Clinical trial NCT04760080: Association of Hydroxychloroquine, BRAF and MEK Inhibitors in Metastatic Melanoma : a Retrospective Case-control Study.
Official title: Adjunction of Hydroxychloroquine in Patients With a Metastatic Melanoma Who Are Resistant to BRAF and MEK Inhibitors : a Retrospective Case-control Study.
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Dermatology and Oncology
Keywords: metastatic melanoma
BRAF inhibitor
MEK inhibitor
hydroxychloroquine
autophagy
Lead sponsor: Hospices Civils de Lyon
Sponsor class: OTHER
First posted: 2021-02-18
Enrollment: 31
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients treated

* for a BRAF mutated metastatic melanoma in Pr Dalle's dermatology ward at Centre Hospitalier Lyon Sud,
* From January 2008 to June 2020
* who received a treatment by immunotherapy before receiving a treatment by dabrafenib/trametinib
* who became resistant to dabrafeib/trametinib
* and received after disease progression either a treatment by dabrafenib/trametinib and hydroxychloroquine or a cytotoxic chemotherapy

Brief summary: Patients with a BRAF mutated melanoma are usually treated in France by a first line of immunotherapy followed by a second line that combines a BRAF inhibitor (dabrafenib, vemurafenib, encorafenib) and a MEK inhibitor (trametinib, cobimetinib, binimetinib).

The combination dabrafenib/trametinib is initially very efficient but it is unfortunately limited because acquired resistances usually occur after a year of treatment. Patients who become resistant to dabrafenib/trametinib and immunotherapy, unfortunately do not have an approved effective treatment at their disposal. They usually receive a palliative chemotherapy by dacarbazine or fotemustine, and they have a mean overall survival that is less than three months.

Activation of autophagy in presence of BRAF and MEK inhibitors is a known mechanism of resistance to BRAF/MEK inhibitors. Hydroxychloroquine is an autophagy inhibitor and it has been suggested in vitro that it could decrease resistance to BRAF/MEK inhibitors.

Following the positive results in 2018 of a phase I/II study in the USA that showed the efficacy and the absence of toxicity of the association of Dabrafenib, Trametinib and hydroxychloroquine when used as a first line treatement, we proposed to our patients who had become resistant to the dabrafenib/trametinib combination, to pursue their treatment beyond progression and to receive in addition hydroxychloroquine.

This prescription was initiated in patients for whom no further therapeutic options were available, after validation by a multidisciplinary tumor board. All patients were informed that the combination dabrafenib/trametinib/hydroxychloroquine was not approved by a regulatory agency.


Eligibility criteria: Inclusion Criteria:

* Patients with metastatic melanoma with an activating BRAF mutation
* Who received at least one line of immunotherapy
* Whose disease is resistant to a BRAF inhibitor used as a single agent or in combination with a MEK inhibitor
* Who received either cytotoxic chemotherapy or the combination dabrafenib + trametinib + hydroxychloroquine after disease progression to dabrafenib/trametinib from January 2008 to June 2020 in the Dermatology ward of the Lyon Sud Hospital

Exclusion Criteria:

* Patients who did not received an immunotherapy prior to dabrafenib/trametinib treatment
* Absence of tumor board validation

Primary outcomes:
measure: Comparison of progression free survival (PFS) in patients who are resistant to dabrafenib/trametinib who receive dabrafenib/trametinib/hydroxychloroquine despite tumor progression versus cytotoxic chemotherapy
timeFrame: Patients treated from January 2008 to June 2020 will be included retrospectively in this study. Data cut off will be defined in June 2020.
Secondary outcomes:
Other outcomes:
Locations:
city: Pierre-Bénite
country: France
facility: Centre Hospitalier Lyon Sud
Study officials:
affiliation: Centre Hospitalier Lyon Sud, Dermatology unit
name: Victoire REYNAUD, MD
role: PRINCIPAL_INVESTIGATOR
References: