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Sunitinib and Erlotinib in Treating Patients With Unresectable or Metastatic Kidney Cancer

Primary Purpose

Kidney Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
erlotinib hydrochloride
sunitinib malate
biopsy
Sponsored by
OHSU Knight Cancer Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Kidney Cancer focused on measuring stage III renal cell cancer, stage IV renal cell cancer, clear cell renal cell carcinoma, recurrent renal cell cancer

Eligibility Criteria

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

DISEASE CHARACTERISTICS:

  • Histologically confirmed renal cell carcinoma with a component of clear cell or papillary carcinoma

    • Unresectable or metastatic disease (radiologically or clinically confirmed)
  • Measurable disease (≥ 1 site)
  • No known brain metastasis that has not been adequately treated with radiotherapy and/or surgery

PATIENT CHARACTERISTICS:

  • Eastern Cooperative Oncology Group (ECOG) performance status 0-2
  • Absolute neutrophil count ≥ 1,500/mm³
  • Platelet count ≥ 100,000/mm³
  • No grade 3 hemorrhage within the past 4 weeks
  • Bilirubin ≤ 1.5 times upper limit of normal (ULN)
  • Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) ≤ 2.5 times ULN (< 5 times ULN if due to underlying disease)
  • No chronic liver disease (i.e., chronic active hepatitis or cirrhosis)
  • Creatinine ≤ 1.5 times ULN
  • None of the following cardiovascular conditions within the past 12 months:

    • Myocardial infarction
    • Severe/unstable angina
    • Coronary/peripheral artery bypass graft
    • Symptomatic congestive heart failure
    • Cerebrovascular accident or transient ischemic attack
    • Pulmonary embolism
    • Ongoing cardiac dysrhythmia ≥ grade 2
    • Atrial fibrillation of any grade
    • Prolongation of the corrected QT (QTc) interval to > 450 msec for males or to > 470 msec for females
  • Left Ventricular Ejection Fraction (LVEF) normal by Multigated Acquisition (MUGA) or echocardiogram
  • No hypertension uncontrolled with medical therapy
  • No other active malignancy within the past 5 years except basal cell skin cancer or cervical carcinoma in situ
  • No uncontrolled adrenal insufficiency
  • No uncontrolled hypothyroidism
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 3 months after completion of study treatment
  • No severe and/or uncontrolled medical disease (i.e., uncontrolled diabetes, chronic renal disease, or active uncontrolled infection)
  • No impaired gastrointestinal (GI) function or GI disease that may significantly alter the absorption of study drugs
  • No other severe acute or chronic medical or psychiatric condition or laboratory abnormality that would preclude study participation

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • More than 4 weeks since prior major surgery
  • More than 4 weeks since prior cytotoxic chemotherapy (6 weeks for nitrosoureas or mitomycin C)
  • More than 4 weeks since prior radiotherapy
  • No prior radiotherapy to > 25% of the bone marrow
  • More than 28 days since prior investigational agents
  • No prior sunitinib malate
  • No prior anti-epidermal growth factor receptor therapy (e.g., erlotinib hydrochloride, panitumumab, cetuximab, or gefitinib)
  • No concurrent therapeutic warfarin

    • Low-dose oral warfarin ≤ 2 mg daily for deep vein thrombosis prophylaxis is allowed after the maximum tolerated dose of erlotinib hydrochloride is determined
  • No concurrent Hypericum perforatum (St. John's wort)
  • No concurrent chemotherapy or biologic therapy
  • No other concurrent anticancer therapy
  • No other concurrent investigational agents

Sites / Locations

  • University of Southern California
  • Providence Cancer Center at Providence Portland Medical Center
  • OHSU Knight Cancer Institute
  • Salem Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Erlotinib and Sunitinib

Arm Description

Drug: erlotinib hydrochloride Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily; 100 mg/day, continuous daily; 1.5= 125 mg/day, continuous daily; 150 mg/day, continuous daily Drug: sunitinib malate Will be administered at 50 mg daily, 4 weeks on, 2 weeks off

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose (MTD) of Erlotinib Hydrochloride When Used in Combination With Sunitinib.
The MTD is defined as the dose that produces dose limiting toxicity (DLT) in 33% of the patients.
Progression-free Survival at 8 Months
Defined as the proportion of patients who are progression free (CR, PR and SD) at 8 months after initiating treatment with sunitinib in combination with erlotinib in patients with metastatic or unresectable clear cell or papillary carcinoma of the kidney. Complete Response (CR)= disappearance of all target lesions, Partial Response (PR)= At least a 30% decrease in the sum of the longest diameter of target lesions, and Stable Disease (SD)= Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (20% increase in the sum).

Secondary Outcome Measures

To Determine the Safety of Sunitinib in Combination With Erlotinib
Median Time to Progression
The Kaplan-Meier method will be used to estimate the median time to progression.
Proportion of Patients Whose Best Overall Response is Complete Response, Partial Response, Stable Disease, or Progressive Disease
Maximum Percent Change in Tumor Measurement
The maximum percent change in Tumor Measurement is the greatest percent change in longest diameter (LD) for the target lesions from the baseline LD. For patients with no change in LD, the maximum percent change is the lowest increase in LD from the baseline LD.

Full Information

First Posted
January 19, 2007
Last Updated
May 1, 2017
Sponsor
OHSU Knight Cancer Institute
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00425386
Brief Title
Sunitinib and Erlotinib in Treating Patients With Unresectable or Metastatic Kidney Cancer
Official Title
A Dose Escalation Phase II Study of Sunitinib Plus Erlotinib in Advanced Renal Carcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
May 2017
Overall Recruitment Status
Completed
Study Start Date
August 2006 (undefined)
Primary Completion Date
August 2010 (Actual)
Study Completion Date
March 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
OHSU Knight Cancer Institute
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Sunitinib and erlotinib may stop the growth of tumor cell by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Giving sunitinib together with erlotinib may kill more tumor cells. PURPOSE: This phase II trial is studying the best dose of erlotinib when given together with sunitinib and to see how well they work in treating patients with unresectable or metastatic kidney cancer.
Detailed Description
OBJECTIVES: Primary Determine the maximum tolerated dose of erlotinib hydrochloride when administered with sunitinib malate in patients with unresectable or metastatic renal cell carcinoma. Determine the 8-month progression-free survival of patients treated with this regimen. Secondary Determine the safety of sunitinib malate and erlotinib hydrochloride in these patients. Determine the duration of response in these patients. Determine the proportion of patients whose best overall response is complete response, partial response, stable disease, or progressive disease. Determine the overall survival of patients treated with this regimen. Determine the maximum percent reduction in tumor measurement in patients treated with this regimen. Collect blood and tissue from these patients for future correlative studies. OUTLINE: This is an open-label, multicenter, dose-escalation study of erlotinib hydrochloride. Patients receive oral sunitinib malate once daily on days 1-28 and oral erlotinib hydrochloride once daily on days 1-42. Treatment repeats every 6 weeks in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of erlotinib hydrochloride until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose at which 33% of patients experience dose-limiting toxicity. Once the MTD is determined, patients are treated with erlotinib hydrochloride at the MTD and sunitinib malate. Patients undergo blood and tumor specimen collection periodically during study for future correlative studies. PROJECTED ACCRUAL: A total of 49 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Kidney Cancer
Keywords
stage III renal cell cancer, stage IV renal cell cancer, clear cell renal cell carcinoma, recurrent renal cell 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
60 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Erlotinib and Sunitinib
Arm Type
Experimental
Arm Description
Drug: erlotinib hydrochloride Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily; 100 mg/day, continuous daily; 1.5= 125 mg/day, continuous daily; 150 mg/day, continuous daily Drug: sunitinib malate Will be administered at 50 mg daily, 4 weeks on, 2 weeks off
Intervention Type
Drug
Intervention Name(s)
erlotinib hydrochloride
Intervention Description
Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily; 100 mg/day, continuous daily; 1.5= 125 mg/day, continuous daily; 150 mg/day, continuous daily
Intervention Type
Drug
Intervention Name(s)
sunitinib malate
Intervention Description
Will be administered at 50 mg daily, 4 weeks on, 2 weeks off
Intervention Type
Procedure
Intervention Name(s)
biopsy
Intervention Description
Paraffin block (or unstained slides) of the primary tumor and/or metastatic lesions (as available) and a plasma sample for future correlative studies will be collected. A paraffin block (or at least 10 unstained slides, each of 10 micromillimeter thickness) from the original paraffin-embedded biopsy material taken at the diagnosis will be stored at 4 degrees Celsius.
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose (MTD) of Erlotinib Hydrochloride When Used in Combination With Sunitinib.
Description
The MTD is defined as the dose that produces dose limiting toxicity (DLT) in 33% of the patients.
Time Frame
Participants assessed for DLTs weekly during the first cycle of treatment and every 3 weeks in subsequent cycles until at least one DLT occurs in 33% or more of participants at that dose; participants assessed for the duration of the study, up to 7 years
Title
Progression-free Survival at 8 Months
Description
Defined as the proportion of patients who are progression free (CR, PR and SD) at 8 months after initiating treatment with sunitinib in combination with erlotinib in patients with metastatic or unresectable clear cell or papillary carcinoma of the kidney. Complete Response (CR)= disappearance of all target lesions, Partial Response (PR)= At least a 30% decrease in the sum of the longest diameter of target lesions, and Stable Disease (SD)= Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (20% increase in the sum).
Time Frame
8 months after initiating treatment with sunitinib in combination with erlotinib in patients with metastatic or unresectable clear cell or papillary carcinoma of the kidney
Secondary Outcome Measure Information:
Title
To Determine the Safety of Sunitinib in Combination With Erlotinib
Time Frame
For the duration of the study, up to 7 years
Title
Median Time to Progression
Description
The Kaplan-Meier method will be used to estimate the median time to progression.
Time Frame
For the duration of the study, up to 7 years
Title
Proportion of Patients Whose Best Overall Response is Complete Response, Partial Response, Stable Disease, or Progressive Disease
Time Frame
From the start of treatment until the criteria for response is met.
Title
Maximum Percent Change in Tumor Measurement
Description
The maximum percent change in Tumor Measurement is the greatest percent change in longest diameter (LD) for the target lesions from the baseline LD. For patients with no change in LD, the maximum percent change is the lowest increase in LD from the baseline LD.
Time Frame
Baseline through end of study, up to 7 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed renal cell carcinoma with a component of clear cell or papillary carcinoma Unresectable or metastatic disease (radiologically or clinically confirmed) Measurable disease (≥ 1 site) No known brain metastasis that has not been adequately treated with radiotherapy and/or surgery PATIENT CHARACTERISTICS: Eastern Cooperative Oncology Group (ECOG) performance status 0-2 Absolute neutrophil count ≥ 1,500/mm³ Platelet count ≥ 100,000/mm³ No grade 3 hemorrhage within the past 4 weeks Bilirubin ≤ 1.5 times upper limit of normal (ULN) Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) ≤ 2.5 times ULN (< 5 times ULN if due to underlying disease) No chronic liver disease (i.e., chronic active hepatitis or cirrhosis) Creatinine ≤ 1.5 times ULN None of the following cardiovascular conditions within the past 12 months: Myocardial infarction Severe/unstable angina Coronary/peripheral artery bypass graft Symptomatic congestive heart failure Cerebrovascular accident or transient ischemic attack Pulmonary embolism Ongoing cardiac dysrhythmia ≥ grade 2 Atrial fibrillation of any grade Prolongation of the corrected QT (QTc) interval to > 450 msec for males or to > 470 msec for females Left Ventricular Ejection Fraction (LVEF) normal by Multigated Acquisition (MUGA) or echocardiogram No hypertension uncontrolled with medical therapy No other active malignancy within the past 5 years except basal cell skin cancer or cervical carcinoma in situ No uncontrolled adrenal insufficiency No uncontrolled hypothyroidism Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 3 months after completion of study treatment No severe and/or uncontrolled medical disease (i.e., uncontrolled diabetes, chronic renal disease, or active uncontrolled infection) No impaired gastrointestinal (GI) function or GI disease that may significantly alter the absorption of study drugs No other severe acute or chronic medical or psychiatric condition or laboratory abnormality that would preclude study participation PRIOR CONCURRENT THERAPY: See Disease Characteristics More than 4 weeks since prior major surgery More than 4 weeks since prior cytotoxic chemotherapy (6 weeks for nitrosoureas or mitomycin C) More than 4 weeks since prior radiotherapy No prior radiotherapy to > 25% of the bone marrow More than 28 days since prior investigational agents No prior sunitinib malate No prior anti-epidermal growth factor receptor therapy (e.g., erlotinib hydrochloride, panitumumab, cetuximab, or gefitinib) No concurrent therapeutic warfarin Low-dose oral warfarin ≤ 2 mg daily for deep vein thrombosis prophylaxis is allowed after the maximum tolerated dose of erlotinib hydrochloride is determined No concurrent Hypericum perforatum (St. John's wort) No concurrent chemotherapy or biologic therapy No other concurrent anticancer therapy No other concurrent investigational agents
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christopher W. Ryan, MD
Organizational Affiliation
OHSU Knight Cancer Institute
Official's Role
Study Chair
Facility Information:
Facility Name
University of Southern California
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
Providence Cancer Center at Providence Portland Medical Center
City
Portland
State/Province
Oregon
ZIP/Postal Code
97213-2967
Country
United States
Facility Name
OHSU Knight Cancer Institute
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239-3098
Country
United States
Facility Name
Salem Hospital
City
Salem
State/Province
Oregon
ZIP/Postal Code
97301
Country
United States

12. IPD Sharing Statement

Citations:
Citation
Ryan CW, Curti BD, Pattee KJ, et al.: A dose-escalation phase II study of sunitinib (S) plus erlotinib (E) in advanced renal carcinoma (RCC). [Abstract] American Society of Clinical Oncology 2008 Genitourinary Cancers Symposium, Feb 14-16, 2008, San Francisco, CA. A-361, 2008.
Results Reference
result
PubMed Identifier
35688679
Citation
Feng Z, Curti BD, Quinn DI, Strother JM, Chen Z, Agnor R, Beer TM, Ryan CW. A Phase II, Single-arm Trial of Sunitinib and Erlotinib in Advanced Renal Cell Carcinoma. Clin Genitourin Cancer. 2022 Oct;20(5):415-422. doi: 10.1016/j.clgc.2022.04.018. Epub 2022 May 5.
Results Reference
derived

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Sunitinib and Erlotinib in Treating Patients With Unresectable or Metastatic Kidney Cancer

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