Carcinoma, Renal Cell
Conditions
Brief summary
This trial has two parts. The purpose of the first part of the trial is to determine the doses of 2 drugs, sunitinib malate and interferon alfa-2b, that can be given safely in combination. This part is currently closed to enrollment. The purpose of the second part of the trial is to see if sunitinib malate given on a 4/2 schedule (4 weeks on treatment, 2 weeks off treatment cycle) is any better at delaying progression of renal cell cancer than sunitinib malate given on a continuous dosing schedule. The trial will also determine the number of patients whose cancer responds to the treatments, whether life of patients can be extended, what the side effects are of the treatments, how bothersome disease or treatment-related symptoms are to patients, and whether tests can be found that will predict which patients may or may not respond to these treatments in the future.
Interventions
Sunitinib malate starting dose 37.5 mg daily continuous daily regimen.
Sunitinib malate starting dose 50 mg per day for four weeks, followed by a two week off-drug period. This six week cycle is repeated.
Sponsors
Study design
Eligibility
Inclusion criteria
* Advanced renal cell carcinoma of clear cell origin or a component of clear cell histology. * Measurable disease
Exclusion criteria
* Prior systemic therapy of any kind for advanced renal cell cancer * History of brain metastases * Uncontrolled hypertension
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors Model | From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years | MSKCC Prognostic Factor Model assessed as low(0),intermediate(1-2) or high(=\>3) based on number of criteria present such as Karnofsky performance status \< 80 %, Lactate dehydrogenase \> 1.5 \* Upper limit of Normal,Hemoglobin \< lower limit of normal, serum calcium \> 10 mg/dL;Time from first diagnosis of renal cell carcinoma to start of systemic therapy of \< 1 year.TTP was time from start of study treatment to first documentation of objective tumor progression or death due to cancer.TTP was calculated as (first event date minus date of first dose of study medication plus 1) divided by 30.44. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Objective Response (OR) | From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years | 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). Confirmed responses are those that persist on repeat imaging study at least 4 weeks after initial documentation of response. CR are defined as the disappearance of all lesions (target and/or non target). PR are those with atleast 30% decrease in the sum of the longest dimensions of the target lesions taking as a reference the baseline sum longest dimensions. |
| Duration of Response (DR) | From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years | Time from the first documentation of objective tumor response to objective tumor progression or death due to any cause. Duration of tumor response was calculated as (the date of the first documentation of objective tumor progression or death due to cancer minus the date of the first CR or PR that was subsequently confirmed plus 1) divided by 30.44. DR was calculated for the subgroup of participants with a confirmed objective tumor response. |
| Overall Survival (OS) Assessed Using MSKCC Prognostic Factors Model | From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years | MSKCC Prognostic Factor Model assessed as low (0), intermediate (1-2) or high (=\>3) based upon number of criteria present. Criteria as follows: Karnofsky performance status \< 80 %, Lactate dehydrogenase \> 1.5 \* Upper limit of Normal, Hemoglobin \< lower limit of normal for local lab, Corrected serum calcium \> 10 mg/dL; Time from first diagnosis of renal cell carcinoma to start of systemic therapy of \< 1 year. OS was defined as time from date of start of treatment to date of death due to any cause. OS, in months, was calculated as (event date -start of treatment date + 1)/30.44. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Functional Assessment of Cancer Therapy-General (FACT-G) | From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years | FACT-G is core questionnaire of Functional Assessment of Chronic Illness Therapy (FACIT) measurement system to evaluate quality of life (QoL) in cancer population.FACT-G consisted of 27 questions grouped in 4 domains of general Health-Related QoL(HRQoL):Physical Well-being(PWB),Social/Family Well-Being (SWB),Emotional Well-Being (EWB) and Functional Well-Being (FWB);each ranging from 0 (not at all) to 4 (very much) so that FACT-G ranged between 0-108.Since questions could be reversed coded, as appropriate, before calculating FACT-G,0 and 108 could be considered worst and best health states. |
| FACT-Kidney Symptom Index for Disease Related Symptoms (FKSI-DRS) | From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years | FKSI-DRS is a subset of FKSI which is a questionnaire for Functional Assessment of Cancer Therapy -Kidney Symptom Index used to assess QoL/participant-reported outcomes for participants diagnosed with renal cell cancer. The FKSI contained 15 questions and the FKSI-DRS consisted of 9 questions each ranging from 0 (not at all) to 4 (very much) so that FKSI-DRS ranged between 0-36. Since the questions could be reversed coded, as appropriate, before calculating FKSI-DRS, 0 and 36 could be considered the worst and best health states based on the 9 questions comprising FKSI-DRS. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Sunitinib 37.5 mg + Interferon Alpha-2b Sunitinib 37.5 mg or 50 mg self administered orally once daily in the evening for 4 consecutive weeks followed by 2 weeks off (Schedule 4/2) to comprise a complete 6-weeks cycle. Concomitant Interferon (IFN) alpha-2b self-administered at a dose of 3 million units (MU) or 6 MU or 9MU subcutaneously (s.c.) 3 times weekly on non-consecutive days for up to 1 year (9 cycles) of treatment or early withdrawal. | 25 |
| Sunitinib 50 mg (Schedule 4/2) Sunitinib 50 mg self administered orally, once daily in the morning for 4 consecutive weeks followed by 2 weeks off treatment to comprise a complete 6-weeks cycle. | 146 |
| Sunitinib 37.5 mg Sunitinib 37.5 mg continuous daily dosing (CDD) self administered orally once daily in the morning. | 146 |
| Total | 317 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Non-randomized Period | Adverse Event | 8 | 0 | 0 |
| Non-randomized Period | Death | 1 | 0 | 0 |
| Non-randomized Period | Other | 3 | 0 | 0 |
| Non-randomized Period | Participant not willing to participate | 1 | 0 | 0 |
| Non-randomized Period | Progressive disease | 10 | 0 | 0 |
| Randomized Period | Adverse Event | 0 | 23 | 25 |
| Randomized Period | Death | 0 | 2 | 3 |
| Randomized Period | Global deterioration of health status | 0 | 6 | 7 |
| Randomized Period | Lost to Follow-up | 0 | 1 | 0 |
| Randomized Period | Objective progression or relapse | 0 | 77 | 86 |
| Randomized Period | Other | 0 | 9 | 6 |
| Randomized Period | randomized but not treated | 0 | 0 | 3 |
| Randomized Period | Withdrawal by Subject | 0 | 9 | 2 |
Baseline characteristics
| Characteristic | Sunitinib 50 mg (Schedule 4/2) | Sunitinib 37.5 mg + Interferon Alpha-2b | Sunitinib 37.5 mg | Total |
|---|---|---|---|---|
| Age Continuous | 60.4 Years STANDARD_DEVIATION 9.8 | 62.4 Years STANDARD_DEVIATION 7.2 | 64.3 Years STANDARD_DEVIATION 9.7 | 62.4 Years STANDARD_DEVIATION 9.7 |
| Sex: Female, Male Female | 45 Participants | 5 Participants | 57 Participants | 107 Participants |
| Sex: Female, Male Male | 101 Participants | 20 Participants | 89 Participants | 210 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 | 25 / 25 | 144 / 146 | 142 / 143 |
| serious Total, serious adverse events | 7 / 25 | 50 / 146 | 54 / 143 |
Outcome results
Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors Model
MSKCC Prognostic Factor Model assessed as low(0),intermediate(1-2) or high(=\>3) based on number of criteria present such as Karnofsky performance status \< 80 %, Lactate dehydrogenase \> 1.5 \* Upper limit of Normal,Hemoglobin \< lower limit of normal, serum calcium \> 10 mg/dL;Time from first diagnosis of renal cell carcinoma to start of systemic therapy of \< 1 year.TTP was time from start of study treatment to first documentation of objective tumor progression or death due to cancer.TTP was calculated as (first event date minus date of first dose of study medication plus 1) divided by 30.44.
Time frame: From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years
Population: The intent-to-treat (ITT) population included all participants who were randomized into the study regardless of whether they received study medication.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Sunitinib 50 mg (Schedule 4/2) | Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors Model | Stratified analysis : Intermediate Risk (1-2) | 8.0 Months |
| Sunitinib 50 mg (Schedule 4/2) | Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors Model | Stratified analysis : High Risk (=>3) | 3.1 Months |
| Sunitinib 50 mg (Schedule 4/2) | Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors Model | Overall unstratified analysis | 9.9 Months |
| Sunitinib 50 mg (Schedule 4/2) | Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors Model | Stratified analysis : Low Risk (0) | 20.7 Months |
| Sunitinib 37.5 mg | Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors Model | Overall unstratified analysis | 7.1 Months |
| Sunitinib 37.5 mg | Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors Model | Stratified analysis : Intermediate Risk (1-2) | 7.1 Months |
| Sunitinib 37.5 mg | Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors Model | Stratified analysis : Low Risk (0) | 8.4 Months |
| Sunitinib 37.5 mg | Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors Model | Stratified analysis : High Risk (=>3) | 4.4 Months |
Duration of Response (DR)
Time from the first documentation of objective tumor response to objective tumor progression or death due to any cause. Duration of tumor response was calculated as (the date of the first documentation of objective tumor progression or death due to cancer minus the date of the first CR or PR that was subsequently confirmed plus 1) divided by 30.44. DR was calculated for the subgroup of participants with a confirmed objective tumor response.
Time frame: From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years
Population: DR was calculated for the subgroup of participants from the ITT set, with a confirmed OR.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sunitinib 50 mg (Schedule 4/2) | Duration of Response (DR) | 12.5 Months |
| Sunitinib 37.5 mg | Duration of Response (DR) | 8.7 Months |
Overall Survival (OS) Assessed Using MSKCC Prognostic Factors Model
MSKCC Prognostic Factor Model assessed as low (0), intermediate (1-2) or high (=\>3) based upon number of criteria present. Criteria as follows: Karnofsky performance status \< 80 %, Lactate dehydrogenase \> 1.5 \* Upper limit of Normal, Hemoglobin \< lower limit of normal for local lab, Corrected serum calcium \> 10 mg/dL; Time from first diagnosis of renal cell carcinoma to start of systemic therapy of \< 1 year. OS was defined as time from date of start of treatment to date of death due to any cause. OS, in months, was calculated as (event date -start of treatment date + 1)/30.44.
Time frame: From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years
Population: ITT population included all participants who were randomized into the study regardless of whether they received study medication.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Sunitinib 50 mg (Schedule 4/2) | Overall Survival (OS) Assessed Using MSKCC Prognostic Factors Model | High Risk (equal or more than 3) | 3.5 Months |
| Sunitinib 50 mg (Schedule 4/2) | Overall Survival (OS) Assessed Using MSKCC Prognostic Factors Model | Intermediate Risk (1-2) | 19.3 Months |
| Sunitinib 50 mg (Schedule 4/2) | Overall Survival (OS) Assessed Using MSKCC Prognostic Factors Model | Low Risk (0) | NA Months |
| Sunitinib 37.5 mg | Overall Survival (OS) Assessed Using MSKCC Prognostic Factors Model | High Risk (equal or more than 3) | 6.1 Months |
| Sunitinib 37.5 mg | Overall Survival (OS) Assessed Using MSKCC Prognostic Factors Model | Intermediate Risk (1-2) | 21.8 Months |
| Sunitinib 37.5 mg | Overall Survival (OS) Assessed Using MSKCC Prognostic Factors Model | Low Risk (0) | 28.9 Months |
Percentage of Participants With Objective Response (OR)
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). Confirmed responses are those that persist on repeat imaging study at least 4 weeks after initial documentation of response. CR are defined as the disappearance of all lesions (target and/or non target). PR are those with atleast 30% decrease in the sum of the longest dimensions of the target lesions taking as a reference the baseline sum longest dimensions.
Time frame: From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years
Population: ITT population included all participants who were randomized into the study regardless of whether they received study medication.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sunitinib 50 mg (Schedule 4/2) | Percentage of Participants With Objective Response (OR) | 32.2 Percentage of participants |
| Sunitinib 37.5 mg | Percentage of Participants With Objective Response (OR) | 28.1 Percentage of participants |
FACT-Kidney Symptom Index for Disease Related Symptoms (FKSI-DRS)
FKSI-DRS is a subset of FKSI which is a questionnaire for Functional Assessment of Cancer Therapy -Kidney Symptom Index used to assess QoL/participant-reported outcomes for participants diagnosed with renal cell cancer. The FKSI contained 15 questions and the FKSI-DRS consisted of 9 questions each ranging from 0 (not at all) to 4 (very much) so that FKSI-DRS ranged between 0-36. Since the questions could be reversed coded, as appropriate, before calculating FKSI-DRS, 0 and 36 could be considered the worst and best health states based on the 9 questions comprising FKSI-DRS.
Time frame: From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years
Population: ITT population included all participants who were randomized into the study regardless of whether they received study medication.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Sunitinib 50 mg (Schedule 4/2) | FACT-Kidney Symptom Index for Disease Related Symptoms (FKSI-DRS) | 28.3 Units on scale | Standard Deviation 5.6 |
| Sunitinib 37.5 mg | FACT-Kidney Symptom Index for Disease Related Symptoms (FKSI-DRS) | 27.2 Units on scale | Standard Deviation 5.9 |
Functional Assessment of Cancer Therapy-General (FACT-G)
FACT-G is core questionnaire of Functional Assessment of Chronic Illness Therapy (FACIT) measurement system to evaluate quality of life (QoL) in cancer population.FACT-G consisted of 27 questions grouped in 4 domains of general Health-Related QoL(HRQoL):Physical Well-being(PWB),Social/Family Well-Being (SWB),Emotional Well-Being (EWB) and Functional Well-Being (FWB);each ranging from 0 (not at all) to 4 (very much) so that FACT-G ranged between 0-108.Since questions could be reversed coded, as appropriate, before calculating FACT-G,0 and 108 could be considered worst and best health states.
Time frame: From date of randomization until the date of first documented progression or date of death due to any cause, assessed up to a maximum of 2 years
Population: ITT population included all participants who were randomized into the study regardless of whether they received study medication.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Sunitinib 50 mg (Schedule 4/2) | Functional Assessment of Cancer Therapy-General (FACT-G) | 78.0 Units on a scale | Standard Deviation 15.9 |
| Sunitinib 37.5 mg | Functional Assessment of Cancer Therapy-General (FACT-G) | 77.0 Units on a scale | Standard Deviation 17.1 |