Comparing tunlametinib capsules with chemotherapy for advanced NRAS-mutant melanoma

Efficacy and Safety of Tunlametinib Capsules Versus Combination Chemotherapy of Investigator's Choice in Advanced NRAS-mutant Melanoma Patients Who Had Previously Received Immunotherapy

This study is testing if tunlametinib capsules can work better than standard chemotherapy for people with advanced melanoma that has NRAS mutations and who have already tried immunotherapy.

Quick facts

• Phase: PHASE3
• Study type: Interventional
• Enrollment: 165 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Shanghai Kechow Pharma, Inc. (industry)
• Drugs / interventions: chemotherapy, immunotherapy, tunlametinib
• Locations: 1 site (Beijing, Beijing Municipality)
• Trial ID: NCT06008106 on ClinicalTrials.gov

What this trial studies

This phase III clinical trial evaluates the efficacy and safety of tunlametinib capsules against a combination chemotherapy regimen in patients with advanced melanoma harboring NRAS mutations who have previously undergone immunotherapy. The study involves 165 participants who will be randomly assigned to receive either tunlametinib or a chemotherapy regimen of the investigator's choice, administered every 28 days. Efficacy will be assessed through independent radiology reviews, while safety will be monitored closely after treatment. Follow-up for survival status and new treatments will occur every 12 weeks post-treatment.

Who should consider this trial

Good fit: Ideal candidates include adults aged 18 and older with unresectable stage III or metastatic IV melanoma and a confirmed NRAS mutation.

Not a fit: Patients who have not experienced immunotherapy failure or those with resectable melanoma may not benefit from this study.

Why it matters

Potential benefit: If successful, this trial could provide a new treatment option for patients with advanced NRAS-mutant melanoma who have not responded to immunotherapy.

How similar studies have performed: Other studies have shown promise in targeting NRAS mutations in melanoma, but this specific approach with tunlametinib is relatively novel.

Eligibility criteria

Inclusion Criteria:

1. ≥ 18 years of age.
2. Patients with unresectable stage III or metastatic IV melanoma confirmed by histology or cytology.
3. History of immunotherapy failure or could not tolerate immunotherapy
4. NRAS mutation at baseline;.
5. There is at least one lesion that can be evaluated as target lesions according to Response Evaluation Criteria in Solid Tumors (RECIST v1.1).
6. Eastern cooperative oncology group (ECOG) performance status of grade 0-1.
7. Life expectancy \> 3 months.
8. No major surgery (excluding baseline tumor biopsy) or major trauma occurred at least 4weeks prior to investigational drug administration.
9. Left ventricular ejection fraction (LVEF) ≥ 50% within 7 days before dosing according to echocardiographic findings.
10. Key laboratory tests must be conducted within 7 days before dosing and meet the inclusion criteria:
11. Able to understand and voluntarily sign the Informed Consent Form.
12. Patients must be willing and able to complete the study procedure and follow-up examination.

Exclusion Criteria:

* Exclusion Criteria:

  1. Having the following treatment before receiving the study drug: ① received chemotherapy, targeted therapy or other study drug treatment within 4 weeks before the first administration or within 5 half lives of the drug (whichever is longer); ② received immunotherapy and biological therapy within 4 weeks before the first administration; ③ received traditional Chinese medicines with anti-tumor activities approved by National Medical Products Administration (NMPA) within 2 weeks before the first administration.;
  2. The toxic reactions of previous anti-tumor treatment have not been recovered;
  3. Current use of other anti-cancer drugs.
  4. Subjects with symptomatic or untreated brain metastasis, meningeal metastasis or spinal cord compression except for subjects with asymptomatic brain metastasis;
  5. History of any of the following within 6 months of screening: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass grafting, symptomatic congestive heart failure, severe heart arrhythmia requiring medication, uncontrolled hypertension, cerebrovascular accident, or transient ischemic attack, diabetic ketoacidosis, deep vein thrombosis, or symptomatic pulmonary embolism.
  6. ECG Corrected Q-T interval formula (QTcB) ≥ 480 msec (adjusted by Bazett's formula) during screening, or a history of congenital long QT syndrome.
  7. History or current evidence of retinal diseases;
  8. Previous or current neuromuscular diseases related to CK elevation;
  9. Previous or current interstitial lung disease or interstitial pneumonitis;
  10. Uncontrolled concomitant diseases or infectious diseases.
  11. Bleeding symptoms of grade 3 as defined by the National Cancer Institute General Terminology Standard for Adverse Events (NCI CTCAE V5.0) within the 4 weeks prior to study initiation.
  12. Inability to swallow the capsule, refractory nausea and vomiting, malabsorption, external biliary diversion, or any small intestinal resection that would preclude adequate absorption of the study drug.
  13. Patients who are receiving and cannot discontinue regimen-prohibited intravenous or oral drugs that affect CYP isoenzymes (strong inducers and strong inhibitors of CYP2C9) at least 1 week prior to initiation of study treatment and during the study period.
  14. Patients with a history of malignancy within the past 5 years;
  15. Human immunodeficiency virus (HIV) antibody positive; syphilis antibody (anti-TP) positive; Hepatitis C virus (HCV) antibody positive and HCV RNA positive; HBsAg positive and HBV DNA positive.
  16. Patients who have been previously treated with MEK inhibitors.
  17. Patients with known hypersensitivity to investigational drug, proposed chemotherapy or their analogues.
  18. History of allogeneic bone marrow transplantation or organ transplantation.
  19. Serum pregnancy test results are positive for premenopausal female patients;
  20. Other severe, acute, or chronic clinical or psychiatric disorders or laboratory abnormalities that may increase the risk and interfere with the study results in the opinion of investigator.

Where this trial is running

Beijing, Beijing Municipality

• Beijing Cancer Hospital — Beijing, Beijing Municipality, China (RECRUITING)

Study contacts

• Study coordinator: Lixia Gong, Master

Conditions: Melanoma, Mitogen-Activated Protein Kinase Kinases, NRAS