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High Dose IL-2 and Stereotactic Ablative Body Radiation Therapy for Metastatic Renal Cancer

Primary Purpose

Metastatic Clear Cell Renal Cell Carcinoma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
IL-2
Stereotactic Ablative Body Radiation Therapy
Sponsored by
University of Texas Southwestern Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Clear Cell Renal Cell Carcinoma focused on measuring kidney cancer, metastatic cancer

Eligibility Criteria

18 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Biopsy-proven metastatic clear cell RCC.
  2. Radiographic evidence of metastatic disease. 2.1 Patients with any number of metastatic site are allowed to enroll. However, only up to six sites will be selected for SBRT treatment, at the discretion of the treating radiation oncologist.
  3. Patient must have ≥1 lesion of size >1.5cm.
  4. Previous treatment with surgery, radiation, chemotherapy, immunotherapy or any targeted agents are allowed 28 days before the start of HD IL-2
  5. Age ≥ 18 years.
  6. Performance status ECOG 0, 1.
  7. Patient must be eligible for HD IL-2 treatment
  8. Patient must be eligible for SABR to one or more extra cranial sites.
  9. Adequate organ and marrow function as defined below:

    • leukocytes ≥ 3,000/mcL
    • absolute neutrophil count ≥ 1,500/mcL
    • platelets ≥ 50,000/mcl
    • total bilirubin ≤ 2mg/dL
    • AST(SGOT)/ALT(SPGT) ≤ 2.5 X institutional upper limit of normal
  10. 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, for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.

    10.1 A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:

    • Has not undergone a hysterectomy or bilateral oophorectomy; or
    • Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).
  11. Ability to understand and the willingness to sign a written informed consent
  12. Adequate Renal function with Cr ≤ 1.6 mg/dL.
  13. Adequate cardiac function (adequate perfusion; no ischemia) on thallium (or Tc) stress test
  14. Adequate pulmonary function on PFT (FEV1 >65%; DLCO>60%).

Exclusion Criteria:

  1. Subjects who have had chemotherapy or radiotherapy within 4 weeks prior to entering the study
  2. History of HIV, Hepatitis B, Hepatitis C and HTLV serology
  3. Subjects may not be receiving any other investigational or standard antineoplastic agents.
  4. Subjects with known brain metastases should be excluded from this clinical trial because of their poor prognosis
  5. Subjects with life expectancy < 6 months.
  6. History of allergic reactions to recombinant IL-2
  7. Uncontrolled recurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia,.
  8. Psychiatric illness/social situations that would limit compliance with study requirements.
  9. Subjects must not be pregnant or nursing due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants.
  10. Systemic or topical steroid use or other immunosuppressive therapy within the past 28 days
  11. Subjects required to take corticosteroids or other immunosuppressive therapy such as those with organ allograft

Sites / Locations

  • University of Texas Southwestern Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

treatment

Arm Description

HD IL-2 (brand name Proleukin), 600,000 U/kg q8h X 14 dose, IV infusion; SABR dose varying from 8Gy-20Gy in 1-3 fractions.

Outcomes

Primary Outcome Measures

Response Rate
Treatment response will be measured using the immune related Response Evaluation Criteria in Solid Tumors (RECIST) criteria (iRECIST) which are a minor modification of RECIST 1.1 for immunotherapy

Secondary Outcome Measures

Overall Survival
Overall Survival (OS), which is defined as the time between date of registration and the date of death due to any cause.
Progression Free Survival
Progression Free Survival (PFS), which is defined according to the immune Response Evaluation Criteria in Solid Tumors (iRECIST) as the time between date of registration and the first date of documented disease progression or date of death due to any cause.
Time to Progression
Time to Progression (TTP), which is defined as time between date of registration and date of documented progression
Local Control Rate
Local recurrence is defined as tumor recurrence within the planning target volume. Local control rate will be evaluated by imaging techniques such as CT or MRI. Local recurrence will be defined as an increase of > 20% in tumor size.
Median Response Duration
Median response duration, which is defined as the time between the date a response (CR or PR) was first seen until date of progression
Tumor-specific Immune Response
Immune response will be measured using ELISpot assay, T-cell proliferation assay and ELISA.
Number of Participants With Adverse Events
Adverse events will be determined according to Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0.
Health-related Quality of Life (HRQoL).

Full Information

First Posted
July 5, 2013
Last Updated
July 28, 2021
Sponsor
University of Texas Southwestern Medical Center
Collaborators
Prometheus Laboratories
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1. Study Identification

Unique Protocol Identification Number
NCT01896271
Brief Title
High Dose IL-2 and Stereotactic Ablative Body Radiation Therapy for Metastatic Renal Cancer
Official Title
A Phase II Trial of High Dose IL-2 and Stereotactic Ablative Body Radiation Therapy (SABR) for Patients With Metastatic Clear Cell Renal Cell Cancer (mRCC)
Study Type
Interventional

2. Study Status

Record Verification Date
July 2021
Overall Recruitment Status
Completed
Study Start Date
October 2, 2013 (Actual)
Primary Completion Date
August 25, 2020 (Actual)
Study Completion Date
April 20, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Texas Southwestern Medical Center
Collaborators
Prometheus Laboratories

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
In this i-SABR (immunotherapy + Stereotactic Ablative Body Radiation) trial, the stereotactic radiation to multiple metastatic sites is delivered not only to eradicate sites of bulky progressive disease, but also to provide antigen presentation and immune stimulation which is expected to act synergistically when immediately followed by the non-specific immune stimulation provided by treatment with HD IL-2 and thereby increase the response rate and complete response for metastatic clear cell renal cell cancer patients. Both HD IL-2 and SABR are FDA approved therapeutic cancer treatment

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Clear Cell Renal Cell Carcinoma
Keywords
kidney cancer, metastatic cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
treatment
Arm Type
Experimental
Arm Description
HD IL-2 (brand name Proleukin), 600,000 U/kg q8h X 14 dose, IV infusion; SABR dose varying from 8Gy-20Gy in 1-3 fractions.
Intervention Type
Drug
Intervention Name(s)
IL-2
Intervention Description
HD IL-2 (brand name Proleukin), 600,000 U/kg q8h X 14 dose, IV infusion
Intervention Type
Radiation
Intervention Name(s)
Stereotactic Ablative Body Radiation Therapy
Other Intervention Name(s)
SABR, SBRT
Intervention Description
SABR dose varying from 8Gy-20Gy in 1-3 fractions
Primary Outcome Measure Information:
Title
Response Rate
Description
Treatment response will be measured using the immune related Response Evaluation Criteria in Solid Tumors (RECIST) criteria (iRECIST) which are a minor modification of RECIST 1.1 for immunotherapy
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Overall Survival
Description
Overall Survival (OS), which is defined as the time between date of registration and the date of death due to any cause.
Time Frame
4 years
Title
Progression Free Survival
Description
Progression Free Survival (PFS), which is defined according to the immune Response Evaluation Criteria in Solid Tumors (iRECIST) as the time between date of registration and the first date of documented disease progression or date of death due to any cause.
Time Frame
4 years
Title
Time to Progression
Description
Time to Progression (TTP), which is defined as time between date of registration and date of documented progression
Time Frame
4 years
Title
Local Control Rate
Description
Local recurrence is defined as tumor recurrence within the planning target volume. Local control rate will be evaluated by imaging techniques such as CT or MRI. Local recurrence will be defined as an increase of > 20% in tumor size.
Time Frame
4 years
Title
Median Response Duration
Description
Median response duration, which is defined as the time between the date a response (CR or PR) was first seen until date of progression
Time Frame
4 years
Title
Tumor-specific Immune Response
Description
Immune response will be measured using ELISpot assay, T-cell proliferation assay and ELISA.
Time Frame
4 years
Title
Number of Participants With Adverse Events
Description
Adverse events will be determined according to Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0.
Time Frame
4 years
Title
Health-related Quality of Life (HRQoL).
Time Frame
4 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Biopsy-proven metastatic clear cell RCC. Radiographic evidence of metastatic disease. 2.1 Patients with any number of metastatic site are allowed to enroll. However, only up to six sites will be selected for SBRT treatment, at the discretion of the treating radiation oncologist. Patient must have ≥1 lesion of size >1.5cm. Previous treatment with surgery, radiation, chemotherapy, immunotherapy or any targeted agents are allowed 28 days before the start of HD IL-2 Age ≥ 18 years. Performance status ECOG 0, 1. Patient must be eligible for HD IL-2 treatment Patient must be eligible for SABR to one or more extra cranial sites. Adequate organ and marrow function as defined below: leukocytes ≥ 3,000/mcL absolute neutrophil count ≥ 1,500/mcL platelets ≥ 50,000/mcl total bilirubin ≤ 2mg/dL AST(SGOT)/ALT(SPGT) ≤ 2.5 X institutional upper limit of normal 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, for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. 10.1 A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria: Has not undergone a hysterectomy or bilateral oophorectomy; or Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months). Ability to understand and the willingness to sign a written informed consent Adequate Renal function with Cr ≤ 1.6 mg/dL. Adequate cardiac function (adequate perfusion; no ischemia) on thallium (or Tc) stress test Adequate pulmonary function on PFT (FEV1 >65%; DLCO>60%). Exclusion Criteria: Subjects who have had chemotherapy or radiotherapy within 4 weeks prior to entering the study History of HIV, Hepatitis B, Hepatitis C and HTLV serology Subjects may not be receiving any other investigational or standard antineoplastic agents. Subjects with known brain metastases should be excluded from this clinical trial because of their poor prognosis Subjects with life expectancy < 6 months. History of allergic reactions to recombinant IL-2 Uncontrolled recurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia,. Psychiatric illness/social situations that would limit compliance with study requirements. Subjects must not be pregnant or nursing due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants. Systemic or topical steroid use or other immunosuppressive therapy within the past 28 days Subjects required to take corticosteroids or other immunosuppressive therapy such as those with organ allograft
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Raquibul Hannan, MD, PhD
Organizational Affiliation
University of Texas Southwestern Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Texas Southwestern Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States

12. IPD Sharing Statement

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High Dose IL-2 and Stereotactic Ablative Body Radiation Therapy for Metastatic Renal Cancer

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