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This phase I/II trial studies the safety, best dose and effectiveness of targeted gene therapy combined with isolated limb infusion (ILI) of melphalan and dactinomycin for treating patients with advanced extremity melanoma that cannot be removed by surgery. Adding gene therapy to a standard chemotherapy regimen in the isolated limb may enhance anti-cancer effects by inducing a systemic immune response against the tumor cells.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment (targeted gene therapy and ILI) | Experimental | Patients receive melphalan and dactinomycin via ILI. Patients then receive CRAd 3/5-delta via ILI. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| dactinomycin | Biological | Given via ILI |
|
| Measure | Description | Time Frame |
|---|---|---|
| Optimal tolerated dose (OTD) of CRAd 3/5 | Defined as the dose level at which > 50% of target lesion viral infectivity is achieved and < 2 of 6 patients have dose limiting toxicities. | 14 days |
| Response rate (complete response [CR] + partial response [PR]) of CRAd 3/5-delta in combination with standard M-ILI (Phase II) | Assessed using revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) | 3 months |
| Progression Free Survival (Phase II) | Duration of time from start of treatment to time of progression or death, whichever occurs first. | 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| Safety of CRAd 3/5-delta in combination with standard M-ILI | Descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all toxicity reporting. | 2 years |
| Infectivity rate of CRAd 3/5-delta |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ryan Fields, M.D. | Washington University School of Medicine | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21111960 | Background | Turley RS, Raymond AK, Tyler DS. Regional treatment strategies for in-transit melanoma metastasis. Surg Oncol Clin N Am. 2011 Jan;20(1):79-103. doi: 10.1016/j.soc.2010.09.008. | |
| 16301451 | Background | Aloia TA, Grubbs E, Onaitis M, Mosca PJ, Cheng TY, Seigler H, Tyler DS. Predictors of outcome after hyperthermic isolated limb perfusion: role of tumor response. Arch Surg. 2005 Nov;140(11):1115-20. doi: 10.1001/archsurg.140.11.1115. |
| Label | URL |
|---|---|
| Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine | View source |
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| ID | Term |
|---|---|
| D008545 | Melanoma |
| ID | Term |
|---|---|
| D018358 | Neuroendocrine Tumors |
| D017599 | Neuroectodermal Tumors |
| D009373 | Neoplasms, Germ Cell and Embryonal |
| D009370 | Neoplasms by Histologic Type |
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| ID | Term |
|---|---|
| D003609 | Dactinomycin |
| D008558 | Melphalan |
| ID | Term |
|---|---|
| D006575 | Heterocyclic Compounds, 3-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D010456 | Peptides, Cyclic |
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| melphalan | Drug | Given via ILI |
|
|
| Conditionally replicative adenovirus 3/5-delta | Biological | Given via ILI |
|
|
Lesion biopsies; quantified using immunohistochemical staining method. |
| 2 days; baseline and day 1 or 2 post treatment |
| 16791448 | Background | Brady MS, Brown K, Patel A, Fisher C, Marx W. A phase II trial of isolated limb infusion with melphalan and dactinomycin for regional melanoma and soft tissue sarcoma of the extremity. Ann Surg Oncol. 2006 Aug;13(8):1123-9. doi: 10.1245/ASO.2006.05.003. Epub 2006 Jun 21. |
| 21343562 | Background | Beasley GM, Riboh JC, Augustine CK, Zager JS, Hochwald SN, Grobmyer SR, Peterson B, Royal R, Ross MI, Tyler DS. Prospective multicenter phase II trial of systemic ADH-1 in combination with melphalan via isolated limb infusion in patients with advanced extremity melanoma. J Clin Oncol. 2011 Mar 20;29(9):1210-5. doi: 10.1200/JCO.2010.32.1224. Epub 2011 Feb 22. |
| 18509706 | Background | Kroon HM, Moncrieff M, Kam PC, Thompson JF. Outcomes following isolated limb infusion for melanoma. A 14-year experience. Ann Surg Oncol. 2008 Nov;15(11):3003-13. doi: 10.1245/s10434-008-9954-6. Epub 2008 May 29. |
| 21493111 | Background | Raymond AK, Beasley GM, Broadwater G, Augustine CK, Padussis JC, Turley R, Peterson B, Seigler H, Pruitt SK, Tyler DS. Current trends in regional therapy for melanoma: lessons learned from 225 regional chemotherapy treatments between 1995 and 2010 at a single institution. J Am Coll Surg. 2011 Aug;213(2):306-16. doi: 10.1016/j.jamcollsurg.2011.03.013. Epub 2011 Apr 13. |
| 10955787 | Background | Alvarez RD, Barnes MN, Gomez-Navarro J, Wang M, Strong TV, Arafat W, Arani RB, Johnson MR, Roberts BL, Siegal GP, Curiel DT. A cancer gene therapy approach utilizing an anti-erbB-2 single-chain antibody-encoding adenovirus (AD21): a phase I trial. Clin Cancer Res. 2000 Aug;6(8):3081-7. |
| D009369 | Neoplasms |
| D009380 | Neoplasms, Nerve Tissue |
| D018326 | Nevi and Melanomas |
| D012878 | Skin Neoplasms |
| D009371 | Neoplasms by Site |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D047028 | Macrocyclic Compounds |
| D011083 | Polycyclic Compounds |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D009588 | Nitrogen Mustard Compounds |
| D009150 | Mustard Compounds |
| D006846 | Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D010649 | Phenylalanine |
| D024322 | Amino Acids, Aromatic |
| D000598 | Amino Acids, Cyclic |
| D000596 | Amino Acids |