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Study of Hydroxychloroquine Before Surgery in Patients With Primary Renal Cell Carcinoma

Primary Purpose

Renal Cell Carcinoma

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Hydroxychloroquine (HC)
Sponsored by
University of Pittsburgh
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, Hydroxychloroquine, Nephrectomy, Autophagy

Eligibility Criteria

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

Inclusion Criteria:

  • Subjects with suspected primary or metastatic RCC (stage 1-IV) with planned nephrectomy or partial nephrectomy.
  • ECOG performance status ≤1
  • Normal renal, hepatic, and hematologic function at the time of enrollment as evidenced by:

    • Serum creatinine level ≤1.5 the upper limits of normal (ULN)
    • Serum total bilirubin level ≤1.5 X ULN
  • White blood cell count > or = 3.5x109/ml per ml and platelet count ≥ 100x109 per ml
  • Age >18 years.
  • Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  • Subjects who have received chemotherapy for any diagnosis within 12 months prior to study entry.
  • Prior use of radiotherapy or investigational agents for RCC.
  • Concurrent malignancies with evidence of active or measurable disease except non-melanoma skin cancer
  • Inability to adhere to study and/or follow-up procedures
  • History of allergic reactions or hypersensitivity to the study drug (hydroxychloroquine) or current therapy with the study drug for other reasons.
  • Other concurrent experimental therapy.
  • The effects of HC on the developing human fetus are unknown. For this reason women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. All females of childbearing potential must have a blood test or urine study within two weeks prior to registration to rule out pregnancy. Should a woman become pregnant while participating in this study, she should inform her treating physician immediately. If a man impregnates a woman while participating in this study, he should inform his treating physician immediately as well.
  • HIV-positive patients are not excluded from the study. However, for patients receiving combination anti-retroviral therapy, the potential impact of pharmacokinetic interactions with HC is unknown. Therefore, HIV-positive patients actively receiving anti-retroviral therapy are excluded from the study.
  • Patients with psoriasis are ineligible unless the disease is well controlled and they are under the care of a specialist who agrees to monitor the patient for exacerbations.
  • Patients requiring the use of enzyme-inducing anti-epileptic medication that includes: phenytoin, carbamazepine, phenobarbital, primidone or oxcarbazepine are excluded. Hydroxychloroquine is known to affect the CYP2D6 metabolic pathway. A list of drugs with potential interaction is included in Appendix H.
  • Patients with previously documented macular degeneration or diabetic retinopathy are excluded.
  • Patients with known glucose-6-phosphate dehydrogenase (GP6D) deficiency
  • EKG with QTc >500 msec at baseline (average of 3 determinations at 10 minutes interval). Subjects with ventricular pacemaker for whom QT interval is not measurable will be eligible on a case-by-case basis.

Sites / Locations

  • UPCI/UPMC Cancer Centers
  • UPMC Department of Urology

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Hydroxychloroquine (HC)

Arm Description

HC orally for 14 days prior to nephrectomy

Outcomes

Primary Outcome Measures

Measure biologic markers of autophagy in tumor and normal tissues (peripheral blood mononuclear cells, renal parenchyma) following a short course of pre-operative oral hydroxychloroquine [HC] in patients with renal cell carcinoma.

Secondary Outcome Measures

Measure the serum biomarker response (HMGB1, sRAGE, VEGF, fibronectin, CRP, IL-6, nicotinamide N-methyltransferase, thrombospondin-1, CD 14, and ferritin) following pre-operative oral HC.
Assess the effect of pre-operative HC on phenotype and function of DC and NK cells
Assess the effect of pre-operative HC on abundance of neutrophils, NK cells, T-cells and T-cell subsets, PDCs and MDCs in the resected tumor, expression of CAIX and NOX4 compared with matched age/sex/histology matched controls.
Assess miRNAs pre and post HC and postoperatively in blood and in resected tumor and normal kidney compared to stage- and grade-matched controls.

Full Information

First Posted
June 10, 2010
Last Updated
October 24, 2016
Sponsor
University of Pittsburgh
Collaborators
National Institutes of Health (NIH)
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1. Study Identification

Unique Protocol Identification Number
NCT01144169
Brief Title
Study of Hydroxychloroquine Before Surgery in Patients With Primary Renal Cell Carcinoma
Official Title
A Phase IB Study of Hydroxychloroquine Prior to Nephrectomy in Patients With Primary Renal Cell Carcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
October 2016
Overall Recruitment Status
Terminated
Why Stopped
barriers to accrual: delay until surgery and additional pre-operative visits
Study Start Date
October 2010 (undefined)
Primary Completion Date
September 2016 (Actual)
Study Completion Date
September 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Pittsburgh
Collaborators
National Institutes of Health (NIH)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The main goal of this research study is to determine whether treating patients with renal cell cancer with hydroxychloroquine before surgery can make the cancer easier to kill. Another goal is to see how the study drug affects the body's immune cells which fight cancer cells.
Detailed Description
Autophagy is a cellular survival mechanism that protects from stress-induced programmed death. Autophagy may enable renal cancer to escape from cytokine therapy, cytotoxic chemotherapy or targeted agents. Hydroxychloroquine prevents autophagy by blocking acidification of lysosomes, and is being studied in clinical trials as a means of enhancing of cancer therapy. This phase Ib clinical trial will test the hypothesis that pre-operative exposure to HC reduces biologic markers of autophagy in peripheral blood, normal kidney and renal cancer specimens obtained at the time of nephrectomy. These data will be used in the design and pharmacodynamic monitoring of future therapeutic trials of HC in combination with high dose interleukin-2 and other systemic therapies for advanced RCC.

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, Hydroxychloroquine, Nephrectomy, Autophagy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Hydroxychloroquine (HC)
Arm Type
Experimental
Arm Description
HC orally for 14 days prior to nephrectomy
Intervention Type
Drug
Intervention Name(s)
Hydroxychloroquine (HC)
Other Intervention Name(s)
Plaquenil®
Intervention Description
Subjects will receive HC orally for 14 days prior to surgery. The fixed dose of HC will be 400 mg/day in divided doses (200 mg bid). The final dose will be administered on the evening prior to nephrectomy.
Primary Outcome Measure Information:
Title
Measure biologic markers of autophagy in tumor and normal tissues (peripheral blood mononuclear cells, renal parenchyma) following a short course of pre-operative oral hydroxychloroquine [HC] in patients with renal cell carcinoma.
Time Frame
Pre-hydroxychloroquine (HC), post-HC/pre-nephrectomy, post-nephrectomy (up to 1 month)
Secondary Outcome Measure Information:
Title
Measure the serum biomarker response (HMGB1, sRAGE, VEGF, fibronectin, CRP, IL-6, nicotinamide N-methyltransferase, thrombospondin-1, CD 14, and ferritin) following pre-operative oral HC.
Time Frame
One month post-nephrectomy
Title
Assess the effect of pre-operative HC on phenotype and function of DC and NK cells
Time Frame
One month post-nephrectomy
Title
Assess the effect of pre-operative HC on abundance of neutrophils, NK cells, T-cells and T-cell subsets, PDCs and MDCs in the resected tumor, expression of CAIX and NOX4 compared with matched age/sex/histology matched controls.
Time Frame
One month post-nephrectomy
Title
Assess miRNAs pre and post HC and postoperatively in blood and in resected tumor and normal kidney compared to stage- and grade-matched controls.
Time Frame
Pre-HC, post-HC/pre-nephrectomy, post-nephrectomy (1 month)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects with suspected primary or metastatic RCC (stage 1-IV) with planned nephrectomy or partial nephrectomy. ECOG performance status ≤1 Normal renal, hepatic, and hematologic function at the time of enrollment as evidenced by: Serum creatinine level ≤1.5 the upper limits of normal (ULN) Serum total bilirubin level ≤1.5 X ULN White blood cell count > or = 3.5x109/ml per ml and platelet count ≥ 100x109 per ml Age >18 years. Ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: Subjects who have received chemotherapy for any diagnosis within 12 months prior to study entry. Prior use of radiotherapy or investigational agents for RCC. Concurrent malignancies with evidence of active or measurable disease except non-melanoma skin cancer Inability to adhere to study and/or follow-up procedures History of allergic reactions or hypersensitivity to the study drug (hydroxychloroquine) or current therapy with the study drug for other reasons. Other concurrent experimental therapy. The effects of HC on the developing human fetus are unknown. For this reason women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. All females of childbearing potential must have a blood test or urine study within two weeks prior to registration to rule out pregnancy. Should a woman become pregnant while participating in this study, she should inform her treating physician immediately. If a man impregnates a woman while participating in this study, he should inform his treating physician immediately as well. HIV-positive patients are not excluded from the study. However, for patients receiving combination anti-retroviral therapy, the potential impact of pharmacokinetic interactions with HC is unknown. Therefore, HIV-positive patients actively receiving anti-retroviral therapy are excluded from the study. Patients with psoriasis are ineligible unless the disease is well controlled and they are under the care of a specialist who agrees to monitor the patient for exacerbations. Patients requiring the use of enzyme-inducing anti-epileptic medication that includes: phenytoin, carbamazepine, phenobarbital, primidone or oxcarbazepine are excluded. Hydroxychloroquine is known to affect the CYP2D6 metabolic pathway. A list of drugs with potential interaction is included in Appendix H. Patients with previously documented macular degeneration or diabetic retinopathy are excluded. Patients with known glucose-6-phosphate dehydrogenase (GP6D) deficiency EKG with QTc >500 msec at baseline (average of 3 determinations at 10 minutes interval). Subjects with ventricular pacemaker for whom QT interval is not measurable will be eligible on a case-by-case basis.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jodi K. Maranchie, MD
Organizational Affiliation
University of Pittsburgh Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
UPCI/UPMC Cancer Centers
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15232
Country
United States
Facility Name
UPMC Department of Urology
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15232
Country
United States

12. IPD Sharing Statement

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Study of Hydroxychloroquine Before Surgery in Patients With Primary Renal Cell Carcinoma

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