Carcinoma, Renal Cell, Kidney Neoplasms
Conditions
Keywords
Advanced Renal Cell Carcinoma, Kidney Cancer
Brief summary
The primary objective of this study is efficacy. The primary efficacy endpoint of this study is a comparison of the overall survival of subjects treated with CCI-779 \[Temsirolimus\], administered intravenously \[IV\] once weekly and the combination of CCI-779, administered IV once weekly with Interferon Alfa \[IFN alfa\] subcutaneously \[SC\] three times per week \[TIW\], compared with the overall survival of subjects treated with IFN alfa (SC TIW) alone, in poor-prognosis subjects with advanced RCC.
Interventions
15 mg of CCI-779 given Intra Venously once per week; 6 MU of IFN alfa (Roferon) given Sub Cutaneously three time /week
25 mg of CCI-779 given Intra Venously once per week
Interferon alfa (Roferon) 3 MU given Sub Cutaneously three time /week for the first week, 9 MU given Sub Cutaneously three time /week for the second week, 18 MU given Sub Cutaneously three time /week thereafter.
Sponsors
Study design
Eligibility
Inclusion criteria
* This study will be conducted in subjects with histologically confirmed, advanced (stage IV or recurrent disease) RCC who have not received prior systemic therapy for their disease,
Exclusion criteria
* Subjects with central nervous system (CNS) metastases * Prior anticancer therapy for RCC * Prior investigational therapy/agents within 4 weeks of randomization
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Baseline up to Month 80 | Overall survival is the duration from randomization to death. For participants who are alive, overall survival is censored at the last contact. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Objective Response | Baseline, every 2 months until tumor progression or death (up to Month 80) | Percentage of participants with objective response based assessment of confirmed complete response (CR) or confirmed partial response (PR) according to Response Evaluation Criteria in Solid Tumors (RECIST). CR was the disappearance of all target lesions and non target lesions. PR was at least a 30 percent (%) decrease in sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD. |
| Percentage of Participants With Clinical Benefit | Baseline, every 2 months until tumor progression or death (up to Month 80) | Clinical benefit: confirmed CR or PR or had stable disease (SD) lasting at least 24 weeks. CR was the disappearance of all target lesions and non target lesions. PR was at least a 30% decrease in sum of the LD of target lesions, taking as reference the baseline sum LD. SD was having neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD. |
| Duration of Response (DR) | Baseline, every month until tumor progression or death (up to Month 80) | DR: Time from first documentation of objective tumor response to first date that recurrence or progressive disease (PD) was objectively documented, taking as a reference for PD, the smallest sum LD recorded since randomization. |
| Progression-Free Survival (PFS) | Baseline, monthly until tumor progression or death (up to Month 80) | PFS based on Independent Central Review Assessment. The period from randomization until disease progression, death or date of last contact. |
| Quality-adjusted Time Without Symptoms or Toxicity (Q-TWiST) | Baseline to Month 80 | The Q-Twist is not a score calculated for each participant but is defined only on a by treatment group basis. For each treatment group, it is the weighted sum of the mean durations of the health states Tox, Twist, and Relapse. Tox is defined as time with severe toxicity related to treatment; Twist: time without symptoms or toxic side effects; and Relapse: time after relapse/progression. The mean duration of each health state is calculated based on the area under the Kaplan Meier curve pertaining to that health state. There is no direct method for calculating the dispersion of Q-Twist, and it is typically done using bootstrap method for purposes of inference (see, e.g., Glasziou PP, Simes RJ, Gelber RD. Quality adjusted survival analysis. Stat Med 1990; 9: 1259-76). In practice, as apparently in the case with this study, the intermediate values resulting from the bootstrap exercise were not displayed. |
| European Quality of Life Health Questionnaire (EQ-5D) - Index Score | Baseline | EQ-5D: participant rated questionnaire to assess health-related quality of life in terms of a single index value. EQ-5D index measured 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Range of EQ-5D index score = -0.594 to 1 where higher scores indicated a better health state. |
| Time to Treatment Failure (TTF) | Baseline, every month until tumor progression or death (up to Month 80) | TTF is defined as the time from the date of randomization to the date of PD or death, withdrawal from treatment due to an adverse event (AE), withdrawal of voluntary consent, or lost to follow-up, whichever occurred first, censored at the date of the conclusion of treatment phase. |
Countries
Argentina, Australia, Canada, Czechia, Germany, Greece, Hungary, Italy, Latvia, Lithuania, Mexico, Netherlands, Poland, Russia, Serbia, Serbia and Montenegro, Slovakia, South Africa, Spain, Sweden, Taiwan, Turkey (Türkiye), Ukraine, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Interferon Alfa Interferon Alfa (Roferon) 3 million units (MU) subcutaneously 3 times per week for 1 week, then 9 MU subcutaneously 3 times per week for 1 week, then 18 MU subcutaneously 3 times per week until disease progression or treatment withdrawal | 207 |
| Temsirolimus Temsirolimus (CCI-779) 25 milligrams (mg) intravenously (IV) once per week until disease progression or treatment withdrawal | 209 |
| Interferon Alfa and Temsirolimus Interferon Alfa (Roferon) 6 MU subcutaneously 3 times per week and Temsirolimus (CCI-779) 15 mg IV once per week until disease progression or treatment withdrawal | 210 |
| Total | 626 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Death | 172 | 169 | 171 |
| Overall Study | Discontinuation of study by Sponsor | 13 | 9 | 13 |
| Overall Study | Disease progression | 0 | 0 | 1 |
| Overall Study | Lost to Follow-up | 5 | 3 | 2 |
| Overall Study | Other | 14 | 24 | 18 |
| Overall Study | Withdrawal by Subject | 3 | 4 | 5 |
Baseline characteristics
| Characteristic | Interferon Alfa | Temsirolimus | Interferon Alfa and Temsirolimus | Total |
|---|---|---|---|---|
| Age Continuous | 59.2 years STANDARD_DEVIATION 10.4 | 58.7 years STANDARD_DEVIATION 10 | 59.3 years STANDARD_DEVIATION 9.8 | 59.1 years STANDARD_DEVIATION 10.1 |
| Sex: Female, Male Female | 59 Participants | 70 Participants | 65 Participants | 194 Participants |
| Sex: Female, Male Male | 148 Participants | 139 Participants | 145 Participants | 432 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 197 / 200 | 208 / 208 | 205 / 208 |
| serious Total, serious adverse events | 99 / 200 | 82 / 208 | 122 / 208 |
Outcome results
Overall Survival (OS)
Overall survival is the duration from randomization to death. For participants who are alive, overall survival is censored at the last contact.
Time frame: Baseline up to Month 80
Population: Intent-to-treat (ITT) Population: all randomized participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Interferon Alfa | Overall Survival (OS) | 7.3 months |
| Temsirolimus | Overall Survival (OS) | 10.9 months |
| Interferon Alfa and Temsirolimus | Overall Survival (OS) | 8.4 months |
Duration of Response (DR)
DR: Time from first documentation of objective tumor response to first date that recurrence or progressive disease (PD) was objectively documented, taking as a reference for PD, the smallest sum LD recorded since randomization.
Time frame: Baseline, every month until tumor progression or death (up to Month 80)
Population: ITT subset of participants who had a response
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Interferon Alfa | Duration of Response (DR) | 7.4 months |
| Temsirolimus | Duration of Response (DR) | 11.1 months |
| Interferon Alfa and Temsirolimus | Duration of Response (DR) | 9.3 months |
European Quality of Life Health Questionnaire (EQ-5D) - Index Score
EQ-5D: participant rated questionnaire to assess health-related quality of life in terms of a single index value. EQ-5D index measured 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Range of EQ-5D index score = -0.594 to 1 where higher scores indicated a better health state.
Time frame: Baseline
Population: ITT;(N)=participants with evaluable data. Week 12 and 32 data collected for individual participants but not summarized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Interferon Alfa | European Quality of Life Health Questionnaire (EQ-5D) - Index Score | 0.656 units on a scale |
| Temsirolimus | European Quality of Life Health Questionnaire (EQ-5D) - Index Score | 0.689 units on a scale |
| Interferon Alfa and Temsirolimus | European Quality of Life Health Questionnaire (EQ-5D) - Index Score | 0.689 units on a scale |
Percentage of Participants With Clinical Benefit
Clinical benefit: confirmed CR or PR or had stable disease (SD) lasting at least 24 weeks. CR was the disappearance of all target lesions and non target lesions. PR was at least a 30% decrease in sum of the LD of target lesions, taking as reference the baseline sum LD. SD was having neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD.
Time frame: Baseline, every 2 months until tumor progression or death (up to Month 80)
Population: ITT
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Interferon Alfa | Percentage of Participants With Clinical Benefit | 16.4 percentage of participants |
| Temsirolimus | Percentage of Participants With Clinical Benefit | 34.0 percentage of participants |
| Interferon Alfa and Temsirolimus | Percentage of Participants With Clinical Benefit | 30.0 percentage of participants |
Percentage of Participants With Objective Response
Percentage of participants with objective response based assessment of confirmed complete response (CR) or confirmed partial response (PR) according to Response Evaluation Criteria in Solid Tumors (RECIST). CR was the disappearance of all target lesions and non target lesions. PR was at least a 30 percent (%) decrease in sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD.
Time frame: Baseline, every 2 months until tumor progression or death (up to Month 80)
Population: ITT
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Interferon Alfa | Percentage of Participants With Objective Response | 5.3 percentage of participants |
| Temsirolimus | Percentage of Participants With Objective Response | 9.1 percentage of participants |
| Interferon Alfa and Temsirolimus | Percentage of Participants With Objective Response | 9.5 percentage of participants |
Progression-Free Survival (PFS)
PFS based on Independent Central Review Assessment. The period from randomization until disease progression, death or date of last contact.
Time frame: Baseline, monthly until tumor progression or death (up to Month 80)
Population: ITT
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Interferon Alfa | Progression-Free Survival (PFS) | 3.2 months |
| Temsirolimus | Progression-Free Survival (PFS) | 5.6 months |
| Interferon Alfa and Temsirolimus | Progression-Free Survival (PFS) | 4.9 months |
Quality-adjusted Time Without Symptoms or Toxicity (Q-TWiST)
The Q-Twist is not a score calculated for each participant but is defined only on a by treatment group basis. For each treatment group, it is the weighted sum of the mean durations of the health states Tox, Twist, and Relapse. Tox is defined as time with severe toxicity related to treatment; Twist: time without symptoms or toxic side effects; and Relapse: time after relapse/progression. The mean duration of each health state is calculated based on the area under the Kaplan Meier curve pertaining to that health state. There is no direct method for calculating the dispersion of Q-Twist, and it is typically done using bootstrap method for purposes of inference (see, e.g., Glasziou PP, Simes RJ, Gelber RD. Quality adjusted survival analysis. Stat Med 1990; 9: 1259-76). In practice, as apparently in the case with this study, the intermediate values resulting from the bootstrap exercise were not displayed.
Time frame: Baseline to Month 80
Population: ITT
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Interferon Alfa | Quality-adjusted Time Without Symptoms or Toxicity (Q-TWiST) | 6.9083 months |
| Temsirolimus | Quality-adjusted Time Without Symptoms or Toxicity (Q-TWiST) | 8.3707 months |
| Interferon Alfa and Temsirolimus | Quality-adjusted Time Without Symptoms or Toxicity (Q-TWiST) | 7.4821 months |
Time to Treatment Failure (TTF)
TTF is defined as the time from the date of randomization to the date of PD or death, withdrawal from treatment due to an adverse event (AE), withdrawal of voluntary consent, or lost to follow-up, whichever occurred first, censored at the date of the conclusion of treatment phase.
Time frame: Baseline, every month until tumor progression or death (up to Month 80)
Population: ITT
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Interferon Alfa | Time to Treatment Failure (TTF) | 1.9 months |
| Temsirolimus | Time to Treatment Failure (TTF) | 3.7 months |
| Interferon Alfa and Temsirolimus | Time to Treatment Failure (TTF) | 2.5 months |