Clear Cell Renal Cell Carcinoma, Metastatic Kidney Carcinoma, Stage III Renal Cell Cancer AJCC v7, Stage IV Renal Cell Cancer AJCC v7
Conditions
Brief summary
This phase I/II trial studies the side effects and best dose of entinostat when given together with aldesleukin and to see how well this works in treating patients with kidney cancer that has spread to other places in the body. Entinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Aldesleukin may stimulate the white blood cells to kill kidney cancer cells. Giving entinostat together with aldesleukin may be a better treatment for metastatic kidney cancer.
Detailed description
PRIMARY OBJECTIVES: I. To evaluate the safety and tolerability of high dose interleukin 2 (aldesleukin) in combination with entinostat in patients with metastatic renal cell carcinoma (RCC). (Phase I) II. To monitor toxicity and estimate the efficacy of high dose aldesleukin combined with entinostat in patients with metastatic RCC. (Phase II) SECONDARY OBJECTIVES: I. To compare the time-to-tumor progression, progression-free survival and overall survival of patients with metastatic RCC treated with high dose aldesleukin combined with entinostat to the historical data of patients treated with high dose aldesleukin alone. (Phase II) II. To assess the toxicity of high dose aldesleukin combined with entinostat. (Phase II) III. To evaluate entinostat pharmacodynamics (PD) in blood and tumor samples. (Phase II) IV. To measure the association between baseline laboratory parameters (e.g. cluster of differentiation \[CD\]4+, CD8+, CD4+/forkhead box P3 \[Foxp3\]), tumor blood metabolism, and a variety of response variables (e.g. toxicity, response and survival). (Phase II) V. To explore the relationship between entinostat exposure with PD endpoints (e.g. toxicity and histone acetylation in peripheral blood mononuclear cells or peripheral blood mononuclear cells \[PBMNCs\] and changes in T cell subset population). (Phase II) VI. To evaluate the modulation of tumor metabolism by fluorodeoxyglucose (FDG, fludeoxyglucose F 18) positron emission tomography (PET)/computed tomography (CT) scan. (Phase II) OUTLINE: This is a phase I, dose-escalation study of entinostat followed by a phase II study. Patients receive entinostat orally (PO) every 2 weeks beginning on day -14 and high-dose aldesleukin intravenously (IV) every 8 hours on days 1-5 and 15-19. Cycles repeat every 84 days\* in the absence of disease progression or unacceptable toxicity. NOTE: \*Patients with evidence of tumor shrinkage may receive up to 3 cycles of high-dose aldesleukin therapy. Patients with stable disease by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 criteria, but without evidence of tumor shrinkage after two cycles will receive only entinostat until disease progression is documented. After completion of study treatment, patients are followed up at 30 days and then every 3 months thereafter.
Interventions
BIOLOGICALAldesleukin
Given IV
PROCEDUREComputed Tomography
Undergo FDG-PET/CT
DRUGEntinostat
Given PO
RADIATIONFludeoxyglucose F-18
Undergo FDG-PET/CT
OTHERLaboratory Biomarker Analysis
Correlative studies
OTHERPharmacological Study
Correlative studies
PROCEDUREPositron Emission Tomography
Undergo FDG-PET/CT
Sponsors
National Cancer Institute (NCI)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients must have pathological diagnosis of renal cell carcinoma that is metastatic or surgically unresectable; the histology must be clear cell carcinoma or predominant clear cell carcinoma * Patients may have received up to two prior therapies including vascular endothelial growth factor (VEGF), mammalian target of rapamycin (mTOR) and programmed cell death (PD)-1/PD ligand 1 (L1) inhibitors; prior palliative radiation to metastatic lesion(s) is permitted, provided there is at least one measurable and/or evaluable lesion(s) that has not been irradiated * Patients must have measurable or evaluable disease * Eastern Cooperative Oncology Group (ECOG) performance status 0 * Life expectancy of greater than 6 months * Hemoglobin \>= 12 g/dL * Leukocytes \>= 3,000/mm\^3 * Absolute neutrophil count \>= 1,500/mm\^3 * Platelets \>= 100,000/mm\^3 * Total bilirubin =\< 1.5 x laboratory upper limit of normal * Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) =\< 2.5 x laboratory upper limit of normal * Creatinine =\< 1.5 x laboratory upper limit of normal or calculated creatinine clearance of \>= 50 ml/min * Lactate dehydrogenase (LDH) within normal limits (WNL) * Corrected calcium =\< 10 mg/dL * Prothrombin time (PT)/international normalized ratio (INR) =\< 1.5 * Urine protein \< 1+; if \>= 1+, 24 hour urine protein should be obtained and should be \< 1000 mg * Forced expiratory volume in 1 second (FEV1) \>= 2.0 liters or \>= 75% of predicted for height and age; (pulmonary function tests \[PFTs\] are required for patients over 50 or with significant pulmonary or smoking history) * No evidence of congestive heart failure, symptoms of coronary artery disease, myocardial infarction less than 6 months prior to entry, serious cardiac arrhythmias, or unstable angina; patients who are over 40 or have had previous myocardial infarction greater than 6 months prior to entry will be required to have a negative or low probability cardiac stress test for cardiac ischemia * No history of cerebrovascular accident or transient ischemic attacks * The effects of entinostat on the developing human fetus at the recommended therapeutic dose are unknown; for this reason Women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately; men with female partners of child bearing potential must also agree to use adequate contraception * Ability to understand and the willingness to sign a written informed consent document
Exclusion criteria
* Patients who have received more than two prior therapies * Concurrent use of valproic acid is not allowed * Patients may not be receiving any other investigational agents * Patients with untreated central nervous system (CNS) metastases; patients should have a head CT/magnetic resonance imaging (MRI) within 28 days prior to treatment initiation; patients with previously excised/gamma knifed solitary or oligometastases and controlled disease are eligible * Any medical condition that would preclude adequate evaluation of the safety and toxicity of the study combination * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure (New York Association class II, III, or IV), angina pectoris requiring nitrate therapy, recent myocardial infarction (\< the last 6 months), cardiac arrhythmia, history of cerebrovascular accident (CVA) within 6 months, hypertension (defined as blood pressure of \> 160 mmHg systolic and/or \> 90 mmHg diastolic on medication) history of peripheral vascular disease, or psychiatric illness/social situations that would limit compliance with study requirements * Patients with a history of allergy to entinostat or other medications that have a benzamide structure (i.e. tiapride, remoxipride, and clebopride) * Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with entinostat * Human immunodeficiency virus (HIV)-positive patients receiving combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with entinostat. In addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy; appropriate studies will be undertaken in patients receiving combination anti-retroviral therapy when indicated * Serious or non-healing wound, ulcer or bone fracture * Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to day 1 therapy * Anticipation of need for major surgical procedures during the course of the study * Left ventricular ejection function \< 45%
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dose-limiting Toxicities of Entinostat When Combined With Aldesleukin Within the Phase I | 84 days | Number of dose-limiting toxicities of entinostat when combined with aldesleukin within the Phase I MEASUREMENT OF EFFECT Patients underwent CT scans at week 11 (+/- 7 days) of each cycle during aldesleukin administration and then every 8-12 weeks (+/- 2 weeks). Response Evaluation Criteria in Solid Tumors (RECIST V.1.0) |
| Overall Response Rate (Complete Plus Partial) (Phase II) | Up to 12 months | The proportion of patients who have a partial or complete response to treatment evaluated by RECIST V.1.0 criteria. MEASUREMENT OF EFFECT Patients underwent CT scans at week 11 (+/- 7 days) of each cycle during aldesleukin administration and then every 8-12 weeks (+/- 2 weeks). Response Evaluation Criteria in Solid Tumors (RECIST V.1.0) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Toxicity (Phase I) | 84 days | Count of participants with grade 4 toxicity. The frequency and grade of toxicities will be tabulated for each dose level. |
| Progression-free Survival | up to 12-months after the last subject enrolls | The median progression-free survival (PFS) was estimated using standard Kaplan-Meier methods, where estimates of the median were obtained with 95% confidence intervals (CIs). PFS was defined as the time from the start of treatment to progression or death due to any cause or last follow-up, patients who did not progress or die were censored. MEASUREMENT OF EFFECT Patients underwent CT scans at week 11 (+/- 7 days) of each cycle during aldesleukin administration and then every 8-12 weeks (+/- 2 weeks). Response Evaluation Criteria in Solid Tumors (RECIST V.1.0) |
| Overall Survival | up to 12-months after the last subject enrolls | The 3-year overall survival (OS) rate was estimated using standard Kaplan-Meier methods, where estimates of the median were obtained with 95% confidence intervals (CIs). OS was defined as the time from the start of treatment to death due to any cause or last follow-up, patients who did not die were censored. |
| Time-to-tumor Progression | up to 12-months after the last subject enrolls | The median time to tumor progression (TTP) was estimated using standard Kaplan-Meier methods, where estimates of the median were obtained with 95% confidence intervals (CIs). TTP was defined as the time from the start of treatment to progression or last follow-up. Patients that did not progress were censored. |
| Incidence of Toxicities | Up to 30 days | The number of participants with serious adverse events. |
| Changes in the Level of Specific T Lymphocytes | Baseline to approximately 4 weeks post-treatment, up to 1 year | Mean percent change from baseline of T lymphocytes. |
| Changes in Tumor Metabolisms by FDG Positron Emission Tomography (PET)/Computed Tomography (CT) Scan | Baseline to approximately 5 weeks post-treatment | For binary predictors, the sensitivity and specificity with 95% confidence intervals will be reported. T tests will be used to compare the mean change between responders and non-responders. If there are sufficient numbers of responders, partial responders and non-responders an ANOVA will be used to compare changes in these three groups. If complete data are obtained for CD4+CD25\^hi T cells at multiple time points post treatment, repeated measures ANOVA will be performed to evaluate data for trends over time. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORSaby George
Roswell Park Cancer Institute
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Dose Level 1 Dose Level 1 Entinostat (3 mg, every 2 weeks, PO) Aldesleukin (600,000 IU/kg, every 8hrs, IV) | 3 |
| Dose Level 2 Dose Level 2 Entinostat (5 mg, every 2 weeks, PO) Aldesleukin (600,000 IU/kg, every 8hrs, IV) | 44 |
| Total | 47 |
Baseline characteristics
| Characteristic | Dose Level 2 | Total | Dose Level 1 |
|---|---|---|---|
| Age, Continuous | 55.64 years STANDARD_DEVIATION 8.35 | 55.53 years STANDARD_DEVIATION 8.65 | 54.0 years STANDARD_DEVIATION 14.73 |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 4 Participants | 4 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 39 Participants | 42 Participants | 3 Participants |
| Sex: Female, Male Female | 7 Participants | 7 Participants | 0 Participants |
| Sex: Female, Male Male | 37 Participants | 40 Participants | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 3 / 3 | 6 / 44 |
| other Total, other adverse events | 1 / 3 | 35 / 44 |
| serious Total, serious adverse events | 0 / 3 | 9 / 44 |
Outcome results
Primary
Dose-limiting Toxicities of Entinostat When Combined With Aldesleukin Within the Phase I
Number of dose-limiting toxicities of entinostat when combined with aldesleukin within the Phase I MEASUREMENT OF EFFECT Patients underwent CT scans at week 11 (+/- 7 days) of each cycle during aldesleukin administration and then every 8-12 weeks (+/- 2 weeks). Response Evaluation Criteria in Solid Tumors (RECIST V.1.0)
Time frame: 84 days
Population: All treated and eligible Phase 1 patients
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Dose Level 1 | Dose-limiting Toxicities of Entinostat When Combined With Aldesleukin Within the Phase I | 0 Participants |
| Dose Level 2 | Dose-limiting Toxicities of Entinostat When Combined With Aldesleukin Within the Phase I | 0 Participants |
Primary
Overall Response Rate (Complete Plus Partial) (Phase II)
The proportion of patients who have a partial or complete response to treatment evaluated by RECIST V.1.0 criteria. MEASUREMENT OF EFFECT Patients underwent CT scans at week 11 (+/- 7 days) of each cycle during aldesleukin administration and then every 8-12 weeks (+/- 2 weeks). Response Evaluation Criteria in Solid Tumors (RECIST V.1.0)
Time frame: Up to 12 months
Population: All Phase II treated and eligible patients
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dose Level 1 | Overall Response Rate (Complete Plus Partial) (Phase II) | .39 Proportion of participants |
Secondary
Changes in the Level of Specific T Lymphocytes
Mean percent change from baseline of T lymphocytes.
Time frame: Baseline to approximately 4 weeks post-treatment, up to 1 year
Population: All treated and evaluable patients
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Dose Level 1 | Changes in the Level of Specific T Lymphocytes | 26.3 percentage of cells count | — |
| Dose Level 2 | Changes in the Level of Specific T Lymphocytes | 10.5 percentage of cells count | Standard Deviation 70.8 |
Secondary
Changes in Tumor Metabolisms by FDG Positron Emission Tomography (PET)/Computed Tomography (CT) Scan
For binary predictors, the sensitivity and specificity with 95% confidence intervals will be reported. T tests will be used to compare the mean change between responders and non-responders. If there are sufficient numbers of responders, partial responders and non-responders an ANOVA will be used to compare changes in these three groups. If complete data are obtained for CD4+CD25\^hi T cells at multiple time points post treatment, repeated measures ANOVA will be performed to evaluate data for trends over time.
Time frame: Baseline to approximately 5 weeks post-treatment
Population: Data for this outcome was not collected. The investigator transferred from Hopkins to Roswell Park and the data for this outcome was not collected.
Secondary
Incidence of Toxicities
The number of participants with serious adverse events.
Time frame: Up to 30 days
Population: All Phase 2 patients. Toxicities only assessed for Phase 2.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Dose Level 1 | Incidence of Toxicities | 9 Participants |
Secondary
Incidence of Toxicity (Phase I)
Count of participants with grade 4 toxicity. The frequency and grade of toxicities will be tabulated for each dose level.
Time frame: 84 days
Population: All Phase I patients
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Dose Level 1 | Incidence of Toxicity (Phase I) | 1 Participants |
| Dose Level 2 | Incidence of Toxicity (Phase I) | 0 Participants |
Secondary
Overall Survival
The 3-year overall survival (OS) rate was estimated using standard Kaplan-Meier methods, where estimates of the median were obtained with 95% confidence intervals (CIs). OS was defined as the time from the start of treatment to death due to any cause or last follow-up, patients who did not die were censored.
Time frame: up to 12-months after the last subject enrolls
Population: All Phase 2 patients. Overall Survival only assessed for Phase 2.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dose Level 1 | Overall Survival | 82.1 percentage of participants |
Secondary
Progression-free Survival
The median progression-free survival (PFS) was estimated using standard Kaplan-Meier methods, where estimates of the median were obtained with 95% confidence intervals (CIs). PFS was defined as the time from the start of treatment to progression or death due to any cause or last follow-up, patients who did not progress or die were censored. MEASUREMENT OF EFFECT Patients underwent CT scans at week 11 (+/- 7 days) of each cycle during aldesleukin administration and then every 8-12 weeks (+/- 2 weeks). Response Evaluation Criteria in Solid Tumors (RECIST V.1.0)
Time frame: up to 12-months after the last subject enrolls
Population: All Phase 2 patients. PFS only assessed for Phase 2.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Dose Level 1 | Progression-free Survival | 14.0 months |
Secondary
Time-to-tumor Progression
The median time to tumor progression (TTP) was estimated using standard Kaplan-Meier methods, where estimates of the median were obtained with 95% confidence intervals (CIs). TTP was defined as the time from the start of treatment to progression or last follow-up. Patients that did not progress were censored.
Time frame: up to 12-months after the last subject enrolls
Population: All Phase 2 patients.TTP only assessed for Phase 2.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Dose Level 1 | Time-to-tumor Progression | 14 months |