Melanoma Clinical Trial
Study Comparing Investigational Drug HBI-8000 Combined With Nivolumab vs. Nivolumab in Patients With Advanced Melanoma
This is a phase 3 study to compare the efficacy and safety of HBI-8000 or Placebo combined with nivolumab on patients with unresectable or metastatic melanoma and eligible patients who are not adolescents or patients with new, progressive brain metastasis will be stratified by PD-L1 expression and LDH level.
This is a multicenter, randomized, double-blind, placebo-controlled Phase 3 study of HBI-8000 or Placebo combined with nivolumab. Randomization of eligible patients will be stratified by PD-L1 expression (positive, ≥1% expression level versus negative, <1% expression level) and LDH (normal versus elevated) in the main study. Adults with new, progressive brain metastasis, or adolescents with or without new progressive brain metastasis will be enrolled in a separate, non-randomized, open-label cohort to receive the combination of HBI-8000 and nivolumab.
In the main study, eligible patients will be randomized within the appropriate stratum at a 1:1 ratio to the Test arm or the Control arm. Study treatment will be initiated within 3 days of randomization.
A treatment cycle consists of 28 days. Patients will be treated with one of the following:
Test arm: HBI-8000 30 mg oral BIW + nivolumab IV at specific doses on specific days
Control arm: Placebo oral BIW + nivolumab IV at specific doses on specific days
The Study Treatment (HBI-8000 or Placebo) is administered approximately 30 minutes after a full meal.
The Study Treatment (HBI-8000 or Placebo) will be administered twice a week on the following days of every 28-day cycle:
CxW1: Days 1, 4
CxW2: Days 8, 11
CxW3: Days 15, 18
CxW4: Days 22, 25
Study treatment must commence within 3 days after randomization and continue up to 2 years or until disease progression (confirmed), unacceptable toxicity or patient withdrawal of consent.
In addition to Study Treatment, nivolumab is administered at specific doses on specific days as an intravenous infusion over approximately 30 minutes. Nivolumab will be administered on Day 1 of each cycle.
For non-randomized cohort for special population, eligible subjects will receive HBI-8000 30 mg oral BIW and nivolumab IV at specific doses on specific days, under the same schedule as described above. For adolescents weighing < 40 kg, nivolumab will be dosed at specific doses every 4 weeks. Nivolumab will be administered on Day 1 of each cycle.
Histopathologically confirmed diagnosis of non-uveal, Stage III (unresectable), or Stage IV (metastatic) melanoma according to AJCC staging system (8th edition).
Known BRAF V600 mutation status or consent to BRAF V600 mutation testing before randomization.
Tumor tissue available for PD-L1 testing at central lab. PD-L1 expression level is required for randomization. In order to be randomized, a patient must be classified as PD-L1 positive or PD-L1 negative according to the following criteria:
PD-L1 positive (≥ 1% tumor cell membrane staining in a minimum of a hundred evaluable tumor cells) vs
PD-L1 negative (< 1% tumor cell membrane staining in a minimum of a hundred evaluable tumor cells).
Note: If an insufficient amount of tumor tissue from an unresectable or metastatic site is available prior to the start of the Screening Phase, patients must consent to allow the acquisition of additional tumor tissue for assessment of the biomarker.
Males or females 12 years of age or older.
ECOG performance status ≤1 for age ≥18 years, Lansky performance score ≥80% for age 12 to 17 years.
At least one measurable lesion defined by RECIST 1.1 criteria, (separate from the lesion to be used for tumor tissue collection for PD-L1 testing) not counting brain metastasis with:
Longest diameter ≥10 mm by CT (when slice thickness is ≤5 mm); or ≥ 2× slice thickness (when slice thickness is >5 mm)
Pathologically enlarged lymph node: ≥15 mm in short axis by CT (when slice thickness is ≤5 mm)
Clinical: ≥10 mm (that can be accurately measured with calipers).
Have not received anti-PD-1, anti-PD-L1 or other systemic therapy for unresectable or metastatic melanoma, except for the following, provided that the patient has recovered from all treatment-related toxicities:
BRAF mutation targeting therapy > 4 weeks before administration of Study Treatment.
Adjuvant or neoadjuvant therapy with PD-1 or PD-L1 inhibitors or anti-CTLA-4) is allowed if disease progression/or recurrence occurred at least 6 months after the last dose and no clinically significant immune related toxicities leading to treatment discontinuation were observed
Adjuvant interferon therapy must have been completed > 6 weeks before administration of Study Treatment
Any prior radiotherapy or minor surgery must be completed at least 2 weeks and 1 week respectively before Day 1 dosing and recovered from all treatment related toxicities
Screening laboratory results within 14 days prior to randomization:
Hematology: WBC ≥3000/μL, neutrophils ≥1500/μL, platelets ≥100 × 103/μL, hemoglobin ≥10.0 g/dL independent of transfusion. The use of erythropoietic growth factor to achieve hemoglobin (Hgb) ≥ 10 g/dl is acceptable.
The CrCL≥ 30 mL/min using Cockcroft-Gault formula.
AST and ALT ≤3 × ULN, alkaline phosphatase ≤2.5 × ULN unless bone metastases present (patients with documented bone metastases: alkaline phosphatase <5 x ULN), bilirubin ≤ 1.5 × ULN (unless known Gilbert's disease where it must be 3 serum albumin ≥ 3.0 gdL).
Negative serum pregnancy test at baseline for women of childbearing potential.
Females of childbearing potential (non-surgically sterile or premenopausal female capable of becoming pregnant) and all males (due to potential risk of drug exposure through the ejaculate) must agree to use adequate birth control measures from study start, during the study and for 5 months after the last dose of Study Drug. Acceptable methods of birth control in this trial include two highly effective methods of birth control (as determined by the Investigator; one of the methods must be a barrier technique) or abstinence.
Have the ability to understand and the willingness to sign a written informed consent document, comply with study scheduled treatment, visits and assessments.
History of ≥ Grade 3 hypersensitivity reactions to monoclonal antibodies.
Previous treatment with a PD-1, PD-L1, PD-L2, CTLA-4 inhibitor, or any other agents targeting T-cell co-stimulation or immune checkpoint pathways for unresectable or metastatic melanoma.
History of a cardiovascular illness including: congestive heart failure (New York Heart Association Grade III or IV); unstable angina or myocardial infarction within the previous 6 months; or symptomatic cardiac arrhythmia despite medical management. QT interval corrected by heart rate using QTcF >450 ms in males or >470 ms in females, or congenital long QT syndrome.
Uncontrolled hypertension, systolic blood pressure (SBP) >160 mmHg or diastolic blood pressure (DBP) >100 mmHg.
Patients with new, active, or progressive brain metastases or leptomeningeal disease with except when considered for a separate special open-label cohort described in protocol Section 5.3 or "Inclusion of Patients with Progressive Brain Metastasis" section in the protocol synopsis.
History of hemorrhagic diarrhea, inflammatory bowel disease, active uncontrolled peptic ulcer, or bowel resection that affects absorption of orally administered drugs.
Active, known, or suspected autoimmune disease, except for Type I diabetes mellitus, hypothyroidism requiring only hormone replacement, or skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic therapy.
Active uncontrolled bacterial, viral, or fungal infection requiring systemic therapy.
Known history of testing positive for HIV, known AIDS.
Hepatitis B surface antigen positive or hepatitis C antibody positive. Further investigation per institutional practices may be performed to exclude active infection.
Patients with a condition requiring chronic systemic treatment with either corticosteroids (>10 mg daily prednisone or equivalents) or other immunosuppressive medications within 14 days before administration of Study Treatment. Inhaled or topical steroids, or adrenal replacement dose of corticosteroids at dose ≤ 10 mg/day prednisone equivalent are permitted.
Use of another investigational agent (drug or vaccine not marketed for any indication) 28 days or before administration of Study Treatment. If the investigational agent is a monoclonal antibody then within 3 months before administration of Study Treatment
Pregnant or breast-feeding women.
Second malignancy unless in remission for 2 years or locally curable cancers that have been treated with curative intent with no evidence of recurrence, such as:
Basal or squamous cell skin cancer
Superficial bladder cancer
Carcinoma in situ of cervix or breast
Incidental prostate cancer
Non melanomatous skin cancer
Carcinoma in situ of the cervix treated with curative intent
Prostate cancer treated with curative intent with serum prostate specific antigen (PSA) < 2.0 ng/mL
Patients with medical conditions requiring administration of strong cytochrome P450 (CYP), CYP3A4 Inducers and Inhibitors.
Uncontrolled adrenal insufficiency or active chronic liver disease.
Has received approved live vaccine/live attenuated vaccines within 30 days of planned Cycle 1 Day 1. Inactivated viral vaccines or vaccines based upon subviral component are allowed; however intranasal influenza vaccines (e.g. Flu-Mist) are not allowed. COVID-19 vaccination should be administered at least 7 days before Cycle 1 Day 1.
Underlying medical conditions that, in the Investigator's opinion, will make the administration of Study Treatment hazardous or obscure the interpretation of toxicity determination or AEs.
Unwilling or unable to comply with procedures required in this protocol.
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There are 86 Locations for this study
Pasadena California, 91105, United States
Redlands California, 92373, United States
Riverside California, 92505, United States
San Marcos California, 92069, United States
Boca Raton Florida, 33486, United States
Hollywood Florida, 33021, United States
Jacksonville Florida, 32207, United States
Orlando Florida, 32806, United States
Pensacola Florida, 32504, United States
Tampa Florida, 33612, United States
Goshen Indiana, 46526, United States
Lexington Kentucky, 40503, United States
Frederick Maryland, 21701, United States
Bridgeton Missouri, 63044, United States
Kansas City Missouri, 64114, United States
Saint Joseph Missouri, 64506, United States
Billings Montana, 59102, United States
Charlotte North Carolina, 28204, United States
Goldsboro North Carolina, 27534, United States
Canton Ohio, 44718, United States
Philadelphia Pennsylvania, 19107, United States
The Woodlands Texas, 77380, United States
Salt Lake City Utah, 84106, United States
Fairfax Virginia, 22031, United States
Milwaukee Wisconsin, 53226, United States
Sippy Downs Queensland, 4556, Australia
Tweed Heads , , Australia
Graz , 8036, Austria
Innsbruck , 6020, Austria
Brasschaat , 2930, Belgium
Brussels , 1200, Belgium
Ghent , 9000, Belgium
Hasselt , 3500, Belgium
Hasselt , , Belgium
Liège , 4000, Belgium
Ottignies , 1340, Belgium
Salvador Bahia, 41950, Brazil
Curitiba Paraná, 81520, Brazil
Londrina Paraná, 86015, Brazil
Centro Rio Grande Do Sul, 99010, Brazil
Lajeado Rio Grande Do Sul, 95900, Brazil
Porto Alegre Rio Grande Do Sul, 90850, Brazil
Santa Cruz Do Sul Rio Grande Do Sul, 96810, Brazil
São Cristóvão Rio Grande Do Sul, 98700, Brazil
Barretos Sao Paulo, 14784, Brazil
Jaú São Paulo, 17210, Brazil
São José Do Rio Preto São Paulo, 15090, Brazil
Olomouc , 77900, Czechia
Ostrava-Poruba , 70852, Czechia
Prague , 10034, Czechia
Besançon , , France
Boulogne-Billancourt , , France
Dijon , , France
La Tronche , , France
Lille , , France
Marseille , 13385, France
Paris , , France
Pierre-Bénite , , France
Rouen , 76031, France
Villejuif , , France
Berlin , 10117, Germany
Berlin , 13585, Germany
Dresden, , 01307, Germany
Erfurt , 99089, Germany
Essen , , Germany
Freiburg , 79104, Germany
Heidelberg , 69120, Germany
Koeln , 50937, Germany
Leipzig , 04103, Germany
Luebeck , 23538, Germany
Mainz , 55131, Germany
Mannheim , 68167, Germany
Tuebingen , 72076, Germany
Bologna , 40138, Italy
Misterbianco , 95045, Italy
Napoli , 80131, Italy
Palermo , 90127, Italy
Roma , 00168, Italy
Siena , 53100, Italy
Verona , 37134, Italy
Auckland , , New Zealand
Hamilton , , New Zealand
Tauranga , 3112, New Zealand
Johannesburg Gauteng, 2196, South Africa
Pretoria Gauteng, 0081, South Africa
Pretoria Gauteng, 0084, South Africa
Roodepoort Gauteng, 1709, South Africa
George Western Cape, 6529, South Africa
Kraaifontein Western Cape, 7570, South Africa
Rondebosch Western Cape, 7700, South Africa
Barcelona , 08035, Spain
Barcelona , 08036, Spain
Barcelona , 08908, Spain
Barcelona , 08916, Spain
Barcelona , , Spain
Madrid , 28033, Spain
Madrid , 28040, Spain
Madrid , 28050, Spain
Madrid , , Spain
Málaga , 29010, Spain
Sevilla , , Spain
Zaragoza , , Spain
Edinburgh , EH4 2, United Kingdom
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