A Multicenter Trial of Adjuvant Interferon Alfa-2b for Melanoma Patients With Early Lymph Node Metastasis Detected by Lymphatic Mapping and Sentinel Lymph Node Biopsy
recombinant interferon alfa
+ recombinant interferon alfa
+ Observation
Neoplasms+9
+ Neoplasms by Histologic Type
+ Neoplasms by Site
Treatment Study
Summary
Study start date: October 1, 1999
Actual date on which the first participant was enrolled.OBJECTIVES: Compare the efficacy of regional lymphadenectomy with or without adjuvant high-dose interferon alfa-2b on disease-free survival and overall survival of patients with invasive cutaneous melanoma with early or submicroscopic sentinel lymph node metastasis detected by histology or immunohistochemistry or by polymerase chain reaction (PCR). Compare the effect of lymphadenectomy vs observation on disease-free survival and overall survival of patients with submicroscopic sentinel lymph node metastasis detected only by PCR. Determine the recurrence rate and survival of patients with submicroscopic sentinel lymph node metastasis detected only by PCR. Determine the positive and negative predictive value of reverse transcriptase PCR analysis of sentinel lymph nodes and peripheral blood to identify patients at risk for recurrence and death. OUTLINE: This is a randomized, multicenter study. Patients in the randomized portions of Protocols A and B are stratified according to tumor thickness (1-2 mm vs 3-4 mm vs greater than 4 mm) and tumor ulceration (yes vs no). All patients undergo wide local tumor excision with lymphatic mapping and sentinel node biopsy. Patients with tumors with ambiguous drainage patterns undergo lymphoscintigraphy prior to tumor excision. Patients with evidence of metastatic melanoma in the sentinel node(s) by routine histology, serial sectioning, or immunohistochemistry and who have undergone a prior regional lymph node dissection proceed to protocol A. Protocol A: Patients with metastasis in a single sentinel node with no evidence of extracapsular extension and no metastatic disease in nonsentinel nodes are randomized to 1 of 2 treatment arms. Arm I: Patients receive adjuvant high-dose interferon alfa-2b IV 5 days a week for 4 weeks, then subcutaneously 3 times a week for 48 weeks. Arm II: Patients undergo observation. Patients with metastases in more than one sentinel node with evidence of extracapsular extension or metastasis in any nonsentinel node receive adjuvant high-dose interferon alfa-2b as in arm I. Patients with no evidence of sentinel node(s) metastases by routine histology, serial sectioning, and immunohistochemistry and are negative by polymerase chain reaction (PCR) analysis are observed. Protocol B: Patients with positive sentinel node(s) by PCR analysis are randomized to one of three treatment arms. Arm I: Patients undergo observation. Arm II: Patients undergo lymph node dissection. Arm III: Patients undergo lymph node dissection followed by adjuvant high-dose interferon alfa-2b IV 5 days a week for 4 weeks. Patients are followed every 3 months for 2 years, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 3,000 patients will be accrued for this study within 5 years.
Protocol
This section provides details of the study plan, including how the study is designed and what the study is measuring.3000 patients to be enrolled
Total number of participants that the clinical trial aims to recruit.Treatment Study
Eligibility
Researchers look for people who fit a certain description, called eligibility criteria: person's general health condition or prior treatments.Any sex
Biological sex of participants that are eligible to enroll.From 18 to 70 Years
Range of ages for which participants are eligible to join.Healthy volunteers not allowed
If individuals who are healthy and do not have the condition being studied can participate.Conditions
Pathology
Criteria
DISEASE CHARACTERISTICS: Histologically confirmed invasive cutaneous melanoma Breslow thickness at least 1.0 mm Primary site must be on head, neck, trunk or extremity No more than 90 days since biopsy Protocol A: One or more sentinel lymph nodes with histologic or immunohistochemical evidence of metastatic melanoma Prior regional lymph node dissection Protocol B: Sentinel lymph nodes with no histologic or immunohistochemical evidence of metastatic melanoma Sentinel lymph node positive by reverse transcriptase polymerase chain reaction No prior wide local excision of the primary tumor with a margin greater than 1.5 cm No primary melanoma involving the eye or mucous membranes No clinical evidence of satellite lesions or intransit, regional nodal, or distant metastases No second primary invasive melanoma No prior surgery in the region of the primary draining nodal basin that would disrupt normal lymphatic drainage patterns (e.g., skin grafts, tissue transfers or flaps, or lymph node dissections) PATIENT CHARACTERISTICS: Age: 18 to 70 Performance status: Karnofsky 70-100% Life expectancy: At least 10 years Hematopoietic: WBC at least 3,000/mm^3 Absolute granulocyte count at least 1,500/mm^3 Platelet count at least 70,000/mm^3 Hemoglobin at least 10.0 g/dL Hepatic: Bilirubin less than 2.0 mg/dL SGOT/SGPT less than 3 times upper limit of normal (ULN) Alkaline phosphatase less than 3 times ULN No severe decompensated liver disease (e.g., cirrhosis or autoimmune hepatitis) No other significant liver disease that would preclude study participation Renal: Creatinine normal Cardiovascular: No cardiovascular disease (e.g., angina or congestive heart failure) No myocardial infarction within the past year No tachyarrhythmias Pulmonary: No severe debilitating pulmonary disease (e.g., chronic obstructive pulmonary disease) Other: No hypersensitivity to interferon alfa-2b or related compounds or any component of the injection No major depression or other major psychiatric illness No thyroid disorder with thyroid function that is not maintained within the normal range with medications No autoimmune disease No primary or secondary immunodeficiencies No severe diabetes mellitus prone to ketoacidosis No significant retinal abnormalities No evidence of infection No other malignancy within the past 5 years except basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or stage I laryngeal cancer No other medical condition that would preclude study participation Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 6 months after the study PRIOR CONCURRENT THERAPY: Biologic therapy: No prior immunotherapy Chemotherapy: No prior chemotherapy Endocrine therapy: At least 6 months since prior oral or parenteral steroids Radiotherapy: No prior radiotherapy Surgery: See Disease Characteristics No prior organ transplantation Other: At least 6 months since prior immunosuppressants No concurrent immunosuppressants resulting from prior organ transplantation
Study Plan
Find out more about all the medication administered in this study, their detailed description and what they involve.5 intervention groups are designated in this study
This study does not include a placebo group
Treatment Groups
Group I
ExperimentalGroup II
ExperimentalGroup III
ExperimentalGroup IV
ExperimentalGroup 5
ExperimentalStudy Centers
These are the hospitals, clinics, or research facilities where the trial is being conducted. You can find the location closest to you and its status.This study has 4 locations
University of Alabama at Birmingham Comprehensive Cancer Center
Birmingham, United StatesOpen University of Alabama at Birmingham Comprehensive Cancer Center in Google MapsJames Graham Brown Cancer Center at University of Louisville
Louisville, United StatesCancer Institute of New Jersey
New Brunswick, United StatesRoswell Park Cancer Institute
Buffalo, United States