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Clinical Trial to Assess the Importance of Nephrectomy (CARMENA)

Primary Purpose

Metastatic Renal Cell Carcinoma

Status
Completed
Phase
Phase 3
Locations
France
Study Type
Interventional
Intervention
Nephrectomy
Sunitinib alone
Sponsored by
Assistance Publique - Hôpitaux de Paris
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Renal Cell Carcinoma focused on measuring Nephrectomy,, metastatic renal cell carcinoma,, sunitinib

Eligibility Criteria

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

Inclusion Criteria:

  • age ≥ 18 years
  • ECOG Performance Status 0 - 1
  • Biopsy (primary tumour or metastases) confirming the diagnosis of clear cell carcinoma
  • Documented metastatic disease
  • Absence of prior systemic treatment for kidney cancer including AA
  • Tumour amenable to nephrectomy (partial or total) in the opinion of the patient's urologist. Patients presenting with an inferior vena cava thrombosis can be included.
  • Patients for which the indication of Sunitinib is considered according to the recommendations rules given by national health authorities of participating countries. The prescription of Sunitinib in the circumstances of the study is considered as a standard treatment.
  • Platelets > or = 100 x 109/L, haemoglobin >or = 9 g/dl, neutrophils >or = 1.5 x 109/L;
  • Bilirubin < or = 2 mg/dL, aspartate transaminase (ASAT) and alanine transaminase (ALAT)< or = 2.5 times the upper normal limit (UNL) or < or = 5 times UNL for patients with liver metastases
  • Patients of child bearing age should use contraceptive methods
  • Patient able to follow the procedures outlined in the protocol as far as the planning of visits and examinations are concerned.
  • Life expectancy ≥ 3 months
  • Written informed consent
  • Patient without brain metastases or with radiotherapy or surgery treated brain metastases without progression into 6 weeks and non treated by corticoid
  • Patient non treated by anticoagulants excepted HBPM

Exclusion Criteria:

  • Prior systemic treatment for kidney cancer (including Anti Angiogenic)
  • Bilateral kidney cancer
  • Pregnant or breast feeding women
  • Acute coronary syndrome or episode of myocardial infarction or severe or unstable angina within the last 6 months as well as severe diabetes with severe peripheral arteriopathy or deep phlebitis not treated with low molecular weight heparin or arterial thrombosis within the last 3 months
  • Patients being treated with antivitamin K with curative intent (please note that patients being treated with low molecular weight heparin can be included)
  • Medical, general or psychiatric difficulties which, in the opinion of the Investigator, would make it inappropriate for trial entry
  • Symptomatic or untreated brain metastases (patients with brain metastases that have been treated by radiotherapy or surgery and have stable disease within 6 weeks, and are not requiring treatment with corticosteroids can be included)
  • Previous history of gastric disease or malabsorption, syndrome compromising the absorption of Sunitinib
  • Experimental treatment within the 28 days preceding inclusion
  • Other cancer within the previous 5 years (except for insitu skin carcinoma and treated localised prostate cancer with undetectable PSA)
  • Patient has received treatment with IV biphosphonate

Sites / Locations

  • Hopital Necker

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

A

B

Arm Description

Nephrectomy + sunitinib

Sunitinib alone

Outcomes

Primary Outcome Measures

The primary endpoint is overall survival.

Secondary Outcome Measures

Objective Response (complete or partial) is evaluated according to RECIST 1.1 criteria
Clinical benefit (complete response, partial or stable for at least 12 weeks).
Progression-Free Survival
Non-compliance to Sunitinib treatment is evaluated in arm A (nephrectomy + sunitinib) as the percentage of patients not starting sunitinib treatment within 6 weeks after nephrectomy
Non-compliance to sunitinib treatment is evaluated in arm B (sunitinib alone) as the percentage of patients needing nephrectomy
Post operative morbidity is evaluated as the percentage of deaths within 30 days following nephrectomy

Full Information

First Posted
June 29, 2009
Last Updated
April 13, 2021
Sponsor
Assistance Publique - Hôpitaux de Paris
Collaborators
Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT00930033
Brief Title
Clinical Trial to Assess the Importance of Nephrectomy
Acronym
CARMENA
Official Title
Randomized Phase III Trial Evaluating the Importance of Nephrectomy in Patients Presenting With Metastatic Renal Cell Carcinoma Treated With Sunitinib
Study Type
Interventional

2. Study Status

Record Verification Date
April 2021
Overall Recruitment Status
Completed
Study Start Date
September 9, 2009 (Actual)
Primary Completion Date
October 22, 2018 (Actual)
Study Completion Date
October 22, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Assistance Publique - Hôpitaux de Paris
Collaborators
Pfizer

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The study compare the standard treatment with nephrectomy + sunitinib to treatment with sunitinib alone without nephrectomy. This study will be the first trial on this competitive context
Detailed Description
The 2 previous studies on the impact of nephrectomy (EORTC, SWOG) in metastatic renal cell carcinoma have justified recommendation to initial nephrectomy for patients presenting with metastatic renal cell carcinoma. But these studies were performed at the time of immunotherapy. The objective is Evaluation of the importance of nephrectomy in patients with metastatic renal cell carcinoma treated with sunitinib (AA) Arm A : Nephrectomy followed by Sunitinib Arm B : Sunitinib alone Sunitinib will be administrated orally daily for 4 weeks followed by a 2 week rest( schedule 4/2), 6 weeks are considered as a cycle The starting dose will be 50 mg daily with provision for dose reduction based on tolerability Patient will be treated until disease progression or unacceptable toxicity occurrence or withdraw.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Renal Cell Carcinoma
Keywords
Nephrectomy,, metastatic renal cell carcinoma,, sunitinib

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
452 (Actual)

8. Arms, Groups, and Interventions

Arm Title
A
Arm Type
Active Comparator
Arm Description
Nephrectomy + sunitinib
Arm Title
B
Arm Type
Experimental
Arm Description
Sunitinib alone
Intervention Type
Procedure
Intervention Name(s)
Nephrectomy
Intervention Description
Current surgery
Intervention Type
Other
Intervention Name(s)
Sunitinib alone
Other Intervention Name(s)
Sunitinib alone without nephrectomy
Intervention Description
Sunitinib alone without nephrectomy
Primary Outcome Measure Information:
Title
The primary endpoint is overall survival.
Time Frame
starting at 4 months
Secondary Outcome Measure Information:
Title
Objective Response (complete or partial) is evaluated according to RECIST 1.1 criteria
Time Frame
Starting at 4 months
Title
Clinical benefit (complete response, partial or stable for at least 12 weeks).
Time Frame
Starting at 4 months
Title
Progression-Free Survival
Time Frame
Starting at 4 months
Title
Non-compliance to Sunitinib treatment is evaluated in arm A (nephrectomy + sunitinib) as the percentage of patients not starting sunitinib treatment within 6 weeks after nephrectomy
Time Frame
Starting at 4 months
Title
Non-compliance to sunitinib treatment is evaluated in arm B (sunitinib alone) as the percentage of patients needing nephrectomy
Time Frame
Starting at 4 months
Title
Post operative morbidity is evaluated as the percentage of deaths within 30 days following nephrectomy
Time Frame
Starting at 4 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: age ≥ 18 years ECOG Performance Status 0 - 1 Biopsy (primary tumour or metastases) confirming the diagnosis of clear cell carcinoma Documented metastatic disease Absence of prior systemic treatment for kidney cancer including AA Tumour amenable to nephrectomy (partial or total) in the opinion of the patient's urologist. Patients presenting with an inferior vena cava thrombosis can be included. Patients for which the indication of Sunitinib is considered according to the recommendations rules given by national health authorities of participating countries. The prescription of Sunitinib in the circumstances of the study is considered as a standard treatment. Platelets > or = 100 x 109/L, haemoglobin >or = 9 g/dl, neutrophils >or = 1.5 x 109/L; Bilirubin < or = 2 mg/dL, aspartate transaminase (ASAT) and alanine transaminase (ALAT)< or = 2.5 times the upper normal limit (UNL) or < or = 5 times UNL for patients with liver metastases Patients of child bearing age should use contraceptive methods Patient able to follow the procedures outlined in the protocol as far as the planning of visits and examinations are concerned. Life expectancy ≥ 3 months Written informed consent Patient without brain metastases or with radiotherapy or surgery treated brain metastases without progression into 6 weeks and non treated by corticoid Patient non treated by anticoagulants excepted HBPM Exclusion Criteria: Prior systemic treatment for kidney cancer (including Anti Angiogenic) Bilateral kidney cancer Pregnant or breast feeding women Acute coronary syndrome or episode of myocardial infarction or severe or unstable angina within the last 6 months as well as severe diabetes with severe peripheral arteriopathy or deep phlebitis not treated with low molecular weight heparin or arterial thrombosis within the last 3 months Patients being treated with antivitamin K with curative intent (please note that patients being treated with low molecular weight heparin can be included) Medical, general or psychiatric difficulties which, in the opinion of the Investigator, would make it inappropriate for trial entry Symptomatic or untreated brain metastases (patients with brain metastases that have been treated by radiotherapy or surgery and have stable disease within 6 weeks, and are not requiring treatment with corticosteroids can be included) Previous history of gastric disease or malabsorption, syndrome compromising the absorption of Sunitinib Experimental treatment within the 28 days preceding inclusion Other cancer within the previous 5 years (except for insitu skin carcinoma and treated localised prostate cancer with undetectable PSA) Patient has received treatment with IV biphosphonate
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Arnaud Mejean, MD PhD
Organizational Affiliation
Assistance Publique - Hôpitaux de Paris
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hopital Necker
City
Paris
ZIP/Postal Code
75015
Country
France

12. IPD Sharing Statement

Citations:
PubMed Identifier
29860937
Citation
Mejean A, Ravaud A, Thezenas S, Colas S, Beauval JB, Bensalah K, Geoffrois L, Thiery-Vuillemin A, Cormier L, Lang H, Guy L, Gravis G, Rolland F, Linassier C, Lechevallier E, Beisland C, Aitchison M, Oudard S, Patard JJ, Theodore C, Chevreau C, Laguerre B, Hubert J, Gross-Goupil M, Bernhard JC, Albiges L, Timsit MO, Lebret T, Escudier B. Sunitinib Alone or after Nephrectomy in Metastatic Renal-Cell Carcinoma. N Engl J Med. 2018 Aug 2;379(5):417-427. doi: 10.1056/NEJMoa1803675. Epub 2018 Jun 3.
Results Reference
derived
PubMed Identifier
24338498
Citation
Leon L, Garcia-Figueiras R, Suarez C, Arjonilla A, Puente J, Vargas B, Mendez Vidal MJ, Sebastia C. Recommendations for the clinical and radiological evaluation of response to treatment in metastatic renal cell cancer. Target Oncol. 2014 Mar;9(1):9-24. doi: 10.1007/s11523-013-0304-7. Epub 2013 Dec 12. Erratum In: Target Oncol. 2014 Jun;9(2):181. Garcia-Figueras, Roberto [corrected to Garcia-Figueiras, Roberto].
Results Reference
derived

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Clinical Trial to Assess the Importance of Nephrectomy

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