Ocular MelanomaPhase 3FOCUSNCT02678572
Percutaneous Hepatic Perfusion in Patients With Hepatic-dominant Ocular Melanoma
A Phase 3 study testing Melphalan/HDS in people with Ocular Melanoma and Uveal Melanoma, run by Delcath Systems Inc. at 22 sites in 9 countries.
Trial summary
This study will evaluate patients who have ocular melanoma that has spread from the eye to the liver: Patients in the study will be treated with Melphalan/HDS up to 6 total treatments and will be followed until death. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Ocular Melanoma, Uveal Melanoma
- What is being tested?
- Melphalan/HDS
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 102 participants
- Where
- 22 sitesin 9 countries
- Study dates
- 1 Feb 2016to 15 Aug 2023
- Phase
- Phase 3
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Male or female patients ≥ 18 years of age.
- Patients must weigh ≥ 35 kg (due to possible size limitations with respect to percutaneous catheterization of the femoral artery and vein using the Delcath Hepatic Delivery System).
- 50% or less histologically or cytologically-proven ocular melanoma metastases in the parenchyma of the liver.
- Disease in the liver must be measurable by computed tomography (CT) and/or magnetic resonance imaging (MRI).
- Evidence of limited extrahepatic disease on preoperative radiological studies is acceptable if the life threatening component of disease is in the liver. Limited extrahepatic disease is defined in this protocol as follows: metastasis in bone, subcutaneous, lung or lymph nodes that is amenable to resection or radiation and has a defined treatment plan. Patients with extra-hepatic tumor burden which does not have a defined treatment plan (i.e. monitor or is unable to be resected or radiated) must not be included in the trial.
- Scans used to determine eligibility (CT scan of the chest/abdomen/pelvis and MRI of the liver) must be performed within 28 days prior to randomization. An MRI of the liver is required at screening to validate that CT accurately reflects the extent of disease in the liver. For patients with MRI intolerance, a 3-phase liver CT is to be done in place of liver MRI.
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- Patients must not have chemotherapy, radiotherapy, chemoembolization, radioembolization, or immunoembolization for their malignancy within 30 days prior to treatment and must have recovered from all side effects of therapeutic and diagnostic interventions except those listed in Appendix B of the study protocol.
- Patients receiving anti programmed cell death protein 1 (PD-1) immunotherapy such as pembrolizumab or nivolumab, or human cytotoxic T-lymphocyte antigen 4 blocking antibody such as ipilimumab should wait 8 weeks before Melphalan/HDS treatment.
- Patients must have an ECOG PS of 0-1 at screening and on the day prior to treatment.
- Patients must have adequate hepatic function as evidenced by total serum bilirubin ≤ 1.5 x the upper limit of normal (ULN) and a prothrombin time (PT) within 2 seconds of the upper normal limit. Aspartate aminotransferase/alanine aminotransferase (AST/ALT) must be ≤ 2.5 x ULN.
- Patients must have a platelet count > 100,000/µL, hemoglobin ≥ 10.0 gm/dL, white blood cell count (WBC) > 2,000/uL, absolute neutrophil count (ANC) ≥ 1.5 x 109/L, and a serum creatinine ≤ 1.5 mg/dL unless the measured creatinine clearance is > 40 mL/min/1.73 m2.
- Women of childbearing potential (WOCBP) must have a negative serum pregnancy test (β-human chorionic gonadotropin) within 7 days prior to randomization.
- Provided signed informed consent.
Who cannot join
- Patients with Child-Pugh Class B or C cirrhosis or with evidence of portal hypertension by history, endoscopy, or radiologic studies.
- Those with New York Heart Association functional classification II, III or IV active cardiac conditions, including unstable coronary syndromes (unstable or severe angina, recent myocardial infarction), worsening or new-onset congestive heart failure, significant arrhythmias and severe valvular disease must be evaluated for risks of undergoing general anesthesia.
- History or evidence of clinically significant pulmonary disease that precludes the use of general anesthesia.
- Women of childbearing potential (WOCBP) i.e. fertile meaning not permanently sterilized and having had a menstrual period within the past 12 months) unable to undergo hormonal suppression to avoid menstruation during treatment.
- WOCBP and fertile males (not permanently sterile by bilateral orchidectomy) unwilling or unable to use highly effective contraception method for consent to at least 6 months after the last administration of study treatment (e.g. combined hormonal contraception; progestogen-only hormonal contraception; Intrauterine device, intrauterine hormone-releasing system; bilateral tubal occlusion, vasectomized partner or sexual abstinence).
- Females that are pregnant or breastfeeding patients
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- Patients taking immunosuppressive drugs; however, oral corticosteroids ≤ 10 mg/day are allowed.
- Patients who are unable to be temporarily removed from chronic anti-coagulation therapy.
- Patients with active bacterial infections with systemic manifestations (malaise, fever, leucocytosis) are not eligible until completion of appropriate therapy.
- Patients with severe allergic reaction to iodine contrast, which cannot be controlled by premedication with antihistamines and steroids (because a hepatic angiogram is needed for the Delcath system procedure).
- Patients with a history of or known hypersensitivity to melphalan or the components of the Melphalan/HDS system.
- Patients with latex allergy.
- Patients with a history of hypersensitivity to heparin or the presence of heparin-induced thrombocytopenia.
- Patients with a history of bleeding disorders or evidence of intracranial abnormalities which would put them at risk for bleeding with anti-coagulation (e.g., strokes, active metastases).
- Patients with a history of gastrinoma, hepatic vasculature incompatible with perfusion, hepatofugal flow in the portal vein or known unresolved venous shunting.
- Known varices at risk of bleeding, including medium or large esophageal or gastric varices, or active peptic ulcer.
- Patients with prior Whipple's procedure.
- Patients with brain metastases or presence of other intracranial lesions at risk for bleeding by history or baseline radiologic imaging.
- Patients with active liver infection, including Hepatitis B and Hepatitis C infection. Patients with anti-hepatitis B core antibody (HBc) positive, or hepatitis B surface antigen (HBsAg) but DNA negative are exception(s).
- Uncontrolled endocrine disorders including diabetes mellitus, hypothyroidism, or hyperthyroidism.
- Received any investigational agent for any indication within 30 days prior to first treatment.
- Not recovered from side effects of prior therapy to ≤ Grade 1 (according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE v. 4.03). Certain side effects that are unlikely to develop into serious or life-threatening events (e.g. alopecia) are allowed at > Grade 1.
- Cancers other than ocular melanoma for which the patient is currently under treatment or still deemed not to be cancer free.
Trial locations and contacts
22 sites in 9 countries.
22 sites in 9 countries
United States9 sites
Emory University
Atlanta, Georgia, 30322
University of Chicago
Chicago, Illinois, 60637
Ohio State University James Cancer Center
Columbus, Ohio, 43210
Duke University Medical Center
Durham, North Carolina, 27710
University of Tennessee Health Science Center
Memphis, Tennessee, 38163
Stanford University
Palo Alto, California, 19380
Thomas Jefferson University
Philadelphia, Pennsylvania, 19107
Moffitt Cancer Center
Tampa, Florida, 33612
University of Arizona
Tucson, Arizona, 85719
Germany5 sites
Charité Unversitätsmedizin Berlin Comprehensive Cancer Center
Berlin, 10117
Universitätsklinikum Giessen und Marburg
Marburg, 35043
Universitätshautklinik Münster
Münster
Universitätsklinikum Regensburg
Regensburg, 93053
Universitätsklinikum Würzburg
Würzburg, 97080
United Kingdom2 sites
Aintree University Hospital
Liverpool, L9 7AL
University Hospital Southampton NHS Trust
Southampton, Hampshire, SO16 6YD
About this study
Official title: A Single-arm, Multi-Center, Open-Label Study to Evaluate the Efficacy, Safety and Pharmacokinetics of Melphalan/HDS Treatment in Patients With Hepatic-Dominant Ocular Melanoma
This study will evaluate patients who have ocular melanoma that has spread from the eye to the liver: Patients in the study will be treated with Melphalan/HDS up to 6 total treatments and will be followed until death. This study will evaluate the safety and efficacy of the treatment and how long patients live and how long it takes for the cancer to advance or respond to the treatment.
Read the detailed description
The study will consist of 3 phases: a screening phase, treatment phase, and follow-up phase.
Screening Phase: Screening assessments will be conducted within 28 days prior to the eligibility date to determine each patient's overall eligibility and baseline characteristics. These assessments will include medical history, physical examination, Eastern Cooperative Oncology Group (ECOG) performance status (PS), 12 lead electrocardiogram (ECG), echocardiogram (ECHO), vital signs, full hematology and biochemistry, Quality of Life questionnaire, radiologic assessments of baseline disease status and concomitant medications.
For patients with a history of liver surgery or major vasculature surgery, an angiogram evaluation of their vasculature will be performed for compatibility for Percutaneous Hepatic Perfusion (PHP) prior to confirming eligibility.
Eligibility date: This is the date on which all screening assessments have been completed and the patient is determined to be eligible for the trial.
Treatment Phase: Eligible patients will be treated with Melphalan/HDS 3.0 mg/kg Ideal Body Weight (IBW) and must begin treatment within 14 days being eligible. Melphalan/HDS treatment, patients will receive up to 6 treatments. Each treatment cycle consists of 6 weeks with an acceptable delay for another 2 weeks before the next planned treatment to allow for recovery of melphalan-related toxicity, if needed. Tumor response will be assessed every 12 weeks (+ 2 weeks) until disease progression. If the patient receives only 1 treatment, the disease assessment scans will be conducted 12 weeks after the date of the first treatment. The assessment scans will be reviewed by an Independent Review Committee (IRC), also referred to as Independent Central Review. At any time when progressive disease (PD) is observed, the patient will be removed from further study treatment and followed until death. Melphalan/HDS treatment will also be discontinued in the event that recovery from treatment related toxicity requires more than 8 weeks from last treatment. An end-of-treatment visit will be conducted approximately 6 to 8 weeks following the final study treatment. Ongoing treatment related adverse events (AEs) at the end-of-treatment visit will be followed until the severity is within one of the following parameters (1) Symptoms are resolved or return to baseline; (2) CTCAE Grade < 1 or can be explained; (3) patient death. The maximum possible duration of the study treatment for any patient will be 12 months.
Follow-up Phase: Once the patient has completed the end-of-treatment (EOT) visit in accordance with the schedule of events they will enter the follow-up phase. If the disease has not progressed at the EOT (Section 6.2), the patient will need to continue with disease assessment visits every 12 weeks (+ 2 weeks) until disease progression is documented. If the disease has progressed before or at the EOT their follow-up is to be by phone every 3 months for survival status until death.
Patients will be monitored, following the completion of study treatment, for the development of myelodysplasia and secondary leukemia.
- Conditions
- Ocular Melanoma, Uveal Melanoma
- Being tested
- Melphalan/HDS
- Keywords
- melphalan, PHP, chemosaturation, Delcath, ocular melanoma, uveal melanoma, percutaneous hepatic perfusion, liver metastasis
- Medical subject headings
- Uveal Melanoma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Melphalan/HDSCombination product
Also called Alkeran
Melphalan (3 mg/kg IBW) with Hepatic Device System (HDS)
| Study group | Role | What they receive |
|---|---|---|
| Melphalan/HDS | Experimental | 3 mg/kg ideal body weight of melphalan for infusion administered directly to the liver via percutaneous hepatic perfusion (PHP) over 30 minutes followed by a 30 minute washout. Treatment cycles are to be repeated every 6-8 weeks until disease progression. Receives: Combination Product: Melphalan/HDS |
What is being measured
The primary outcome is the main question the study is designed to answer.
Objective Response Rate (ORR) as Determined by Independent Central Review Committee.
Objective Response Rate (partial or complete) as determined by Independent Central Review Committee.
This is assessed per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR
Measured: Patients will be assessed for ORR from baseline through completion of treatment. [assessed up to 36 months].
Secondary outcomes (4)
Duration of Response (DOR) as Determined by Independent Central Review Committee
Duration of Response (DOR) is defined as the time from first documented confirmed response of CR or PR based on RECIST v1.1 determined by the IRC to the first documented progression or death due to any cause.
This is determined by MRI and / or CT imaging that is conducted every 12 weeks on all patients that started study treatment.
Measured: From time of 1st treatment until there is evidence of disease progression [assessed up to 36 months]
Disease Control Rate (DCR) Determined by Independent Central Review Committee
DCR is defined as the proportion of patients with a best overall response of CR of any duration, PR of any duration, or stable disease (SD) for a minimum of 12 weeks from the eligibility date for PHP-OCM-301A patients (and randomization date for PHP-OCM-301 patients).
This is determined by the evaluation of MRI and / or CT imaging conducted every 12 weeks on all patients that have received study treatment.
Measured: ORR will be assessed every 10-14 weeks from the start of 1st treatment and continues until the earlier of either when there is evidence of disease progression or 1 year from 1st treatment up to 12 months.
Overall Survival
Overall Survival will be measured from the eligibility date for PHP-OCM-301A patients (and randomization date for PHP-OCM-301 patients) to the date of death (included all-cause mortality).
Measured: From the start of the study to the date the patient was last known alive. [assessed up to 36 months]
Progression-Free Survival
PFS is defined as the time from the eligibility date for PHP-OCM-301A patients (and randomization date for PHP-OCM-301 patients) to the first occurrence of disease progression (either hepatic or extra-hepatic), as determined by the Investigator and / or Independent Central Review Committee assessments using RECIST (version 1.1), or death from any cause.
Progression is defined using RECIST v1.1, as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.
Measured: From start of study until disease progression. [assessed up to 36 months]
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Feb 2016 (estimated)
- Study start1 Feb 2016
- Primary completion18 May 2023
- Study completion15 Aug 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Ocular MelanomaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Model description
- This is a multi-center, single-arm, open-label study to evaluate the efficacy and safety of Melphalan/HDS in patients with hepatic dominant metastatic ocular melanoma. The study will be conducted at approximately 40 centers in the United States and Europe.
- Masking
- None (open label)
- Enrolment
- 102 participants (actual)
Sponsor and investigators
- Lead sponsor
- Delcath Systems Inc.
- Sponsor type
- Industry (pharma, biotech, devices)
- Collaborators
- IQVIA Biotech
- Responsible party
- Sponsor
- Investigators
- Jonathan Zager, MD, Principal investigator, Moffitt Cancer Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02678572
- Sponsor's protocol ID
- PHP-OCM-301A
- Acronym
- FOCUS
- Status last verified
- Apr 2026
- First submitted
- 1 Feb 2016
- Last updated
- 10 Sep 2026
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- Yes
- Individual data sharing
- No
Publications
Zager JS, Orloff M, Ferrucci PF, Choi J, Eschelman DJ, Glazer ES, Ejaz A, Howard JH, Richtig E, Ochsenreither S, Reddy SA, Lowe MC, Beasley GM, Gesierich A, Bender A, Gschnell M, Dummer R, Rivoire M, Arance A, Fenwick SW, Sacco JJ, Haferkamp S, Weishaupt C, John J, Wheater M, Ottensmeier CH. Efficacy and Safety of the Melphalan/Hepatic Delivery System in Patients with Unresectable Metastatic Uveal Melanoma: Results from an Open-Label, Single-Arm, Multicenter Phase 3 Study. Ann Surg Oncol. 2024 Aug;31(8):5340-5351. doi: 10.1245/s10434-024-15293-x. Epub 2024 May 4.
PubMed 38704501