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Study of Interleukin-2, Interferon-alpha and Bevacizumab in Metastatic Kidney Cancer

Primary Purpose

Metastatic Renal Cell Carcinoma

Status
Unknown status
Phase
Phase 2
Locations
Denmark
Study Type
Interventional
Intervention
Interleukin-2
Interferon Alfa-2b
Bevacizumab
Sponsored by
University of Aarhus
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Renal Cell Carcinoma focused on measuring Bevacizumab, interleukin-2, interferon-alpha

Eligibility Criteria

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

Inclusion Criteria:

  1. Signed written informed consent
  2. Patient must be willing and able to comply with the protocol.
  3. Age ≥ 18 years.
  4. Histologic og cytologic biopsy proven locally advanced or metastatic renal cell carcinoma, considered non-candidates for curative surgery. Nephrectomy is not mandatory.
  5. Patient with renal cell carcinoma (RCC) with a clear-cell histologic component confirmed by local pathology review.
  6. Females with a negative serum pregnancy test unless childbearing potential can be otherwise excluded
  7. Fertile women of childbearing potential (<2 years after last menstruation) and men must use effective means of contraception
  8. Memorial-Sloan-Kettering-Cancer-Centre favourable- and intermediate prognostic group.
  9. Measurable or non-measurable disease (as per RECIST1.1 criteria)
  10. Karnofsky Performance status of 70% or higher.
  11. Life expectancy greater than 4 months.
  12. The required laboratory values at baseline are as follows:

Haematology:

WCC ≥ 3.0 x 109/L, Platelet count ≥ 100 x 109/L, Haemoglobin ≥ 6.2 mmol/l, (INR) ≤ 1.5, APTT ≤ 1.5 x ULN

Biochemistry:

Total bilirubin ≤ 1.5 x upper limit of normal (ULN), AST, ALT ≤ 2.5 x ULN in patients without liver metastases, ≤ 5 x ULN in patients with liver metastases, Serum Creatinine ≤ 150 micromol/L

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Exclusion Criteria:

  1. Prior systemic treatment for metastatic RCC disease
  2. Major surgical procedure, open surgical biopsy, or significant traumatic injury within 28 days prior to randomization.
  3. Serious non-healing wound, ulcer or bone fracture.
  4. Evidence of current central nervous system (CNS) metastases or spinal cord compression. Patient must undergo an MRI or CT scan of the brain (with contrast, if possible) within 28 days prior to randomization.
  5. Seizure(s) not controlled with standard medical therapy.
  6. Dipstick urine test of protein ≥ 2+.
  7. Other malignancies within 5 years prior to randomization (other than curatively treated basal cell carcinoma of the skin and/or in situ carcinoma of the cervix).
  8. Evidence of bleeding diathesis or coagulopathy.
  9. Ongoing or recent (within 10 days prior to study treatment start) need for full therapeutic dose of oral anticoagulants or chronic daily treatment with aspirin. Low molecular weight heparin are allowed
  10. Uncontrolled hypertension (≥ 160 mm Hg systolic and/or ≥ 100 mm Hg diastolic) while receiving chronic medication.
  11. Clinically significant (i.e. active) cardiovascular disease, for example cerebrovascular accidents (≤ 6 months before randomisation), myocardial infarction (≤ 6 months before randomisation), unstable angina, New York Heart Association (NYHA) grade II or greater congestive heart failure, or serious cardiac arrhythmia requiring medication.
  12. Recent (within the 30 days prior to randomization) treatment with another investigational drug or participation in another investigational study.
  13. Chronic treatment with corticosteroids (dose of ≥ 10 mg/day methylprednisolone equivalent), excluding inhaled steroids.
  14. History or presence of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates use of an investigational drug or patient at high risk from treatment complications.
  15. Known hypersensitivity to interleukin-2, Interferon, alfa or bevacizumab.

Serial blood test, serial tumor biopsies and serial dynamic contrast-enhanced imaging will be obtained as part of a translational research program integrated in the clinical trial.

Part(s) of the translational research program may be omitted in the individual patient due to practical, technical or safety reasons, without having consequences for participating in the additional translational research investigations or the clinical part of the study.

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Sites / Locations

  • Aarhus University Hospital
  • Herlev University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Interleukin-2, interferon, bevacizumab

Interleukin-2 and interferon-alfa

Arm Description

Outcomes

Primary Outcome Measures

Progression free survival, PFS

Secondary Outcome Measures

Response rate, RR
Overall survival, (OS)
Duration of response
Time to progression, (TTP)
Time to treatment failure, (TTTF)
Time to treatment failure is defined as time between date of randomisation and date of insufficient therapeutic response (including disease progression), death, withdrawal of treatment due to adverse events or laboratory abnormality, or withdrawn informed consent.
Tolerability
Toxicity is recorded according to CTCAE v3.0
Frequency of surgical resection of residual disease
This is calculated as number of patients having surgical resection of residual disease compared with the total number of treated patients.
Frequency of no evidence of disease (NED)
This is calculated as the total number of patients having no evidence of disease as a result of CR to treatment, or as a result of PR/SD to treatment followed by surgical resection of residual disease, compared with the total number of treated patients.
To explore the immunomodulatory effect of therapy in serial blood samples and serial tumor core biopsies and to correlate these biomarkers with outcome
Blood tests and core biopsies from accessible tumor lesions will be obtained at baseline, after cycle 1 and at PD. Blood analyses will include assessment of dendritic cells, FoxP3+ regulatory T-cells, NK-cells, T-subsets, neutrophils, monocytes, cytotoxic activity and antibody-dependent cellular cytotoxicity (ADCC). Tumor analyses will include assessment of intratumoral immune cells, markers related to HIF accumulation and CD34+ microvessel density.
To assess dynamic contrast-enhanced imaging as a potential biomarker.
Dynamic contrast-enhanced imaging (CT, MRI, and US) will be obtained at baseline, week 5 and at routine tumor assessments, if appropriate, for estimation of tumor blood perfusion change. An exploratory analysis to identify any potential relationship between each of these assessments and outcome (progression free survival, survival, time to progression, response rate and safety) will be performed.

Full Information

First Posted
June 29, 2010
Last Updated
December 1, 2014
Sponsor
University of Aarhus
Collaborators
Danish Renal Cancer Study Group
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1. Study Identification

Unique Protocol Identification Number
NCT01274273
Brief Title
Study of Interleukin-2, Interferon-alpha and Bevacizumab in Metastatic Kidney Cancer
Official Title
A Randomized Phase II Trial of IL-2/IFN-α Plus Bevacizumab Versus IL-2/IFN-α in Metastatic Renal Cell Carcinoma (mRCC) - Danish Renal Cancer Group (DARENCA) Study-1
Study Type
Interventional

2. Study Status

Record Verification Date
August 2012
Overall Recruitment Status
Unknown status
Study Start Date
October 2009 (undefined)
Primary Completion Date
December 2015 (Anticipated)
Study Completion Date
December 2015 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Aarhus
Collaborators
Danish Renal Cancer Study Group

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine whether interleukin-2, interferon-alpha in combination with bevacizumab are effective in the treatment of metastatic renal cell carcinoma (mRCC).
Detailed Description
Bevacizumab as monotherapy has effect in metastatic renal cell carcinoma (mRCC). Bevacizumab in combination with interferon-alfa (IFN-α) has significant efficacy in mRCC and has been approved by EMA and FDA. The present study will assess whether the combination of Interleukin-2 (IL-2) and IFN-α with bevacizumab may add efficacy in patients with mRCC with a tolerable safety profile.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Renal Cell Carcinoma
Keywords
Bevacizumab, interleukin-2, interferon-alpha

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Interleukin-2, interferon, bevacizumab
Arm Type
Experimental
Arm Title
Interleukin-2 and interferon-alfa
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Interleukin-2
Other Intervention Name(s)
Aldesleukin
Intervention Description
2.4 MIU/m2 s.c. two times daily, 5 days per week, weeks 1 and 2, every 28-day-cycle, for a maximum of 9 cycles (i.e.for a maximum of 9 months).
Intervention Type
Drug
Intervention Name(s)
Interferon Alfa-2b
Other Intervention Name(s)
IntronA
Intervention Description
IFN-alfa given as one priming-week of daily IFN 3.0 MIU, followed by up to 9 treatment cycles (i.e. for a maximum of 9 months) with IFN-alfa 3.0 MIU as a fixed dose s.c. once daily - 5 days per week.
Intervention Type
Drug
Intervention Name(s)
Bevacizumab
Other Intervention Name(s)
Avastin
Intervention Description
Bevacizumab doses of 10 mg per kilogram of body weight, given every two weeks i.v. until disease progression, unacceptable toxicity, withdrawal of consent or a maximum of 1 year following obtaining no evidence of disease (NED).
Primary Outcome Measure Information:
Title
Progression free survival, PFS
Time Frame
This is defined as the time between date of randomisation and the first date of documented disease progression or date of death due to any cause.
Secondary Outcome Measure Information:
Title
Response rate, RR
Time Frame
Overall response rate as assessed by the RECIST 1.1 criteria. An overall response is defined as a confirmed complete response (CR) or confirmed partial response (PR).
Title
Overall survival, (OS)
Time Frame
Overall survival is defined as the time between date of randomisation and the date of death due to any cause.
Title
Duration of response
Time Frame
Duration of response is defined as the time between the date a response (CR or PR) was first seen until date of progression.
Title
Time to progression, (TTP)
Time Frame
Time to progression is defined as time between date of randomisation and date of documented progression.
Title
Time to treatment failure, (TTTF)
Description
Time to treatment failure is defined as time between date of randomisation and date of insufficient therapeutic response (including disease progression), death, withdrawal of treatment due to adverse events or laboratory abnormality, or withdrawn informed consent.
Time Frame
see below
Title
Tolerability
Description
Toxicity is recorded according to CTCAE v3.0
Time Frame
see below
Title
Frequency of surgical resection of residual disease
Description
This is calculated as number of patients having surgical resection of residual disease compared with the total number of treated patients.
Time Frame
see below
Title
Frequency of no evidence of disease (NED)
Description
This is calculated as the total number of patients having no evidence of disease as a result of CR to treatment, or as a result of PR/SD to treatment followed by surgical resection of residual disease, compared with the total number of treated patients.
Time Frame
see below
Title
To explore the immunomodulatory effect of therapy in serial blood samples and serial tumor core biopsies and to correlate these biomarkers with outcome
Description
Blood tests and core biopsies from accessible tumor lesions will be obtained at baseline, after cycle 1 and at PD. Blood analyses will include assessment of dendritic cells, FoxP3+ regulatory T-cells, NK-cells, T-subsets, neutrophils, monocytes, cytotoxic activity and antibody-dependent cellular cytotoxicity (ADCC). Tumor analyses will include assessment of intratumoral immune cells, markers related to HIF accumulation and CD34+ microvessel density.
Time Frame
see below
Title
To assess dynamic contrast-enhanced imaging as a potential biomarker.
Description
Dynamic contrast-enhanced imaging (CT, MRI, and US) will be obtained at baseline, week 5 and at routine tumor assessments, if appropriate, for estimation of tumor blood perfusion change. An exploratory analysis to identify any potential relationship between each of these assessments and outcome (progression free survival, survival, time to progression, response rate and safety) will be performed.
Time Frame
see below

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed written informed consent Patient must be willing and able to comply with the protocol. Age ≥ 18 years. Histologic og cytologic biopsy proven locally advanced or metastatic renal cell carcinoma, considered non-candidates for curative surgery. Nephrectomy is not mandatory. Patient with renal cell carcinoma (RCC) with a clear-cell histologic component confirmed by local pathology review. Females with a negative serum pregnancy test unless childbearing potential can be otherwise excluded Fertile women of childbearing potential (<2 years after last menstruation) and men must use effective means of contraception Memorial-Sloan-Kettering-Cancer-Centre favourable- and intermediate prognostic group. Measurable or non-measurable disease (as per RECIST1.1 criteria) Karnofsky Performance status of 70% or higher. Life expectancy greater than 4 months. The required laboratory values at baseline are as follows: Haematology: WCC ≥ 3.0 x 109/L, Platelet count ≥ 100 x 109/L, Haemoglobin ≥ 6.2 mmol/l, (INR) ≤ 1.5, APTT ≤ 1.5 x ULN Biochemistry: Total bilirubin ≤ 1.5 x upper limit of normal (ULN), AST, ALT ≤ 2.5 x ULN in patients without liver metastases, ≤ 5 x ULN in patients with liver metastases, Serum Creatinine ≤ 150 micromol/L - Exclusion Criteria: Prior systemic treatment for metastatic RCC disease Major surgical procedure, open surgical biopsy, or significant traumatic injury within 28 days prior to randomization. Serious non-healing wound, ulcer or bone fracture. Evidence of current central nervous system (CNS) metastases or spinal cord compression. Patient must undergo an MRI or CT scan of the brain (with contrast, if possible) within 28 days prior to randomization. Seizure(s) not controlled with standard medical therapy. Dipstick urine test of protein ≥ 2+. Other malignancies within 5 years prior to randomization (other than curatively treated basal cell carcinoma of the skin and/or in situ carcinoma of the cervix). Evidence of bleeding diathesis or coagulopathy. Ongoing or recent (within 10 days prior to study treatment start) need for full therapeutic dose of oral anticoagulants or chronic daily treatment with aspirin. Low molecular weight heparin are allowed Uncontrolled hypertension (≥ 160 mm Hg systolic and/or ≥ 100 mm Hg diastolic) while receiving chronic medication. Clinically significant (i.e. active) cardiovascular disease, for example cerebrovascular accidents (≤ 6 months before randomisation), myocardial infarction (≤ 6 months before randomisation), unstable angina, New York Heart Association (NYHA) grade II or greater congestive heart failure, or serious cardiac arrhythmia requiring medication. Recent (within the 30 days prior to randomization) treatment with another investigational drug or participation in another investigational study. Chronic treatment with corticosteroids (dose of ≥ 10 mg/day methylprednisolone equivalent), excluding inhaled steroids. History or presence of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates use of an investigational drug or patient at high risk from treatment complications. Known hypersensitivity to interleukin-2, Interferon, alfa or bevacizumab. Serial blood test, serial tumor biopsies and serial dynamic contrast-enhanced imaging will be obtained as part of a translational research program integrated in the clinical trial. Part(s) of the translational research program may be omitted in the individual patient due to practical, technical or safety reasons, without having consequences for participating in the additional translational research investigations or the clinical part of the study. -
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Frede Donskov, MD, DMSc
Organizational Affiliation
Aarhus University Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Poul Geertsen, MD, PhD
Organizational Affiliation
University of Copenhagen
Official's Role
Study Chair
Facility Information:
Facility Name
Aarhus University Hospital
City
Aarhus
ZIP/Postal Code
8000
Country
Denmark
Facility Name
Herlev University Hospital
City
Herlev
ZIP/Postal Code
2730
Country
Denmark

12. IPD Sharing Statement

Citations:
PubMed Identifier
34327591
Citation
Drljevic-Nielsen A, Rasmussen F, Nielsen PS, Stilling C, Thorup K, Mains JR, Madsen HHT, Donskov F. Prognostic value of DCE-CT-derived blood volume and flow compared to core biopsy microvessel density in patients with metastatic renal cell carcinoma. Eur Radiol Exp. 2021 Jul 30;5(1):32. doi: 10.1186/s41747-021-00232-2.
Results Reference
derived
PubMed Identifier
29392960
Citation
Donskov F, Jensen NV, Smidt-Hansen T, Brondum L, Geertsen P. A randomized phase II trial of interleukin-2 and interferon-alpha plus bevacizumab versus interleukin-2 and interferon-alpha in metastatic renal-cell carcinoma (mRCC): results from the Danish Renal Cancer Group (DaRenCa) study-1. Acta Oncol. 2018 May;57(5):589-594. doi: 10.1080/0284186X.2018.1433324. Epub 2018 Feb 2.
Results Reference
derived

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Study of Interleukin-2, Interferon-alpha and Bevacizumab in Metastatic Kidney Cancer

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