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Combination of Temsirolimus and Bevacizumab in Patient With Metastatic Renal Cell Carcinoma (TORAVA)

Primary Purpose

Metastatic Renal Cell Carcinoma

Status
Completed
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
Temsirolimus
Bevacizumab
Sunitinib
Interferon alpha-2a
Sponsored by
Centre Leon Berard
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Renal Cell Carcinoma focused on measuring Temsirolimus, Bevacizumab, Metastatic renal cell carcinoma, Non-progression

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female patients>= 18 years of age;
  • Patients with histological or cytological evidence of metastatic renal cell carcinoma mostly of all type,except for papillary;
  • No prior systemic treatment (chemotherapy, immunotherapy, anti-angiogenic drugs, or treatment under evaluation) for metastatic renal cancer;
  • No brain metastases revealed by MRI or CT-scan within 28 days prior to randomization. Patients with a history of brain metastases treated by surgery +/- radiation therapy can be included if they have normal brain MRI;
  • E.C.O.G performance status =<2;
  • At least one measurable lesion using the RECIST criteria;
  • Blood tests and renal and liver functions in the normal range with, in the 7 days prior to study entry, blood or serum values as follows:

Hemoglobin > 8g/dl; Neutrophil count > 1500*10exp9/L; Platelets > 100*10exp9/L; Serum creatinine < 200µmol/L; Total Bilirubin < 1.5 times upper limit of normal; ALT and AST < 2.5 times upper limit of normal or < 5 ULN for patients with liver metastases, PT or INR < 1.5 times upper limit of normal in the absence of anticoagulant therapy;

  • Absence of proteinuria confirmed by urinary dipstick test
  • Fertile women must use effective means of contraception
  • Mandatory affiliation with a healthy security insurance
  • Signed written informed consent.

Exclusion Criteria:

  • Patient with pure papillary renal cell carcinoma
  • Prior systemic treatment for metastatic renal cancer
  • History of other malignancies, other than curatively treated in-situ carcinoma of the cervix or basal cell carcinoma of the skin, or any other curatively treated cancer with no sign of recurrence within 5 years prior to randomization
  • Evidence of brain metastasis by computerized tomographic scan or MRI in the 28 days prior to randomization. Patients with history of brain metastases treated by exclusive brain therapy are not allowed to participate, even if brain MRI is normal
  • Significant cardiovascular disease or uncontrolled hypertension while receiving appropriate medication (>= 160 mm Hg systolic and/or >= 90 mm Hg diastolic)
  • Hepatic affection like chronic advanced hepatitis, liver cirrhosis or chronic hepatitis recently treated or in process of treatment by immunosuppressive agents, hepatitis auto-immune or history of auto-immune disease
  • Major surgical procedure, open biopsy, or serious non healing wound within 28 days prior to randomization
  • Uncontrolled hypercalcemia while receiving appropriate treatment
  • Uncontrolled hypercholesterolemia or hypertriglyceridemia
  • Patient under anti-vitamin K therapy
  • Patient under strong CYP3A4 inhibitors
  • Patient with severe neuropsychiatric disorder (or comitial crises)
  • Patient included in another clinical trial, except for supportive care trials
  • Pregnant or lactating women (mandatory negative serum or urinary pregnancy test at study entry for all women of childbearing potential)

Sites / Locations

  • Centre Paul Papin
  • Centre Hospitalier Universitaire de Besançon
  • Centre Hospitalier Universitaire de Bordeaux - Hôpital St André
  • Institut Bergonié
  • Centre François Baclesse
  • Centre Jean Perrin
  • Centre Georges François Leclerc
  • Centre Hospitalier de Versailles
  • Centre Hospitalier Universitaire de Lille - Hôpital Claude Huriez
  • Centre Oscar Lambret
  • Centre Hospitalier Universitaire DUPUTRYEN
  • Centre Léon Bérard
  • Centre Hospitalier Universiariare Lyon, Hôpital Lyon Sud
  • Institut Paoli Calmette
  • Centre Val d'Aurelle
  • Clinique Valdegour-Centre médical Oncogard
  • Fondation Hôpital Saint Joseph
  • Hopital du Val de Grâce
  • Hôpital Européen Georges Pompidou
  • Centre Hospilier Universitaire de Poitiers
  • Institut Jean Godinot
  • Centre Eugène Marquis
  • Centre René Gauducheau
  • Institut de Cancérologie de la Loire
  • Centre Hospitalier Starsbourg
  • Hôpital FOCH
  • Institut Claudius Regaud
  • Centre Alexis Vautrin
  • Institut Gustave Roussy

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Active Comparator

Arm Label

A

B

C

Arm Description

Outcomes

Primary Outcome Measures

progression-free rate

Secondary Outcome Measures

Objective response rate:efficacity
Duration of response
Toxicity
Quality of life
progression-free survival and overall survival

Full Information

First Posted
February 8, 2008
Last Updated
February 14, 2013
Sponsor
Centre Leon Berard
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1. Study Identification

Unique Protocol Identification Number
NCT00619268
Brief Title
Combination of Temsirolimus and Bevacizumab in Patient With Metastatic Renal Cell Carcinoma
Acronym
TORAVA
Official Title
Open Label, Randomized, Multicenter Phase II Study of a Combination of Torisel® (Temsirolimus) and Avastin® (Bevacizumab) Versus Sutent® (Sunitinib) and Versus a Combination of Avastin® (Bevacizumab) and Roféron® (Interferon Alpha-2a) in First-line Treatment of Patients With Metastatic Renal Cell Carcinoma.
Study Type
Interventional

2. Study Status

Record Verification Date
February 2013
Overall Recruitment Status
Completed
Study Start Date
February 2008 (undefined)
Primary Completion Date
February 2012 (Actual)
Study Completion Date
February 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Centre Leon Berard

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The TORAVA trial is designed to evaluate the progression-free rate at 48 weeks of a combination of Torisel® and Avastin® given at first-line treatment in patients with metastatic renal cancer. Eligible patients will be randomly assigned, in a 2:1:1 ratio, to either Avastin® + Torisel®, or Sutent® or IFN+Avastin®.
Detailed Description
This is a phase II, open label, randomized, parallel group, multicenter study evaluating first-line treatment of patients with metastatic renal cancer using a combination of Torisel® administered intravenously as 25 mg every week and Avastin® administered intravenously as 10 mg/kg every 2 weeks. Two standard arms with either Sutent® (given orally as 50 mg once daily during 4 weeks, followed by 2 weeks off) or a combination of Avastin® (administered intravenously as 10 mg/kg every 2 weeks) and Interferon (IFN, administered subcutaneously as 9 MU three times a week) will be used to validate the results obtained in the experimental arm (randomization eliminates selection biases), and to assess Sutent® efficacy rate on a more representative population than in Motzer's trial (Motzer NEJM 2007). The study is not designed to provide head-to-head comparisons between the experimental arm (Avastin® + Torisel®) and the two standard arms (Sutent® and IFN + Avastin®). Randomization will be used as a tool for allocating patients evenly into the 3 treatment arms to ensure proper balance of prognostic factors. If the progression-free rates observed in randomly assigned control patients are inconsistent with historical data, it may be a warning that the results observed for the experimental arm should be viewed with caution. Patients will be randomly assigned to either option in a 2:1:1 ratio (half less patients in the standard arms used only as historical comparators), and stratified according to inclusion center and performance status (ECOG PS 0 vs. 1 vs. 2). In the absence of severe toxicity, treatment will be continued until documented progression of the disease (RECIST criteria). Toxicity will be evaluated throughout the treatment period and until disappearance or stabilization of the side effect(s). In case of progression, each investigator makes his/her own treatment decisions, provided that all anti-cancer treatments given to the patients within the frame of the study are reported, as well as their results. Response rates will be assessed between weeks 11-12, 23-24, 35-36, 47-48 in the first year (corresponding to 2 cycles of Sutent®) and every 3 months afterwards until treatment stop, or until patient death or end of clinical data collection.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Renal Cell Carcinoma
Keywords
Temsirolimus, Bevacizumab, Metastatic renal cell carcinoma, Non-progression

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
160 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
A
Arm Type
Experimental
Arm Title
B
Arm Type
Active Comparator
Arm Title
C
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Temsirolimus
Other Intervention Name(s)
Torisel®
Intervention Description
25 mg once per week administered intravenously
Intervention Type
Drug
Intervention Name(s)
Bevacizumab
Other Intervention Name(s)
Avastin®
Intervention Description
10 mg/kg * 1 time /2 weeks administered intravenously
Intervention Type
Drug
Intervention Name(s)
Sunitinib
Other Intervention Name(s)
Sutent®
Intervention Description
50 mg administered orally once daily in 6 weeks cycles :4 weeks of treatment followed by 2 weeks off
Intervention Type
Drug
Intervention Name(s)
Interferon alpha-2a
Other Intervention Name(s)
Roféron®
Intervention Description
Administered subcutaneously as 9 MU three times per week
Primary Outcome Measure Information:
Title
progression-free rate
Time Frame
at 48 weeks post-treatment
Secondary Outcome Measure Information:
Title
Objective response rate:efficacity
Time Frame
Every 12 weeks during 48 weeks
Title
Duration of response
Title
Toxicity
Time Frame
at week 2, week 5-6 and after every 5-6 weeks during 48 weeks
Title
Quality of life
Time Frame
at inclusion, month 6 and at 1 year
Title
progression-free survival and overall survival

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients>= 18 years of age; Patients with histological or cytological evidence of metastatic renal cell carcinoma mostly of all type,except for papillary; No prior systemic treatment (chemotherapy, immunotherapy, anti-angiogenic drugs, or treatment under evaluation) for metastatic renal cancer; No brain metastases revealed by MRI or CT-scan within 28 days prior to randomization. Patients with a history of brain metastases treated by surgery +/- radiation therapy can be included if they have normal brain MRI; E.C.O.G performance status =<2; At least one measurable lesion using the RECIST criteria; Blood tests and renal and liver functions in the normal range with, in the 7 days prior to study entry, blood or serum values as follows: Hemoglobin > 8g/dl; Neutrophil count > 1500*10exp9/L; Platelets > 100*10exp9/L; Serum creatinine < 200µmol/L; Total Bilirubin < 1.5 times upper limit of normal; ALT and AST < 2.5 times upper limit of normal or < 5 ULN for patients with liver metastases, PT or INR < 1.5 times upper limit of normal in the absence of anticoagulant therapy; Absence of proteinuria confirmed by urinary dipstick test Fertile women must use effective means of contraception Mandatory affiliation with a healthy security insurance Signed written informed consent. Exclusion Criteria: Patient with pure papillary renal cell carcinoma Prior systemic treatment for metastatic renal cancer History of other malignancies, other than curatively treated in-situ carcinoma of the cervix or basal cell carcinoma of the skin, or any other curatively treated cancer with no sign of recurrence within 5 years prior to randomization Evidence of brain metastasis by computerized tomographic scan or MRI in the 28 days prior to randomization. Patients with history of brain metastases treated by exclusive brain therapy are not allowed to participate, even if brain MRI is normal Significant cardiovascular disease or uncontrolled hypertension while receiving appropriate medication (>= 160 mm Hg systolic and/or >= 90 mm Hg diastolic) Hepatic affection like chronic advanced hepatitis, liver cirrhosis or chronic hepatitis recently treated or in process of treatment by immunosuppressive agents, hepatitis auto-immune or history of auto-immune disease Major surgical procedure, open biopsy, or serious non healing wound within 28 days prior to randomization Uncontrolled hypercalcemia while receiving appropriate treatment Uncontrolled hypercholesterolemia or hypertriglyceridemia Patient under anti-vitamin K therapy Patient under strong CYP3A4 inhibitors Patient with severe neuropsychiatric disorder (or comitial crises) Patient included in another clinical trial, except for supportive care trials Pregnant or lactating women (mandatory negative serum or urinary pregnancy test at study entry for all women of childbearing potential)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sylvie NEGRIER, MD, PhD
Organizational Affiliation
Centre Leon Berard
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Bernard ESCUDIER, MD
Organizational Affiliation
Gustave Roussy, Cancer Campus, Grand Paris
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centre Paul Papin
City
Angers
Country
France
Facility Name
Centre Hospitalier Universitaire de Besançon
City
Besançon
Country
France
Facility Name
Centre Hospitalier Universitaire de Bordeaux - Hôpital St André
City
Bordeaux
Country
France
Facility Name
Institut Bergonié
City
Bordeaux
Country
France
Facility Name
Centre François Baclesse
City
Caen
Country
France
Facility Name
Centre Jean Perrin
City
Clermont Ferrand
Country
France
Facility Name
Centre Georges François Leclerc
City
Dijon
Country
France
Facility Name
Centre Hospitalier de Versailles
City
Le Chesnay
Country
France
Facility Name
Centre Hospitalier Universitaire de Lille - Hôpital Claude Huriez
City
Lille
Country
France
Facility Name
Centre Oscar Lambret
City
Lille
Country
France
Facility Name
Centre Hospitalier Universitaire DUPUTRYEN
City
Limoges
Country
France
Facility Name
Centre Léon Bérard
City
Lyon
ZIP/Postal Code
69373
Country
France
Facility Name
Centre Hospitalier Universiariare Lyon, Hôpital Lyon Sud
City
Lyon
Country
France
Facility Name
Institut Paoli Calmette
City
Marseille
Country
France
Facility Name
Centre Val d'Aurelle
City
Montpellier
Country
France
Facility Name
Clinique Valdegour-Centre médical Oncogard
City
Nîmes
Country
France
Facility Name
Fondation Hôpital Saint Joseph
City
Paris
Country
France
Facility Name
Hopital du Val de Grâce
City
Paris
Country
France
Facility Name
Hôpital Européen Georges Pompidou
City
Paris
Country
France
Facility Name
Centre Hospilier Universitaire de Poitiers
City
Poitiers
Country
France
Facility Name
Institut Jean Godinot
City
Reims
Country
France
Facility Name
Centre Eugène Marquis
City
Rennes
Country
France
Facility Name
Centre René Gauducheau
City
Saint Herblain
Country
France
Facility Name
Institut de Cancérologie de la Loire
City
Saint Priest en Jarez
Country
France
Facility Name
Centre Hospitalier Starsbourg
City
Strasbourg
Country
France
Facility Name
Hôpital FOCH
City
Suresnes
Country
France
Facility Name
Institut Claudius Regaud
City
Toulouse
Country
France
Facility Name
Centre Alexis Vautrin
City
Vandoeuvre les Nancy
Country
France
Facility Name
Institut Gustave Roussy
City
Villejuif
ZIP/Postal Code
94805
Country
France

12. IPD Sharing Statement

Citations:
PubMed Identifier
17215530
Citation
Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Siebels M, Negrier S, Chevreau C, Solska E, Desai AA, Rolland F, Demkow T, Hutson TE, Gore M, Freeman S, Schwartz B, Shan M, Simantov R, Bukowski RM; TARGET Study Group. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007 Jan 11;356(2):125-34. doi: 10.1056/NEJMoa060655. Erratum In: N Engl J Med. 2007 Jul 12;357(2):203.
Results Reference
background
PubMed Identifier
17215529
Citation
Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, Oudard S, Negrier S, Szczylik C, Kim ST, Chen I, Bycott PW, Baum CM, Figlin RA. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007 Jan 11;356(2):115-24. doi: 10.1056/NEJMoa065044.
Results Reference
background
PubMed Identifier
17538086
Citation
Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A, Staroslawska E, Sosman J, McDermott D, Bodrogi I, Kovacevic Z, Lesovoy V, Schmidt-Wolf IG, Barbarash O, Gokmen E, O'Toole T, Lustgarten S, Moore L, Motzer RJ; Global ARCC Trial. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. 2007 May 31;356(22):2271-81. doi: 10.1056/NEJMoa066838.
Results Reference
background
PubMed Identifier
21664867
Citation
Negrier S, Gravis G, Perol D, Chevreau C, Delva R, Bay JO, Blanc E, Ferlay C, Geoffrois L, Rolland F, Legouffe E, Sevin E, Laguerre B, Escudier B. Temsirolimus and bevacizumab, or sunitinib, or interferon alfa and bevacizumab for patients with advanced renal cell carcinoma (TORAVA): a randomised phase 2 trial. Lancet Oncol. 2011 Jul;12(7):673-80. doi: 10.1016/S1470-2045(11)70124-3. Epub 2011 Jun 12.
Results Reference
result
PubMed Identifier
29563634
Citation
Polena H, Creuzet J, Dufies M, Sidibe A, Khalil-Mgharbel A, Salomon A, Deroux A, Quesada JL, Roelants C, Filhol O, Cochet C, Blanc E, Ferlay-Segura C, Borchiellini D, Ferrero JM, Escudier B, Negrier S, Pages G, Vilgrain I. The tyrosine-kinase inhibitor sunitinib targets vascular endothelial (VE)-cadherin: a marker of response to antitumoural treatment in metastatic renal cell carcinoma. Br J Cancer. 2018 May;118(9):1179-1188. doi: 10.1038/s41416-018-0054-5. Epub 2018 Mar 22.
Results Reference
derived

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Combination of Temsirolimus and Bevacizumab in Patient With Metastatic Renal Cell Carcinoma

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