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| Name | Class |
|---|---|
| Checkmate Pharmaceuticals | INDUSTRY |
| CellSight Technologies, Inc. | INDUSTRY |
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The main goal of this research study is to determine how nivolumab and nivolumab/Vidutolimod (CMP-001) combination affect the likelihood of destroying melanoma involving lymph node and/or in-transit/satellite areas.
The main goal of the PET/CT scan with 18F]F-AraG is to evaluate how [18F]F-AraG uptake changes before and after administration of either nivolumab or nivolumab/CMP-001 combination.
This is a phase II pilot study designed to compare the pCR rate of two neoadjuvant immunotherapies in high-risk resectable melanoma with two integrated biomarkers. The integrated [18F]F-AraG imaging biomarker images activated CD8+ T cells. The CD8+ T cell density biomarker quantitates CD8+ T Cells using an automated method. The primary purpose of the study is to describe the correlation between pCR and the distribution of either biomarkers in patients receiving either neoadjuvant Vidutolimod (CMP-001)/nivolumab or neoadjuvant nivolumab.
Patients with stage IIIB-IIID cutaneous (or unknown primary) melanoma with palpable nodal disease who have yet to undergo definitive surgery are eligible to enroll. Patients with nodal relapse including those who have received prior adjuvant IFN and/or ipilimumab are eligible to enroll.
Suitable patients will be identified pre-operatively. Patients will undergo a 28 day screening evaluation including surgical assessment, clinical assessment, systemic/CNS staging scans, and laboratory studies to confirm suitability. Patients will undergo biopsies of both planned injected and uninjected lesions (Arm A) and target lesion (Arm B). Biopsies of these lesions will occur pre-treatment, at W3 or W4 and the target lesion(s) will be resected at the time of surgery.
Eligible patients will be randomized 1:1 to receive Arm A (neoadjuvant Nivolumab/(CMP) vs. Arm B (neoadjuvant Nivolumab) during the (Prime Phase) pre-operatively. Patients randomized to Arm A will receive: Nivolumab 240mg IV q2 x3 and CMP-001 5mg SC 1st dose then 10mg IT 2nd-7th doses (7 weeks). Patients randomized to Arm B will receive: Nivolumab 240mg IV q2 x3 (6 weeks).
[18F]F-AraG PET-CT scan (18-F PET) is an integrated biomarker and will be performed at 2 imaging time-points: pre-treatment (pre-W1) and on-treatment (W2). At each imaging timepoint, [18F]F-AraG will be administered by a licensed nuclear medicine technologist under the supervision of a nuclear medicine physician on an outpatient basis. Each patient will receive a single bolus injection of 5 mCi [18F]F-AraG IV into a hand or arm vein. At Screening and W2 imaging timepoints, following [18F]F-AraG injection, a 30-min static PET-CT scan will be performed covering the brain to the upper legs.
For CD8+ T cell density assessments, patients will undergo biopsies at 2 timepoints: pre-treatment (Screening) and on-treatment (W3 or W4). In Arm A, patients will undergo biopsies of planned injected and a 2nd uninjected lesion. At each imaging timepoint, biopsies will be performed.
Following the Prime Phase and restaging systemic scans, patients will undergo surgical resection.
Post-operatively, patients will continue to receive maintenance therapy (Boost Phase) per randomization. In the Boost Phase, patients randomized to Arm A (neoadjuvant Nivolumab/(CMP) will receive 480mg IV q4 x12 along with Vidutolimod (CMP-001) 5mg SC q4 x12 over a 48 week period; while patients randomized to Arm B (neoadjuvant Nivolumab) will receive Nivolumab (480mg IV q4 x12 over a 48 week period). In the post-operative period, CMP-001 will be administered subcutaneously (Arm A only).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Nivolumab and Vidutolimod (CMP-001) Combination with [18F]F-AraG PET/CT | Experimental | Prime Phase - Nivolumab 240mg IV, every 2 weeks starting with Cycle 2 (Cycles 2,4,6) for 6 weeks in combination with Vidutolimod 5mg subcutaneous 1st dose, and the remaining injections, 10mg intra-tumorally will be administered Weeks 2-7. [18F]F-AraG PET/CT, single bolus injection of 5 (±10%) mCi IV into a vein, Screening and at Week 2. Boost Phase - Nivolumab 480mg IV, every 4 weeks and CMP-001 5mg subcutaneous every 4 weeks up to 48 weeks. |
|
| Nivolumab with [18F]F-AraG PET/CT | Experimental | Prime Phase - Nivolumab 240mg IV, every 2 weeks starting with Cycle 2 (Cycles 2, 4, 6) for 6 weeks. [18F]F-AraG PET/CT, single bolus injection of 5 (±10%) mCi IV into a vein, Screening and at Week 3. Boost Phase - Nivolumab 480mg IV, every 4 weeks starting from the time of surgery recovery for up to 48 weeks. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Vidutolimod (CMP-001) | Drug | A molecule comprised of a 30 nucleotide strand, flanked by 10 guanines on either end. The nucleotide strand is surrounded by a Qβ viral-like protein. The intended mechanism of action of CMP-001 in oncology is the activation of TLR9 in pDC within the tumor or the tumor-draining lymph nodes (tumor-associated pDC). |
| Measure | Description | Time Frame |
|---|---|---|
| Pathologic Response | Percentage of patients who experience Pathologic CR (pCR), Partial PR (pPR), or Pathologic NR (pNR) per Immune-related Pathologic Response Criteria. pCR is defined as 0% RVT (residual tumor volume) remaining in post-therapy specimen. pPR is defined a 10%<%RVT< 50%. pNR is defined as %RVT>50%. | At the time of surgery (Week 8-10) |
| Distant-metastasis Free Survival (DMFS) | The length of time from initiation of treatment until distant-metastasis of melanoma or death. | Up to 5 years |
| Major Pathologic Response Rate (MPR) | Major Pathologic Response (MPR) is defined as %RVT≤10%. | At the time of surgery (Week 8-10) |
| Measure | Description | Time Frame |
|---|---|---|
| Relapse-Free Survival (RFS) | The length of time from initiation of treatment until melanoma relapse or death. | Up to 24 months |
| 6-month Relapse-Free Survival (RFS) | Percentage of patients without disease relapse at 6 months from start of treatment. |
| Measure | Description | Time Frame |
|---|---|---|
| CD8+ T Cell Density | The quantity of CD8 + T-cells that infiltrate tumors, measured via flow cytometry. | Pre-treatment (Screening), at Week 3 of treatment; up to 21 days |
Inclusion Criteria:
Be willing and able to provide written informed consent for the study.
Be ≥ 18 years of age on day of signing informed consent.
Willingness to undergo [18F]F-AraG PET imaging at pre- and week 3 timepoints.
Diagnosis of histologically or cytologically confirmed diagnosis of cutaneous melanoma belonging to one of the following AJCC TNM stages:
Patients are eligible for this trial either at presentation for primary melanoma with concurrent regional nodal metastasis; or at the time of clinical detected nodal recurrence; and may belong to any of the following groups:
Presence of injectable and measurable disease based on RECIST 1.1.
Willing to undergo tumor biopsy (core, punch, incisional or excisional). Patients must undergo biopsy (core, punch) or open biopsy (incisional, excisional) within 4 weeks of registration on the study and at W4-5.
Performance status of 0 or 1 on the ECOG Performance Scale.
Demonstrate adequate organ function as defined below performed on screening labs obtained within 4 weeks of registration.
Female subject of childbearing potential should have a negative urine or serum pregnancy within 72 hours prior to receiving the first dose of study medication. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
Female subjects of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 26 weeks after the last dose of study medication (Section 5.7.2). Subjects of childbearing potential are those who have not been surgically sterilized or have not been free from menses for > 1 year.
Male subjects should agree to use an adequate method of contraception starting with the first dose of study therapy through 26 weeks after the last dose of study therapy.
Note: Abstinence is acceptable if this is the usual lifestyle and preferred contraception for the subject.
Exclusion Criteria:
History of uveal or mucosal melanoma.
Is currently participating in or has participated in a study of an investigational agent or using an investigational device within 4 weeks of the first dose of treatment.
Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment.
Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study Day 1 or who has not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events due to a previously administered agent.
Active (i.e., symptomatic or growing) central nervous system (CNS) metastases.
Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or in situ cervical cancer that has undergone potentially curative therapy.
Has a systemic disease that requires systemic pharmacologic doses of corticosteroids greater than 10mg daily prednisone (or equivalent). Subjects who are currently receiving steroids at a dose of ≤10mg daily do not need to discontinue steroids prior to enrollment Subjects that require topical, ophthalmologic and inhalational steroids would not be excluded from the study. Subjects with hypothyroidism stable on hormone replacement or Sjogren's syndrome will not be excluded from the study. Subjects who require active immunosuppression (greater than steroid dose discussed above) for any reason are excluded.
Has evidence of interstitial lung disease or active, non-infectious pneumonitis.
Has an active infection requiring systemic therapy.
Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the pre-screening or screening visit through 26 weeks after the last dose of trial treatment.
Has received prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137 or BRAF/MEK inhibitor. Prior treatment with ipilimumab or interferon alfa is allowed. Patients with history of allergic or hypersensitivity reaction to interferon alfa or ipilimumab are also excluded.
Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
Has known active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is detected. Patients with treated Hepatitis B/C with no evidence of active infection may be enrolled.
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| Name | Affiliation | Role |
|---|---|---|
| Diwakar Davar, MD, M.Sc | University of Pittsburgh Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UPMC Hillman Cancer Center | Pittsburgh | Pennsylvania | 15232 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Nivolumab and Vidutolimod (CMP-001) Combination With [18F]F-AraG PET/CT | Prime Phase - Nivolumab 240mg IV, every 2 weeks starting with Cycle 2 (Cycles 2,4,6) for 6 weeks in combination with Vidutolimod 5mg subcutaneous 1st dose, and the remaining injections, 10mg intra-tumorally will be administered Weeks 2-7. [18F]F-AraG PET/CT, single bolus injection of 5 (±10%) mCi IV into a vein, Screening and at Week 2. Boost Phase - Nivolumab 480mg IV, every 4 weeks and CMP-001 5mg subcutaneous every 4 weeks up to 48 weeks. Vidutolimod (CMP-001): The intended mechanism of action of CMP-001 in oncology is the activation of TLR9 in pDC within the tumor or the tumor-draining lymph nodes (tumor-associated pDC). Nivolumab: a fully human Ig G4 antibody that blocks PD-1. Nivolumab was initially approved by the FDA for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor. Nivolumab has also been FDA approved to treat patients with advanced squamous non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, as well as advanced renal cell carcinoma. [18F]F-AraG PET/CT: [18F]F-AraG is an 18F-labeled analog of arabinofuranosylguanine (AraG), a compound that has shown remarkably selective accumulation in T cells. [18F]F-AraG has lower accumulation and more efficient efflux from cancer cells than a dCK agent. |
| FG001 | Nivolumab With [18F]F-AraG PET/CT | Prime Phase - Nivolumab 240mg IV, every 2 weeks starting with Cycle 2 (Cycles 2, 4, 6) for 6 weeks. [18F]F-AraG PET/CT, single bolus injection of 5 (±10%) mCi IV into a vein, Screening and at Week 3. Boost Phase - Nivolumab 480mg IV, every 4 weeks starting from the time of surgery recovery for up to 48 weeks. Nivolumab: a fully human Ig G4 antibody that blocks PD-1. Nivolumab was initially approved by the FDA for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor. Nivolumab has also been FDA approved to treat patients with advanced squamous non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, as well as advanced renal cell carcinoma. [18F]F-AraG PET/CT: [18F]F-AraG is an 18F-labeled analog of arabinofuranosylguanine (AraG), a compound that has shown remarkably selective accumulation in T cells. I[18F]F-AraG has lower accumulation and more efficient efflux from cancer cells than a dCK agent. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
All enrolled participants.
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| ID | Title | Description |
|---|---|---|
| BG000 | Nivolumab and Vidutolimod (CMP-001) Combination With [18F]F-AraG PET/CT | Prime Phase - Nivolumab 240mg IV, every 2 weeks starting with Cycle 2 (Cycles 2,4,6) for 6 weeks in combination with Vidutolimod 5mg subcutaneous 1st dose, and the remaining injections, 10mg intra-tumorally will be administered Weeks 2-7. [18F]F-AraG PET/CT, single bolus injection of 5 (±10%) mCi IV into a vein, Screening and at Week 2. Boost Phase - Nivolumab 480mg IV, every 4 weeks and CMP-001 5mg subcutaneous every 4 weeks up to 48 weeks. Vidutolimod (CMP-001): The intended mechanism of action of CMP-001 in oncology is the activation of TLR9 in pDC within the tumor or the tumor-draining lymph nodes (tumor-associated pDC). Nivolumab: a fully human Ig G4 antibody that blocks PD-1. Nivolumab was initially approved by the FDA for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor. Nivolumab has also been FDA approved to treat patients with advanced squamous non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, as well as advanced renal cell carcinoma. [18F]F-AraG PET/CT: [18F]F-AraG is an 18F-labeled analog of arabinofuranosylguanine (AraG), a compound that has shown remarkably selective accumulation in T cells. [18F]F-AraG has lower accumulation and more efficient efflux from cancer cells than a dCK agent. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Pathologic Response | Percentage of patients who experience Pathologic CR (pCR), Partial PR (pPR), or Pathologic NR (pNR) per Immune-related Pathologic Response Criteria. pCR is defined as 0% RVT (residual tumor volume) remaining in post-therapy specimen. pPR is defined a 10%<%RVT< 50%. pNR is defined as %RVT>50%. | Patients who underwent surgery and were evaluated for pathologic response. | Posted | Number | 95% Confidence Interval | percentage of patients | At the time of surgery (Week 8-10) |
|
Adverse Events data were collected for up to 13 months. All-Cause Mortality data was collected for up to 47 months and 14 days.
Adverse Events and Serious Adverse Events were collected per CTCAE v 4.0
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Nivolumab and Vidutolimod (CMP-001) Combination With [18F]F-AraG PET/CT | Prime Phase - Nivolumab 240mg IV, every 2 weeks starting with Cycle 2 (Cycles 2,4,6) for 6 weeks in combination with Vidutolimod 5mg subcutaneous 1st dose, and the remaining injections, 10mg intra-tumorally will be administered Weeks 2-7. [18F]F-AraG PET/CT, single bolus injection of 5 (±10%) mCi IV into a vein, Screening and at Week 2. Boost Phase - Nivolumab 480mg IV, every 4 weeks and CMP-001 5mg subcutaneous every 4 weeks up to 48 weeks. Vidutolimod (CMP-001): The intended mechanism of action of CMP-001 in oncology is the activation of TLR9 in pDC within the tumor or the tumor-draining lymph nodes (tumor-associated pDC). Nivolumab: a fully human Ig G4 antibody that blocks PD-1. Nivolumab was initially approved by the FDA for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor. Nivolumab has also been FDA approved to treat patients with advanced squamous non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, as well as advanced renal cell carcinoma. [18F]F-AraG PET/CT: [18F]F-AraG is an 18F-labeled analog of arabinofuranosylguanine (AraG), a compound that has shown remarkably selective accumulation in T cells. [18F]F-AraG has lower accumulation and more efficient efflux from cancer cells than a dCK agent. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Anemia | BLOOD AND LYMPHATIC SYSTEM DISORDERS | CTCAE (4.0) | Systematic Assessment |
Not provided
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Barbara Stadterman, MPH, CCRP | UPMC Hillman Cancer Center | 4126475554 | stadtermanbm@upmc.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jan 4, 2024 | Aug 16, 2025 | Prot_SAP_000.pdf |
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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 |
|---|---|
| D000077594 | Nivolumab |
| ID | Term |
|---|---|
| D061067 | Antibodies, Monoclonal, Humanized |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
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|
| Nivolumab | Biological | a fully human Ig G4 antibody that blocks PD-1. Nivolumab was initially approved by the FDA for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor. Nivolumab has also been FDA approved to treat patients with advanced squamous non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, as well as advanced renal cell carcinoma. |
|
| [18F]F-AraG PET/CT | Other | [18F]F-AraG is an 18F-labeled analog of arabinofuranosylguanine (AraG), a compound that has shown remarkably selective accumulation in T cells. It has several advantages over conventional [18F] and existing small molecule PET agents being investigated for immuno-monitoring. [18F]F-AraG has lower accumulation and more efficient efflux from cancer cells than a dCK agent. |
|
| At 6-months |
| 12-month Relapse-Free Survival (RFS) | Percentage of patients without disease relapse at 12 months from start of treatment. | At 12-months |
| 24-month Relapse-Free Survival (RFS) | Percentage of patients without disease relapse at 24 months from start of treatment. | At 24 months |
| Overall Survival (OS) | The length of (survival) time from the start of treatment until death from any cause. | Up to 24 months |
| 6-month Overall Survival (OS) | Percentage of patients alive at 6 months from the start of treatment until death from any cause. | At 6 months |
| 12-month Overall Survival (OS) | Percentage of patients alive at 12 months from the start of treatment until death from any cause. | At 12-months |
| 24-month Overall Survival (OS) | Percentage of patients alive at 24 months from the start of treatment until death from any cause. | At 24 months |
| Adverse Events at Least Possibly Related to Study Treatment | Toxicities defined by NCI Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 are adverse events classified as either possibly, probably, or definitely related to study treatment. The maximum grade for each type of toxicity will be recorded and the frequency of toxicities will be tabulated for the study population. | Up to 47 months and 14 days |
| SUVmax -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV) , SUVpeak, SUVmean, and SUVtotal.The max, peak, mean and total values for each patient will be used to determine the average standard uptake values for the study population. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | At Baseline |
| SUVpeak -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVpeak. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | At Baseline |
| SUVmean -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVmean. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | At Baseline |
| SUVtotal -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVtotal. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | At Baseline |
| SUVmax -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV) , SUVpeak, SUVmean, and SUVtotal.The max, peak, mean and total values for each patient will be used to determine the average standard uptake values for the study population. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Post Treatment - At 5 weeks |
| SUVpeak -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVpeak. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Post Treatment - At 5 weeks |
| SUVmean -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVmean. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Post Treatment - At 5 weeks |
| SUVtotal -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVmean. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Post Treatment - At 5 weeks |
| Change in SUVmax -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV) , SUVpeak, SUVmean, and SUVtotal.The max, peak, mean and total values for each patient will be used to determine the average standard uptake values for the study population. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | At Baseline and Post Treatment at 5 weeks |
| Change in SUVpeak -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVpeak. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Post Treatment - At 5 weeks |
| Change in SUVmean -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVmean. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | At Baseline and Post Treatment - At 5 weeks |
| Change in SUVtotal -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVtotal. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | At Baseline and Post Treatment - At 5 weeks |
| BG001 | Nivolumab With [18F]F-AraG PET/CT | Prime Phase - Nivolumab 240mg IV, every 2 weeks starting with Cycle 2 (Cycles 2, 4, 6) for 6 weeks. [18F]F-AraG PET/CT, single bolus injection of 5 (±10%) mCi IV into a vein, Screening and at Week 3. Boost Phase - Nivolumab 480mg IV, every 4 weeks starting from the time of surgery recovery for up to 48 weeks. Nivolumab: a fully human Ig G4 antibody that blocks PD-1. Nivolumab was initially approved by the FDA for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor. Nivolumab has also been FDA approved to treat patients with advanced squamous non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, as well as advanced renal cell carcinoma. [18F]F-AraG PET/CT: [18F]F-AraG is an 18F-labeled analog of arabinofuranosylguanine (AraG), a compound that has shown remarkably selective accumulation in T cells. I[18F]F-AraG has lower accumulation and more efficient efflux from cancer cells than a dCK agent. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| OG001 | Nivolumab With [18F]F-AraG PET/CT | Prime Phase - Nivolumab 240mg IV, every 2 weeks starting with Cycle 2 (Cycles 2, 4, 6) for 6 weeks. [18F]F-AraG PET/CT, single bolus injection of 5 (±10%) mCi IV into a vein, Screening and at Week 3. Boost Phase - Nivolumab 480mg IV, every 4 weeks starting from the time of surgery recovery for up to 48 weeks. Nivolumab: a fully human Ig G4 antibody that blocks PD-1. Nivolumab was initially approved by the FDA for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor. Nivolumab has also been FDA approved to treat patients with advanced squamous non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, as well as advanced renal cell carcinoma. [18F]F-AraG PET/CT: [18F]F-AraG is an 18F-labeled analog of arabinofuranosylguanine (AraG), a compound that has shown remarkably selective accumulation in T cells. I[18F]F-AraG has lower accumulation and more efficient efflux from cancer cells than a dCK agent. |
|
|
| Primary | Distant-metastasis Free Survival (DMFS) | The length of time from initiation of treatment until distant-metastasis of melanoma or death. | Patients evaluated for response to treatment. | Posted | Median | 95% Confidence Interval | Days | Up to 5 years |
|
|
|
| Primary | Major Pathologic Response Rate (MPR) | Major Pathologic Response (MPR) is defined as %RVT≤10%. | Patients who underwent surgery and were evaluated for pathologic response. | Posted | Number | 95% Confidence Interval | percentage of patients | At the time of surgery (Week 8-10) |
|
|
|
| Secondary | Relapse-Free Survival (RFS) | The length of time from initiation of treatment until melanoma relapse or death. | Patients evaluated for response to treatment. | Posted | Median | 95% Confidence Interval | Days | Up to 24 months |
|
|
|
| Secondary | 6-month Relapse-Free Survival (RFS) | Percentage of patients without disease relapse at 6 months from start of treatment. | Patients evaluated for response to treatment. | Posted | Number | 95% Confidence Interval | percentage of patients | At 6-months |
|
|
|
| Secondary | 12-month Relapse-Free Survival (RFS) | Percentage of patients without disease relapse at 12 months from start of treatment. | Patients evaluated for response to treatment. | Posted | Number | 95% Confidence Interval | percentage of patients | At 12-months |
|
|
|
| Secondary | 24-month Relapse-Free Survival (RFS) | Percentage of patients without disease relapse at 24 months from start of treatment. | Patients evaluated for response to treatment. | Posted | Number | 95% Confidence Interval | percentage of patients | At 24 months |
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| Secondary | Overall Survival (OS) | The length of (survival) time from the start of treatment until death from any cause. | All trial participants. | Posted | Median | 95% Confidence Interval | Days | Up to 24 months |
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| Secondary | 6-month Overall Survival (OS) | Percentage of patients alive at 6 months from the start of treatment until death from any cause. | All trial participants | Posted | Number | 95% Confidence Interval | percentage of patients | At 6 months |
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| Secondary | 12-month Overall Survival (OS) | Percentage of patients alive at 12 months from the start of treatment until death from any cause. | All trial participants. | Posted | Number | 95% Confidence Interval | percentage of patients | At 12-months |
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| Secondary | 24-month Overall Survival (OS) | Percentage of patients alive at 24 months from the start of treatment until death from any cause. | All trial participants. | Posted | Number | 95% Confidence Interval | percentage of patients | At 24 months |
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| Secondary | Adverse Events at Least Possibly Related to Study Treatment | Toxicities defined by NCI Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 are adverse events classified as either possibly, probably, or definitely related to study treatment. The maximum grade for each type of toxicity will be recorded and the frequency of toxicities will be tabulated for the study population. | All treated patients. | Posted | Count of Participants | Participants | Up to 47 months and 14 days |
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| Secondary | SUVmax -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV) , SUVpeak, SUVmean, and SUVtotal.The max, peak, mean and total values for each patient will be used to determine the average standard uptake values for the study population. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | At Baseline |
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| Secondary | SUVpeak -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVpeak. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | At Baseline |
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| Secondary | SUVmean -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVmean. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | At Baseline |
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| Secondary | SUVtotal -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVtotal. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | At Baseline |
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| Secondary | SUVmax -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV) , SUVpeak, SUVmean, and SUVtotal.The max, peak, mean and total values for each patient will be used to determine the average standard uptake values for the study population. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | Post Treatment - At 5 weeks |
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| Secondary | SUVpeak -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVpeak. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | Post Treatment - At 5 weeks |
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| Secondary | SUVmean -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVmean. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | Post Treatment - At 5 weeks |
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| Secondary | SUVtotal -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVmean. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | Post Treatment - At 5 weeks |
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| Secondary | Change in SUVmax -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV) , SUVpeak, SUVmean, and SUVtotal.The max, peak, mean and total values for each patient will be used to determine the average standard uptake values for the study population. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | At Baseline and Post Treatment at 5 weeks |
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| Secondary | Change in SUVpeak -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVpeak. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | Post Treatment - At 5 weeks |
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| Secondary | Change in SUVmean -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVmean. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | At Baseline and Post Treatment - At 5 weeks |
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| Secondary | Change in SUVtotal -Tumor PET Response Via [18F]F-AraG | [18F]F-AraG is an experimental PET imaging agent. Tumor PET response will be assessed via standard uptake values (SUV), SUVtotal. The possible range of SUV values is between 0 - 100. Higher SUV correlates with greater malignancy. | Treated patients who were radiologically evaluable for response. | Posted | Mean | Standard Deviation | g/ml | At Baseline and Post Treatment - At 5 weeks |
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| Other Pre-specified | CD8+ T Cell Density | The quantity of CD8 + T-cells that infiltrate tumors, measured via flow cytometry. | Not Posted | Pre-treatment (Screening), at Week 3 of treatment; up to 21 days | Participants |
| 0 |
| 5 |
| 0 |
| 5 |
| 5 |
| 5 |
| EG001 | Nivolumab With [18F]F-AraG PET/CT | Prime Phase - Nivolumab 240mg IV, every 2 weeks starting with Cycle 2 (Cycles 2, 4, 6) for 6 weeks. [18F]F-AraG PET/CT, single bolus injection of 5 (±10%) mCi IV into a vein, Screening and at Week 3. Boost Phase - Nivolumab 480mg IV, every 4 weeks starting from the time of surgery recovery for up to 48 weeks. Nivolumab: a fully human Ig G4 antibody that blocks PD-1. Nivolumab was initially approved by the FDA for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor. Nivolumab has also been FDA approved to treat patients with advanced squamous non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy, as well as advanced renal cell carcinoma. [18F]F-AraG PET/CT: [18F]F-AraG is an 18F-labeled analog of arabinofuranosylguanine (AraG), a compound that has shown remarkably selective accumulation in T cells. I[18F]F-AraG has lower accumulation and more efficient efflux from cancer cells than a dCK agent. | 1 | 4 | 0 | 4 | 4 | 4 |
| Leukocytosis | BLOOD AND LYMPHATIC SYSTEM DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Sinus bradycardia | CARDIAC DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Adrenal insufficiency | ENDOCRINE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hyperthyroidism | ENDOCRINE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hypothyroidism | ENDOCRINE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Eye pain | EYE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Constipation | GASTROINTESTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Diarrhea | GASTROINTESTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Dry mouth | GASTROINTESTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Flatulence | GASTROINTESTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Nausea | GASTROINTESTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Stomach pain | GASTROINTESTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Chills | GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS | CTCAE (4.0) | Systematic Assessment |
|
| Edema face | GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS | CTCAE (4.0) | Systematic Assessment |
|
| Edema limbs | GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS | CTCAE (4.0) | Systematic Assessment |
|
| Fatigue | GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS | CTCAE (4.0) | Systematic Assessment |
|
| Fever | GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS | CTCAE (4.0) | Systematic Assessment |
|
| General disorders and administration site conditions - Other, specify Sleep disturbance | GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS | CTCAE (4.0) | Systematic Assessment |
|
| Localized edema | GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS | CTCAE (4.0) | Systematic Assessment |
|
| Neck edema | GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS | CTCAE (4.0) | Systematic Assessment |
|
| Pain | GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS | CTCAE (4.0) | Systematic Assessment |
|
| Eye infection | INFECTIONS AND INFESTATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Lung infection | INFECTIONS AND INFESTATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Salivary gland infection | INFECTIONS AND INFESTATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Urinary tract infection | INFECTIONS AND INFESTATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Wound infection | INFECTIONS AND INFESTATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Wound dehiscence | INJURY, POISONING AND PROCEDURAL COMPLICATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Activated partial thromboplastin time prolonged | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Alanine aminotransferase increased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Alkaline phosphatase increased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Aspartate aminotransferase increased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Blood bilirubin increased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Blood lactate dehydrogenase increased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Creatinine increased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Hemoglobin increased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Investigations - Other, specify Blood urea nitrogen increased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Investigations - Other, specify Prothrombin Time prolonged | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Lymphocyte count decreased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Neutrophil count decreased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Thyroid stimulating hormone increased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| White blood cell decreased | INVESTIGATIONS | CTCAE (4.0) | Systematic Assessment |
|
| Anorexia | METABOLISM AND NUTRITION DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hyperglycemia | METABOLISM AND NUTRITION DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hyperkalemia | METABOLISM AND NUTRITION DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hypermagnesemia | METABOLISM AND NUTRITION DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hyperuricemia | METABOLISM AND NUTRITION DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hypokalemia | METABOLISM AND NUTRITION DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hypomagnesemia | METABOLISM AND NUTRITION DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hyponatremia | METABOLISM AND NUTRITION DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hypophosphatemia | METABOLISM AND NUTRITION DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Arthralgia | MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Back pain | MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Generalized muscle weakness | MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Pain in extremity | MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Dizziness | NERVOUS SYSTEM DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Facial muscle weakness | NERVOUS SYSTEM DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Headache | NERVOUS SYSTEM DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Nervous system disorders - Other, specify Peripheral sensory neuropathy | NERVOUS SYSTEM DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Dysuria | RENAL AND URINARY DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Proteinuria | RENAL AND URINARY DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Cough | RESPIRATORY, THORACIC AND MEDIASTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Nasal congestion | RESPIRATORY, THORACIC AND MEDIASTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Pneumonitis | RESPIRATORY, THORACIC AND MEDIASTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Productive cough | RESPIRATORY, THORACIC AND MEDIASTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Sore throat | RESPIRATORY, THORACIC AND MEDIASTINAL DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Pruritus | SKIN AND SUBCUTANEOUS TISSUE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Rash acneiform | SKIN AND SUBCUTANEOUS TISSUE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Rash maculo-papular | SKIN AND SUBCUTANEOUS TISSUE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Skin hypopigmentation | SKIN AND SUBCUTANEOUS TISSUE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Skin ulceration | SKIN AND SUBCUTANEOUS TISSUE DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Flushing | VASCULAR DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
| Hypertension | VASCULAR DISORDERS | CTCAE (4.0) | Systematic Assessment |
|
Not provided
Not provided
Not provided
| 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 |
| D007162 |
| Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| Hypothyroidism |
|
| Diarrhea |
|
| Nausea |
|
| Chills |
|
| Fatigue |
|
| Fever |
|
| Neck edema |
|
| Pain |
|
| Aspartate aminotransferase increased |
|
| Blood bilirubin increased |
|
| Blood lactate dehydrogenase increased |
|
| Blood urea nitrogen increased |
|
| Neutrophil count decreased |
|
| Thyroid stimulating hormone increased |
|
| Hyponatremia |
|
| Hypophosphatemia |
|
| Arthralgia |
|
| Back pain |
|
| Generalized muscle weakness |
|
| Headache |
|
| Nasal congestion |
|
| Pruritus |
|
| Rash acneiform |
|
| Rash maculo-papular |
|
| Skin hypopigmentation |
|
| Flushing |
|
| Hypertension |
|