
                  or Clark I melanoma in situ are eligible

               -  Patients with prior history of basal or squamous skin cancer are eligible

          -  Patients must not have autoimmune disorders or conditions of immunosuppression that
             require current ongoing treatment with systemic corticosteroids (or other systemic
             immunosuppressants), including oral steroids (e.g., prednisone, dexamethasone) or
             continuous use of topical steroid creams or ointments or ophthalmologic steroids; a
             history of occasional (but not continuous) use of steroid inhalers is allowed;
             replacement doses of steroids for patients with adrenal insufficiency are allowed;
             patients who discontinue use of these classes of medication for at least 2 weeks prior
             to randomization are eligible if, in the judgment of the treating physician
             investigator, the patient is not likely to require resumption of treatment with these
             classes of drugs during the study; exclusion from this study also includes patients
             with a history of symptomatic autoimmune disease (e.g., rheumatoid arthritis, systemic
             progressive sclerosis [scleroderma], systemic lupus erythematosus, Sjogren's syndrome,
             autoimmune vasculitis [e.g., Wegener's granulomatosis]); motor neuropathy considered
             of autoimmune origin (e.g., Guillain-Barre syndrome and Myasthenia gravis); other
             central nervous system (CNS) autoimmune disease (e.g., poliomyelitis, multiple
             sclerosis); patients with autoimmune hypothyroid disease or type I diabetes on
             replacement treatment are eligible

          -  Due to the possible effect of treatment with ipilimumab on the immunologic response to
             infectious disease vaccines, patients must not have had any infectious disease
             vaccination (e.g, standard influenza, H1N1 influenza, pneumococcal, meningococcal,
             tetanus toxoid) within 4 weeks prior to randomization

          -  Women must not be pregnant or breast-feeding; all females of childbearing potential
             must have a blood test or urine study during screening to rule out pregnancy; NOTE: a
             woman of childbearing potential (WOCBP) is any woman, regardless of sexual orientation
             or whether they have undergone tubal ligation, who meets the following criteria: has
             not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally
             postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in
             the preceding 24 consecutive months); for the purposes of this study, post-menopause
             is defined as:

               -  Amenorrhea >= 24 consecutive months without another cause, or

               -  For women with irregular menstrual periods and taking hormone replacement therapy
                  (HRT), a documented serum follicle stimulating hormone (FSH) level >= 35 mIU/mL
                  Women who are using oral contraceptives, other hormonal contraceptives (vaginal
                  products, skin patches, or implanted or injectable products), or mechanical
                  products such as an intrauterine device or barrier methods (diaphragm, condoms,
                  spermicides) to prevent pregnancy, or are practicing abstinence or where their
                  partner is sterile (e.g., vasectomy) should be considered to be of childbearing
                  potential; men of fathering potential and WOCBP must be using an adequate method
                  of contraception or must abstain from sexual intercourse to avoid
                  conception/pregnancy throughout the study and for up to 26 weeks after the last
                  dose of ipilimumab or HDI in such a manner that the risk of pregnancy is
                  minimized; men or WOCBP who are unwilling or unable to strictly follow this
                  requirement are not eligible

          -  White blood cells (WBC) >= 3000/uL

          -  Absolute neutrophil count (ANC) >= 1500/uL

          -  Platelets >= 100 x 10^3/uL

          -  Hemoglobin >= 10 g/dL

          -  Serum creatinine =< 1.8 mg/dl

          -  Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.5 x upper limit
             of normal (ULN) for patients with liver metastases and =< 2.0 x ULN for patients
             without liver metastases

          -  Serum bilirubin < 2 x ULN for patients with liver metastases and =< 1.5 x ULN for
             patients without liver metastases, (except patients with Gilbert's syndrome, who must
             have a total bilirubin < 3.0 mg/dL)

          -  No active or chronic infection with human immunodeficiency virus (HIV), hepatitis B,
             or hepatitis C

          -  Patients must be free of brain metastasis by contrast-enhanced computed tomography
             (CT)/magnetic resonance imaging (MRI) scans within 4 weeks prior to enrollment; if
             known to have prior brain metastases, must not have evidence of active brain disease
             after definitive therapy (surgery, radiation therapy or stereotactic radiosurgery) on
             two successive MRI evaluations at least 3 months apart (one of which is =< 4 weeks
             prior to starting the study drugs)

          -  All sites of disease must be evaluated within 4 weeks prior to randomization; patients
             must have measurable disease as defined by Response Evaluation Criteria in Solid
             Tumors (RECIST) version (v)1.1