Phase III Randomized Clinical Trial Comparing Tremelimumab With Standard-of-Care Chemotherapy in Patients With Advanced Melanoma
Identifieur interne : 002244 ( PascalFrancis/Curation ); précédent : 002243; suivant : 002245Phase III Randomized Clinical Trial Comparing Tremelimumab With Standard-of-Care Chemotherapy in Patients With Advanced Melanoma
Auteurs : Antoni Ribas [États-Unis] ; Richard Kefford [Australie] ; Margaret A. Marshall [États-Unis] ; Cornelis J. A. Punt [Pays-Bas] ; John B. Haanen [Pays-Bas] ; Maribel Marmol [Espagne] ; Claus Garbe [Allemagne] ; Helen Gogas [Grèce] ; Jacob Schachter [Israël] ; Gerald Linette [États-Unis] ; Paul Lorigan [Royaume-Uni] ; Kari L. Kendra [États-Unis] ; Michele Maio [Italie] ; Uwe Trefzer [Allemagne] ; Michael Smylie [Canada] ; Grant A. Mcarthur [Australie] ; Brigitte Dreno [France] ; Paul D. Nathan [Royaume-Uni] ; Jacek Mackiewicz [Pologne] ; John M. Kirkwood [États-Unis] ; Jesus Gomez-Navarro [États-Unis] ; BO HUANG [États-Unis] ; Dmitri Pavlov [États-Unis] ; Axel Hauschild [Allemagne]Source :
- Journal of clinical oncology [ 0732-183X ] ; 2013.
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- topic : Homme.
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Abstract
Purpose In phase I/II trials, the cytotoxic T lymphocyte-associated antigen-4-blocking monoclonal antibody tremelimumab induced durable responses in a subset of patients with advanced melanoma. This phase III study evaluated overall survival (OS) and other safety and efficacy end points in patients with advanced melanoma treated with tremelimumab or standard-of-care chemotherapy. Patients and Methods Patients with treatment-naive, unresectable stage Illc or IV melanoma were randomly assigned at a ratio of one to one to tremelimumab (15 mg/kg once every 90 days) or physician's choice of standard-of-care chemotherapy (temozolomide or dacarbazine). Results In all, 655 patients were enrolled and randomly assigned. The test statistic crossed the prespecified futility boundary at second interim analysis after 340 deaths, but survival follow-up continued. At final analysis with 534 events, median OS by intent to treat was 12.6 months (95% CI, 10.8 to 14.3) for tremelimumab and 10.7 months (95% CI, 9.36 to 11.96) for chemotherapy (hazard ratio, 0.88; P= .127). Objective response rates were similar in the two arms: 10.7% in the tremelimumab arm and 9.8% in the chemotherapy arm. However, response duration (measured from date of random assignment) was significantly longer after tremelimumab (35.8 v 13.7 months; P = .0011). Diarrhea, pruritus, and rash were the most common treatment-related adverse events in the tremelimumab arm; 7.4% had endocrine toxicities. Seven deaths in the tremelimumab arm and one in the chemotherapy arm were considered treatment related by either investigators or sponsor. Conclusion This study failed to demonstrate a statistically significant survival advantage of treatment with tremelimumab over standard-of-care chemotherapy in first-line treatment of patients with metastatic melanoma.
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Phase III Randomized Clinical Trial Comparing Tremelimumab With Standard-of-Care Chemotherapy in Patients With Advanced Melanoma</title>
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<author><name sortKey="Schachter, Jacob" sort="Schachter, Jacob" uniqKey="Schachter J" first="Jacob" last="Schachter">Jacob Schachter</name>
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<author><name sortKey="Smylie, Michael" sort="Smylie, Michael" uniqKey="Smylie M" first="Michael" last="Smylie">Michael Smylie</name>
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<author><name sortKey="Nathan, Paul D" sort="Nathan, Paul D" uniqKey="Nathan P" first="Paul D." last="Nathan">Paul D. Nathan</name>
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</affiliation>
</author>
<author><name sortKey="Mackiewicz, Jacek" sort="Mackiewicz, Jacek" uniqKey="Mackiewicz J" first="Jacek" last="Mackiewicz">Jacek Mackiewicz</name>
<affiliation wicri:level="1"><inist:fA14 i1="20"><s1>Zaklad Diagnostyki i Immunologii Nowotworow Wielkopolskie Centrum Onkologii, University of Medical Sciences</s1>
<s2>Poznan</s2>
<s3>POL</s3>
<sZ>19 aut.</sZ>
</inist:fA14>
<country>Pologne</country>
</affiliation>
</author>
<author><name sortKey="Kirkwood, John M" sort="Kirkwood, John M" uniqKey="Kirkwood J" first="John M." last="Kirkwood">John M. Kirkwood</name>
<affiliation wicri:level="1"><inist:fA14 i1="21"><s1>University of Pittsburgh School of Medicine</s1>
<s2>Pittsburgh, PA</s2>
<s3>USA</s3>
<sZ>20 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
</affiliation>
</author>
<author><name sortKey="Gomez Navarro, Jesus" sort="Gomez Navarro, Jesus" uniqKey="Gomez Navarro J" first="Jesus" last="Gomez-Navarro">Jesus Gomez-Navarro</name>
<affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Pfizer Global Research and Development</s1>
<s2>Groton, CT</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
</affiliation>
</author>
<author><name sortKey="Bo Huang" sort="Bo Huang" uniqKey="Bo Huang" last="Bo Huang">BO HUANG</name>
<affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Pfizer Global Research and Development</s1>
<s2>Groton, CT</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
</affiliation>
</author>
<author><name sortKey="Pavlov, Dmitri" sort="Pavlov, Dmitri" uniqKey="Pavlov D" first="Dmitri" last="Pavlov">Dmitri Pavlov</name>
<affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Pfizer Global Research and Development</s1>
<s2>Groton, CT</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
</affiliation>
</author>
<author><name sortKey="Hauschild, Axel" sort="Hauschild, Axel" uniqKey="Hauschild A" first="Axel" last="Hauschild">Axel Hauschild</name>
<affiliation wicri:level="1"><inist:fA14 i1="10"><s1>University of Kiel</s1>
<s2>Kiel</s2>
<s3>DEU</s3>
<sZ>24 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">Journal of clinical oncology</title>
<title level="j" type="abbreviated">J. clin. oncol.</title>
<idno type="ISSN">0732-183X</idno>
<imprint><date when="2013">2013</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Journal of clinical oncology</title>
<title level="j" type="abbreviated">J. clin. oncol.</title>
<idno type="ISSN">0732-183X</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Advanced stage</term>
<term>Cancerology</term>
<term>Chemotherapy</term>
<term>Comparative study</term>
<term>Human</term>
<term>Malignant melanoma</term>
<term>Phase III trial</term>
<term>Randomization</term>
<term>Treatment</term>
<term>Tremelimumab</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Essai clinique phase III</term>
<term>Randomisation</term>
<term>Etude comparative</term>
<term>Trémélimumab</term>
<term>Traitement</term>
<term>Homme</term>
<term>Chimiothérapie</term>
<term>Stade avancé</term>
<term>Cancérologie</term>
<term>Mélanome malin</term>
<term>Soin standard</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term>
</keywords>
</textClass>
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</teiHeader>
<front><div type="abstract" xml:lang="en">Purpose In phase I/II trials, the cytotoxic T lymphocyte-associated antigen-4-blocking monoclonal antibody tremelimumab induced durable responses in a subset of patients with advanced melanoma. This phase III study evaluated overall survival (OS) and other safety and efficacy end points in patients with advanced melanoma treated with tremelimumab or standard-of-care chemotherapy. Patients and Methods Patients with treatment-naive, unresectable stage Illc or IV melanoma were randomly assigned at a ratio of one to one to tremelimumab (15 mg/kg once every 90 days) or physician's choice of standard-of-care chemotherapy (temozolomide or dacarbazine). Results In all, 655 patients were enrolled and randomly assigned. The test statistic crossed the prespecified futility boundary at second interim analysis after 340 deaths, but survival follow-up continued. At final analysis with 534 events, median OS by intent to treat was 12.6 months (95% CI, 10.8 to 14.3) for tremelimumab and 10.7 months (95% CI, 9.36 to 11.96) for chemotherapy (hazard ratio, 0.88; P= .127). Objective response rates were similar in the two arms: 10.7% in the tremelimumab arm and 9.8% in the chemotherapy arm. However, response duration (measured from date of random assignment) was significantly longer after tremelimumab (35.8 v 13.7 months; P = .0011). Diarrhea, pruritus, and rash were the most common treatment-related adverse events in the tremelimumab arm; 7.4% had endocrine toxicities. Seven deaths in the tremelimumab arm and one in the chemotherapy arm were considered treatment related by either investigators or sponsor. Conclusion This study failed to demonstrate a statistically significant survival advantage of treatment with tremelimumab over standard-of-care chemotherapy in first-line treatment of patients with metastatic melanoma.</div>
</front>
</TEI>
<inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0732-183X</s0>
</fA01>
<fA03 i2="1"><s0>J. clin. oncol.</s0>
</fA03>
<fA05><s2>31</s2>
</fA05>
<fA06><s2>5</s2>
</fA06>
<fA08 i1="01" i2="1" l="ENG"><s1>Phase III Randomized Clinical Trial Comparing Tremelimumab With Standard-of-Care Chemotherapy in Patients With Advanced Melanoma</s1>
</fA08>
<fA11 i1="01" i2="1"><s1>RIBAS (Antoni)</s1>
</fA11>
<fA11 i1="02" i2="1"><s1>KEFFORD (Richard)</s1>
</fA11>
<fA11 i1="03" i2="1"><s1>MARSHALL (Margaret A.)</s1>
</fA11>
<fA11 i1="04" i2="1"><s1>PUNT (Cornelis J. A.)</s1>
</fA11>
<fA11 i1="05" i2="1"><s1>HAANEN (John B.)</s1>
</fA11>
<fA11 i1="06" i2="1"><s1>MARMOL (Maribel)</s1>
</fA11>
<fA11 i1="07" i2="1"><s1>GARBE (Claus)</s1>
</fA11>
<fA11 i1="08" i2="1"><s1>GOGAS (Helen)</s1>
</fA11>
<fA11 i1="09" i2="1"><s1>SCHACHTER (Jacob)</s1>
</fA11>
<fA11 i1="10" i2="1"><s1>LINETTE (Gerald)</s1>
</fA11>
<fA11 i1="11" i2="1"><s1>LORIGAN (Paul)</s1>
</fA11>
<fA11 i1="12" i2="1"><s1>KENDRA (Kari L.)</s1>
</fA11>
<fA11 i1="13" i2="1"><s1>MAIO (Michele)</s1>
</fA11>
<fA11 i1="14" i2="1"><s1>TREFZER (Uwe)</s1>
</fA11>
<fA11 i1="15" i2="1"><s1>SMYLIE (Michael)</s1>
</fA11>
<fA11 i1="16" i2="1"><s1>MCARTHUR (Grant A.)</s1>
</fA11>
<fA11 i1="17" i2="1"><s1>DRENO (Brigitte)</s1>
</fA11>
<fA11 i1="18" i2="1"><s1>NATHAN (Paul D.)</s1>
</fA11>
<fA11 i1="19" i2="1"><s1>MACKIEWICZ (Jacek)</s1>
</fA11>
<fA11 i1="20" i2="1"><s1>KIRKWOOD (John M.)</s1>
</fA11>
<fA11 i1="21" i2="1"><s1>GOMEZ-NAVARRO (Jesus)</s1>
</fA11>
<fA11 i1="22" i2="1"><s1>BO HUANG</s1>
</fA11>
<fA11 i1="23" i2="1"><s1>PAVLOV (Dmitri)</s1>
</fA11>
<fA11 i1="24" i2="1"><s1>HAUSCHILD (Axel)</s1>
</fA11>
<fA14 i1="01"><s1>University of California Los Angeles</s1>
<s2>Los Angeles, CA</s2>
<s3>USA</s3>
<sZ>1 aut.</sZ>
</fA14>
<fA14 i1="02"><s1>Westmead Institute for Cancer Research and Melanoma Institute Australia, University of Sydney at Westmead Hospital</s1>
<s2>Sydney, New South Wales</s2>
<s3>AUS</s3>
<sZ>2 aut.</sZ>
</fA14>
<fA14 i1="03"><s1>Peter MacCallum Cancer Centre, East Melbourne</s1>
<s2>Victoria</s2>
<s3>AUS</s3>
<sZ>16 aut.</sZ>
</fA14>
<fA14 i1="04"><s1>Pfizer Global Research and Development</s1>
<s2>Groton, CT</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
</fA14>
<fA14 i1="05"><s1>Radboud University Nijmegen Medical Center</s1>
<s2>Nijmegen</s2>
<s3>NLD</s3>
<sZ>4 aut.</sZ>
</fA14>
<fA14 i1="06"><s1>Netherlands Cancer Institute</s1>
<s2>Amsterdam</s2>
<s3>NLD</s3>
<sZ>5 aut.</sZ>
</fA14>
<fA14 i1="07"><s1>Hospital Clinic of Barcelona</s1>
<s2>Barcelona</s2>
<s3>ESP</s3>
<sZ>6 aut.</sZ>
</fA14>
<fA14 i1="08"><s1>University Hospital Tübingen</s1>
<s2>Tübingen</s2>
<s3>DEU</s3>
<sZ>7 aut.</sZ>
</fA14>
<fA14 i1="09"><s1>Skin Cancer Center, Charite Universitatsmedizin Berlin</s1>
<s2>Berlin</s2>
<s3>DEU</s3>
<sZ>14 aut.</sZ>
</fA14>
<fA14 i1="10"><s1>University of Kiel</s1>
<s2>Kiel</s2>
<s3>DEU</s3>
<sZ>24 aut.</sZ>
</fA14>
<fA14 i1="11"><s1>University of Athens</s1>
<s2>Athens</s2>
<s3>GRC</s3>
<sZ>8 aut.</sZ>
</fA14>
<fA14 i1="12"><s1>Sheba Medical Centre</s1>
<s2>Tel Hashomer</s2>
<s3>ISR</s3>
<sZ>9 aut.</sZ>
</fA14>
<fA14 i1="13"><s1>Washington University School of Medicine</s1>
<s2>St Louis, MO</s2>
<s3>USA</s3>
<sZ>10 aut.</sZ>
</fA14>
<fA14 i1="14"><s1>Christie Hospital, National Health Service Foundation Trust</s1>
<s2>Manchester</s2>
<s3>GBR</s3>
<sZ>11 aut.</sZ>
</fA14>
<fA14 i1="15"><s1>Mount Vernon Hospital</s1>
<s2>Northwood, Middlesex</s2>
<s3>GBR</s3>
<sZ>18 aut.</sZ>
</fA14>
<fA14 i1="16"><s1>Arthur G. James Cancer Hospital and Richard J. Solve Research Institute</s1>
<s2>Columbus, OH</s2>
<s3>USA</s3>
<sZ>12 aut.</sZ>
</fA14>
<fA14 i1="17"><s1>Immunoterapia Oncologica-Azienda Ospedaliera Universitaria Senese</s1>
<s2>Siena</s2>
<s3>ITA</s3>
<sZ>13 aut.</sZ>
</fA14>
<fA14 i1="18"><s1>Cross Cancer Institute, University of Alberta</s1>
<s2>Edmonton, Alberta</s2>
<s3>CAN</s3>
<sZ>15 aut.</sZ>
</fA14>
<fA14 i1="19"><s1>Centre Hospitalier Universitaire de Nantes-Hôtel Dieu, Clinique Dermatologique</s1>
<s2>Nantes</s2>
<s3>FRA</s3>
<sZ>17 aut.</sZ>
</fA14>
<fA14 i1="20"><s1>Zaklad Diagnostyki i Immunologii Nowotworow Wielkopolskie Centrum Onkologii, University of Medical Sciences</s1>
<s2>Poznan</s2>
<s3>POL</s3>
<sZ>19 aut.</sZ>
</fA14>
<fA14 i1="21"><s1>University of Pittsburgh School of Medicine</s1>
<s2>Pittsburgh, PA</s2>
<s3>USA</s3>
<sZ>20 aut.</sZ>
</fA14>
<fA20><s1>616-622</s1>
</fA20>
<fA21><s1>2013</s1>
</fA21>
<fA23 i1="01"><s0>ENG</s0>
</fA23>
<fA43 i1="01"><s1>INIST</s1>
<s2>20094</s2>
<s5>354000182530890160</s5>
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<fA44><s0>0000</s0>
<s1>© 2013 INIST-CNRS. All rights reserved.</s1>
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<fA45><s0>13 ref.</s0>
</fA45>
<fA47 i1="01" i2="1"><s0>13-0098636</s0>
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<fA60><s1>P</s1>
</fA60>
<fA61><s0>A</s0>
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<fA64 i1="01" i2="1"><s0>Journal of clinical oncology</s0>
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<fA66 i1="01"><s0>USA</s0>
</fA66>
<fC01 i1="01" l="ENG"><s0>Purpose In phase I/II trials, the cytotoxic T lymphocyte-associated antigen-4-blocking monoclonal antibody tremelimumab induced durable responses in a subset of patients with advanced melanoma. This phase III study evaluated overall survival (OS) and other safety and efficacy end points in patients with advanced melanoma treated with tremelimumab or standard-of-care chemotherapy. Patients and Methods Patients with treatment-naive, unresectable stage Illc or IV melanoma were randomly assigned at a ratio of one to one to tremelimumab (15 mg/kg once every 90 days) or physician's choice of standard-of-care chemotherapy (temozolomide or dacarbazine). Results In all, 655 patients were enrolled and randomly assigned. The test statistic crossed the prespecified futility boundary at second interim analysis after 340 deaths, but survival follow-up continued. At final analysis with 534 events, median OS by intent to treat was 12.6 months (95% CI, 10.8 to 14.3) for tremelimumab and 10.7 months (95% CI, 9.36 to 11.96) for chemotherapy (hazard ratio, 0.88; P= .127). Objective response rates were similar in the two arms: 10.7% in the tremelimumab arm and 9.8% in the chemotherapy arm. However, response duration (measured from date of random assignment) was significantly longer after tremelimumab (35.8 v 13.7 months; P = .0011). Diarrhea, pruritus, and rash were the most common treatment-related adverse events in the tremelimumab arm; 7.4% had endocrine toxicities. Seven deaths in the tremelimumab arm and one in the chemotherapy arm were considered treatment related by either investigators or sponsor. Conclusion This study failed to demonstrate a statistically significant survival advantage of treatment with tremelimumab over standard-of-care chemotherapy in first-line treatment of patients with metastatic melanoma.</s0>
</fC01>
<fC02 i1="01" i2="X"><s0>002B04</s0>
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<fC02 i1="02" i2="X"><s0>002B08A</s0>
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<s5>08</s5>
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