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Clinical Study of Fianlimab in Combination With Cemiplimab in Adolescent and Adult Patients With Previously Untreated Unresectable Locally Advanced or Metastatic Melanoma

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ClinicalTrials.gov Identifier: NCT05352672
Recruitment Status : Recruiting
First Posted : April 29, 2022
Last Update Posted : February 22, 2024
Sponsor:
Information provided by (Responsible Party):
Regeneron Pharmaceuticals

Brief Summary:

This study is researching an experimental drug called REGN3767, also known as fianlimab (R3767), when combined with another medication called REGN2810, also known as cemiplimab (each individually called a "study drug" or called "study drugs" when combined). The study is focused on patients with a type of skin cancer known as melanoma.

The aims of the study are to see how effective the combination of fianlimab and cemiplimab are in treating the melanoma skin cancer, in comparison with a medication, pembrolizumab, approved for the treatment of melanoma skin cancer in adults, and to observe any similarities, or differences, in how the study drugs work in adolescent participants compared with adult participants.

The study is looking at several other research questions, including:

  • What side effects may happen from receiving the study drugs
  • How much study drug is in the blood at different times
  • Whether the body makes antibodies against the study drugs (which could make the drugs less effective or could lead to side effects). Antibodies are proteins that are naturally found in the blood stream that fight infections.
  • How administering the study drugs might improve quality of life

Condition or disease Intervention/treatment Phase
Melanoma Drug: Fianlimab Drug: Cemiplimab Drug: Pembrolizumab Drug: Placebo Phase 2 Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 1925 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase 2 and Phase 3 Trial of Fianlimab (REGN3767, Anti-LAG-3) + Cemiplimab Versus Pembrolizumab in Patients With Previously Untreated Unresectable Locally Advanced or Metastatic Melanoma
Actual Study Start Date : July 14, 2022
Estimated Primary Completion Date : March 3, 2026
Estimated Study Completion Date : August 31, 2032

Resource links provided by the National Library of Medicine

MedlinePlus Genetics related topics: Melanoma
MedlinePlus related topics: Melanoma

Arm Intervention/treatment
Experimental: A: fianlimab+cemiplimab dose 1
Phase 2 and Phase 3
Drug: Fianlimab
Intravenous (IV) infusion
Other Name: REGN3767

Drug: Cemiplimab
IV infusion
Other Names:
  • REGN2810
  • Libtayo

Experimental: A1: fianlimab+cemiplimab dose 2
Phase 2 and Phase 3 (except for PA1 patients as described in the protocol)
Drug: Fianlimab
Intravenous (IV) infusion
Other Name: REGN3767

Drug: Cemiplimab
IV infusion
Other Names:
  • REGN2810
  • Libtayo

Experimental: B: pembrolizumab+placebo
Phase 2 and Phase 3
Drug: Pembrolizumab
IV infusion
Other Names:
  • MK-3475
  • lambrolizumab
  • Keytruda

Drug: Placebo
IV infusion

Experimental: C: cemiplimab+placebo
Phase 2 (as described in the protocol)
Drug: Cemiplimab
IV infusion
Other Names:
  • REGN2810
  • Libtayo

Drug: Placebo
IV infusion




Primary Outcome Measures :
  1. Objective response rate (ORR) [ Time Frame: Approximately 27 months ]
    Phase 2 Per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 based on Blinded Independent Central Review (BICR)

  2. Progression-free survival (PFS) [ Time Frame: Approximately 27 months ]
    Phase 3 Per RECIST 1.1 based on BICR


Secondary Outcome Measures :
  1. PFS [ Time Frame: Up to 27 months ]
    Per RECIST 1.1 based on BICR or investigator assessment according to RECIST 1.1 and immune RECIST (iRECIST)

  2. Overall survival (OS) [ Time Frame: Up to 96 months ]
  3. ORR [ Time Frame: Up to 27 months ]
    Per RECIST 1.1 based on BICR or investigator assessment according to RECIST 1.1 and iRECIST

  4. Disease control rate (DCR) [ Time Frame: Up to 27 months ]
    Per RECIST 1.1 based on BICR or investigator assessment according to RECIST 1.1 and iRECIST

  5. Duration of response (DoR) [ Time Frame: Up to 27 months ]
    Per RECIST 1.1 based on BICR or investigator assessment according to RECIST 1.1 and iRECIST

  6. Incidence of Adverse Events (AEs) [ Time Frame: Up to 90 days post last dose, approximately 6 years ]
    Including treatment emergent adverse events (TEAEs), serious adverse events (SAEs), adverse events of special interest (AESIs), and/ or immune-related adverse event (imAEs)

  7. Occurrence of interruption and discontinuation of study drug(s) due to AEs [ Time Frame: Up to 90 days post last dose, approximately 6 years ]
    Including TEAEs, AESIs, and/ or imAEs

  8. Incidence of deaths related to TEAEs [ Time Frame: Up to 6 years ]
  9. Incidence of laboratory abnormalities [ Time Frame: Up to 90 days post last dose, approximately 6 years ]
    Will be graded using the current version of the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) grading system (version 5.0)

  10. Concentrations of cemiplimab in serum [ Time Frame: Up to 90 days post last dose, approximately 6 years ]
  11. Concentrations of fianlimab in serum [ Time Frame: Up to 90 days post last dose, approximately 6 years ]
  12. Incidence of anti-drug antibodies (ADA) to fianlimab over time [ Time Frame: Up to 30 days post last dose, approximately 6 years ]
  13. Titer of anti-drug antibodies (ADA) to fianlimab over time [ Time Frame: Up to 30 days post last dose, approximately 6 years ]
  14. Incidence of ADA to cemiplimab over time [ Time Frame: Up to 30 days post last dose, approximately 6 years ]
  15. Titer of ADA to cemiplimab over time [ Time Frame: Up to 30 days post last dose, approximately 6 years ]
  16. Incidence of neutralizing antibodies (NAb) to fianlimab over time [ Time Frame: Up to 30 days post last dose, approximately 6 years ]
  17. Incidence of NAb to cemiplimab over time [ Time Frame: Up to 30 days post last dose, approximately 6 years ]
  18. Patient-reported outcomes (PROs) as measured by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) [ Time Frame: Up to 90 days post last dose, approximately 6 years ]
    EORTC-QLQ-C30 is a 30-item participant self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.

  19. PROs as measured by EQ-5D-5L [ Time Frame: Up to 90 days post last dose, approximately 6 years ]
    The EQ-5D-5L consists of EQ-5D descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. Overall scores range from 0 to 1, with low scores representing a higher level of dysfunction.

  20. PROs as measured by Functional Assessment of Cancer Therapy melanoma (FACTM) (melanoma subscale only) [ Time Frame: Up to 90 days post last dose, approximately 6 years ]
    The FACTM is a melanoma-specific quality of life questionnaire that is composed of items from the Functional Assessment of Cancer Therapy-General (FACT-G). The FACTM is scored on a 5 point Likert-scale: "Not at all", "A little bit", "Somewhat", "Quite a bit", and "Very much.". A Higher score represents higher Health Related Quality of Life (HRQoL).

  21. PROs as measured by Patient Global Impression of Severity (PGIS) [ Time Frame: Up to 21 days post last dose, approximately 6 years ]
    The PGIS is a single 1-item questionnaire designed to assess participant's overall impression of disease severity at a given point in time by using a 4-point Likert scale that ranges from (1) = "none (no symptoms)" to (4) = "severe".

  22. PROs as measured by Patient Global Impression of Change (PGIC) [ Time Frame: Up to 21 days post last dose, approximately 6 years ]
    The PGIC is a single-item questionnaire designed to assess the participant's overall sense of whether there has been a change since starting treatment as rated on a 5-point Likert scale anchored by (1) "much better" to (5) "much worse", with (4) = "no change"

  23. Change in physical functioning per EORTC QLQ-C30 [ Time Frame: Baseline to Week 25 ]
    EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.

  24. Change in role functioning per EORTC QLQ-C30 [ Time Frame: Baseline to Week 25 ]
    EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.

  25. Change in global health status/quality of life (GHS/QoL) per EORTC QLQ-C30 [ Time Frame: Baseline to Week 25 ]
    Global Health Status/Quality of Life (GHS/Qol) Score (Items 29 and 30) using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.

  26. Change in physical functioning per EORTC QLQ-C30 [ Time Frame: Baseline to end of study, approximately 6 years ]
    EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.

  27. Change in role functioning per EORTC QLQ-C30 [ Time Frame: Baseline to end of study, approximately 6 years ]
    EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.

  28. Change in GHS/QoL per EORTC QLQ-C30 [ Time Frame: Baseline to end of study, approximately 6 years ]
    EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   12 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Key Inclusion Criteria:

  1. Age ≥12 years on the date of providing informed consent
  2. Patients with histologically confirmed unresectable Stage III and Stage IV (metastatic) melanoma (AJCC, 8th revised edition) who have not received prior systemic therapy for advanced unresectable disease

    1. Patients who received adjuvant and/or neoadjuvant systemic therapies are eligible if they did not have evidence of progression or recurrence of disease and/or discontinued due to occurrence of unmanageable imAEs ≥ grade 3 (with the exclusion of endocrinopathies which are fully controlled by hormone replacement) while on such therapies. Also, patients must have had a treatment-free and disease-free interval of >6 months. Accrual of these patients is limited to approximately 10% of the total population enrolled in each of the Phase 2 and Phase 3 parts of the study.
    2. Patients with acral and mucosal melanomas are eligible. Combined accrual will be limited to 10% of the total population enrolled in the Phase 3 part of the study.
  3. Measurable disease per RECIST v1.1

    1. Previously irradiated lesions can only be counted as target lesions if they have been demonstrated to progress and no other target lesion is available
    2. Cutaneous lesions should be evaluated as non-target lesions
  4. Performance status:

    1. For adult patients: Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1
    2. For pediatric patients: Karnofsky performance status ≥70 (patients ≥16 years) or Lansky performance status ≥70 (patients ≤16 years)
  5. Anticipated life expectancy of at least 3 months

Key Exclusion Criteria:

  1. Uveal melanoma
  2. Ongoing or recent (within 2 years) evidence of an autoimmune disease that required systemic treatment with immunosuppressive agents. The following are non-exclusionary: vitiligo, childhood asthma that has resolved, residual hypothyroidism that requires only hormone replacement, psoriasis not requiring systemic treatment.
  3. Uncontrolled infection with human immunodeficiency virus (HIV), hepatitis B (HBV) or hepatitis C virus (HCV) infection; or diagnosis of immunodeficiency that is related to, or results in chronic infection
  4. Unknown v-Raf murine sarcoma viral oncogene homolog B1 (BRAF) V600 mutation status as described in the protocol
  5. Systemic immune suppression:

    1. Use of immunosuppressive doses of corticosteroids (>10mg of prednisone per day or equivalent) within 14 days of the first dose of study medication. Physiologic replacement doses are allowed up to and including 10mg of prednisone/day or equivalent. Inhaled or topical steroids are permitted, if they are not for treatment of an autoimmune disorder.
    2. Other clinically relevant forms of systemic immune suppression
  6. Treatment with other anti-cancer therapy including immuno- therapy, chemotherapy, major surgery or biological therapy within 21 days prior to the first dose of trial treatment. Adjuvant hormonotherapy used for breast cancer or other hormone-sensitive cancers in long term remission is allowed.
  7. History or current evidence of significant (CTCAE Grade ≥2) local or systemic infection (e. g., cellulitis, pneumonia, septicemia) requiring systemic antibiotic treatment within 14 days prior to the first dose of trial medication.
  8. Participants with a history of myocarditis.
  9. Active or untreated brain metastases or spinal cord compression. Patients with leptomeningeal disease are excluded. Patients with known brain metastases are eligible if they:

    1. Received radiotherapy or another appropriate standard therapy for the brain metastases,
    2. Have neurologically returned to baseline (except for residual signs and symptoms related to the CNS treatment) for at least 14 days prior to enrollment
    3. Did not require immunosuppressive doses of corticosteroids therapy (>10mg of prednisone per day or equivalent) in the 14 days prior to enrollment
    4. Are asymptomatic with a single untreated brain metastasis <10 mm in size

Note: Other protocol-defined Inclusion/ Exclusion criteria apply


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05352672


Contacts
Layout table for location contacts
Contact: Clinical Trials Administrator 844-734-6643 clinicaltrials@regeneron.com

Locations
Show Show 205 study locations
Sponsors and Collaborators
Regeneron Pharmaceuticals
Investigators
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Study Director: Clinical Trial Management Regeneron Pharmaceuticals
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Responsible Party: Regeneron Pharmaceuticals
ClinicalTrials.gov Identifier: NCT05352672    
Other Study ID Numbers: R3767-ONC-2011
2021-004453-23 ( EudraCT Number )
2023-505772-30-00 ( Registry Identifier: EUCT Number )
First Posted: April 29, 2022    Key Record Dates
Last Update Posted: February 22, 2024
Last Verified: February 2024
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: All Individual Patient Data (IPD) that underlie publicly available results will be considered for sharing
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)
Analytic Code
Time Frame: When Regeneron has received marketing authorization from major health authorities (e.g., FDA, European Medicines Agency (EMA), Pharmaceuticals and Medical Devices Agency (PMDA), etc.) for the product and indication, has made the study results publicly available (e.g., scientific publication, scientific conference, clinical trial registry), has the legal authority to share the data, and has ensured the ability to protect participant privacy.
Access Criteria: Qualified researchers can submit a proposal for access to individual patient or aggregate level data from a Regeneron-sponsored clinical trial through Vivli. Regeneron's Independent Research Request Evaluation Criteria can be found at: https://www.regeneron.com/sites/default/files/Regeneron-External-Data-Sharing-Policy-and-Independent-Research-Request-Evaluation-Criteria.pdf
URL: https://vivli.org/

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Regeneron Pharmaceuticals:
Unresectable
Metastatic
Stage III
Stage IV
Anti-Lymphocyte-activation gene 3 Pathway (LAG-3)
Additional relevant MeSH terms:
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Melanoma
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Nerve Tissue
Nevi and Melanomas
Skin Neoplasms
Neoplasms by Site
Skin Diseases
Pembrolizumab
Cemiplimab
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immune Checkpoint Inhibitors
Molecular Mechanisms of Pharmacological Action