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A Phase Ib Study of Rad001 and Sutent to Treat Renal Cell Carcinoma (Rad/Sutent)

Primary Purpose

Renal Cell Carcinoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Everolimus (RAD001)
Sunitinib (Sutent)
Sponsored by
Daniel George, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Renal Cell Carcinoma focused on measuring Renal Cell Carcinoma, Rad001, Sutent

Eligibility Criteria

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

Inclusion Criteria:

Patients will be eligible for inclusion in this study only if all of the following criteria apply:

  • Patients must have histologically confirmed diagnosis of RCC.
  • Patients must have undergone a nephrectomy
  • Clinical or radiographic evidence of metastatic disease.
  • A minimum of 4 weeks from full field radiation therapy, surgery, chemotherapy or other investigational agent. Treatment may begin one week following limited field radiation therapy.
  • Subjects who have received prior limited field radiotherapy, biologic/immunotherapy or surgery must have a documented recovery period > 2 weeks
  • Patients must have normal organ and marrow function as defined below:

hemoglobin > 9.0g/dL absolute neutrophil count > 1,500/μl platelets > 100,000/μl total bilirubin < 1.5 X upper limit of normal (ULN) AST(SGOT)/ALT(SGPT) < 2.5 X ULN creatinine < 1.5 X ULN (or 24 hour measured creatinine clearance > 40 mL/min) total fasting cholesterol < 350 total triglycerides < 300

  • Age > 18 years.
  • ECOG score of 0-2 (See Appendix 11.1).
  • For patients with diabetes a Hgb A1C of ≤ 8
  • Subject agrees to use a medically acceptable form of birth control during and for at least 3 months after completion of the study treatment, if he/she is sexually active
  • Women of childbearing potential must have a negative serum pregnancy test within 3 days prior to treatment
  • Ability to swallow and retain oral medication.
  • Ability to understand and the willingness to sign a written informed consent document.
  • Written informed consent obtained according to local guidelines

Exclusion Criteria:

A patient will not be eligible for inclusion in this study if any of the following criteria apply:

  • History of solid organ or stem cell transplantation. Also, no current use of chronic immunosuppressive therapy is allowed.
  • Patients with active brain metastases (or history of brain metastases) should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
  • History of HIV, hepatitis B, or hepatitis C infection.
  • Patients who have received investigational, biologic, hormonal (other than ADT), immunotherapy, or chemotherapy less than 4 weeks prior to entry on this study or have not recovered from the toxic effects of such therapy.
  • Patients who have experienced severe trauma or undergone major surgery within 4 weeks prior to entry on this study or have not recovered to grade 1 or less may not participate.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection (requiring antifungal, antibiotic or antiviral therapy), symptomatic congestive heart failure (NYHC II or greater), unstable angina pectoris, cardiac arrhythmia (uncontrolled SVT or any VT), uncontrolled diabetes or psychiatric illness/social situations that would limit compliance with study requirements.
  • Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of RAD001 (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome or small bowel resection).
  • Patients who have received prior treatment with an mTOR inhibitor.
  • Patients who have received prior treatment with Sunitinib are not eligible to participate in this study.

Sites / Locations

  • Duke University Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

RAD001

Arm Description

Outcomes

Primary Outcome Measures

To determine the maximum tolerated dose (MTD)/recommended Phase 2 regimen of 2+1 dosing with Sunitinib and daily RAD001 in patients with advanced renal cell carcinoma.
To determine the safety and tolerability of 2+1 dosing of Sunitinib and daily RAD001 in patients with advanced RCC
To more fully evaluate the safety and tolerability of 2+1 dosing of Sunitinib and daily RAD001 at the MTD/recommended Phase 2 dose in patients with advanced RCC

Secondary Outcome Measures

Describe the non-dose limiting toxicities associated with combination therapy using 2+1 dosing Sunitinib and daily RAD001.
Describe the pharmacokinetics of Sunitinib and RAD001 and evaluate any association with disease response
To estimate objective response rate (partial or complete) seen in patients with advanced RCC in a dose expansion cohort treated at the MTD or recommended Phase 2 dose regimen
To estimate the overall survival of RCC patients treated with Sunitinib and RAD001
To estimate the time to disease progression of RCC patients treated with Sunitinib and RAD001

Full Information

First Posted
November 6, 2008
Last Updated
February 12, 2015
Sponsor
Daniel George, MD
Collaborators
Novartis, Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT00788060
Brief Title
A Phase Ib Study of Rad001 and Sutent to Treat Renal Cell Carcinoma
Acronym
Rad/Sutent
Official Title
A Single Arm, Phase Ib Study of RAD001 and Sunitinib in Patients With Advanced Renal Cell Carcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
February 2015
Overall Recruitment Status
Completed
Study Start Date
October 2008 (undefined)
Primary Completion Date
December 2012 (Actual)
Study Completion Date
December 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Daniel George, MD
Collaborators
Novartis, Pfizer

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a single center, Phase Ib study of Sunitinib and RAD001 in patients with advanced RCC. The study design is a phase I interpatient dose-escalation with a dose expansion at the maximum tolerated dose (MTD) in patients with metastatic RCC . In the dose escalation portion, patients will be treated with sunitinib, given in an intermittent schedule (2 weeks of daily dosing followed by one week off drug. RAD001 will be given daily. Escalation of both drugs will occur as tolerated. Treatment will be arbitrarily divided into 3-week cycles, with dose limiting toxicity (DLT) determined by Cycle 2 Day 0.
Detailed Description
Escalation of both drugs will occur as tolerated. Treatment will be arbitrarily divided into 3-week cycles, with dose limiting toxicity (DLT) determined by Cycle 2 Day 0. Dose levels will be evaluated one at a time beginning with 3 patients. If 1/3 patients demonstrate DLT (as defined in section Complete), then enrollment will proceed to the next dose level. 1/3 patients develops a DLT, then 3 more patients will be accrued to this dose level. If 0-1/6 patients demonstrate DLT, then enrollment will proceed to the next dose level. However, if 2 or more patients out of 6 demonstrate DLT at a dose level, then enrollment will proceed at the next lowest dose level. The highest dose level not resulting in greater than 1/6 DLT will be considered the MTD. Dose expansion will then proceed at this dose level. Once the maximum tolerated dose has been established for this regimen a dose expansion of 20 patients with metastatic RCC will be undertaken. Up to 10 patients with a positive FDG- PET scan at baseline (defined by 1 or more target lesions demonstrating an SUV > 5.0) will begin treatment per Figure 2B. Patients 1-10 will begin Sunitinib on Day 0 and begin RAD001 on Day 14 after repeat FDG-PET scan. Patients 11-20, will have a 2 week lead-in period of RAD001 and will begin Sunitinib 2 weeks later on Day 0. After repeat FDG-PET scan. Both groups of patients will repeat PET scan at Day 14 of cycle 2. Patients with negative FDG PET scans (SUV < 5.0 in all lesions) will not undergo repeat scanning. Patients will undergo evaluations for tumor response every 12 weeks with appropriate measurement studies (CT, MRI, bone scan). In the setting of a mixed response (progressive disease in 1 or more lesions but continued regression or stable disease below baseline in other lesions) patients may continue on study if it is determined by the PI, treating physician and patient that there is ongoing clinical benefit to the patient.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Renal Cell Carcinoma
Keywords
Renal Cell Carcinoma, Rad001, Sutent

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
5 (Actual)

8. Arms, Groups, and Interventions

Arm Title
RAD001
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Everolimus (RAD001)
Other Intervention Name(s)
RAD001
Intervention Description
5mg per day, continuously
Intervention Type
Drug
Intervention Name(s)
Sunitinib (Sutent)
Other Intervention Name(s)
Sutent
Intervention Description
37.5 mg per day, 14 days on, 7 day break
Primary Outcome Measure Information:
Title
To determine the maximum tolerated dose (MTD)/recommended Phase 2 regimen of 2+1 dosing with Sunitinib and daily RAD001 in patients with advanced renal cell carcinoma.
Time Frame
1 year
Title
To determine the safety and tolerability of 2+1 dosing of Sunitinib and daily RAD001 in patients with advanced RCC
Time Frame
1 year
Title
To more fully evaluate the safety and tolerability of 2+1 dosing of Sunitinib and daily RAD001 at the MTD/recommended Phase 2 dose in patients with advanced RCC
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Describe the non-dose limiting toxicities associated with combination therapy using 2+1 dosing Sunitinib and daily RAD001.
Time Frame
1 year
Title
Describe the pharmacokinetics of Sunitinib and RAD001 and evaluate any association with disease response
Time Frame
1 year
Title
To estimate objective response rate (partial or complete) seen in patients with advanced RCC in a dose expansion cohort treated at the MTD or recommended Phase 2 dose regimen
Time Frame
1 year
Title
To estimate the overall survival of RCC patients treated with Sunitinib and RAD001
Time Frame
1 year
Title
To estimate the time to disease progression of RCC patients treated with Sunitinib and RAD001
Time Frame
1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients will be eligible for inclusion in this study only if all of the following criteria apply: Patients must have histologically confirmed diagnosis of RCC. Patients must have undergone a nephrectomy Clinical or radiographic evidence of metastatic disease. A minimum of 4 weeks from full field radiation therapy, surgery, chemotherapy or other investigational agent. Treatment may begin one week following limited field radiation therapy. Subjects who have received prior limited field radiotherapy, biologic/immunotherapy or surgery must have a documented recovery period > 2 weeks Patients must have normal organ and marrow function as defined below: hemoglobin > 9.0g/dL absolute neutrophil count > 1,500/μl platelets > 100,000/μl total bilirubin < 1.5 X upper limit of normal (ULN) AST(SGOT)/ALT(SGPT) < 2.5 X ULN creatinine < 1.5 X ULN (or 24 hour measured creatinine clearance > 40 mL/min) total fasting cholesterol < 350 total triglycerides < 300 Age > 18 years. ECOG score of 0-2 (See Appendix 11.1). For patients with diabetes a Hgb A1C of ≤ 8 Subject agrees to use a medically acceptable form of birth control during and for at least 3 months after completion of the study treatment, if he/she is sexually active Women of childbearing potential must have a negative serum pregnancy test within 3 days prior to treatment Ability to swallow and retain oral medication. Ability to understand and the willingness to sign a written informed consent document. Written informed consent obtained according to local guidelines Exclusion Criteria: A patient will not be eligible for inclusion in this study if any of the following criteria apply: History of solid organ or stem cell transplantation. Also, no current use of chronic immunosuppressive therapy is allowed. Patients with active brain metastases (or history of brain metastases) should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events. History of HIV, hepatitis B, or hepatitis C infection. Patients who have received investigational, biologic, hormonal (other than ADT), immunotherapy, or chemotherapy less than 4 weeks prior to entry on this study or have not recovered from the toxic effects of such therapy. Patients who have experienced severe trauma or undergone major surgery within 4 weeks prior to entry on this study or have not recovered to grade 1 or less may not participate. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection (requiring antifungal, antibiotic or antiviral therapy), symptomatic congestive heart failure (NYHC II or greater), unstable angina pectoris, cardiac arrhythmia (uncontrolled SVT or any VT), uncontrolled diabetes or psychiatric illness/social situations that would limit compliance with study requirements. Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of RAD001 (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome or small bowel resection). Patients who have received prior treatment with an mTOR inhibitor. Patients who have received prior treatment with Sunitinib are not eligible to participate in this study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel J. George, M.D.
Organizational Affiliation
Duke University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Duke University Medical Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27705
Country
United States

12. IPD Sharing Statement

Learn more about this trial

A Phase Ib Study of Rad001 and Sutent to Treat Renal Cell Carcinoma

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