Renal Cell Carcinoma
Conditions
Brief summary
The purpose of this study is to evaluate safety and efficacy of different administration regimens of nivolumab plus ipilimumab in subjects with renal cell carcinoma.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
For more information regarding Bristol-Myers Squibb Clinical Trial participation, please visit www.BMSStudyConnect.com Inclusion Criteria: * Advanced Renal Cell Carcinoma * Must have full activity or, if limited, must be able to walk and carry out light activities such as light house work or office work * Must have at least 1 lesion with measurable disease
Exclusion criteria
* Subjects with active central nervous system metastases * Subjects who received prior therapy with checkpoint inhibitor * Subjects with active, known or suspected autoimmune disease Other protocol defined inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Percentage of Participant With Adverse Events (AEs) in the Broad Scope MedDRA Anaphylactic Reaction Standardized MedDRA Queries (SMQ) Within 2 Days After Any Dose in the Combination Period | From randomization to 2 days following any dose in the combination period (assessed up to November 24th, 2017, approximately 9 months) | The percentage of participants who experienced at least 1 adverse event in the MedDRA Anaphylactic Reaction broad scope SMQ with onset on the day of or within 2 days after any study therapy infusion during the combination period (Part 1). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The Percentage of Participants With Drug Related Grade 3-5 Adverse Events | From first dose to 30 days after last dose of study therapy (up to approximately 48 months) | The percentage of participants who experienced at least 1 adverse event of Grade 3 or higher, judged to be related to study treatment by the investigator, with onset on or after the first dose of study treatment and within 30 days of the last dose of study treatment. Evaluated using Common Terminology Criteria for Adverse Events (NCI CTCAE) version 4.0 criteria. |
| The Percentage of Participants With All Causality Grade 3-5 Adverse Events | From first dose to 30 days after last dose of study therapy (up to approximately 48 months) | The percentage of participants who experienced at least 1 adverse event of Grade 3 or higher with onset on or after the first dose of study treatment and within 30 days of the last dose of study treatment. Evaluated using the NCI CTCAE version 4.0 criteria |
| Objective Response Rate (ORR) | From randomization to the date of objectively documented progression or the date of first subsequent anti-cancer (up to approximately 52 months) | The percentage of participants with a best overall response (BOR) of complete response (CR) or partial response (PR). The BOR is defined as the best response designation, as determined by the investigator, recorded between the date of randomization and the date of objectively documented progression per RECIST 1.1 or the date of first subsequent anti-cancer therapy, whichever occurs first. For participants without documented progression or subsequent therapy, all available response designations will contribute to the BOR assessment. Complete Response is defined as the disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10mm. Partial Response is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. |
| The Percentage of Participant With Adverse Events in the Narrow Scope MedDRA Anaphylactic Reaction Standardized MedDRA Queries (SMQ) Occurring Within 2 Days After Any Dose in the Combination Period | From randomization to 2 days following any dose in the combination period (assessed up to November 24th, 2017, approximately 9 months) | The percentage of participants who experienced at least 1 adverse event in the MedDRA Anaphylactic Reaction narrow scope SMQ with onset on the day of or within 2 days after any study therapy infusion during the combination period (Part 1). |
| Geometric Mean Trough Concentrations of Nivolumab and Ipilimumab | pre-dose on day 1 of cycle 2 and 4 | Serum concentration-time data of nivolumab and ipilimumab administered as a fixed ratio combination to that of sequentially administered nivolumab and ipilimumab is summarized prior to the next dose (predose). 1 Cycle = 3 weeks |
| Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | EOI on day 1 of cycle 1, 2, and 4 | Serum concentration-time data of nivolumab and ipilimumab administered as a fixed ratio combination to that of sequentially administered nivolumab and ipilimumab is summarized at the end of infusion (EOI). 1 Cycle = 3 weeks |
| Progression Free Survival (PFS) | From randomization to the first date of documented progression or death due to any cause (up to approximately 52 months) | The time between the date of randomization and the first date of documented progression, or death due to any cause, whichever occurs first (per investigator). Participants who die without progression will be considered to have progressed on the date of their death. Participants who did not progress or die are censored on the date of their last evaluable tumor assessment. Participants with no on study tumor assessments and who did not die will be censored on their date of randomization. Participants who started anti-cancer therapy without a prior reported progression will be censored on the date of their last evaluable tumor assessment prior to the first subsequent anti-cancer therapy. Progression is defined as at least a 20% increase in the sum of diameters of target lesions. The sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression) |
Countries
Australia, Chile, United States
Participant flow
Pre-assignment details
104 participants were randomized and treated
Participants by arm
| Arm | Count |
|---|---|
| Arm A: Fixed Ratio Combination Participants recieve a fixed ratio combination (BMS-986237) of nivolumab and ipilimumab in a 3:1 ratio (nivolumab 3 mg/kg and ipilimumab1 mg/kg) every 3 weeks for 4 doses. Participants will then receive nivolumab 480 mg flat dose infused over 30 minutes every four weeks. | 52 |
| Arm B: Sequential Combination Nivolumab 3 mg/kg and ipilimumab 1 mg/kg will be administered sequentially every 3 weeks for up to 4 doses. Participants will then receive nivolumab 480 mg flat dose infused over 30 minutes every four weeks. | 52 |
| Total | 104 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event Unrelated to Study Drug | 2 | 3 |
| Overall Study | Death | 2 | 6 |
| Overall Study | Disease Progression | 20 | 22 |
| Overall Study | Maximum clinical benefit | 1 | 0 |
| Overall Study | Not reported | 1 | 1 |
| Overall Study | Other reasons | 6 | 6 |
| Overall Study | Participant no longer meets study criteria | 0 | 1 |
| Overall Study | Participant request to discontinue study treatment | 4 | 1 |
| Overall Study | Study Drug Toxicity | 15 | 11 |
Baseline characteristics
| Characteristic | Arm A: Fixed Ratio Combination | Arm B: Sequential Combination | Total |
|---|---|---|---|
| Age, Continuous | 62.2 Years STANDARD_DEVIATION 10.9 | 62.6 Years STANDARD_DEVIATION 9.9 | 62.4 Years STANDARD_DEVIATION 10.4 |
| Race/Ethnicity, Customized American Indian or Alaska Native | 0 Count of participants | 0 Count of participants | 0 Count of participants |
| Race/Ethnicity, Customized Asian | 3 Count of participants | 0 Count of participants | 3 Count of participants |
| Race/Ethnicity, Customized Black or African American | 1 Count of participants | 0 Count of participants | 1 Count of participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 1 Count of participants | 0 Count of participants | 1 Count of participants |
| Race/Ethnicity, Customized Other | 1 Count of participants | 1 Count of participants | 2 Count of participants |
| Race/Ethnicity, Customized White | 46 Count of participants | 51 Count of participants | 97 Count of participants |
| Sex: Female, Male Female | 10 Participants | 14 Participants | 24 Participants |
| Sex: Female, Male Male | 42 Participants | 38 Participants | 80 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 26 / 52 | 29 / 52 |
| other Total, other adverse events | 49 / 52 | 48 / 52 |
| serious Total, serious adverse events | 27 / 52 | 25 / 52 |
Outcome results
The Percentage of Participant With Adverse Events (AEs) in the Broad Scope MedDRA Anaphylactic Reaction Standardized MedDRA Queries (SMQ) Within 2 Days After Any Dose in the Combination Period
The percentage of participants who experienced at least 1 adverse event in the MedDRA Anaphylactic Reaction broad scope SMQ with onset on the day of or within 2 days after any study therapy infusion during the combination period (Part 1).
Time frame: From randomization to 2 days following any dose in the combination period (assessed up to November 24th, 2017, approximately 9 months)
Population: All treated participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Fixed Ratio Combination | The Percentage of Participant With Adverse Events (AEs) in the Broad Scope MedDRA Anaphylactic Reaction Standardized MedDRA Queries (SMQ) Within 2 Days After Any Dose in the Combination Period | 11.5 Percentage of Participants |
| Arm B: Sequential Combination | The Percentage of Participant With Adverse Events (AEs) in the Broad Scope MedDRA Anaphylactic Reaction Standardized MedDRA Queries (SMQ) Within 2 Days After Any Dose in the Combination Period | 11.5 Percentage of Participants |
Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab
Serum concentration-time data of nivolumab and ipilimumab administered as a fixed ratio combination to that of sequentially administered nivolumab and ipilimumab is summarized at the end of infusion (EOI). 1 Cycle = 3 weeks
Time frame: EOI on day 1 of cycle 1, 2, and 4
Population: All treated participants with available serum time-concentration data
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Arm A: Fixed Ratio Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Nivolumab - Cycle 1 Day 1 | 57.1 ug/mL | Geometric Coefficient of Variation 22.4 |
| Arm A: Fixed Ratio Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Ipilimumab - Cycle 1 Day 1 | 17.6 ug/mL | Geometric Coefficient of Variation 23.7 |
| Arm A: Fixed Ratio Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Ipilimumab - Cycle 4 Day 1 | 24.9 ug/mL | Geometric Coefficient of Variation 31.3 |
| Arm A: Fixed Ratio Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Ipilimumab - Cycle 2 Day 1 | 21.4 ug/mL | Geometric Coefficient of Variation 24.8 |
| Arm A: Fixed Ratio Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Nivolumab - Cycle 4 Day 1 | 85.1 ug/mL | Geometric Coefficient of Variation 30.1 |
| Arm A: Fixed Ratio Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Nivolumab - Cycle 2 Day 1 | 70.6 ug/mL | Geometric Coefficient of Variation 27.6 |
| Arm B: Sequential Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Nivolumab - Cycle 4 Day 1 | 88.9 ug/mL | Geometric Coefficient of Variation 55.1 |
| Arm B: Sequential Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Ipilimumab - Cycle 4 Day 1 | 19.5 ug/mL | Geometric Coefficient of Variation 38.5 |
| Arm B: Sequential Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Nivolumab - Cycle 2 Day 1 | 79.5 ug/mL | Geometric Coefficient of Variation 71.9 |
| Arm B: Sequential Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Ipilimumab - Cycle 2 Day 1 | 15.6 ug/mL | Geometric Coefficient of Variation 37.9 |
| Arm B: Sequential Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Ipilimumab - Cycle 1 Day 1 | 13.4 ug/mL | Geometric Coefficient of Variation 61.1 |
| Arm B: Sequential Combination | Geometric Mean End of Infusion (EOI) Concentrations of Nivolumab and Ipilimumab | Nivolumab - Cycle 1 Day 1 | 60.7 ug/mL | Geometric Coefficient of Variation 23 |
Geometric Mean Trough Concentrations of Nivolumab and Ipilimumab
Serum concentration-time data of nivolumab and ipilimumab administered as a fixed ratio combination to that of sequentially administered nivolumab and ipilimumab is summarized prior to the next dose (predose). 1 Cycle = 3 weeks
Time frame: pre-dose on day 1 of cycle 2 and 4
Population: All treated participants with available serum time-concentration data
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Arm A: Fixed Ratio Combination | Geometric Mean Trough Concentrations of Nivolumab and Ipilimumab | Ipilimumab - Cycle 2 Day 1 | 3.92 ug/mL | Geometric Coefficient of Variation 28.9 |
| Arm A: Fixed Ratio Combination | Geometric Mean Trough Concentrations of Nivolumab and Ipilimumab | Ipilimumab - Cycle 4 Day 1 | 5.90 ug/mL | Geometric Coefficient of Variation 37.8 |
| Arm A: Fixed Ratio Combination | Geometric Mean Trough Concentrations of Nivolumab and Ipilimumab | Nivolumab - Cycle 2 Day 1 | 16.2 ug/mL | Geometric Coefficient of Variation 29.1 |
| Arm A: Fixed Ratio Combination | Geometric Mean Trough Concentrations of Nivolumab and Ipilimumab | Nivolumab - Cycle 4 Day 1 | 28.5 ug/mL | Geometric Coefficient of Variation 35.3 |
| Arm B: Sequential Combination | Geometric Mean Trough Concentrations of Nivolumab and Ipilimumab | Nivolumab - Cycle 4 Day 1 | 30.5 ug/mL | Geometric Coefficient of Variation 43.1 |
| Arm B: Sequential Combination | Geometric Mean Trough Concentrations of Nivolumab and Ipilimumab | Ipilimumab - Cycle 2 Day 1 | 3.43 ug/mL | Geometric Coefficient of Variation 43.1 |
| Arm B: Sequential Combination | Geometric Mean Trough Concentrations of Nivolumab and Ipilimumab | Nivolumab - Cycle 2 Day 1 | 16.1 ug/mL | Geometric Coefficient of Variation 46.3 |
| Arm B: Sequential Combination | Geometric Mean Trough Concentrations of Nivolumab and Ipilimumab | Ipilimumab - Cycle 4 Day 1 | 5.39 ug/mL | Geometric Coefficient of Variation 39.8 |
Objective Response Rate (ORR)
The percentage of participants with a best overall response (BOR) of complete response (CR) or partial response (PR). The BOR is defined as the best response designation, as determined by the investigator, recorded between the date of randomization and the date of objectively documented progression per RECIST 1.1 or the date of first subsequent anti-cancer therapy, whichever occurs first. For participants without documented progression or subsequent therapy, all available response designations will contribute to the BOR assessment. Complete Response is defined as the disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10mm. Partial Response is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: From randomization to the date of objectively documented progression or the date of first subsequent anti-cancer (up to approximately 52 months)
Population: All treated participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Fixed Ratio Combination | Objective Response Rate (ORR) | 50.0 Percentage of Particpants |
| Arm B: Sequential Combination | Objective Response Rate (ORR) | 32.7 Percentage of Particpants |
Progression Free Survival (PFS)
The time between the date of randomization and the first date of documented progression, or death due to any cause, whichever occurs first (per investigator). Participants who die without progression will be considered to have progressed on the date of their death. Participants who did not progress or die are censored on the date of their last evaluable tumor assessment. Participants with no on study tumor assessments and who did not die will be censored on their date of randomization. Participants who started anti-cancer therapy without a prior reported progression will be censored on the date of their last evaluable tumor assessment prior to the first subsequent anti-cancer therapy. Progression is defined as at least a 20% increase in the sum of diameters of target lesions. The sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression)
Time frame: From randomization to the first date of documented progression or death due to any cause (up to approximately 52 months)
Population: All treated participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm A: Fixed Ratio Combination | Progression Free Survival (PFS) | 12.06 Months |
| Arm B: Sequential Combination | Progression Free Survival (PFS) | 7.69 Months |
The Percentage of Participants With All Causality Grade 3-5 Adverse Events
The percentage of participants who experienced at least 1 adverse event of Grade 3 or higher with onset on or after the first dose of study treatment and within 30 days of the last dose of study treatment. Evaluated using the NCI CTCAE version 4.0 criteria
Time frame: From first dose to 30 days after last dose of study therapy (up to approximately 48 months)
Population: All treated participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Fixed Ratio Combination | The Percentage of Participants With All Causality Grade 3-5 Adverse Events | 73.1 Percentage of Particpants |
| Arm B: Sequential Combination | The Percentage of Participants With All Causality Grade 3-5 Adverse Events | 65.4 Percentage of Particpants |
The Percentage of Participants With Drug Related Grade 3-5 Adverse Events
The percentage of participants who experienced at least 1 adverse event of Grade 3 or higher, judged to be related to study treatment by the investigator, with onset on or after the first dose of study treatment and within 30 days of the last dose of study treatment. Evaluated using Common Terminology Criteria for Adverse Events (NCI CTCAE) version 4.0 criteria.
Time frame: From first dose to 30 days after last dose of study therapy (up to approximately 48 months)
Population: All treated participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Fixed Ratio Combination | The Percentage of Participants With Drug Related Grade 3-5 Adverse Events | 48.1 Percentage of Participants |
| Arm B: Sequential Combination | The Percentage of Participants With Drug Related Grade 3-5 Adverse Events | 42.3 Percentage of Participants |
The Percentage of Participant With Adverse Events in the Narrow Scope MedDRA Anaphylactic Reaction Standardized MedDRA Queries (SMQ) Occurring Within 2 Days After Any Dose in the Combination Period
The percentage of participants who experienced at least 1 adverse event in the MedDRA Anaphylactic Reaction narrow scope SMQ with onset on the day of or within 2 days after any study therapy infusion during the combination period (Part 1).
Time frame: From randomization to 2 days following any dose in the combination period (assessed up to November 24th, 2017, approximately 9 months)
Population: All treated participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Fixed Ratio Combination | The Percentage of Participant With Adverse Events in the Narrow Scope MedDRA Anaphylactic Reaction Standardized MedDRA Queries (SMQ) Occurring Within 2 Days After Any Dose in the Combination Period | 0 Percentage of Participants |
| Arm B: Sequential Combination | The Percentage of Participant With Adverse Events in the Narrow Scope MedDRA Anaphylactic Reaction Standardized MedDRA Queries (SMQ) Occurring Within 2 Days After Any Dose in the Combination Period | 0 Percentage of Participants |