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Sunitinib Malate Schedule 4/2 vs. Sunitinib Malate Continuous Dosing As First-Line Therapy For Metastatic Renal Cell Cancer (RCC)

A Randomized Phase II Study Of The Efficacy And Safety Of Sunitinib Malate Schedule 4/2 vs. Sunitinib Malate Continuous Dosing As First-Line Therapy For Metastatic Renal Cell Cancer (Renal EFFECT Trial)

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00267748
Enrollment
317
Registered
2005-12-21
Start date
2005-12-31
Completion date
2010-06-30
Last updated
2011-09-05

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Carcinoma, Renal Cell

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

DRUGSunitinib Malate Continuous Daily Dosing

Sunitinib malate starting dose 37.5 mg daily continuous daily regimen.

DRUGSunitinib Malate Schedule 4/2

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

Pfizer
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors ModelFrom 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 yearsMSKCC 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

MeasureTime frameDescription
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 yearsPercentage 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 yearsTime 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 ModelFrom 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 yearsMSKCC 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

MeasureTime frameDescription
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 yearsFACT-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 yearsFKSI-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

ArmCount
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
Total317

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Non-randomized PeriodAdverse Event800
Non-randomized PeriodDeath100
Non-randomized PeriodOther300
Non-randomized PeriodParticipant not willing to participate100
Non-randomized PeriodProgressive disease1000
Randomized PeriodAdverse Event02325
Randomized PeriodDeath023
Randomized PeriodGlobal deterioration of health status067
Randomized PeriodLost to Follow-up010
Randomized PeriodObjective progression or relapse07786
Randomized PeriodOther096
Randomized Periodrandomized but not treated003
Randomized PeriodWithdrawal by Subject092

Baseline characteristics

CharacteristicSunitinib 50 mg (Schedule 4/2)Sunitinib 37.5 mg + Interferon Alpha-2bSunitinib 37.5 mgTotal
Age Continuous60.4 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 Participants5 Participants57 Participants107 Participants
Sex: Female, Male
Male
101 Participants20 Participants89 Participants210 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
25 / 25144 / 146142 / 143
serious
Total, serious adverse events
7 / 2550 / 14654 / 143

Outcome results

Primary

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.

ArmMeasureGroupValue (MEDIAN)
Sunitinib 50 mg (Schedule 4/2)Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors ModelStratified 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 ModelStratified 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 ModelOverall unstratified analysis9.9 Months
Sunitinib 50 mg (Schedule 4/2)Time to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors ModelStratified analysis : Low Risk (0)20.7 Months
Sunitinib 37.5 mgTime to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors ModelOverall unstratified analysis7.1 Months
Sunitinib 37.5 mgTime to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors ModelStratified analysis : Intermediate Risk (1-2)7.1 Months
Sunitinib 37.5 mgTime to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors ModelStratified analysis : Low Risk (0)8.4 Months
Sunitinib 37.5 mgTime to Tumor Progression (TTP) Assessed Using Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Factors ModelStratified analysis : High Risk (=>3)4.4 Months
Comparison: For High risk factor, the hazard ratio of TTP was estimated using stratified Cox Proportional Hazard model with the MSKCC prognostic factors (low, intermediate, high), used in the randomization, as a stratum and median TTP was estimated using Kaplan-Meier method. Log rank method was used to calculate p value.p-value: 0.8695% CI: [0.423, 2.803]Log Rank
Comparison: For intermediate risk factor, the hazard ratio of TTP was estimated using stratified Cox Proportional Hazard model with the MSKCC prognostic factors (low, intermediate, high), used in the randomization, as a stratum and median TTP was estimated using Kaplan-Meier method. Log rank method was used to calculate p value.p-value: 0.58395% CI: [0.623, 1.306]Log Rank
Comparison: For low risk factor, the hazard ratio of TTP was estimated using stratified Cox Proportional Hazard model with the MSKCC prognostic factors (low, intermediate, high), used in the randomization, as a stratum and median TTP was estimated using Kaplan-Meier method. Log rank method was used to calculate p value.p-value: 0.07595% CI: [0.288, 1.074]Log Rank
Comparison: For overall stratified analysis, the hazard ratio of TTP was estimated using stratified Cox Proportional Hazard model with the MSKCC prognostic factors (low, intermediate, high), used in the randomization, as a stratum and median TTP was estimated using Kaplan-Meier method. Log rank method was used to calculate p value.p-value: 0.2295% CI: [0.609, 1.124]Log Rank
Comparison: For overall unstratified analysis, the hazard ratio of TTP was estimated using stratified Cox Proportional Hazard model. Two-sided unstratified Log rank method was used to calculate p value.p-value: 0.0995% CI: [0.572, 1.044]Log Rank
Secondary

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.

ArmMeasureValue (MEDIAN)
Sunitinib 50 mg (Schedule 4/2)Duration of Response (DR)12.5 Months
Sunitinib 37.5 mgDuration of Response (DR)8.7 Months
Secondary

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.

ArmMeasureGroupValue (MEDIAN)
Sunitinib 50 mg (Schedule 4/2)Overall Survival (OS) Assessed Using MSKCC Prognostic Factors ModelHigh Risk (equal or more than 3)3.5 Months
Sunitinib 50 mg (Schedule 4/2)Overall Survival (OS) Assessed Using MSKCC Prognostic Factors ModelIntermediate Risk (1-2)19.3 Months
Sunitinib 50 mg (Schedule 4/2)Overall Survival (OS) Assessed Using MSKCC Prognostic Factors ModelLow Risk (0)NA Months
Sunitinib 37.5 mgOverall Survival (OS) Assessed Using MSKCC Prognostic Factors ModelHigh Risk (equal or more than 3)6.1 Months
Sunitinib 37.5 mgOverall Survival (OS) Assessed Using MSKCC Prognostic Factors ModelIntermediate Risk (1-2)21.8 Months
Sunitinib 37.5 mgOverall Survival (OS) Assessed Using MSKCC Prognostic Factors ModelLow Risk (0)28.9 Months
Comparison: For high risk factor, the hazard ratio of OS was estimated using stratified Cox Proportional Hazard model with the MSKCC prognostic factors (low, intermediate, high), used in the randomization, as a stratum and median OS was estimated using Kaplan-Meier method. Log rank method was used to calculate p value.p-value: 0.86695% CI: [0.481, 2.387]Log Rank
Comparison: For intermediate risk factor,the hazard ratio of OS was estimated using stratified Cox Proportional Hazard model with the MSKCC prognostic factors (low, intermediate, high), used in the randomization, as a stratum and median OS was estimated using Kaplan-Meier method. Log rank method was used to calculate p value.p-value: 0.43995% CI: [0.785, 1.741]Log Rank
Comparison: For low risk factor, the hazard ratio of OS was estimated using stratified Cox Proportional Hazard model with the MSKCC prognostic factors (low, intermediate, high), used in the randomization, as a stratum and median OS was estimated using Kaplan-Meier method. Log rank method was used to calculate p value.p-value: 0.61495% CI: [0.538, 2.851]Log Rank
Comparison: For overall stratified analysis, the hazard ratio of OS was estimated using stratified Cox Proportional Hazard model with the MSKCC prognostic factors (low, intermediate, high), used in the randomization, as a stratum and median OS was estimated using Kaplan-Meier method. Log rank method was used to calculate p value.p-value: 0.36595% CI: [0.838, 1.612]Log Rank
Secondary

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.

ArmMeasureValue (NUMBER)
Sunitinib 50 mg (Schedule 4/2)Percentage of Participants With Objective Response (OR)32.2 Percentage of participants
Sunitinib 37.5 mgPercentage of Participants With Objective Response (OR)28.1 Percentage of participants
Comparison: Response rate was estimated for each treatment group, 95% Confidence Interval (CI) on the difference in response rate between the 2 treatments was computed. P-value was calculated from a Pearson chi-square test.p-value: 0.44495% CI: [-6.4, 14.6]Chi-squared
Other Pre-specified

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.

ArmMeasureValue (MEAN)Dispersion
Sunitinib 50 mg (Schedule 4/2)FACT-Kidney Symptom Index for Disease Related Symptoms (FKSI-DRS)28.3 Units on scaleStandard Deviation 5.6
Sunitinib 37.5 mgFACT-Kidney Symptom Index for Disease Related Symptoms (FKSI-DRS)27.2 Units on scaleStandard Deviation 5.9
Comparison: P value was calculated using sample t-test.p-value: 0.1967t-test, 2 sided
Other Pre-specified

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.

ArmMeasureValue (MEAN)Dispersion
Sunitinib 50 mg (Schedule 4/2)Functional Assessment of Cancer Therapy-General (FACT-G)78.0 Units on a scaleStandard Deviation 15.9
Sunitinib 37.5 mgFunctional Assessment of Cancer Therapy-General (FACT-G)77.0 Units on a scaleStandard Deviation 17.1
Comparison: P value was calculated using sample t-test.p-value: 0.6737t-test, 2 sided

Source: ClinicalTrials.gov · Data processed: Mar 18, 2026