title: Treatment of unresectable stage IV metastatic melanoma with aviscumine after anti-neoplastic treatment failure: a phase II, multi-centre study.
abstract: BACKGROUND
  Aviscumine, a recombinant plant protein, is an immune modulator that induces ribotoxic stress at the 28S ribosomal RNA subunit. In this way cytokine release and T-cell responses are enhanced. This phase II trial was conducted to test the efficacy and safety of aviscumine in patients with systemically pre-treated metastatic melanoma stage IV.
  
  
  METHODS
  A total of 32 patients with progressive stage IV melanoma after failure of standard therapy were enrolled onto a single-arm, multi-centre, open-label, phase II trial. All patients had an ECOG performance status of 0 or 1. Patients received 350 ng aviscumine twice weekly by subcutaneous injection until progression. The primary end points were progression-free survival (PFS) and overall survival (OS). Safety was assessed as adverse events (AEs). Tumor response was assessed every eight weeks and survival of patients was followed up to one year after the end of therapy. Thirty one patients (intent-to-treat population (ITT)) were assessed for efficacy; safety was assessed in the whole population.
  
  
  RESULTS
  One patient achieved a partial response (PR) and 10 patients showed stable disease/no change (SD). The median progression-free survival (mPFS) was 63 days (95% CI 57-85) and median overall survival (mOS) was 335 days (95% CI 210-604). In total 210 treatment-emergent adverse events were recorded. Grade 1 or 2 AEs occurred in 72% of patients and were mostly application-site effects such as pruritus Grade 3-4 treatment-emergent drug-related adverse events occurred in 9% of patients.
  
  
  CONCLUSIONS
  These results suggest that aviscumine may have a clinical impact in patients with previously treated metastatic melanoma and provide rationale for further clinical evaluation of this agent. In the light of effective new immune checkpoint blockers it might be a candidate for combinations with these agents.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00658437.
authors.affiliation: Dermatologikum Berlin, Berlin, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Trefzer
authors.affiliation: Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Hannover, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gutzmer
authors.affiliation: Charité- Universitätsmedizin Berlin, Hauttumorcentrum Charité (HTCC), Klinik für Dermatologie, Venerologie und Allergologie, Berlin, Germany.
authors.forename: Tabea
authors.initials: T
authors.lastname: Wilhelm
authors.affiliation: Hautärzte Zentrum Hannover, Hannover, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Schenck
authors.affiliation: Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein -Campus Kiel-, Kiel, Germany.
authors.forename: Katharina C
authors.initials: KC
authors.lastname: Kähler
authors.affiliation: Institut für Diagnostische Radiologie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Jacobi
authors.affiliation: MELEMA Pharma GmbH, Hamburg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Witthohn
authors.affiliation: MELEMA Pharma GmbH, Hamburg, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Lentzen
authors.affiliation: Elbe-Klinikum Buxtehude, Dermatologisches Zentrum, Buxtehude, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Mohr
keywords: Aviscumine; CY-503; Cancer immunotherapy; Metastatic melanoma stage IV; Phase II trial; Ribosome-inactivating protein