Locally advanced and/or metastatic clear cell renal cancer Cancer Kidney cancer
Conditions
Interventions
Current interventions as of 31/10/2014:
Sunitinib: one cycle of treatment refers to 50mg (starting dose) od, days 1-28, repeated every 42 days.
Pazopanib: one cycle of treatment refers to 800mg (star
Sponsors
University of Leeds (UK)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Current inclusion criteria as of 31/10/2014: 1. Male or female aged = 18 years old 2. Histological confirmation of a component of clear cell renal cell cancer 3. Inoperable loco-regional or metastatic disease 4. No prior systemic therapy for advanced disease (inoperable loco-regional and/or metastatic disease) 4.1 Allowed situation: previous treatment in the SORCE study providing on placebo arm and not active sorafenib arms 5. Eastern Cooperative Oncology Group (ECOG) performance status 0-1 6. Uni-dimensionally measurable disease (RECIST criteria 7. Full blood count: 7.1 Haemoglobin (Hb) = 9 g/dl 7.2. Absolute Neutrophil Count (ANC) = 1 x 10 9/l 7.3. Platelets = 80 x 10 9/l 8. Renal biochemistry: measured or calculated GFR = 30 ml/min 9. Hepatobiliary function 9.1. Aspartate transaminase (AST) or alanine transaminase (ALT) = 2.5 x ULN 9.2. Bilirubin (BR) = 1.5 x ULN, or in patients with Gilbert?s syndrome BR = x3 x ULN and direct BR = 35% 10. Provided written informed consent prior to any trial-specific procedures 11. Able and willing to comply with the terms of the protocol including: 11.1. Commencement of sunitinib or pazopanib within 5 (actual not working) days of randomisation 11.2. Temporarily stopping sunitinib or pazopanib if randomised to the DFIS arm 11.3. Capable of oral self-medication 11.4 randomisation within 42 days of the baseline CT scan 11.5. Capable of reporting toxicity and completing quality of life (QoL) and medical resource utilisation (MRU) / Health Economics questionnaires 12. If female and of child-bearing potential, must: 12.1. Have a negative pregnancy test within 72 hours prior to randomisation, and not be breast-feeding 12.2. Agree to use adequate, medically approved, contraceptive precautions (oral or barrier contraceptive under the supervision of a General Practitioner or Family Planning Clinic) during, and for 30 days after the last dose of sunitinib or pazopanib 13. If male with a partner of child bearing potential, must agree to use adequate, medically approved, contraceptive precautions (oral or barrier contraceptive under the supervision of a General Practitioner or Family Planning Clinic) during, and for 30 days after the last dose of sunitinib or pazopanib 14. Requirement to start first-line therapy with either sunitinib or pazopanib and decision already made as to which TKI to be used according to local standard practice 15. Allowed situations include: 15.1. Primary renal cancer in-situ or previous nephrectomy 15.2. Previous brain metastases treated with complete surgical resection, Stereotactic Brain Radiation Therapy (SBRT) or gamma knife with no subsequent evidence of progression (patients treated with whole brain radiotherapy are not eligible) 15.3. Previous radiotherapy and/or previous/ongoing bisphosphonates or bone anti-resorptive drugs for the treatment of symptomatic bony metastasis. Care should be taken to follow dental guidelines for the anti-bone resoptive drug. Inclusion criteria from 15/05/2013 to 31/10/2014: 1. Male or female aged = 18 years old 2. Histological confirmation of predominantly clear cell renal cell cancer 3. Inoperable loco-regional or metastatic disease 4. No prior systemic therapy for advanced disease (inoperable loco-regional and/or metastatic disease) 5. Eastern Cooperative Oncology Group (ECOG) performance status 0-1 6. Uni-dimensionally measurable disease (RECIST criteria, see Appendix 3) 7. Full blood count: 7.1 Haemoglobin (Hb)
Exclusion criteria
Exclusion criteria: Current exclusion criteria as of 31/10/2014: 1. Pulmonary or mediastinal disease causing obstruction or clinically significant bleeding/haemoptysis 2. Patients with an estimated life expectancy of <6 months 3. Known contraindications to the particular TKI to be used (i.e. sunitinib or pazopanib) 4. Any previous treatment with sunitinib, pazopanib or other tyrosine kinase inhibitor (including in the adjuvant setting) 5. Untreated brain metastases 6. Any concurrent or previous other invasive cancer that could confuse diagnosis or endpoints 6.1. Allowed situations include (but not limited to): non-melanomatous skin cancer or superficial bladder cancer; for all other cases please discuss with Clinical Trials Research Unit (CTRU)) 7. Hypersensitivity to the particular TKI to be used (i.e. sunitinib or pazopanib) 8. Any concomitant medication or substances forming part of local ongoing care known to significantly affect, or have the potential to significantly affect, the activity or pharmacokinetics of the particular TKI to be used (i.e. sunitinib or pazopanib) 9. Poorly controlled hypertension despite maximal medical therapy 10. Any other serious medical or psychiatric condition which in the opinion of the investigator could affect participation in the STAR trial, including gastro-intestinal abnormalities limiting effectiveness of orally administrated drugs, uncontrolled infections, current or recent history of clinically significant cardiovascular disease, significant haemorrhage or gastrointestinal perforation or fistula which, in the opinion of the local investigator, would render the patient unsuitable for standard sunitinib or pazopanib therapy Exclusion criteria from 15/05/2013 to 31/10/2014: 1. Pulmonary or mediastinal disease causing obstruction or bleeding/haemoptysis 2. Patients with an estimated life expectancy of <6 months 3. Known contraindications to sunitinib or pazopanib 4. No previous treatment with sunitinib, pazopanib or other tyrosine kinase inhibitor (including in the adjuvant setting) 5. Untreated brain metastases 6. Any concurrent or previous other invasive cancer that could confuse diagnosis (non-melanomatous skin cancer or superficial bladder cancer acceptable, for all other cases please discuss with Clinical Trials Research Unit (CTRU)) 7. Hypersensitivity to sunitinib or pazopanib 8. Any concomitant medication or substances forming part of local ongoing care known to significantly affect, or have the potential to significantly affect, the activity or pharmacokinetics of sunitinib or pazopanib (see section 10.2 for further information on concomitant medications) 9. Poorly controlled hypertension despite maximal medical therapy 10. Any other serious medical or psychiatric condition which in the opinion of the investigator could affect participation in the STAR trial, including gastro-intestinal abnormalities limiting effectiveness of orally administrated drugs, uncontrolled infections, current or recent history of clinically significant cardiovascular disease, significant haemorrhage or gastrointestinal perforation or fistula which, in the opinion of the local investigator, would render the patient unsuitable for standard sunitinib or pazopanib therapy Exclusion criteria from time of registration until 15/05/2013: 1. Pulmonary or mediastinal disease causing obstruction or bleeding/haemoptysis 2. Patients with an estimated life expectancy of <6 months 3. Known contraindications to sunitinib 4. No pr
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Stage A: Recruitment rate/month 2. Stage B: Time to Strategy Failure (TSF) 3. Stage C/Overall: 2 year OS and averaged QALY (over recruitment and follow-up) | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Time to strategy failure (TSF) 2. Summative progression free interval (SPFI) 3. Cost effectiveness (health economic endpoints) 4. Toxicity 5. Quality of Life (FACT-G, FSKI-15, EQ-5D and EQ-VAS) 6. Progression free survival (PFS) Ancilliary study: Translational: tissue and imaging | — |
Countries
England, United Kingdom
Outcome results
None listed