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Rotating Pazopanib and Everolimus to Avoid Resistance (ROPETAR)

Primary Purpose

Clear Cell Renal Carcinoma

Status
Completed
Phase
Phase 2
Locations
Netherlands
Study Type
Interventional
Intervention
Pazopanib
Everolimus
Pazopanib
Everolimus
Everolimus
Pazopanib
Sponsored by
Netherlands Working Group on Immunotherapy of Oncology
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Clear Cell Renal Carcinoma focused on measuring Renal carcinoma, Resistance, Reversible, Translational

Eligibility Criteria

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

Inclusion Criteria:

  • Subjects must provide written informed consent prior to performance of study-specific procedures or assessments, and must be willing to comply with treatment and follow-up.
  • Age ≥ 18 years.
  • Histologically confirmed diagnosis of progressive metastatic clear cell renal cell cancer defined as >10% of the tumor cells having the clear cell phenotype.
  • Locally advanced (defined as disease not amenable to curative surgery or radiation therapy) or metastatic RCC (equivalent to Stage IV RCC according to AJCC staging).
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.
  • Measurable disease.
  • No prior systemic anti-cancer treatment against clear cell renal carcinoma.
  • Adequate organ system function.
  • Non-childbearing potential.

Exclusion Criteria:

  • Prior malignancy.
  • History or clinical evidence of central nervous system (CNS) metastases or leptomeningeal carcinomatosis.
  • Clinically significant gastrointestinal abnormalities that may increase the risk for gastrointestinal bleeding.
  • Clinically significant gastrointestinal abnormalities that may affect absorption of investigational product.
  • Presence of uncontrolled infection.
  • Known past or present infection with Hepatitis B virus (HBV), Hepatitis C virus (HCV) or Human Immunodeficiency Virus (HIV).
  • Corrected QT interval (QTc) > 480 msecs using Bazett's formula.
  • History of one or more of the following cardiovascular conditions within the past 6 months:

    1. Cardiac angioplasty or stenting
    2. Myocardial infarction
    3. Stable or unstable angina pectoris.
    4. Coronary artery bypass graft surgery.
    5. Symptomatic peripheral vascular disease
    6. Class III or IV congestive heart failure, as defined by the New York Heart Association (NYHA).
  • Poorly controlled hypertension [defined as systolic blood pressure (SBP) of ≥160 mmHg or diastolic blood pressure (DBP) of ≥ 90mmHg].
  • History of cerebrovascular accident including transient ischemic attack (TIA), pulmonary embolism or untreated deep venous thrombosis (DVT) within the past 6 months.
  • Prior major surgery or trauma within 28 days prior to first dose of study drug and/or presence of any nonhealing wound, fracture, or ulcer (procedures such as catheter placement not considered to be major).
  • Evidence of active bleeding or bleeding diathesis.
  • Known endobronchial lesions and/or lesions infiltrating major pulmonary vessels.
  • Hemoptysis in excess of 2.5 mL (or one half teaspoon) within 8 weeks of first dose of study drug.
  • Any serious and/or unstable pre-existing medical, psychiatric, or other condition that could interfere with subject's safety, provision of informed consent, or compliance to study procedures.
  • Unable or unwilling to discontinue use of prohibited medications or modify the dosing of interacting drugs for at least 14 days or five half-lives of a drug (whichever is longer) prior to the first dose of study drug and for the duration of the study.
  • Pregnant or lactating female.
  • Treatment with any of the following anti-cancer therapies: Radiation therapy, surgery or tumor embolization within 14 days prior to the first dose of Pazopanib OR Chemotherapy, immunotherapy, biologic therapy, investigational therapy or hormonal therapy.

Sites / Locations

  • St. Franciscus Gasthuis
  • Medisch Centrum Alkmaar
  • Acedemisch Medisch Centrum Amsterdam
  • NKI-AVL
  • Amphia ziekenhuis Breda
  • Haga Ziekenhuis
  • Maxima Medisch Centrum
  • UMC Groningen
  • Atrium Medisch Centrum Heerlen
  • Medische Centrum Leeuwarden
  • Acedemisch ziekenhuis Maastricht
  • St. Antonius ziekenhuis
  • Erasmus Medisch Centrum
  • Orbis Medisch Centrum
  • St. Elisabeth ziekenhuis
  • UMC Utrecht
  • Isala klinieken

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Alternating regimen

Sequential treatment

Arm Description

In the experimental arm (Arm A) alternating treatment will consist of 8 weeks of Pazopanib 800 mg qd alternated by 8 weeks of Everolimus 10 mg qd until first progression(PD per RECIST 1.1)followed thereafter by Pazopanib (when PD after 8 weeks of Everolimus)or Everolimus (when PD after 8 weeks of Pazopanib) monotherapy until second progression.

The comparative arm (Arm B) will be the standard regimen of Pazopanib (800 mg qd continuously) until progression, followed thereafter by Everolimus (10 mg qd continuously) until progression.

Outcomes

Primary Outcome Measures

Progression free survival

Secondary Outcome Measures

Time to second progression
Time between first progression and second progression (PD) per RECIST 1.1 on Everolimus monotherapy (when PD after 8 weeks Pazopanib) or Pazopanib monotherapy (when PD after 8 weeks Everolimus) as second line treatment in experimental arm and time to progressive disease on Everolimus as second line treatment in comparative arm.
Change in Quality of life assessed by the FKSI-DRS and EORTC QLQ-C30 questionnaires compared to baseline
Quality of life will be assessed bi-monthly by using the FACT Kidney Symptom Index (FKSI)-Disease Related Symptom (DRS)and the EORTC QLQ-C30 questionnaire. The symptoms covered by the FKSI-DRS include fatigue, pain, weight loss, dyspnea, cough, fever and hematuria. The EORTC QLQ-C30 questionnaire evaluates five functional scales (physical, role, emotional, social and cognitive functioning), three symptom scales (fatigue, pain, nausea, and vomiting), a global health status/QoL scale, and six single items (dyspnea, diarrhea, constipation, anorexia, insomnia and financial impact).
Toxicity reported as number/percentage of patients with adverse events
Adverse events will be reported according Criteria for Adverse Events v4.0 (NCI CTCAE v4)
Overall survival

Full Information

First Posted
April 7, 2011
Last Updated
July 15, 2014
Sponsor
Netherlands Working Group on Immunotherapy of Oncology
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1. Study Identification

Unique Protocol Identification Number
NCT01408004
Brief Title
Rotating Pazopanib and Everolimus to Avoid Resistance
Acronym
ROPETAR
Official Title
A Randomized Phase II Study to Explore the Efficacy and Feasibility of Upfront Bi-monthly Rotations Between Everolimus and Pazopanib in Patients With Advanced or Metastatic Clear Cell Renal Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
July 2014
Overall Recruitment Status
Completed
Study Start Date
November 2011 (undefined)
Primary Completion Date
April 2014 (Actual)
Study Completion Date
April 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Netherlands Working Group on Immunotherapy of Oncology

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
In this study will be examined whether alternating treatment between two classes of drugs (TKI's and m-TOR inhibitors) postpones or prevents drug resistance in patients with renal cancer.
Detailed Description
Current practice is to treat with VEGFR-TKI or mTOR inhibitors until progression and then continue with the next active agent. From a biological perspective, TKI's will most likely activate compensatory pathways which, may ultimately lead to the development of resistance. Recent studies suggest that resistance to treatment with TKI may be reversible after stopping treatment. There is therefore a rationale to alternate treatment to prevent or delay the occurrence of resistance. Our hypothesis is that alternating active agents in clear cell renal carcinoma (ccRCC) may reduce side effects, improve tolerability and compliance of treatment and prolong progression free survival and overall survival compared to the standard of care.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Clear Cell Renal Carcinoma
Keywords
Renal carcinoma, Resistance, Reversible, Translational

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Alternating regimen
Arm Type
Experimental
Arm Description
In the experimental arm (Arm A) alternating treatment will consist of 8 weeks of Pazopanib 800 mg qd alternated by 8 weeks of Everolimus 10 mg qd until first progression(PD per RECIST 1.1)followed thereafter by Pazopanib (when PD after 8 weeks of Everolimus)or Everolimus (when PD after 8 weeks of Pazopanib) monotherapy until second progression.
Arm Title
Sequential treatment
Arm Type
Active Comparator
Arm Description
The comparative arm (Arm B) will be the standard regimen of Pazopanib (800 mg qd continuously) until progression, followed thereafter by Everolimus (10 mg qd continuously) until progression.
Intervention Type
Drug
Intervention Name(s)
Pazopanib
Other Intervention Name(s)
Votrient, L01XE11
Intervention Description
Tablet 800mg qd til progression
Intervention Type
Drug
Intervention Name(s)
Everolimus
Other Intervention Name(s)
Afinitor, L01XE10
Intervention Description
tablet 10 mg qd til progression
Intervention Type
Drug
Intervention Name(s)
Pazopanib
Other Intervention Name(s)
Votrient, L01XE11
Intervention Description
tablet 800mg qd, alternating schedule: 8 weeks Pazopanib, 8 weeks Everolimus
Intervention Type
Drug
Intervention Name(s)
Everolimus
Other Intervention Name(s)
Afinitor, L01XE10
Intervention Description
tablet 10mg qd, alternating schedule: 8 weeks Pazopanib, 8 weeks Everolimus
Intervention Type
Drug
Intervention Name(s)
Everolimus
Other Intervention Name(s)
Afinitor, L01XE10
Intervention Description
Everolimus 10mg qd monotherapy until second progression (PD per RECIST 1.1)when first progression after 8 weeks of Pazopanib in alternating regimen
Intervention Type
Drug
Intervention Name(s)
Pazopanib
Other Intervention Name(s)
Votrient, L01XE11
Intervention Description
Pazopanib 800mg qd monotherapy until second progression (PD per RECIST 1.1) when first progression after 8 weeks of Everolimus in alternating regimen
Primary Outcome Measure Information:
Title
Progression free survival
Time Frame
Randomization until earliest date of disease progression (according RECIST 1.1 criteria) or death, an expected average of one year
Secondary Outcome Measure Information:
Title
Time to second progression
Description
Time between first progression and second progression (PD) per RECIST 1.1 on Everolimus monotherapy (when PD after 8 weeks Pazopanib) or Pazopanib monotherapy (when PD after 8 weeks Everolimus) as second line treatment in experimental arm and time to progressive disease on Everolimus as second line treatment in comparative arm.
Time Frame
Time between first and second progression, an expected average of five months
Title
Change in Quality of life assessed by the FKSI-DRS and EORTC QLQ-C30 questionnaires compared to baseline
Description
Quality of life will be assessed bi-monthly by using the FACT Kidney Symptom Index (FKSI)-Disease Related Symptom (DRS)and the EORTC QLQ-C30 questionnaire. The symptoms covered by the FKSI-DRS include fatigue, pain, weight loss, dyspnea, cough, fever and hematuria. The EORTC QLQ-C30 questionnaire evaluates five functional scales (physical, role, emotional, social and cognitive functioning), three symptom scales (fatigue, pain, nausea, and vomiting), a global health status/QoL scale, and six single items (dyspnea, diarrhea, constipation, anorexia, insomnia and financial impact).
Time Frame
From randomization until one month after ceasing study medication, an expected average of 18 months
Title
Toxicity reported as number/percentage of patients with adverse events
Description
Adverse events will be reported according Criteria for Adverse Events v4.0 (NCI CTCAE v4)
Time Frame
From randomization until one month after ceasing study medication, an expected average of 18 months
Title
Overall survival
Time Frame
Time between randomization and death, an estimated average of 2-5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects must provide written informed consent prior to performance of study-specific procedures or assessments, and must be willing to comply with treatment and follow-up. Age ≥ 18 years. Histologically confirmed diagnosis of progressive metastatic clear cell renal cell cancer defined as >10% of the tumor cells having the clear cell phenotype. Locally advanced (defined as disease not amenable to curative surgery or radiation therapy) or metastatic RCC (equivalent to Stage IV RCC according to AJCC staging). Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. Measurable disease. No prior systemic anti-cancer treatment against clear cell renal carcinoma. Adequate organ system function. Non-childbearing potential. Exclusion Criteria: Prior malignancy. History or clinical evidence of central nervous system (CNS) metastases or leptomeningeal carcinomatosis. Clinically significant gastrointestinal abnormalities that may increase the risk for gastrointestinal bleeding. Clinically significant gastrointestinal abnormalities that may affect absorption of investigational product. Presence of uncontrolled infection. Known past or present infection with Hepatitis B virus (HBV), Hepatitis C virus (HCV) or Human Immunodeficiency Virus (HIV). Corrected QT interval (QTc) > 480 msecs using Bazett's formula. History of one or more of the following cardiovascular conditions within the past 6 months: Cardiac angioplasty or stenting Myocardial infarction Stable or unstable angina pectoris. Coronary artery bypass graft surgery. Symptomatic peripheral vascular disease Class III or IV congestive heart failure, as defined by the New York Heart Association (NYHA). Poorly controlled hypertension [defined as systolic blood pressure (SBP) of ≥160 mmHg or diastolic blood pressure (DBP) of ≥ 90mmHg]. History of cerebrovascular accident including transient ischemic attack (TIA), pulmonary embolism or untreated deep venous thrombosis (DVT) within the past 6 months. Prior major surgery or trauma within 28 days prior to first dose of study drug and/or presence of any nonhealing wound, fracture, or ulcer (procedures such as catheter placement not considered to be major). Evidence of active bleeding or bleeding diathesis. Known endobronchial lesions and/or lesions infiltrating major pulmonary vessels. Hemoptysis in excess of 2.5 mL (or one half teaspoon) within 8 weeks of first dose of study drug. Any serious and/or unstable pre-existing medical, psychiatric, or other condition that could interfere with subject's safety, provision of informed consent, or compliance to study procedures. Unable or unwilling to discontinue use of prohibited medications or modify the dosing of interacting drugs for at least 14 days or five half-lives of a drug (whichever is longer) prior to the first dose of study drug and for the duration of the study. Pregnant or lactating female. Treatment with any of the following anti-cancer therapies: Radiation therapy, surgery or tumor embolization within 14 days prior to the first dose of Pazopanib OR Chemotherapy, immunotherapy, biologic therapy, investigational therapy or hormonal therapy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
E.E. Voest, MD/PhD
Organizational Affiliation
UMC Utrecht
Official's Role
Principal Investigator
Facility Information:
Facility Name
St. Franciscus Gasthuis
City
Rotterdam
State/Province
Zuid-Holland
Country
Netherlands
Facility Name
Medisch Centrum Alkmaar
City
Alkmaar
Country
Netherlands
Facility Name
Acedemisch Medisch Centrum Amsterdam
City
Amsterdam
Country
Netherlands
Facility Name
NKI-AVL
City
Amsterdam
Country
Netherlands
Facility Name
Amphia ziekenhuis Breda
City
Breda
Country
Netherlands
Facility Name
Haga Ziekenhuis
City
Den Haag
Country
Netherlands
Facility Name
Maxima Medisch Centrum
City
Eindhoven
Country
Netherlands
Facility Name
UMC Groningen
City
Groningen
Country
Netherlands
Facility Name
Atrium Medisch Centrum Heerlen
City
Heerlen
Country
Netherlands
Facility Name
Medische Centrum Leeuwarden
City
Leeuwarden
Country
Netherlands
Facility Name
Acedemisch ziekenhuis Maastricht
City
Maastricht
Country
Netherlands
Facility Name
St. Antonius ziekenhuis
City
Nieuwegein
Country
Netherlands
Facility Name
Erasmus Medisch Centrum
City
Rotterdam
Country
Netherlands
Facility Name
Orbis Medisch Centrum
City
Sittard-Geleen
Country
Netherlands
Facility Name
St. Elisabeth ziekenhuis
City
Tilburg
Country
Netherlands
Facility Name
UMC Utrecht
City
Utrecht
ZIP/Postal Code
3508 GA
Country
Netherlands
Facility Name
Isala klinieken
City
Zwolle
Country
Netherlands

12. IPD Sharing Statement

Citations:
PubMed Identifier
27918762
Citation
Cirkel GA, Hamberg P, Sleijfer S, Loosveld OJL, Dercksen MW, Los M, Polee MB, van den Berkmortel F, Aarts MJ, Beerepoot LV, Groenewegen G, Lolkema MP, Tascilar M, Portielje JEA, Peters FPJ, Klumpen HJ, van der Noort V, Haanen JBAG, Voest EE; Dutch WIN-O Consortium. Alternating Treatment With Pazopanib and Everolimus vs Continuous Pazopanib to Delay Disease Progression in Patients With Metastatic Clear Cell Renal Cell Cancer: The ROPETAR Randomized Clinical Trial. JAMA Oncol. 2017 Apr 1;3(4):501-508. doi: 10.1001/jamaoncol.2016.5202.
Results Reference
derived
Links:
URL
http://www.win-o.nl
Description
Dutch Immunotherapy consortion for oncology

Learn more about this trial

Rotating Pazopanib and Everolimus to Avoid Resistance

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