Phase III Trial of Carboplatin and Paclitaxel With or Without Sorafenib in Metastatic Melanoma

Author:

Flaherty Keith T.1,Lee Sandra J.1,Zhao Fengmin1,Schuchter Lynn M.1,Flaherty Lawrence1,Kefford Richard1,Atkins Michael B.1,Leming Philip1,Kirkwood John M.1

Affiliation:

1. Keith T. Flaherty and Lynn M. Schuchter, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Keith T. Flaherty, Massachusetts General Hospital Cancer Center; Sandra J. Lee and Fengmin Zhao, Dana-Farber Cancer Institute; Michael B. Atkins, Beth Israel Deaconess Medical Center, Boston, MA; Lawrence Flaherty, Karmanos Cancer Center, Wayne State University, Detroit, MI; Richard Kefford, Westmead Hospital,...

Abstract

Purpose The primary objective of this study was to determine whether carboplatin, paclitaxel, and sorafenib (CPS) improve overall survival (OS) compared with carboplatin and paclitaxel (CP) in chemotherapy-naive patients with metastatic melanoma. Patients and Methods In this double-blind, randomized, placebo-controlled phase III study, all patients received carboplatin at area under the [concentration-time] curve 6 and paclitaxel 225 mg/m2 intravenously once every 21 days with random assignment to sorafenib 400 mg orally twice per day on days 2 through 19 every 21 days or placebo. The primary end point was OS, and secondary end points included progression-free survival, objective tumor response, and toxicity. Results In all, 823 patients were enrolled over 34 months. At final analysis, the median OS was 11.3 months (95% CI, 9.8 to 12.2 months) for CP and 11.1 months (95% CI, 10.3 to 12.3 months) for CPS; the difference in the OS distribution was not statistically significant by the stratified log-rank test, stratified on American Joint Committee on Cancer (AJCC) stage, Eastern Cooperative Oncology Group (ECOG) performance status, and prior therapy (P = .878). Median progression-free survival was 4.9 months for CPS and 4.2 months for CP (P = .092, stratified log-rank test). Response rate was 20% for CPS and 18% for CP (P = .427). More patients on the CPS arm had grade 3 or higher toxicities (84% v 78%; P = .027), with increased rash, hand-foot syndrome, and thrombocytopenia accounting for most of the difference. Conclusion Sorafenib does not improve OS when given in combination with CP for chemotherapy-naive patients with metastatic melanoma. This study establishes benchmark end points for the CP regimen in first-line therapy of metastatic melanoma.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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