Transarterial Chemoembolization for the Treatment of Uveal Melanoma With Liver Metastases

Study Purpose

This phase II trial studies the effect of transarterial chemoembolization in treating patients with uveal melanoma that has spread to the liver (liver metastases). Transarterial chemoembolization involves the injection of a blocking agent (gelatin sponge, ethiodized oil) and a chemotherapy agent (carmustine) directly into the artery in the liver to treat liver cancers. Chemotherapy drugs, such as carmustine, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. transarterial chemoembolization with carmustine in combination with ethiodized oil and gelatin sponge may help cause the tumors in the liver to shrink or disappear.

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

No
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Interventional
Eligible Ages 18 Years and Over
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

  • - Histologically confirmed metastatic uveal melanoma in the liver.
  • - Tumor burden < 75%.
Patients must have at least one tumor measuring >= 10 mm in longest diameter by magnetic resonance imaging (MRI) or triphasic computed tomography (CT) (if MRI is not available or contraindicated)
  • - No prior transarterial catheter-directed therapies.
Prior hepatic tumor ablation, hepatic radiation or liver resection will be permitted as long as growing measurable liver tumors exists. Prior systemic treatments are allowed as long as there are no outstanding toxicities greater than grade 1.
  • - Willingness and ability to give informed consent.
  • - Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
  • - Serum creatinine =< 2.0 mg/dl.
  • - Bilirubin =< 2.0 mg/ml.
Exceptions will be made for patients with diagnosed Gilbert's Syndrome. In this instance, a bilirubin level =< 3.0 mg/ml will be allowed for this patients with this syndrome.
  • - Albumin >= 3.0 g/dl.
  • - No ascites.
  • - Granulocyte count >= 1500/m^3.
  • - Platelet count >= 150,000/m^3.

Exclusion Criteria:

  • - Less than 18 years of age.
  • - Previous liver-directed treatments including immunoembolization, chemoembolization, radioembolization, hepatic arterial perfusion, or drug-eluting beads.
  • - Presence of life-limiting extrahepatic metastasis that requires systemic treatment within 3 months.
However, radiation treatment of extrahepatic metastases such as bone, lymph nodes or subcutaneous metastases will be permitted while the patient is on study. Zometa or X-Geva to treat bone metastases will also be permitted. Immune check-point inhibitors while on study will NOT be permitted.
  • - Portal vein occlusion, or inadequate collateral portal venous flow, as determined by MRI.
  • - Known active viral or autoimmune hepatitis requiring treatments with serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) equal or greater than 5 times normal.
  • - Presence of uncontrolled hypertension or congestive heart failure, or acute myocardial infarction within 6 months of entry.
  • - Presence of any other medical conditions that imply a survival of less than six months.
  • - Uncontrolled severe bleeding tendency or active gastrointestinal (GI) bleeding due to varices or main portal vein occlusion.
Abnormal coagulation test must be corrected prior to the procedure.
  • - History of life-threatening allergic reaction to iodinated contrast or BCNU despite pre-treatment with steroids.
  • - Pregnant and/or breastfeeding women.
  • - Presence of known untreated brain metastases.
If patients have had previous treatment for brain metastasis, an MRI or CT of the brain must confirm the stabilization of the brain metastasis for more than 4 weeks. - Biliary obstruction, biliary stent, or prior biliary surgery including sphincterotomy but excluding cholecystectomy

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT04728633
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

Phase 2
Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

Thomas Jefferson University
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

Carin Gonsalves, MD
Principal Investigator Affiliation Thomas Jefferson University
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

Other
Overall Status Recruiting
Countries United States
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

Metastatic Malignant Neoplasm in the Liver, Metastatic Uveal Melanoma, Stage IV Choroidal and Ciliary Body Melanoma AJCC V8
Additional Details

PRIMARY OBJECTIVE: To determine the efficacy (clinical response) in terms of disease control rate (DCR) (complete response [CR] + partial response [PR] + stable disease [SD]) with chemoembolization of hepatic metastases with 300 mg of carmustine (BCNU) in ethiodized oil in metastatic uveal melanoma patients. SECONDARY OBJECTIVES: To investigate overall survival (OS) and progression-free survival (PFS) in uveal melanoma patients with hepatic metastases. To assess the toxicity of the above treatment regimen. OUTLINE: Patients undergo transarterial chemoembolization (TACE) by receiving an infusion of carmustine dissolved in ethiodized oil and an injection of gelatin sponge. Treatment repeats once every 4 weeks (Q4W) for bilobar disease or once every 7 weeks (Q7W) for unilobar disease in the absence of disease progression or unacceptable toxicity or until maximum clinical benefit is obtained. After completion of study treatment, patients are followed up at 30 days, and then every 2 months for up to 2 years.

Arms & Interventions

Arms

Experimental: Treatment (carmustine, ethiodized oil, gelatin sponge)

Patients undergo TACE by receiving an infusion of carmustine dissolved in ethiodized oil and an injection of gelatin sponge. Treatment repeats Q4W for bilobar disease or Q7W for unilobar disease in the absence of disease progression or unacceptable toxicity or until maximum clinical benefit is obtained.

Interventions

Drug: - Carmustine

Given via infusion

Drug: - Ethiodized Oil

Given via infusion

Procedure: - Transarterial Chemoembolization

Undergo TACE

Other: - Medical Device Usage and Evaluation

Given gelatin sponge via injection

Contact a Trial Team

If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.

Philadelphia, Pennsylvania

Status

Recruiting

Address

Sidney Kimmel Cancer Center at Thomas Jefferson Univeristy

Philadelphia, Pennsylvania, 19107

Site Contact

Carin Gonsalves, MD

Carin.Gonsalves@jefferson.edu

215-955-6385

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