A Study Evaluating the Safety and Efficacy of Cobimetinib Plus Atezolizumab in BRAFV600 Wild-type Melanoma With Central Nervous System Metastases and Cobimetinib Plus Atezolizumab and Vemurafenib in BRAFV600 Mutation-positive Melanoma With Central Nervous System Metastases
Condition: Metastatic Melanoma
MeSH terms: Melanoma; Neoplasm Metastasis
Intervention: Cobimetinib; Atezolizumab; Vemurafenib
Intervention description: 60 mg (three tablets of 20 mg each) orally (PO) once a day (QD) on Days 1-21 of each 28-day cycle.; Atezolizumab will be given at a fixed dose of 840 mg by intravenous (IV) infusion on Days 1 and 15 of each 28-day cycle.
Only for cohort 2, no dose of atezolizumab will be given during the run-in period (cycle 1).; Participants will receive vemurafenib 960 mg (four 240 mg tablets) orally (PO) twice daily (BID) on days 1-21 of the run-in period (cycle 1); thereafter, they will receive vemurafenib 720 mg dose (three 240 mg tablets) PO BID on days 22-28 of cycle 1 and on days 1-28 of all subsequent cycles.
Intervention MeSH terms: Atezolizumab; Vemurafenib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 80.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This study will evaluate the efficacy and safety of cobimetinib plus atezolizumab in
      participants with BRAFV600 wild-type melanoma with central nervous system (CNS) metastases
      and of cobimetinib plus atezolizumab and vemurafenib in BRAFV600 mutation-positive melanoma
      patients with CNS metastases.
    

Eligibility criteria:

        Inclusion Criteria:

        Disease-specific inclusion criteria:

          -  Histologically confirmed melanoma with radiologically confirmed brain metastases

          -  Documented BRAFV600 mutation status of melanoma tumour tissue using a validated
             genetic test.

          -  Measurable brain metastases

          -  Prior systemic therapy for metastatic melanoma is allowed with exceptions as detailed
             in the exclusion criteria

          -  Prior SRT or surgical therapy of ≤ 10 brain metastases is allowed but prior WBRT is
             not allowed

          -  Adverse effects of all prior systemic or local treatment must have either returned to
             baseline or become stable and manageable prior to initiation of study treatment.

        General inclusion criteria:

          -  Age ≥18 years

          -  Able to comply with the study protocol, in the investigator's judgment

          -  ECOG Performance Status ≤ 2

          -  Life expectancy of > 3 months

          -  Willing and able to complete health and quality of life questionnaires required by the
             protocol

          -  Adequate hematologic and end-organ function

          -  Female patients of childbearing potential and male patients with partners of
             childbearing potential must agree to always use two effective forms of contraception
             during the course of this study and for at least six months after completion of study
             therapy.

          -  Male patients must agree to refrain from donating sperm for at least six months after
             the last dose of cobimetinib

        Exclusion criteria:

        Disease-specific exclusion criteria:

          -  Ocular melanoma

          -  Leptomeningeal involvement

          -  Uncontrolled tumour-related pain

          -  Uncontrolled pleural effusion, pericardial effusion, or ascites requiring repeated
             drainage more than once every 28 days.

          -  Prior WBRT treatment for CNS disease

          -  Increasing corticosteroid dose during the seven days prior to initiation of study
             treatment or current dexamethasone or equivalent dose of > 8 mg/day

          -  Prior treatment with a BRAF or MEK inhibitor

          -  For patients assigned to Cohort 1 only: prior immunotherapy in the metastatic setting
             is not allowed. Prior immunotherapy is allowed in the adjuvant setting, provided it is
             completed ≥ 90 days prior to study treatment initiation.

        For patients assigned to Cohort 2 only: prior immunotherapy in either the adjuvant or
        metastatic setting is not allowed.

          -  Major surgical procedure other than for diagnosis within four weeks prior to
             initiation of study treatment, or anticipation of need for a major surgical procedure
             during the course of the study

          -  Known hypersensitivity to biopharmaceutical agents produced in Chinese hamster ovary
             cells or to any formulation component of cobimetinib or atezolizumab or, for patients
             assigned to Cohort 2 only, vemurafenib

          -  Any anti-cancer therapy, including chemotherapy, hormonal therapy and radiotherapy,
             within two weeks prior to initiation of study treatment

          -  Patients assigned to Cohort 2 only: Concomitant treatment with anticonvulsants other
             than gabapentin, vigabatrin and levetiracetam

          -  Patients assigned to Cohort 2 only: acetaminophen is prohibited within seven days
             prior to initiation of study treatment unless the patient has an absolute
             contraindication to the to the use of non-steroidal anti-inflammatory drugs (NSAIDs)
             or aspirin

          -  Active malignancy (other than melanoma) or a prior malignancy within the past three
             years

        General exclusion criteria:

          -  Known risk factors for ocular toxicity

          -  History of clinically significant cardiac dysfunction

          -  Inability to swallow medications

          -  Malabsorption condition that would alter the absorption of orally administered
             medications

          -  Traumatic injury within two weeks prior to initiation of study treatment

          -  Prior allogeneic stem cell or solid organ transplantation

          -  Active or history of autoimmune disease or immune deficiency

          -  History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g. bronchiolitis
             obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of
             active pneumonitis on screening chest computed tomography (CT) scan

          -  Uncontrolled diabetes or symptomatic hyperglycaemia

          -  Any Grade ≥ 3 haemorrhage or bleeding event within 28 days of study treatment
             initiation

          -  History of stroke, reversible ischemic neurological defect, or transient ischemic
             attack within six months prior to study treatment initiation

          -  Positive human immunodeficiency virus (HIV) test at screening

          -  Hepatitis B virus (HBV) infection (chronic or acute)

          -  Active hepatitis C virus (HCV) infection

          -  Active tuberculosis

          -  History of severe allergic, anaphylactic or other hypersensitivity reactions to
             chimeric or humanized antibodies or fusion proteins

          -  Severe infection within four weeks prior to initiation of study treatment

          -  Signs or symptoms of infection within two weeks prior to initiation of study treatment

          -  Any serious medical condition or abnormality in clinical laboratory tests that, in the
             investigator's judgment, precludes the patient's safe participation in, and completion
             of, the study

          -  Any psychological, familial, sociological, or geographical condition that may hamper
             compliance with the protocol and follow-up after treatment discontinuation

          -  Pregnancy, breastfeeding, or intention of becoming pregnant during the study. Women of
             childbearing potential must have a negative serum pregnancy test result within seven
             days prior to initiation of study treatment.

          -  Treatment with therapeutic oral or IV antibiotics within two weeks prior to initiation
             of study treatment

          -  Administration of a live, attenuated vaccine within four weeks prior to initiationof
             study treatment or anticipation of need for such a vaccine during the study

          -  Treatment with systemic immunostimulatory agents within 28 days or 5 half-lives of the
             drug, whichever is shorter, prior to study treatment initiation

          -  Treatment with systemic immunosuppressive medications within two weeks prior to study
             treatment initiation

          -  Treatment with investigational drug within 28 days or 5 half-lives of the drug,
             whichever is longer, prior to initiation of study treatment

          -  For patients to be assigned to Cohort 2 only: anticipated use of any concomitant
             medication during or within seven days prior to initiation of study treatment that is
             known to cause QT prolongation

          -  Consumption of foods, supplements, or drugs that are strong or moderate CYP3A4 enzyme
             inducers or inhibitors at least seven days prior to initiation of study treatment.