To Assess The Efficacy And Safety Of Vismodegib And Radiotherapy In Advanced Basal Cell Carcinoma

Carcinoma, Basal Cell Clinical Trial

— virgilio  

Official title:

A Single Arm, Phase II, Multicenter Study To Assess The Efficacy And Safety Of Vismodegib And Radiotherapy In Patients With High Risk Or Locally Advanced Basal Cell Carcinoma Not Amenable To Radical Surgery

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT02956889
• Other study ID #: ONC-2015-001
• Status: Terminated
• Phase: Phase 2
• Start date: October 2016
• Est. completion date: January 2020

Study information

• Verified date: January 2020
• Source: Istituto Clinico Humanitas
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a Fleming-A' Hern, single arm, multicenter, no-profit, phase II study of radiotherapy and Vismodegib in adult patients with high risk or locally advanced basal cell carcinoma not amenable to radical surgery cell carcinoma (BCC) (comparator: not applicable).

The recruitment period is expected to be approximately 24 months. The trial will consist of a Screening/Baseline period (Day -28 to -1), a Treatment Period when patients will be treated with radiotherapy (4 weeks) followed by Vismodegib 150 mg/die continuously for six cycles (24 weeks).

The study will end 14 months after start of treatment of the last patient enrolled and evaluable according to primary end point.

Description:

This is a Fleming-A' Hern, single arm, multicenter, no-profit, phase II study of radiotherapy and Vismodegib in adult patients with high risk or locally advanced basal cell carcinoma not amenable to radical surgery cell carcinoma (BCC) (comparator: not applicable).

The recruitment period is expected to be approximately 24 months. The trial will consist of a Screening/Baseline period (Day -28 to -1), a Treatment Period when patients will be treated with radiotherapy (4 weeks) followed by Vismodegib 150 mg/die continuously for six cycles (24 weeks).

The study will end 14 months after start of treatment of the last patient enrolled and evaluable according to primary end point.

The primary objective is to evaluate the activity of the study therapy (radiotherapy followed by six cycles of Vismodegib 150 mg/d continuously) in terms of proportion of patients progression free at 12 months.

The secondary objectives are: to evaluate the efficacy of the study therapy in terms of progression free survival (PFS) and overall survival (OS); to assess the response in terms of overall response rate (ORR) (complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD)); to assess duration of response (DoR); to assess the safety in terms of incidence, type, and severity of adverse events (AEs) and serious adverse events (SAEs) ;to measure the effects of skin disease on quality of life (QoL) of patients under therapy (Skindex-16)

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 14
• Est. completion date: January 2020
• Est. primary completion date: February 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Written, signed informed consent

2. Age = 18 years

3. Histopathologic confirmation that the lesion is BCC before enrollment

4. Patients with high risk of relapse BCC not undergone radical surgery, for which treating physician must consider the disease to be no more operable.

5. Clinical features defining high risk of relapse include infiltrative growth margins, size, tumor location, histological subtype (the morpheaform, the sclerosing, the infiltrating, the micronodular and the metatypical subtypes are associated with higher risk of relapse as compared to the risk associated with the superficial and the nodular types), recurrent-refractory tumors (see Table 1), basal cell carcinoma size (largest tumor diameter) = 5 cm for head and neck tumors

6. Clinical features for definition of "BCC not amenable for radical surgery" include:

• BCC that has recurred in the same location after minimum 2 surgical procedures (excluding biopsies) and/or curative resection is deemed unlikely

• multifocal BCC or extensive tumors (see table 1) with bleeding or infected areas

• anticipated substantial morbidity and/or deformity from surgery (e.g., removal of all or part of a facial structure, such as nose, ear, eyelid, eye; or requirement for limb amputation)

7. Patients with BCCs localized where surgery is technically difficult, or would result in unacceptable tissue destruction

8. Patients with a clinical contraindication to surgery

9. Previous radiotherapy on other BCC

10. Patients with measurable and/or non-measurable disease (as defined by RECIST, v1.1) are allowed

11. Eastern Cooperative Oncology Group (ECOG) performance status of 0-1

12. Adequate hematopoietic capacity, defined as the following:

• Hemoglobin : 8.5 g/dl

• Absolute neutrophil count (ANC) = 1500/mL

• Platelet count = 75,000/mL

13. Adequate hepatic function, defined as the following:

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) = 3 times the upper limit of normal (ULN)Total bilirubin = 1.5 × ULN or within 3 × ULN for patients with documented Gilbert syndrome. Adequate renal function, defined by calculated serum creatinine clearance (CrCl) = 30 mL/min

14. For women of childbearing potential, a negative serum pregnancy test within 7days prior to commencement of dosing is required.

15. Women of child-bearing potential must use two methods of acceptable contraception including one highly effective method and a barrier method, as directed by their physician, during treatment and for at least 24 months after completion of study treatment. Highly effective methods of contraception are defined as those which result in a low failure rate (i.e., less than 1% per year) when used consistently and correctly (e.g., implants, injectables, combined oral contraception, or intra-uterine devices). At the discretion of the Investigator, acceptable methods of contraception may include total abstinence. Periodic abstinence (e.g., calendar, ovulation, symptothermal, and post ovulation methods) and withdrawal are not acceptable methods of contraception (See Appendix B).

16. For male patients with female partners of childbearing potential, agreement to use a condom, even after a vasectomy, during sexual intercourse with female partners while being treated with Vismodegib, and for 2 months after completion of study treatment

17. Agreement not to donate blood or blood products during the study and for at least 24 months after completion of study treatment (Vismodegib).

Exclusion Criteria:

1. Inability or unwillingness to swallow capsules

2. Inability or unwillingness to comply with study procedures

3. Pregnancy or lactation (lactation not allowed for at least 24 months after completion of study treatment)

4. Concurrent non-protocol-specified anti-tumor therapy (e.g., chemotherapy, other targeted therapy, photodynamic therapy, including participation in an experimental drug study)

5. Metastatic BCC

6. Gorlin Syndrome or any other contraindication to radiotherapy

7. Recent (i.e., within the past 28 days prior to enrollment in this study) or current participation in another experimental drug study

8. Uncontrolled medical illness, including advanced malignancies, at the discretion of the Investigator

9. History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that might affect interpretation of the results of the study or renders the patient at high risk for treatment complications

Related Conditions & MeSH terms

• Carcinoma
• Carcinoma, Basal Cell

Intervention

Drug:
• Vismodegib
Patients will receive a continuous once-daily oral dosing of Vismodegib at a dosage of 150 mg .

Radiation:
• Radiotherapy
Radiotherapy (RT) will be administered with a total dose of 50 Gy/2.5 Gy per fraction over 4 weeks.

Locations

Country	Name	City	State
Italy	Istituto Clinico humanitas	Rozzano	Mi

Sponsors (1)

Lead Sponsor	Collaborator
Istituto Clinico Humanitas

Country where clinical trial is conducted

Italy, 

References & Publications (9)

Chang AL, Solomon JA, Hainsworth JD, Goldberg L, McKenna E, Day BM, Chen DM, Weiss GJ. Expanded access study of patients with advanced basal cell carcinoma treated with the Hedgehog pathway inhibitor, vismodegib. J Am Acad Dermatol. 2014 Jan;70(1):60-9. doi: 10.1016/j.jaad.2013.09.012. Epub 2013 Nov 1. — View Citation

Diffey BL, Langtry JA. Skin cancer incidence and the ageing population. Br J Dermatol. 2005 Sep;153(3):679-80. — View Citation

Gailani MR, Ståhle-Bäckdahl M, Leffell DJ, Glynn M, Zaphiropoulos PG, Pressman C, Undén AB, Dean M, Brash DE, Bale AE, Toftgård R. The role of the human homologue of Drosophila patched in sporadic basal cell carcinomas. Nat Genet. 1996 Sep;14(1):78-81. — View Citation

Pollom EL, Bui TT, Chang AL, Colevas AD, Hara WY. Concurrent Vismodegib and Radiotherapy for Recurrent, Advanced Basal Cell Carcinoma. JAMA Dermatol. 2015 Sep;151(9):998-1001. doi: 10.1001/jamadermatol.2015.0326. — View Citation

Sekulic A, Migden MR, Oro AE, Dirix L, Lewis KD, Hainsworth JD, Solomon JA, Yoo S, Arron ST, Friedlander PA, Marmur E, Rudin CM, Chang AL, Low JA, Mackey HM, Yauch RL, Graham RA, Reddy JC, Hauschild A. Efficacy and safety of vismodegib in advanced basal-cell carcinoma. N Engl J Med. 2012 Jun 7;366(23):2171-9. doi: 10.1056/NEJMoa1113713. — View Citation

Strasswimmer JM. Potential Synergy of Radiation Therapy With Vismodegib for Basal Cell Carcinoma. JAMA Dermatol. 2015 Sep;151(9):925-6. doi: 10.1001/jamadermatol.2015.0977. — View Citation

Tang JY, Mackay-Wiggan JM, Aszterbaum M, Yauch RL, Lindgren J, Chang K, Coppola C, Chanana AM, Marji J, Bickers DR, Epstein EH Jr. Inhibiting the hedgehog pathway in patients with the basal-cell nevus syndrome. N Engl J Med. 2012 Jun 7;366(23):2180-8. doi: 10.1056/NEJMoa1113538. — View Citation

Telfer NR, Colver GB, Morton CA; British Association of Dermatologists. Guidelines for the management of basal cell carcinoma. Br J Dermatol. 2008 Jul;159(1):35-48. doi: 10.1111/j.1365-2133.2008.08666.x. Review. — View Citation

Von Hoff DD, LoRusso PM, Rudin CM, Reddy JC, Yauch RL, Tibes R, Weiss GJ, Borad MJ, Hann CL, Brahmer JR, Mackey HM, Lum BL, Darbonne WC, Marsters JC Jr, de Sauvage FJ, Low JA. Inhibition of the hedgehog pathway in advanced basal-cell carcinoma. N Engl J Med. 2009 Sep 17;361(12):1164-72. doi: 10.1056/NEJMoa0905360. Epub 2009 Sep 2. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	evaluate the activity of the study therapy in terms of proportion of patients progression free	The primary objective is to evaluate the activity of the study therapy (radiotherapy followed by six cycles of Vismodegib 150 mg/d continuously) in terms of proportion of patients progression free at 12 months.	1 years
Secondary	evaluate the efficacy of the study therapy in terms of progression free survival	The secondary objectives are: to evaluate the efficacy of the study therapy in terms of progression free survival (PFS)	2 years
Secondary	evaluate the efficacy of the study therapy in terms overall survival	The secondary objectives are: to evaluate the efficacy of the study therapy in terms of overall survival (OS);	2 years
Secondary	response in terms of overall response rate (ORR)	to assess the response in terms of ORR (complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD))	2 years
Secondary	duration of response	to assess duration of response (DoR);	2 years
Secondary	assess the safety in terms of incidence, type, and severity of adverse events (AEs) and serious adverse events (SAEs)	to assess the safety in terms of incidence, type, and severity of AEs and SAEs	2 years
Secondary	measure the effects of skin disease on quality of life (QoL) of patients	to measure the effects of skin disease on quality of life (QoL) of patients under therapy (Skindex-16)	2 years