Melanoma: METRIC trial

Abbreviations

No EU-CTR

  • METRIC references
    2012-07-12
    Keith T. Flaherty
    Improved Survival with MEK Inhibition in BRAF-Mutated Melanoma
Investigated (inv)
Comparator (comp)

TRAM

chemo

214

108

Phase:

3

Randomisation:

Open label

Primary tumour:

Melanoma

Subtype (biomarker):

V600E MT, V600K MT

Stage:

meta

Line of therapy:

L1

Primary
TRAM
chemo
HR
p
PFS
4.8 mo
1.5 mo
0.45 (0.33-0.63)
<0.001
Secondaries
TRAM
chemo
HR
p
OS @6mo.
81%
67%
0.54 (0.32-0.92)
0.01
CR
2%
0%
PR
20%
8%
(all grades, %)
TRAM
chemo
p
Rash
57
10
NA
Diarrhea
43
16
NA
Fatigue
26
27
NA
Peripheral edema
26
3
NA
Acneiform dermatitis
19
1
NA
Nausea
18
37
NA
Alopecia
17
19
NA
Hypertension
15
7
NA
Constipation
14
23
NA
Vomiting
13
19
NA
  • Inclusion
  • Exclusion

- ≥18 years of age - Stage III unresectable (Stage IIIc) or metastatic (Stage IV) cutaneous melanoma which is also determined to be BRAF V600E/K mutation-positive by the central laboratory - Received no prior treatment or up to one prior regimen of chemotherapy for advanced or metastatic melanoma. Prior treatment with immunotherapy (except for prior ipilimumab, which is only allowed if given in the adjuvant setting), cytokine therapy, biological or vaccine regimen is permitted. Prior use of sorafenib is allowed - Measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST 1.1) - Women of childbearing potential and men with reproductive potential must agree to use effective contraception during the study. Additionally, women of childbearing potential must have a negative serum pregnancy test within 14 days before randomization - Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-1 - Adequate screening organ function.

- Any prior use of BRAF inhibitors or MEK inhibitors. - Subjects who have received dacarbazine or paclitaxel before randomization will not be eligible to receive the same chemotherapy as study medication (i.e. a subject who received prior dacarbazine cannot receive dacarbazine on this trial and would thus receive paclitaxel if randomized to the control arm) - History of another malignancy. Exception: Subjects who have been disease-free for 3 years, or subjects with a history of completely resected non-melanoma skin cancer or successfully treated in situ carcinoma are eligible. Subjects with second malignancies that are indolent or definitively treated may be enrolled. - Known Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), or Hepatitis C Virus (HCV) infection (except for chronic or cleared HBV and HCV infection which will be allowed) - Brain metastases with the following exceptions that are ALL confirmed by the GSK Medical Monitor: All known lesions must be previously treated with surgery or stereotactic radiosurgery, and Brain lesion(s), if still present, must be confirmed stable (i.e. no increase in lesion size) for ≥90 days before randomization (must be documented with two consecutive MRI or CT scans using contrast), and asymptomatic with no corticosteroids requirement for ≥ 30 days before randomization, and no enzyme-inducing anticonvulsants for ≥30 days before randomization - History or evidence of cardiovascular risk including any of the following: • QTcB ≥ 480 msec. • History or evidence of current clinically significant uncontrolled arrhythmias. Exception: Subjects with controlled atrial fibrillation for >30 days before randomization are eligible • History of acute coronary syndromes (including myocardial infarction and unstable angina), coronary angioplasty, or stenting within 6 months before randomization. • History or evidence of current ≥ Class II congestive heart failure as defined by the New York Heart Association • History of interstitial lung disease or pneumonitis - History or current evidence/risk of retinal vein occlusion (RVO) or central serous retinopathy (CSR): • History of RVO or CSR, or predisposing factors to RVO or CSR (e.g. uncontrolled glaucoma or ocular hypertension, uncontrolled hypertension, uncontrolled diabetes mellitus, or history of hyperviscosity or hypercoagulability syndromes). • Visible retinal pathology as assessed by ophthalmic exam that is considered a risk factor for RVO or CSR such as: - Evidence of new optic disc cupping. - Intraocular pressure >21 mm Hg as measured by tonography

Characteristics
TRAM
chemo
Agedc-comma sexdc-comma race
Median age - yr (range)
55 (23–85)
54 (21–77)
Male - no. (%)
120 (56)
53 (49)
White race - no. (%)
214 (100)
108 (100)
ECOG - no. (%)
0
136 (64)
69 (64)
1
78 (36)
39 (36)
Extent of metastatic - no. (%)
M1a
24 (11)
15 (14)
M1b
35 (16)
22 (20)
M1c
144 (67)
63 (58)
Unresectable IIIC
10 (5)
8 (7)
LDH - no. (%)
≤ULN
134 (63)
66 (61)
>ULN
77 (36)
42 (39)
Missing data
3 (1)
0
Previous chemotherapy - no. (%)
No
143 (67)
70 (65)
Yes
71 (33)
38 (35)
Other
History of brain metastasis - no. (%)
9 (4)
2 (2)
Disease at ≥3 sites - no. (%)
123 (57)
56 (52)
Previous immunotherapy - no. (%)
68 (32)
30 (28)
Ad-hoc:
no.pts inv.
no.pts comp.
TRAM
chemo
HR
p
  • PFS
analisys of PFS
TRAM
chemo
HR (95% CI)
Mutation status (n)
V600Edc-comma no brain metastasis (273)
0.44 (0.31–0.64)
V600Edc-comma no brain metastasis dc-and prev. treatment (97)
0.52 (0.29–0.93)
Mutation status (n)
V600Edc-comma no brain meta & no prev. treatment (176)
0.44 (0.28–0.69)
V600K (40)
0.50 (0.18–1.35)
Age - yr (n)
≥65 (71)
0.58 (0.29–1.18)
<65 (251)
0.44 (0.31–0.65)
Sex (n)
Male (173)
0.53 (0.33–0.84)
Female (149)
0.38 (0.23–0.62)
Disease stage (n)
IIIcdc-comma IVM1adc-comma IVM1b (114)
0.44 (0.25–0.78)
IVM1c (207)
0.43 (0.28–0.66)
ECOG (n)
0 (205)
0.55 (0.36–0.83)
1 (117)
0.38 (0.22–0.65)
LDH (n)
≤ULN (200)
0.45 (0.29–0.71)
>ULN (119)
0.47 (0.29–0.76)
analisys of
TRAM
chemo
HR (95% CI)