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Evaluate the Efficacy of Sorafenib in Renal Cell Carcinoma Patients After a Radical Resection of the Metastases

Primary Purpose

Metastatic Renal Cell Carcinoma

Status
Unknown status
Phase
Phase 2
Locations
Italy
Study Type
Interventional
Intervention
sorafenib
Sponsored by
Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

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

Eligibility Criteria

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

INCLUSION CRITERIA

  • Age ≥ 18 years
  • Patients with cytological or histological diagnosis of Renal Cell Carcinoma (RCC)
  • Absence of residual lesions following surgical removal of metastatic disease. Assessment must be performed by CT-scan or MRI
  • Histologically proven disease free margins of resected surgical specimen
  • No more than three months from radical resection on metastases.
  • ECOG Performance Status of 0 or 2
  • Life expectancy of at least 12 weeks.
  • Adequate bone marrow, liver and renal function as assessed by the following laboratory requirements to be conducted within 7 days prior to screening:
  • Hemoglobin > 9.0 g/dl
  • Absolute neutrophil count (ANC) >1,500/mm3
  • Platelet count 100,000/ml
  • Total bilirubin < 1.5 times the upper limit of normal
  • ALT and AST < 2.5 x upper limit of normal (< 5 x upper limit of normal for patients with liver involvement of their cancer)
  • Alkaline phosphatase 4 x ULN
  • PT-INR/PTT < 1.5 x upper limit of normal [Patients who are being therapeutically anticoagulated with an agent such as coumadin or heparin will be allowed to participate provided that no prior evidence of underlying abnormality in these parameters exists.] For patients on warfarin, close monitoring of at least weekly evaluations will be performed, until INR is stable based on a measurement at pre-dose, as defined by the local standard of care.
  • Serum creatinine < 1.5 x upper limit of normal
  • Amylase and lipase <1.5 X upper limit of normal
  • Signed informed consent must be obtained prior to any study specific procedures

EXCLUSION CRITERIA:

  • Prior systemic treatment for metastatic RCC. It is allowed an adjuvant or neoadjuvant therapy before or after nephrectomy if stopped at least 6 months before the resection of metastatic lesion/s.
  • History of cardiac disease: congestive heart failure >NYHA class 2; active CAD (MI more than 6 mo prior to study entry is allowed); cardiac arrhythmias requiring anti-arrhythmic therapy (beta blockers or digoxin are permitted) or uncontrolled hypertension (>= 160 mmHg systolic and/or 90 mmHg diastolic).
  • History of HIV infection or chronic hepatitis B or C
  • Active clinically serious infections (> grade 2 NCI-CTC version 3.0)
  • Symptomatic metastatic brain or meningeal tumors unless the patient is > 6 months from definitive therapy, has a negative imaging study within 4 weeks of study entry and is clinically stable with respect to the tumor at the time of study entry. Also the patient must not be undergoing acute steroid therapy or taper (chronic steroid therapy is acceptable provided that the dose is stable for one month prior to and following screening radiographic studies)
  • Patients with seizure disorder requiring medication (such as steroids or anti-epileptics)
  • History of organ allograft
  • Patients with evidence or history of bleeding diathesis
  • Patients undergoing renal dialysis
  • History of other disease, metabolic dysfunction, physical examination finding or clinical laboratory finding giving reasonable suspicion of a disease condition that contraindicates use of an investigational drug or patient at high risk from treatment complications
  • Previous or concurrent cancer that is distinct in primary site or histology from the cancer being evaluated in this study EXCEPT cervical carcinoma in situ, treated basal cell carcinoma, superficial bladder tumors (Ta, Tis & T1) or any cancer curatively treated > 3 years prior to study entry.
  • Anticancer chemotherapy or immunotherapy during the study or within 4 weeks of study entry.
  • Radiotherapy during study or within 3 weeks of start of study drug.
  • Major surgery within 4 weeks of start of study
  • Autologous bone marrow transplant or stem cell rescue within 4 months of study
  • Use of biologic response modifiers, such as G-CSF, within 3 week of study entry. (G-CSF and other hematopoietic growth factors may be used in the management of acute toxicity such as febrile neutropenia when clinically indicated or at the discretion of the investigator, however they may not be substituted for a required dose reduction.) (Patients taking chronic erythropoietin are permitted provided no dose adjustment is undertaken within 2 months prior to the study or during the study)
  • Investigational drug therapy outside of this trial during or within 4 weeks of study entry
  • Prior exposure to the study drug.
  • Pregnant or breast-feeding patients. Women of childbearing potential must have a negative pregnancy test performed within 7 days of the start of treatment. Both men and women enrolled in this trial must use adequate barrier birth control measures during the course of the trial and two weeks after the completion of trial.
  • Substance abuse, medical, psychological or social conditions that may interfere with the patient's participation in the study or evaluation of the study results
  • Any condition that is unstable or could jeopardize the safety of the patient and their compliance in the study
  • Patients unable to swallow oral medications

Sites / Locations

  • Istituto Tumori Milano
  • Cinzia Ortega
  • Alessandra Bearz
  • Alfredo Berruti
  • Saverio Cinieri
  • Francesco Atzori
  • Rodolfo Passalaqua
  • Francesco Di Costanzo
  • Vincenzo Emanuele Chiuri
  • Alessandra Mosca
  • Vittorio Gebbia
  • Enrico Cortesi
  • Francesco Cognetti
  • Franco Morelli

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Sorafenib

Best Supportive Care

Arm Description

Active Arm

Comparator

Outcomes

Primary Outcome Measures

Recurrence Free Survival
Efficacy of Sorafenib compared with BSC, in RCC patients that have undergone radical resection of recurrent metastatic disease, after prior nephrectomy. The primary efficacy endpoint is Recurrence Free Survival (RFS),

Secondary Outcome Measures

Overall Survival
Safety Profile
Physical examination, vital signs, Red blood count: haemoglobin, hematocrit, platelet count, white blood cell count. WBC should include differential neutrophil, lymphocyte, monocyte, basophil and eosinophil counts. Electrolyte panel: sodium, potassium, chloride and corrected calcium.Chemistry panel: AST, ALT, bilirubin, alkaline phosphatase, uric acid, total protein, albumin, calcium, lipase, amylase, phosphate, LDH, glucose, creatinine,BUN, and bicarbonate. Coagulation panel: PT, PT-INR, PTT. Urinalysis, Adverse event
Vascular endothelial growth factors (VEGF) levels in BSC and Sorafenib arm.

Full Information

First Posted
September 8, 2011
Last Updated
September 16, 2021
Sponsor
Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
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1. Study Identification

Unique Protocol Identification Number
NCT01444807
Brief Title
Evaluate the Efficacy of Sorafenib in Renal Cell Carcinoma Patients After a Radical Resection of the Metastases
Official Title
A Randomized, Open Label, Multicenter Phase 2 Study, to Evaluate the Efficacy of Sorafenib in Patients With Advanced Renal Cell Carcinoma (RCC) After a Radical Resection of the Metastases
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Unknown status
Study Start Date
December 2011 (undefined)
Primary Completion Date
March 2017 (Actual)
Study Completion Date
March 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Fondazione IRCCS Istituto Nazionale dei Tumori, Milano

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Evaluate the efficacy and tolerability of sorafenib in RCC patients underwent to metastasectomy
Detailed Description
Advanced RCC presents poor prognosis, because its pathogenesis is not clearly understood. However, up-regulation of the Ras pathway is thought to play a role. VEGF expression could represent independent prognostic factors for survival possibly linking expression of this protein with clinical outcome. Sorafenib is a potent inhibitor of both Raf-kinase and VEGF R2 signalling The anti-tumoral activity of Sorafenib was clearly demonstrated in phase III trial regarding advanced pretreated RCC. Surgical removal of metastatic disease could potentially increase the disease control rate. Particularly in patients with a disease free interval post nephrectomy of at least 1 year, with one small metastatic lesion, metastasectomy could represents an important therapeutic approach. After a radical resection of the metastatic disease is unclear if an anti-tumoral systemic therapy may increase patient survival. In summary, both the preclinical and clinical data support further evaluation of Sorafenib in RCC patients.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
132 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Sorafenib
Arm Type
Experimental
Arm Description
Active Arm
Arm Title
Best Supportive Care
Arm Type
No Intervention
Arm Description
Comparator
Intervention Type
Drug
Intervention Name(s)
sorafenib
Other Intervention Name(s)
Nexavar (Bayer Health Care - Leverkusen - Germany)
Intervention Description
sorafenib 400 mg bid
Primary Outcome Measure Information:
Title
Recurrence Free Survival
Description
Efficacy of Sorafenib compared with BSC, in RCC patients that have undergone radical resection of recurrent metastatic disease, after prior nephrectomy. The primary efficacy endpoint is Recurrence Free Survival (RFS),
Time Frame
December 2011 - December 2014 (3 years)
Secondary Outcome Measure Information:
Title
Overall Survival
Time Frame
December 2011 - December 2014 (3 years)
Title
Safety Profile
Description
Physical examination, vital signs, Red blood count: haemoglobin, hematocrit, platelet count, white blood cell count. WBC should include differential neutrophil, lymphocyte, monocyte, basophil and eosinophil counts. Electrolyte panel: sodium, potassium, chloride and corrected calcium.Chemistry panel: AST, ALT, bilirubin, alkaline phosphatase, uric acid, total protein, albumin, calcium, lipase, amylase, phosphate, LDH, glucose, creatinine,BUN, and bicarbonate. Coagulation panel: PT, PT-INR, PTT. Urinalysis, Adverse event
Time Frame
December 2011 - December 2014 (3 years)
Title
Vascular endothelial growth factors (VEGF) levels in BSC and Sorafenib arm.
Time Frame
December 2011 - December 2014 (3 years)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA Age ≥ 18 years Patients with cytological or histological diagnosis of Renal Cell Carcinoma (RCC) Absence of residual lesions following surgical removal of metastatic disease. Assessment must be performed by CT-scan or MRI Histologically proven disease free margins of resected surgical specimen No more than three months from radical resection on metastases. ECOG Performance Status of 0 or 2 Life expectancy of at least 12 weeks. Adequate bone marrow, liver and renal function as assessed by the following laboratory requirements to be conducted within 7 days prior to screening: Hemoglobin > 9.0 g/dl Absolute neutrophil count (ANC) >1,500/mm3 Platelet count 100,000/ml Total bilirubin < 1.5 times the upper limit of normal ALT and AST < 2.5 x upper limit of normal (< 5 x upper limit of normal for patients with liver involvement of their cancer) Alkaline phosphatase 4 x ULN PT-INR/PTT < 1.5 x upper limit of normal [Patients who are being therapeutically anticoagulated with an agent such as coumadin or heparin will be allowed to participate provided that no prior evidence of underlying abnormality in these parameters exists.] For patients on warfarin, close monitoring of at least weekly evaluations will be performed, until INR is stable based on a measurement at pre-dose, as defined by the local standard of care. Serum creatinine < 1.5 x upper limit of normal Amylase and lipase <1.5 X upper limit of normal Signed informed consent must be obtained prior to any study specific procedures EXCLUSION CRITERIA: Prior systemic treatment for metastatic RCC. It is allowed an adjuvant or neoadjuvant therapy before or after nephrectomy if stopped at least 6 months before the resection of metastatic lesion/s. History of cardiac disease: congestive heart failure >NYHA class 2; active CAD (MI more than 6 mo prior to study entry is allowed); cardiac arrhythmias requiring anti-arrhythmic therapy (beta blockers or digoxin are permitted) or uncontrolled hypertension (>= 160 mmHg systolic and/or 90 mmHg diastolic). History of HIV infection or chronic hepatitis B or C Active clinically serious infections (> grade 2 NCI-CTC version 3.0) Symptomatic metastatic brain or meningeal tumors unless the patient is > 6 months from definitive therapy, has a negative imaging study within 4 weeks of study entry and is clinically stable with respect to the tumor at the time of study entry. Also the patient must not be undergoing acute steroid therapy or taper (chronic steroid therapy is acceptable provided that the dose is stable for one month prior to and following screening radiographic studies) Patients with seizure disorder requiring medication (such as steroids or anti-epileptics) History of organ allograft Patients with evidence or history of bleeding diathesis Patients undergoing renal dialysis History of other disease, metabolic dysfunction, physical examination finding or clinical laboratory finding giving reasonable suspicion of a disease condition that contraindicates use of an investigational drug or patient at high risk from treatment complications Previous or concurrent cancer that is distinct in primary site or histology from the cancer being evaluated in this study EXCEPT cervical carcinoma in situ, treated basal cell carcinoma, superficial bladder tumors (Ta, Tis & T1) or any cancer curatively treated > 3 years prior to study entry. Anticancer chemotherapy or immunotherapy during the study or within 4 weeks of study entry. Radiotherapy during study or within 3 weeks of start of study drug. Major surgery within 4 weeks of start of study Autologous bone marrow transplant or stem cell rescue within 4 months of study Use of biologic response modifiers, such as G-CSF, within 3 week of study entry. (G-CSF and other hematopoietic growth factors may be used in the management of acute toxicity such as febrile neutropenia when clinically indicated or at the discretion of the investigator, however they may not be substituted for a required dose reduction.) (Patients taking chronic erythropoietin are permitted provided no dose adjustment is undertaken within 2 months prior to the study or during the study) Investigational drug therapy outside of this trial during or within 4 weeks of study entry Prior exposure to the study drug. Pregnant or breast-feeding patients. Women of childbearing potential must have a negative pregnancy test performed within 7 days of the start of treatment. Both men and women enrolled in this trial must use adequate barrier birth control measures during the course of the trial and two weeks after the completion of trial. Substance abuse, medical, psychological or social conditions that may interfere with the patient's participation in the study or evaluation of the study results Any condition that is unstable or could jeopardize the safety of the patient and their compliance in the study Patients unable to swallow oral medications
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Giuseppe Procopio, MD
Organizational Affiliation
Istituto Tumori Milano
Official's Role
Study Chair
Facility Information:
Facility Name
Istituto Tumori Milano
City
Milan
State/Province
Mi
ZIP/Postal Code
20156
Country
Italy
Facility Name
Cinzia Ortega
City
Alba
Country
Italy
Facility Name
Alessandra Bearz
City
Aviano
Country
Italy
Facility Name
Alfredo Berruti
City
Brescia
Country
Italy
Facility Name
Saverio Cinieri
City
Brindisi
Country
Italy
Facility Name
Francesco Atzori
City
Cagliari
Country
Italy
Facility Name
Rodolfo Passalaqua
City
Cremona
Country
Italy
Facility Name
Francesco Di Costanzo
City
Firenze
Country
Italy
Facility Name
Vincenzo Emanuele Chiuri
City
Lecce
Country
Italy
Facility Name
Alessandra Mosca
City
Novara
Country
Italy
Facility Name
Vittorio Gebbia
City
Palermo
Country
Italy
Facility Name
Enrico Cortesi
City
Roma
Country
Italy
Facility Name
Francesco Cognetti
City
Roma
Country
Italy
Facility Name
Franco Morelli
City
San Giovanni Rotondo
Country
Italy

12. IPD Sharing Statement

Plan to Share IPD
Yes
Citations:
PubMed Identifier
23212738
Citation
Ljungberg B. The role of metastasectomy in renal cell carcinoma in the era of targeted therapy. Curr Urol Rep. 2013 Feb;14(1):19-25. doi: 10.1007/s11934-012-0293-6.
Results Reference
background
Links:
URL
http://www.istitutotumori.mi.it
Description
Web page of Istituto Tumori in Milan

Learn more about this trial

Evaluate the Efficacy of Sorafenib in Renal Cell Carcinoma Patients After a Radical Resection of the Metastases

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