Excision of Lymph Node Trial (EXCILYNT) (Mel69)

Study Overview
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Brief Summary
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The purpose of this study is to find out if removing only the cancerous lymph node (known as a lymph node excision) is effective at preventing cancer from coming back in the same area of the lymph node excision. The study team is also trying to find out the side effects of this type of surgery and how much the surgery impacts quality of life. In order to be eligible for this study, participants must have been diagnosed with metastatic melanoma and have one detected cancerous lymph node by imaging (CT/PET scan) or clinical examination, and are a candidate for lymph node excision.

Official Title
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Lymph Node Excision (LNEx) for Patients With Stage III Melanoma With One Clinically Positive Node: Excision of Lymph Node Trial [EXCILYNT]

Conditions
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Melanoma

Intervention / Treatment
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* Procedure: Excision of clinically detected lymph node metastasis before any systemic therapy
* Procedure: Excision of clinically detected lymph node metastasis after neoadjuvant systemic therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Provision of signed and dated informed consent form. Stated willingness to comply with all study procedures and availability for the duration of the study. Male or female, aged 18 years or older at enrollment ECOG performance status of 0-2 Subjects must have histologically (or cytologically) confirmed metastatic melanoma to only one lymph node in the axilla, groin, or iliac basin that was detected clinically. A clinically positive lymph node is defined as a palpable and clinically suspicious node (based on palpation or imaging), or non-palpable lymph node that is FDG-avid or ≥ 0.95 cm on PET-CT, based on professional assessment of the radiologist, and that also is confirmed to contain metastatic melanoma on biopsy. a) The clinically positive lymph node may have been removed within 8 weeks prior to enrollment, and in that case may or may not have been evaluated by PET-CT; it is considered a clinically positive node if it was either identified as clinically suspicious on exam and/or on preoperative scans based on FDG-avidity and/or diameter ≥ 0.95 cm, and also confirmed histologically. The clinically positive node must be within the primary draining node basin of the primary melanoma, or the metastasis may be from an unknown primary site. A node that was removed at sentinel node biopsy will not meet this eligibility criterion. A patient will not be eligible if there is evidence of an additional clinically positive node on imaging or physical exam after excision of the first clinically positive node. Subjects must be able to undergo LNEx and must not be on a clinical trial that requires TLND. a. Subjects may have previously had metastatic melanoma to a sentinel node in the same node basin, if complete lymph node dissection was not done, and if at least 1 year has elapsed since the prior positive sentinel node biopsy. Individuals will be required to have radiological studies to rule out radiologically evident melanoma metastasis. Required studies include: PET-CT scan, and Head CT scan or MRI These scans may have been performed prior to resection of the primary melanoma and/or sentinel node biopsy if they showed no evidence of other metastases. Exclusion Criteria: Subjects who have had a prior complete lymph node dissection or radiation therapy of the clinically positive node basin. Subjects who have, or have had, in-transit or satellite metastases from the same primary melanoma that has metastasized to the cLN that is the focus of the current study. Subjects who have, or have had, one or more metastases distant to the primary draining lymph node basin. An individual with small radiologic or clinical findings of an indeterminate nature may still be eligible: examples include a new 5 mm lung nodule that is too small to characterize or an asymptomatic 12 mm bony lucency that is not classic for malignancy, where clinical care may otherwise be to follow the patient with repeat imaging rather than to treat the lesion. Subjects with pre-existing lymphedema that precludes assessment of lymphedema. Subjects whose treating physician(s) plan adjuvant radiation therapy to the involved node basin, because that also would confound assessment of node basin recurrence and lymphedema. Individuals for whom there is a medical contraindication or potential problem in complying with the requirements of the protocol in the opinion of the investigator. Subjects with a prior or concurrent malignancy may be eligible if its natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the regimen. Subjects who are receiving systemic or intratumoral therapy for this melanoma within 3 months of enrollment. They may have received prior adjuvant systemic therapy for an earlier stage of disease, but should be off that therapy for 3 months prior to enrollment. The only exception is for patients who are being treated at a participating center with neoadjuvant therapy for 1 cLN, and who otherwise meet criteria for enrollment. They should be screened and enrolled as soon as possible. The intent of this exception is to allow enrollment of patients who are being evaluated at that center before the study is open but whose LN Excision date can occur after the study is open to enrollment. For such patients, data collected prior to starting neoadjuvant therapy should be recorded as screening data (such as imaging studies), but baseline lymphedema measurements, FACT-M and WPAI surveys, and anything else not done prior to starting neoadjuvant therapy should be performed as soon as possible, and prior to LN Excision.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cohort 1: Excision of cLN before systemic therapy<br>Excision of the clinically detected metastatic lymph node before systemic therapy. | Procedure: Excision of clinically detected lymph node metastasis before any systemic therapy<br>* Surgical intervention to remove the clinically detected lymph node metastasis after which physician choice adjuvant systemic therapy is permitted<br>|
| Experimental: Cohort 2: Excision of cLN after neoadjuvant systemic therapy<br>Excision of the clinically detected metastatic lymph node after systemic neoadjuvant therapy. | Procedure: Excision of clinically detected lymph node metastasis after neoadjuvant systemic therapy<br>* Surgical intervention to remove the clinically detected lymph node metastasis after physician choice neo adjuvant systemic therapy. Physician choice adjuvant therapy is allowed after surgery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Node basin-only recurrence | Number of participants with recurrence of melanoma within the node basin without concurrent or preceding distant metastatic recurrence | 3 years after the lymph node excision | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lymphedema | Proportion of patients with lymphedema in the extremity closest to the dissected lymph node basin | within 3 years after the lymph node excision | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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melanoma, surgery, lymph node excision