Renal Cell Carcinoma
Conditions
Keywords
RCC,, mTOR pathway,, angiogenesis,, PFS,, partial response [PR] + complete response [CR]), metastatic recurrent renal cell carcinoma, metastatic unresectable renal cell carcinoma
Brief summary
Renal cell carcinoma (RCC) accounts for more than 200,000 new cases of cancer and over 100,000 cancer deaths annually in the World (Ferlay, et al., 2004). It is estimated that there were about 15,000 new cases of RCC in the region that excludes the Americas, European Union and Japan. Renal cell carcinomas arise from the proximal tubal epithelium are more common in males than in females with an overall lifetime risk of 1 in 75 and a median age of diagnosis of 65 years. Everolimus (Certican®) has been approved since 2003 in more than 60 countries for the prevention of organ rejection in patients with renal and cardiac transplantation. Everolimus (RAD001) is a derivative of rapamycin, which acts as a signal transduction inhibitor. It targets mTOR, a key protein kinase regulating cell growth, proliferation, and survival. The mTOR pathway activity is modulated by the phosphatidylinositol-3-kinase (PI3K)/protein kinase B AKT (AKT) pathway, a pathway known to be deregulated in numerous human cancers. RAD001 (Afinitor®) has been investigated as an anticancer agent based on its potential to act: * directly on the tumor cells by inhibiting tumor cell growth and proliferation; * indirectly by inhibiting angiogenesis leading to reduced tumor vascularity (via potent inhibition of tumor cell hypoxia-inducible factor 1 (HIF-1) activity, VEGF production, and VEGF-induced proliferation of endothelial cells). Primary: To evaluate the PFS rate over time. Secondary: * To evaluate the disease control rate (stable disease \[SD\] + partial response \[PR\] + complete response \[CR\]); * To evaluate the objective response rate (ORR; where ORR = CR + PR) and duration; * To describe the safety profile of RAD001.
Interventions
DRUGRAD001
Sponsors
Novartis Pharmaceuticals
Study design
Allocation
NON_RANDOMIZED
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 may be entered in the study only if they meet all of the following criteria: * Age ≥18 years old; * Patients with advanced renal cell carcinoma with confirmed clear or non-clear cell histology, with or without nephrectomy, and with any MSKCC prognosis; * Prior cytokine therapy is permitted; * Patients with at least one measurable lesion at baseline as per the Response Evaluation Criteria in Solid Tumors (RECIST) criteria. If skin lesions are reported as target lesions, they must be documented (at baseline and at every physical exam) using color photography and a measuring device (such as a caliper) in clear focus to allow the size of the lesion(s) to be determined from the photograph; * Life expectancy ≥3 months. Life expectancy should be judged in relation to other determining patient eligibility factors such as laboratory results, Karnofsky Performance Status, etc.; * Patients with a Karnofsky Performance Status ≥70%; * Adequate bone marrow function as shown by: absolute neutrophil count (ANC) ≥1.5 x 109/L, platelets ≥100 x 109/L, hemoglobin (Hb) \>9 g/dL; * Adequate liver function: serum bilirubin ≤1.5 x upper limit of normal (ULN), alanine transaminase (ALT), and aspartate transaminase (AST) ≤2.5 x ULN; * Adequate renal function: serum creatinine ≤1.5 x ULN; * Females of childbearing potential must have had a negative serum or urine pregnancy test 7 days prior to the administration of the study treatment start; * Patients who give a written informed consent obtained according to local guidelines.
Exclusion criteria
Patients may not be entered into the study if they meet any of the following criteria: * Patients within 2 weeks post-minor surgery (e.g., herniorrhaphy), 4 weeks post-major surgery (e.g., intra-thoracic, intra-abdominal, or intra-pelvic) to avoid wound healing complications. Percutaneous biopsies require no waiting time prior to study entry; * Patients with a recent history of hemoptysis, ≥0.5 teaspoon of red blood; * Patients who have received prior systemic treatment for their metastatic RCC other than with cytokine therapy; * Patients who received prior therapy with a VEGF pathway inhibitor, such as sunitinib, sorafenib, and bevacizumab; * Patients who have previously received mTOR inhibitors (sirolimus, temsirolimus, everolimus, deferolimus); * History or clinical evidence of central nervous system (CNS) metastases. Note: Subjects who have previously-treated CNS metastases (surgery ± radiotherapy, radiosurgery, or gamma knife) and meet all 3 of the following criteria are eligible: Are asymptomatic; Have had no evidence of active CNS metastases for ≥6 months prior to enrollment and; Have no requirement for steroids or enzyme-inducing anticonvulsants (EIAC); • Clinically significant gastrointestinal abnormalities including, but not limited to: Malabsorption syndrome; Major resection of the stomach or small bowel that could affect the absorption of study drug; Active peptic ulcer disease; Inflammatory bowel disease; Ulcerative colitis, or other gastrointestinal conditions with increased risk of perforation; History of abdominal fistula, gastrointestinal perforation, or intra abdominal abscess within 28 days prior to beginning of study treatment; * Patients receiving chronic systemic treatment with corticosteroids (dose of ≥10 mg/day methylprednisone equivalent) or another immune-suppressive agent. Inhaled and topical steroids are acceptable, as well as opotherapy after bilateral adrenal gland removal; * Patients with a known history of human immunodeficiency virus seropositivity; * Patients with autoimmune hepatitis; * Patients with an active, bleeding diathesis. Patients may use coumadin or heparin preparations; * Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study; * Patients who have a history of another primary malignancy ≤3 years, with the exception of non-melanoma skin cancer and carcinoma in situ of uterine; * Female patients who are pregnant or breastfeeding, or adults of reproductive potential who are not using effective birth control methods. If barrier contraceptives are being used, these must be continued throughout the study by both sexes. Oral contraceptives are not acceptable; * Patients who are using other investigational agents or who had received investigational drugs ≤4 weeks prior to study treatment start; Patients unwilling or unable to comply with the protocol. Other protocol-defined inclusion/exclusion may apply
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PFS (Progression-Free Survival) | Approximately 4 years | the time from the date of the start of RAD001 treatment to the date of the first documented disease progression or death due to any cause |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Disease Control Rate (Stable Disease [SD] + Partial Response [PR] + Complete Response [CR]); | Approximately 4 years | The disease control rate was based on the data as per local radiological review following the RECIST criteria. The disease control rate is defined as the proportion of patients with CR, PR, or SD and was summarized in terms of percentage with 95% exact Clopper-Pearson CIs |
| Objective Response Rate (ORR; Where ORR = CR + PR) | Approximately 4 years | The overall tumor response was based on the data as per local radiological review, following RECIST criteria. The ORR is defined as the proportion of patients with CR or PR and was summarized in terms of percentage with 95% exact Clopper-Pearson CIs |
| Duration of Response (DOR) | Approximately 4 years | The DOR analysis applied only to patients whose overall response was CR or PR and was defined as the time from onset of response (CR/PR) to progression or death from any cause |
| Overall Survival | Approximately 4 years | Overall survival is defined as the time from date of start of treatment to date of death due to any cause. If a patient is not known to have died, survival will be censored at the date of last contact. |
Countries
Algeria, Egypt, India, Jordan, Lebanon, Russia, Saudi Arabia, South Africa, Thailand, Tunisia
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| RAD001 Two 5 mg RAD001 tablets | 142 |
| Total | 142 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Abnormal laboratory value | 2 |
| Overall Study | Abnormal test procedure result | 1 |
| Overall Study | Adverse Event | 20 |
| Overall Study | Death | 11 |
| Overall Study | Disease progression | 88 |
| Overall Study | Lost to Follow-up | 6 |
| Overall Study | New cancer therapy | 2 |
| Overall Study | Patient withdrew consent | 5 |
| Overall Study | Protocol deviation | 3 |
Baseline characteristics
| Characteristic | RAD001 |
|---|---|
| Age, Continuous | 55.5 Years STANDARD_DEVIATION 12.63 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 42 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 27 Participants |
| Race (NIH/OMB) White | 71 Participants |
| Sex: Female, Male Female | 55 Participants |
| Sex: Female, Male Male | 87 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 33 / 142 |
| other Total, other adverse events | 125 / 142 |
| serious Total, serious adverse events | 48 / 142 |
Outcome results
Primary
PFS (Progression-Free Survival)
the time from the date of the start of RAD001 treatment to the date of the first documented disease progression or death due to any cause
Time frame: Approximately 4 years
Population: The Intent-to-Treat population (ITT population) consisted of all patients treated with RAD001.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| RAD001 | PFS (Progression-Free Survival) | 27.71 Weeks |
Comparison: Single arm open label study95% CI: [21.86, 35.29]
Secondary
Disease Control Rate (Stable Disease [SD] + Partial Response [PR] + Complete Response [CR]);
The disease control rate was based on the data as per local radiological review following the RECIST criteria. The disease control rate is defined as the proportion of patients with CR, PR, or SD and was summarized in terms of percentage with 95% exact Clopper-Pearson CIs
Time frame: Approximately 4 years
Population: The Intent-to-Treat population (ITT population) consisted of all patients treated with RAD001.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RAD001 | Disease Control Rate (Stable Disease [SD] + Partial Response [PR] + Complete Response [CR]); | 74.6 Percentage of Participants |
Secondary
Duration of Response (DOR)
The DOR analysis applied only to patients whose overall response was CR or PR and was defined as the time from onset of response (CR/PR) to progression or death from any cause
Time frame: Approximately 4 years
Population: The Intent-to-Treat population (ITT population) consisted of all patients treated with RAD001.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| RAD001 | Duration of Response (DOR) | 169 Weeks |
Secondary
Objective Response Rate (ORR; Where ORR = CR + PR)
The overall tumor response was based on the data as per local radiological review, following RECIST criteria. The ORR is defined as the proportion of patients with CR or PR and was summarized in terms of percentage with 95% exact Clopper-Pearson CIs
Time frame: Approximately 4 years
Population: The Intent-to-Treat population (ITT population) consisted of all patients treated with RAD001.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RAD001 | Objective Response Rate (ORR; Where ORR = CR + PR) | 17 Percentage of participants |
Secondary
Overall Survival
Overall survival is defined as the time from date of start of treatment to date of death due to any cause. If a patient is not known to have died, survival will be censored at the date of last contact.
Time frame: Approximately 4 years
Population: The Intent-to-Treat population (ITT population) consisted of all patients treated with RAD001.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| RAD001 | Overall Survival | NA Weeks |
Comparison: The median overall survival was not evaluable, this presents the 25th percentile of overall survival95% CI: [31.29, 106.43]