Melanoma Clinical Trial
Inhaled Sargramostim in Treating Patients With Melanoma Metastatic to the Lung
Summary
RATIONALE: Inhaling sargramostim may interfere with the growth of tumor cells and may be an effective treatment for melanoma that has spread to the lung.
PURPOSE: This phase I trial is studying the side effects and best dose of inhaled sargramostim in treating patients with melanoma that is metastatic to the lung.
Full Description
OBJECTIVES:
Determine immunomodulatory effects of aerosolized sargramostim (GM-CSF) in patients with metastatic melanoma to the lung (part A).
Determine toxicity profile of this therapy, in terms of pulmonary and hematologic toxicity, in these patients.
Determine, preliminarily, the therapeutic effects of this therapy, in terms of progression-free survival, overall survival, and objective response rate, in these patients.
Determine the maximum tolerated dose of GM-CSF in these patients (part B).
OUTLINE: This is a dose-escalation, multicenter study.
Patients receive aerosolized sargramostim (GM-CSF) twice a day on days 1-7 and 15-21. Treatment repeats every 28 days for 2 courses. Patients with no disease progression after completion of course 2 may continue on treatment until disease progression. Patients are grouped to 1 of 2 dose-escalation regimens (part A vs B).
Part A: Cohorts of 5-10 patients receive escalating doses of GM-CSF until the optimal immunostimulatory dose (ISD) is determined. The optimal ISD is defined as the dose at which at least 7 of 10 patients experience immunostimulation. Once the optimal ISD is determined, 10 patients receive aerosolized GM-CSF at a dose halfway between the optimal ISD and the preceding dose. Dose escalation is discontinued if at least 2 of 5 or at least 4 of 10 patients on a particular dose level experience dose-limiting toxicity.
Part B: Cohorts of 3-6 patients receive escalating doses of GM-CSF until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. At least 6 patients are treated at the MTD.
After completion of study therapy, patients are followed at 3 months, every 2 months for 1 year, and then every 3-4 months for 5 years.
PROJECTED ACCRUAL: A total of 85 patients will be accrued for this study.
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically confirmed metastatic melanoma to the lung for which no known standard therapy exists
At least 1 unidimensionally measurable lesion
HLA-A2 positive (part A patients only)
Previously treated CNS metastases allowed provided there is no evidence of disease progression within the past 3 months
PATIENT CHARACTERISTICS:
Age:
18 and over
Performance status:
ECOG 0-2
Life expectancy:
At least 12 weeks
Hematopoietic:
Absolute neutrophil count at least 1,000/mm^3
Platelet count at least 75,000/mm^3
Hemoglobin at least 8.0 g/dL
Hepatic:
Bilirubin no greater than 2 times upper limit of normal (ULN)
AST no greater than 3 times ULN
Renal:
Creatinine no greater than 2.5 times ULN
Cardiovascular:
No New York Heart Association class III or IV heart disease
Pulmonary:
No pulmonary disease requiring concurrent active therapy (e.g., supplemental oxygen or bronchodilator)
FEV_1 at least 65% of predicted and at least 1.5 L
Immunologic:
No known immunodeficiency state
No known autoimmune disease
No uncontrolled infection
Other:
No active psychotic disorder requiring pharmacotherapy
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy:
More than 2 weeks since prior biologic therapy
More than 2 weeks since prior immunotherapy
More than 4 weeks since prior filgrastim (G-CSF) or sargramostim (GM-CSF)
No other concurrent biologic therapy or immunotherapy
No concurrent G-CSF
No concurrent GM-CSF other than study drug
Chemotherapy:
More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin)
No concurrent chemotherapy
Endocrine therapy:
More than 2 weeks since prior corticosteroids
No concurrent glucocorticosteroids
Radiotherapy:
More than 2 weeks since prior radiotherapy
No concurrent radiotherapy
Surgery:
Not specified
Other:
More than 7 days since prior parenteral antibiotics
No concurrent parenteral antibiotics
No concurrent immunosuppressive agents
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There are 71 Locations for this study
Scottsdale Arizona, 85259, United States
Jacksonville Florida, 32224, United States
Aurora Illinois, 60507, United States
Bloomington Illinois, 61701, United States
Canton Illinois, 61520, United States
Carthage Illinois, 62321, United States
Eureka Illinois, 61530, United States
Galesburg Illinois, 61401, United States
Galesburg Illinois, 61401, United States
Havana Illinois, 62644, United States
Hopedale Illinois, 61747, United States
Joliet Illinois, 60435, United States
Kewanee Illinois, 61443, United States
Macomb Illinois, 61455, United States
Normal Illinois, 61761, United States
Normal Illinois, 61761, United States
Ottawa Illinois, 61350, United States
Ottawa Illinois, 61350, United States
Pekin Illinois, 61554, United States
Peoria Illinois, 61614, United States
Peoria Illinois, 61615, United States
Peoria Illinois, 61615, United States
Peoria Illinois, 61636, United States
Peoria Illinois, 61637, United States
Peru Illinois, 61354, United States
Princeton Illinois, 61356, United States
Spring Valley Illinois, 61362, United States
Urbana Illinois, 61801, United States
Urbana Illinois, 61801, United States
Michigan City Indiana, 46360, United States
Cedar Rapids Iowa, 52403, United States
Des Moines Iowa, 50307, United States
Des Moines Iowa, 50309, United States
Des Moines Iowa, 50309, United States
Des Moines Iowa, 50309, United States
Des Moines Iowa, 50314, United States
Des Moines Iowa, 50314, United States
Des Moines Iowa, 50316, United States
West Des Moines Iowa, 50266, United States
Adrian Michigan, 49221, United States
Lambertville Michigan, 48144, United States
Monroe Michigan, 48162, United States
Monroe Michigan, 48162, United States
Burnsville Minnesota, 55337, United States
Coon Rapids Minnesota, 55433, United States
Edina Minnesota, 55435, United States
Fridley Minnesota, 55432, United States
Maplewood Minnesota, 55109, United States
Minneapolis Minnesota, 55407, United States
Robbinsdale Minnesota, 55422, United States
Rochester Minnesota, 55905, United States
Saint Louis Park Minnesota, 55416, United States
St. Louis Park Minnesota, 55416, United States
St. Paul Minnesota, 55102, United States
Waconia Minnesota, 55387, United States
Woodbury Minnesota, 55125, United States
Omaha Nebraska, 68122, United States
Omaha Nebraska, 68124, United States
Omaha Nebraska, 68131, United States
Bismarck North Dakota, 58501, United States
Bismarck North Dakota, 58501, United States
Bismarck North Dakota, 58501, United States
Bismarck North Dakota, 58502, United States
Bowling Green Ohio, 43402, United States
Fremont Ohio, 43420, United States
Lima Ohio, 45804, United States
Maumee Ohio, 43537, United States
Maumee Ohio, 43537, United States
Oregon Ohio, 43616, United States
Oregon Ohio, 43616, United States
Sandusky Ohio, 44870, United States
Sandusky Ohio, 44870, United States
Sylvania Ohio, 43560, United States
Tiffin Ohio, 44883, United States
Toledo Ohio, 43606, United States
Toledo Ohio, 43608, United States
Toledo Ohio, 43614, United States
Toledo Ohio, 43617, United States
Toledo Ohio, 43623, United States
Wauseon Ohio, 43567, United States
Danville Pennsylvania, 17822, United States
State College Pennsylvania, 16801, United States
Wilkes-Barre Pennsylvania, 18711, United States
Sioux Falls South Dakota, 57105, United States
Sioux Falls South Dakota, 57105, United States
Sioux Falls South Dakota, 57117, United States
Fredericksburg Virginia, 22401, United States
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