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Report for Clinical Trial NCT01942993

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

The Effect of BRAF Inhibition With Vemurafenib On The Innate and Adaptive Immune Systems in Patients With Unresectable Stage III or Stage IV Melanoma Expressing a V600 BRAF Mutation

Approximately 40-60 % of cutaneous melanomas select for a mutation in a protein called BRAF which is part of a signaling pathway called the Mitogen Activated Protein Kinase (MAPK) pathway. When BRAF is mutated the MAPK pathway remains active allowing for melanoma to grow. Vemurafenib is an oral treatment which blocks the activity of BRAF which leads to decreasing the activity of the MAPK pathway. When patients with melanoma expressing specific mutation in BRAF are treated with vemurafenib approximately 50% will develop a response to treatment with shrinkage of tumor. When compared to a standard chemotherapy called dacarbazine used to treat melanoma, treatment with vemurafenib leads to a statistically significant overall survival or living longer benefit. Because of this survival benefit vemurafenib was Food and Drug Administration (FDA) approved for the treatment of metastatic melanoma expressing a BRAF mutation called V600E BRAF. There is increasing evidence that the immune system can also be important in affecting melanoma growth and survival and there are immune treatments FDA approved for the treatment of metastatic melanoma. There is some limited evidence that blocking BRAF with vemurafenib may affect the activity of components of the immune system. It is important to better characterize and understand the effects of vemurafenib treatment on various components of the immune system. The purpose of this study is to systematically evaluate the effects of vemurafenib treatment (at FDA approved dosing regimen) on parts of the immune systems called the innate and adaptive immune systems. The hypothesis is that vemurafenib treatment will affect the immune system.

NCT01942993 Melanoma
MeSH:Melanoma
HPO:Cutaneous melanoma Melanoma

1 Interventions

Name: Vemurafenib

Description: Vemurafenib will be administered at the FDA approved dose of 960 mg approximately 12 hours apart with or without a meal. Vemurafenib is provided at 240-mg film-coated tablets packed in bottles for oral administration. Vemurafenib should be swallowed whole with a glass of water and the medication should not be chewed or crushed. Management of symptomatic adverse events may require dose reductions, treatment interruptions, or treatment discontinuation. Dose reductions below 480 mg twice daily are not recommended.
Type: Drug
Group Labels: 1

Vemurafenib


Primary Outcomes

Description: Immuno-fluorescence and flow cytometry will be performed on blood specimens obtained to determine changes in the immune cell signature in the blood on day 8 after initiation of vemurafenib treatment as compared to baseline

Measure: Changes in the immune cellular signature in the blood circulation

Time: baseline and day 8

Description: Immuno-fluorescence and flow cytometry will be performed on blood specimens obtained to determine changes in the immune cell signature in the blood on day 57 after initiation of vemurafenib treatment as compared to baseline

Measure: Changes in the immune cellular signature in the blood circulation

Time: baseline and day 57

Secondary Outcomes

Description: Immuno-fluorescence and flow cytometry will be performed on tumor specimens obtained to determine changes in the immune cell signature in the tumor on day 8-10 after initiation of vemurafenib treatment as compared to baseline

Measure: Changes in the immune cellular signature in the tumor

Time: baseline and day 8-10

Description: Global changes in the blood transcriptome in response to vemurafenib therapy will be performed using gene expression arrays. Change in the blood transcriptosome on day 8 as compared to baseline.

Measure: Changes in Transcriptional Profile in the blood

Time: baseline and day 8

Description: Global changes in the blood transcriptome in response to vemurafenib therapy will be performed using gene expression arrays. Change in the blood transcriptosome on day 57 as compared to baseline.

Measure: Changes in Transcriptional Profile in the blood

Time: baseline and day 57

Description: Global changes in the transcriptosome of tumor associated immune cells in response to therapy will be performed using gene expression arrays. The transcriptosome in tumor will be compared on purified tumor immune cells obtained from a pretreatment tumor biopsy performed at baseline and a second biopsy obtained after starting treatment and obtained between days 8-10.

Measure: Change in Transcriptional Profile in Tumor

Time: baseline and day 8-10

Description: change in dendritic cell function at day 8 as compared to baseline

Measure: Changes in Dendritic Cell function in Blood

Time: baseline and day 8

Description: change in dendritic cell function at day 57 as compared to baseline

Measure: Changes in Dendritic Cell function in Blood

Time: baseline and day 57

Description: Changes in dendritic cell function in tumor on day 8-10 as compared to baseline

Measure: Changes in Dendritic Cell function in Tumor

Time: baseline and day 8-10

Description: Changes in macrophage function in blood at day 8 as compared to baseline

Measure: Changes in Macrophage Function in Blood

Time: baseline and day 8

Description: Changes in macrophage function in blood at day 57 as compared to baseline

Measure: Changes in Macrophage Function in Blood

Time: baseline and day 57

Description: changes in macrophage function in tumor on day 8-10 as compared to baseline

Measure: Changes in Macrophage Function in Tumor

Time: baseline and day 8-10

Description: changes in global T cell function in blood on day 8 as compared to baseline

Measure: Changes in Global T cell function in Blood

Time: baseline and day 8

Description: changes in global T cell function in blood on day 57 as compared to baseline

Measure: Changes in Global T cell function in Blood

Time: baseline and day 57

Description: Changes in Global T cell function in Tumor on day 8 as compared to baseline

Measure: Changes in Global T cell function in Tumor

Time: baseline and day 8-10

Description: Changes in Tumor Antigen Specific T cell Function using CD154 induction assay on day 8 as compared to baseline

Measure: Changes in Tumor Antigen Specific T cell Function in blood

Time: baseline and day 8

Description: Changes in Tumor Antigen Specific T cell Function using CD154 induction assay on day 15 as compared to baseline

Measure: Changes in Tumor Antigen Specific T cell Function in blood

Time: baseline and day 15

Description: Changes in Tumor Antigen Specific T cell Function using CD154 induction assay on day 126 as compared to baseline

Measure: Changes in Tumor Antigen Specific T cell Function in blood

Time: baseline and day 126

Description: Changes in Histocytometry of tumor on day 8-10 as compared to baseline. Histocytometry is a novel microscopic analytical method (Gerner et al. 2012) which combines the advantages of flow cytometry and Microscopic techniques. This techniques allows for the visualization and quantification of phenotypically complex cellular subsets and provides spatial and cell-cell interactions.

Measure: Changes in Histocytometry of tumor

Time: baseline and day 8-10

Description: changes in tumor burden using CT or MRI imaging studies

Measure: response to vemurafenib treatment

Time: up to 57 days

Description: development of cutaneous squamous cell carcinomas assessment

Measure: Development of Cutaneous Squamous Cell Carcinomas

Time: up to one year

Purpose: Treatment

Allocation: N/A

Single Group Assignment


There is one SNP

SNPs


1 V600E

Because of this survival benefit vemurafenib was Food and Drug Administration (FDA) approved for the treatment of metastatic melanoma expressing a BRAF mutation called V600E BRAF. --- V600E ---

Over 90% of mutations in BRAF occur at position V600 with the most common being a V600E mutation. --- V600E ---

The response rate to treatment with vemurafenib in patients with stage IV melanoma expressing a V600E BRAF mutation is approximately 50%. --- V600E ---

Based on this survival benefit vemurafenib was FDA approved for treatment of stage IV melanoma expressing a V600E BRAF mutation. --- V600E ---



HPO Nodes


HPO: