Carcinoma, Renal Cell Metastasis
Conditions
Brief summary
To evaluate the anti-tumor activity of SU011248 (sunitinib) in cytokine-refractory metastatic renal cell carcinoma (RCC) when administered in a continuous treatment regimen
Interventions
37.5 mg/day, oral, continuous daily dosing
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically proven renal cell carcinoma with metastases. * Evidence of unidimensionally measurable disease as per Response Evaluation Criteria in Solid Tumors (RECIST). * Failure of 1 prior cytokine-based therapy for metastatic disease. Patients treated with IFN-á alone must have received IFN-á for at least 4 weeks. * Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1. * Resolution of all acute toxic effects of prior therapy or surgical procedures to grade 1. * Adequate organ function
Exclusion criteria
* Prior treatment with any systemic therapy other than 1 cytokine-based therapy. * Previous treatment on a SU011248 (sunitinib) clinical trial. * Major surgery, radiation therapy, or systemic therapy within 4 weeks of starting the study treatment. * Diagnosis of any second malignancy within the last 3 years, except basal cell carcinoma, squamous cell skin cancer, or in situ carcinoma that has been adequately treated with no evidence of recurrent disease for 12 months. * History of or known brain metastases, spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease on screening Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scan. * Any of the following within the 12 months prior to starting the study treatment: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, congestive heart failure, cerebrovascular accident or transient ischemic attack, or pulmonary embolism. * Ongoing cardiac dysrhythmias of grade 2, atrial fibrillation of any grade, or QTc interval \>450 msec for males or \>470 msec for females. * Hypertension that cannot be controlled by medications (\>150/100 mmHg despite optimal medical therapy). * Ongoing treatment with therapeutic doses of Coumadin (however, low dose Coumadin up to 2 mg PO daily for deep vein thrombosis prophylaxis is allowed). * Known human immunodeficiency virus (HIV) infection.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response (Complete Response[CR] + Partial Response[PR]) in Subjects | 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation includes 28 day post study follow up | Confirmed objective responses using RECIST criteria defined as responses persisting on repeat imaging study for 2 assessments with at least 4 weeks between, and evaluating all target and non-target sites followed since baseline. Two PRs separated by an SD or NE visit in between was considered a confirmed response if the 2 PRs were \> 4 weeks apart. CR=disappearance of all target lesions. PR is a \>=30% decrease in the sum of the longest dimensions of the target lesions taking as a reference the baseline sum longest dimensions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Tumor Progression (TTP) | 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation includes 28 day post study follow up | Time from date of first dose of study medication to date of first documentation of objective tumor progression using RECIST criteria that occurred on treatment including within 28 days after the last dose of study medication. TTP censored on the day following the date of last oncologic assessment documenting absence of tumor progression. TTP based on the number of subjects with measurable disease at baseline, the correct histological cancer type, and had disease that was refractory to prior cytokine-based therapy(105 in total group). |
| Progression Free Survival (PFS) | 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation includes 28 day post study follow up | Using RECIST criteria: Time from date 1st dose study medication to date 1st documentation of objective tumor progression or death due to any cause occurring on treatment including within 28 days after last dose, whichever occurred 1st. Censored on day following the date of last oncologic assessment documenting absence of tumor progression. PFS based on the number of subjects with measurable disease at baseline, the correct histological cancer type, and had disease that was refractory to prior cytokine-based therapy(105 in total group). |
| Overall Survival | 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation includes 28 day post study follow up | Overall survival is time from the date of first dose of medication to the date of death due to any cause |
| Duration of Tumor Response | 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation includes 28 day post study follow up | Using RECIST criteria: date of 1st objective tumor response (CR or PR) subsequently confirmed to date of 1st objective tumor progression or to death due to any cause within 28 days after last dose of study medication, whichever was first. Censored on day after the date of the last oncologic assessment documenting no tumor progression. |
| Change From Baseline in Euro-QoL Five Dimension (EQ-5D) Weighted Health Index | Day 1 and day 15 of each treatment cycle from cycle 1 to cycle 4; day 1 of each treatment cycle after cycle 4 up to one year. | EQ-5D health status in 5 dimensions (mobility, self-care, pain / discomfort, anxiety / depression, usual activities) with a weighted health index based on general population values where 0.0=death and 1.0 = perfect health. Change: median index score at observation minus median index score at baseline. |
| Change From Baseline in EuroQoL Visual Analog Scale (EQ-VAS) Overall Health Thermometer Score | Day 1 and day 15 of each treatment cycle from cycle 1 to cycle 4; day 1 of each treatment cycle after cycle 4 up to one year. | EQ-VAS score on the self-rated thermometer indicated the patient's own assessment of their health status from 0 (worst) to 100 (best) imaginable health state. Change: median score at observation minus median score at baseline. Maximum changes (increase or decrease from baseline). |
| Summary of FACIT Fatigue Scale Overall Score | Day 1 and day 15 of each treatment cycle from cycle 1 to cycle 4; day 1 of each treatment cycle after cycle 4 up to one year. | FACIT Fatigue Scale: Overall score from 13-questionnaire, which measures fatigue / asthenia for patients with chronic, life-threatening illnesses. For each question, a patient rates his / her condition for the past week on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much). Higher scores always represent less fatigue / asthenia. Outcome based on completed questionnaires. |
Countries
France, Germany, Greece, Netherlands, Sweden, Switzerland, United States
Participant flow
Recruitment details
Patients must have failed 1 prior cytokine-based therapy for metastatic renal cell carcinoma and had to have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
Pre-assignment details
ECOG performance status definition 0=fully active, able to carry on all pre-disease activities without restriction 1= restricted in physically strenuous activity but ambulatory & able to carry out work of a light or sedentary nature (eg light house work or office work)
Participants by arm
| Arm | Count |
|---|---|
| AM Dose Sunitinib Malate (SU011248) Patients received a starting dose of 37.5 mg/day of sunitinib malate in the morning repeated 4-week cycles continuing for up to 1 year in absence of any withdrawal criteria.Per the statistical analysis plan, the primary outcome of objective response was evaluated in patients who had measurable disease at baseline, the correct histological cancer type, & were refractory to prior cytokine-based therapy. Of 107 subjects enrolled, 2 patients did not have measurable disease at baseline, and therefore, were excluded from the analysis. | 54 |
| PM Dose Sunitinib Malate (SU011248) Patients received a starting dose of 37.5 mg/day of sunitinib malate in the evening repeated 4-week cycles continuing for up to 1 year in absence of any withdrawal criteria.Per the statistical analysis plan, the primary outcome of objective response was evaluated in patients who had measurable disease at baseline, the correct histological cancer type, & were refractory to prior cytokine-based therapy. Of 107 subjects enrolled, 2 patients did not have measurable disease at baseline, and therefore, were excluded from the analysis. | 53 |
| Total | 107 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 7 | 9 |
| Overall Study | consent withdrawn | 1 | 1 |
| Overall Study | Death | 0 | 1 |
| Overall Study | Lack of Efficacy | 31 | 33 |
Baseline characteristics
| Characteristic | AM Dose Sunitinib Malate (SU011248) | PM Dose Sunitinib Malate (SU011248) | Total |
|---|---|---|---|
| Age Continuous | 59.3 years STANDARD_DEVIATION 9.27 | 57.2 years STANDARD_DEVIATION 11.48 | 58.2 years STANDARD_DEVIATION 10.43 |
| Sex: Female, Male Female | 8 Participants | 11 Participants | 19 Participants |
| Sex: Female, Male Male | 46 Participants | 42 Participants | 88 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 54 / — | 53 / — |
| serious Total, serious adverse events | 21 / — | 20 / — |
Outcome results
Objective Response (Complete Response[CR] + Partial Response[PR]) in Subjects
Confirmed objective responses using RECIST criteria defined as responses persisting on repeat imaging study for 2 assessments with at least 4 weeks between, and evaluating all target and non-target sites followed since baseline. Two PRs separated by an SD or NE visit in between was considered a confirmed response if the 2 PRs were \> 4 weeks apart. CR=disappearance of all target lesions. PR is a \>=30% decrease in the sum of the longest dimensions of the target lesions taking as a reference the baseline sum longest dimensions.
Time frame: 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation includes 28 day post study follow up
Population: ITT; CR,PR calculated from patients with measurable disease at baseline+correct histological cancer type+ refractory to prior cytokine-based therapy n= 53,52 (AM,PM)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| AM Dose Sunitinib Malate (SU011248) | Objective Response (Complete Response[CR] + Partial Response[PR]) in Subjects | 15 participants |
| PM Dose Sunitinib Malate (SU011248) | Objective Response (Complete Response[CR] + Partial Response[PR]) in Subjects | 6 participants |
Change From Baseline in Euro-QoL Five Dimension (EQ-5D) Weighted Health Index
EQ-5D health status in 5 dimensions (mobility, self-care, pain / discomfort, anxiety / depression, usual activities) with a weighted health index based on general population values where 0.0=death and 1.0 = perfect health. Change: median index score at observation minus median index score at baseline.
Time frame: Day 1 and day 15 of each treatment cycle from cycle 1 to cycle 4; day 1 of each treatment cycle after cycle 4 up to one year.
Population: ITT
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| AM Dose Sunitinib Malate (SU011248) | Change From Baseline in Euro-QoL Five Dimension (EQ-5D) Weighted Health Index | Maximum Increase | 0.0 score on scale |
| AM Dose Sunitinib Malate (SU011248) | Change From Baseline in Euro-QoL Five Dimension (EQ-5D) Weighted Health Index | Maximum Decrease | 0.0 score on scale |
| PM Dose Sunitinib Malate (SU011248) | Change From Baseline in Euro-QoL Five Dimension (EQ-5D) Weighted Health Index | Maximum Increase | 0.0 score on scale |
| PM Dose Sunitinib Malate (SU011248) | Change From Baseline in Euro-QoL Five Dimension (EQ-5D) Weighted Health Index | Maximum Decrease | -0.1 score on scale |
Change From Baseline in EuroQoL Visual Analog Scale (EQ-VAS) Overall Health Thermometer Score
EQ-VAS score on the self-rated thermometer indicated the patient's own assessment of their health status from 0 (worst) to 100 (best) imaginable health state. Change: median score at observation minus median score at baseline. Maximum changes (increase or decrease from baseline).
Time frame: Day 1 and day 15 of each treatment cycle from cycle 1 to cycle 4; day 1 of each treatment cycle after cycle 4 up to one year.
Population: ITT
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| AM Dose Sunitinib Malate (SU011248) | Change From Baseline in EuroQoL Visual Analog Scale (EQ-VAS) Overall Health Thermometer Score | Maximum Increase | 0.0 score on scale |
| AM Dose Sunitinib Malate (SU011248) | Change From Baseline in EuroQoL Visual Analog Scale (EQ-VAS) Overall Health Thermometer Score | Maximum Decrease | -10.0 score on scale |
| PM Dose Sunitinib Malate (SU011248) | Change From Baseline in EuroQoL Visual Analog Scale (EQ-VAS) Overall Health Thermometer Score | Maximum Increase | 0.0 score on scale |
| PM Dose Sunitinib Malate (SU011248) | Change From Baseline in EuroQoL Visual Analog Scale (EQ-VAS) Overall Health Thermometer Score | Maximum Decrease | -9.0 score on scale |
Duration of Tumor Response
Using RECIST criteria: date of 1st objective tumor response (CR or PR) subsequently confirmed to date of 1st objective tumor progression or to death due to any cause within 28 days after last dose of study medication, whichever was first. Censored on day after the date of the last oncologic assessment documenting no tumor progression.
Time frame: 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation includes 28 day post study follow up
Population: ITT; DR time from start of 1st documentation of objective tumor response to 1st documentation of objective tumor progression or death \& calculated for the subgroup of subjects with a confirmed objective tumor response. Descriptive statistics for responders who had an event. Total number responders n= 15,6(AM,PM). Response duration n=7,3(AM,PM).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| AM Dose Sunitinib Malate (SU011248) | Duration of Tumor Response | 24.0 weeks |
| PM Dose Sunitinib Malate (SU011248) | Duration of Tumor Response | 32.0 weeks |
Overall Survival
Overall survival is time from the date of first dose of medication to the date of death due to any cause
Time frame: 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation includes 28 day post study follow up
Population: ITT; Patients who are alive at the time of analysis or who are lost to follow up are censored on the last date they were known to be alive. Estimates are based on the Kaplan-Meier method with 95% CI calculated based on Brookmeyer and Crowley method. n=54,53(AM,PM).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| AM Dose Sunitinib Malate (SU011248) | Overall Survival | 91.4 weeks |
| PM Dose Sunitinib Malate (SU011248) | Overall Survival | 76.4 weeks |
Progression Free Survival (PFS)
Using RECIST criteria: Time from date 1st dose study medication to date 1st documentation of objective tumor progression or death due to any cause occurring on treatment including within 28 days after last dose, whichever occurred 1st. Censored on day following the date of last oncologic assessment documenting absence of tumor progression. PFS based on the number of subjects with measurable disease at baseline, the correct histological cancer type, and had disease that was refractory to prior cytokine-based therapy(105 in total group).
Time frame: 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation includes 28 day post study follow up
Population: ITT; Calculation based on subgroup of patients with baseline disease assessment, measurable disease at baseline, correct histological type and are refractory to cytokine. Estimates based on Kaplan-Meier method with 95% CI calculated based on Brookmeyer and Crowley. N=53,52(AM,PM).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| AM Dose Sunitinib Malate (SU011248) | Progression Free Survival (PFS) | 35.7 weeks |
| PM Dose Sunitinib Malate (SU011248) | Progression Free Survival (PFS) | 35.3 weeks |
Summary of FACIT Fatigue Scale Overall Score
FACIT Fatigue Scale: Overall score from 13-questionnaire, which measures fatigue / asthenia for patients with chronic, life-threatening illnesses. For each question, a patient rates his / her condition for the past week on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much). Higher scores always represent less fatigue / asthenia. Outcome based on completed questionnaires.
Time frame: Day 1 and day 15 of each treatment cycle from cycle 1 to cycle 4; day 1 of each treatment cycle after cycle 4 up to one year.
Population: ITT; Results summarized by cohort \& time point through Cycle 13 (the last cycle for which more than 3 subjects completed the questionnaire on either arm). If more than 50% of the items in the scale were answered, then missing items were imputed with the mean of the non-missing items scored at that visit. Outcome based on completed questionnaires.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AM Dose Sunitinib Malate (SU011248) | Summary of FACIT Fatigue Scale Overall Score | Baseline Score n=52,52 | 39.5 score on scale | Standard Deviation 11.41 |
| AM Dose Sunitinib Malate (SU011248) | Summary of FACIT Fatigue Scale Overall Score | Maximum Post-Baseline Score n=53,52 | 43.4 score on scale | Standard Deviation 7.86 |
| AM Dose Sunitinib Malate (SU011248) | Summary of FACIT Fatigue Scale Overall Score | Minimum Post-Baseline Score n=53,52 | 28.0 score on scale | Standard Deviation 12.34 |
| PM Dose Sunitinib Malate (SU011248) | Summary of FACIT Fatigue Scale Overall Score | Baseline Score n=52,52 | 39.6 score on scale | Standard Deviation 10.15 |
| PM Dose Sunitinib Malate (SU011248) | Summary of FACIT Fatigue Scale Overall Score | Maximum Post-Baseline Score n=53,52 | 42.7 score on scale | Standard Deviation 8.19 |
| PM Dose Sunitinib Malate (SU011248) | Summary of FACIT Fatigue Scale Overall Score | Minimum Post-Baseline Score n=53,52 | 29.4 score on scale | Standard Deviation 13.65 |
Time to Tumor Progression (TTP)
Time from date of first dose of study medication to date of first documentation of objective tumor progression using RECIST criteria that occurred on treatment including within 28 days after the last dose of study medication. TTP censored on the day following the date of last oncologic assessment documenting absence of tumor progression. TTP based on the number of subjects with measurable disease at baseline, the correct histological cancer type, and had disease that was refractory to prior cytokine-based therapy(105 in total group).
Time frame: 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation includes 28 day post study follow up
Population: ITT;TTP calculated based on subgroup with baseline disease assessment, measurable disease at baseline, correct histological type and refractory to cytokine.Estimates based on Kaplan-Meier method with 95% CI calculated based on Brookmeyer and Crowley. n=53,52(AM,PM).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| AM Dose Sunitinib Malate (SU011248) | Time to Tumor Progression (TTP) | 35.7 weeks |
| PM Dose Sunitinib Malate (SU011248) | Time to Tumor Progression (TTP) | 35.9 weeks |