Kidney Neoplasms
Conditions
Brief summary
The purpose of this study is to assess the safety and efficacy of nivolumab combined with ipilimumab in intermediate and poor-risk participants with previously untreated advanced renal cell carcinoma (RCC) or metastatic RCC (mRCC) in India.
Interventions
Specified dose on specified days
Specified dose on specified days
Sponsors
Study design
Eligibility
Inclusion criteria
* Histological confirmation of renal cell carcinoma (RCC) with clear cell component including participants who may have sarcomatoid features * Qualifies as intermediate or poor risk by meeting at least one of the prognostic factors as per the International Metastatic RCC Database Consortium (IMDC) criteria * Indian participants with Indian ethnicity living in India * No prior systemic therapy for RCC * Measurable disease lesion by computed tomography (CT) or magnetic resonance imaging (MRI) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria
Exclusion criteria
* Participants with active, untreated, symptomatic central nervous system (CNS) metastases * Major surgery less than 28 days prior to the first dose of study treatment * Participants with an autoimmune disease, or any other condition, requiring systemic treatment with either corticosteroids or other immunosuppressive medications Other protocol-defined inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | From first dose until 100 days after the last dose or for a maximum of 52 weeks from the date of the first on-study dose of nivolumab, whichever occurs earlier. | IMAEs are a type of adverse event that occurs when the immune system reacts against the body's own tissues, including diarrhea/colitis, hepatitis, pneumonitis, nephritis and renal dysfunction, rash, and endocrine (adrenal insufficiency, hypophysitis, hypothyroidism/thyroiditis, hyperthyroidism, and diabetes mellitus). IMAE analyses includes events, regardless of causality, which occurred during the study and follow-up. Only participants who received immune-modulating medication for treatment of the event are reported, with the exception of endocrine events, which will be included regardless of treatment since these events are often managed without immunosuppression. High grade (Grade 3 to 4 and Grade 5) IMAEs are reported. IMAEs are graded on a scale from 1 to 5, in which Grade 3 is severe or medically significant but not immediately life-threatening; Grade 4 events may require hospitalization; Grade 5 events are fatal. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Resolution of High Grade Immune-Mediated Adverse Event (IMAE) | From first dose until resolution of IMAE (up to approximately 15 months) | Time to resolution of IMAEs is defined as the longest time from onset to complete resolution or improvement to the grade at baseline among all clustered AEs experienced by the participant in this category per adverse event criteria category. Events which worsened into grade 5 events (death) or have a resolution date equal to the date of death are considered unresolved. If a clustered AE is considered as unresolved, the resolution date will be censored to the last known alive date. Improvement to the grade at baseline implies that all different events in the clustered adverse event should at least have improved to the corresponding (i.e. with same preferred term) baseline grade. High grade (Grades 3 through 5) IMAEs are reported. IMAEs are graded on a scale from 1 to 5, in which Grade 3 is severe or medically significant but not immediately life-threatening; Grade 4 events may require hospitalization; Grade 5 events are fatal. |
| The Number of Participants Who Received Immune-Modulating Medication | From first dose up to 100 days after last dose (up to approximately 15 months) | Immune modulating medications are medications entered on an immune modulating medication form or available from the most current pre-defined list of immune modulating medications. This list is revisited whenever UMC WHO releases a new version and updated accordingly. |
| Time to Onset of High Grade Immune-Mediated Adverse Event (IMAE) | From first dose until onset of IMAE (up to approximately 15 months) | Time to onset is defined as the time between the day of the first dose of study treatment and the onset date of the earliest AE (Grades 3-5) in this category. All IMAEs that occurred between first dose and 100 days past last dose are recorded. IMAEs are a type of adverse event that occurs when the immune system reacts against the body's own tissues. IMAE analyses includes events, regardless of causality, which occurred during the study and follow-up. Only participants who received immune-modulating medication for treatment of the event are reported, with the exception of endocrine events, which will be included regardless of treatment since these events are often managed without immunosuppression. High grade (Grades 3 through 5) IMAEs are reported. IMAEs are graded on a scale from 1 to 5, in which Grade 3 is severe or medically significant but not immediately life-threatening; Grade 4 events may require hospitalization; Grade 5 events are fatal. |
| Time to Response (TTR) | From first dose to the date of CR or PR (up to approximately 15 months) | TTR is defined as the time from the date of first dose to the date of the first confirmed documented response (CR or PR). For the non-responders, TTR was censored at the maximum time of response + 1 day of all participants. CR= Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR= At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. |
| Duration of Response (DoR) | From first documented response (CR or PR) up to first documented progression or death due to any cause, whichever occurs first (up to approximately 3 years) | Duration of Response (DOR) is defined as the time between the date of first documented response (CR or PR) that was subsequently confirmed to the date of the first documented progression as determined using RECIST 1.1, or death due to any cause, whichever occurs first. For participants who neither progress nor die, the duration of response will be censored on the date of their last evaluable tumor assessment. For participants who start subsequent therapy before progression or die, the duration of response will be censored on the date of their last evaluable tumor assessment conducted on or prior to the initiation of the subsequent therapy. CR= Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR= At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Analysis based on Kaplan Meier estimates. |
| Objective Response Rate (ORR) | From first dose up to 100 days after last dose (up to approximately 15 months) | Objective Response Rate (ORR) was defined as the number of participants with a best overall response of confirmed Complete Response (CR) or Partial Response (PR) (per RECIST 1.1 criteria) divided by the number of all treated participants. RECIST 1.1 = Response Evaluation Criteria in Solid Tumors. CR= Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR= At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. |
Countries
India
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Nivolumab + Ipilimumab Participants received nivolumab 3mg/kg Q3W combined with ipilimumab 1mg/kg Q3W for 4 doses followed by nivolumab 3mg/kg Q2W for up to 52 weeks. | 101 |
| Total | 101 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse event unrelated to study drug | 9 |
| Overall Study | Disease progression | 39 |
| Overall Study | Other reasons | 1 |
| Overall Study | Participants withdrew consent | 2 |
| Overall Study | Study drug toxicity | 14 |
Baseline characteristics
| Characteristic | Nivolumab + Ipilimumab |
|---|---|
| Age, Continuous | 56.0 Years STANDARD_DEVIATION 9.99 |
| Race/Ethnicity, Customized Asian Indian | 101 Participants |
| Sex: Female, Male Female | 22 Participants |
| Sex: Female, Male Male | 79 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 11 / 101 |
| other Total, other adverse events | 80 / 101 |
| serious Total, serious adverse events | 37 / 101 |
Outcome results
Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE)
IMAEs are a type of adverse event that occurs when the immune system reacts against the body's own tissues, including diarrhea/colitis, hepatitis, pneumonitis, nephritis and renal dysfunction, rash, and endocrine (adrenal insufficiency, hypophysitis, hypothyroidism/thyroiditis, hyperthyroidism, and diabetes mellitus). IMAE analyses includes events, regardless of causality, which occurred during the study and follow-up. Only participants who received immune-modulating medication for treatment of the event are reported, with the exception of endocrine events, which will be included regardless of treatment since these events are often managed without immunosuppression. High grade (Grade 3 to 4 and Grade 5) IMAEs are reported. IMAEs are graded on a scale from 1 to 5, in which Grade 3 is severe or medically significant but not immediately life-threatening; Grade 4 events may require hospitalization; Grade 5 events are fatal.
Time frame: From first dose until 100 days after the last dose or for a maximum of 52 weeks from the date of the first on-study dose of nivolumab, whichever occurs earlier.
Population: All treated participants
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Pneumonitis Grade 3-4 | 2 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Nephritis and Renal Dysfunction Grade 3-4 | 1 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Rash Grade 3-4 | 2 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Adrenal Insufficiency Grade 3-4 | 1 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Diarrhea/Colitis Grade 3-5 | 0 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Hepatitis Grade 3-5 | 0 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Nephritis and Renal Dysfunction Grade 5 | 0 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Rash Grade 5 | 0 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Hypersensitivity Grade 3-5 | 0 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Adrenal Insufficiency Grade 5 | 0 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Hypothyroidism/Thyroiditis Grade 3-5 | 0 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Diabetes Mellitus Grade 3-5 | 0 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Hyperthyroidism Grade 3-5 | 0 Participants |
| Nivolumab + Ipilimumab | Total Number of Participants Experiencing High Grade Immune-Mediated Adverse Events (IMAE) | Hypophysitis Grade 3-5 | 0 Participants |
Duration of Response (DoR)
Duration of Response (DOR) is defined as the time between the date of first documented response (CR or PR) that was subsequently confirmed to the date of the first documented progression as determined using RECIST 1.1, or death due to any cause, whichever occurs first. For participants who neither progress nor die, the duration of response will be censored on the date of their last evaluable tumor assessment. For participants who start subsequent therapy before progression or die, the duration of response will be censored on the date of their last evaluable tumor assessment conducted on or prior to the initiation of the subsequent therapy. CR= Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR= At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Analysis based on Kaplan Meier estimates.
Time frame: From first documented response (CR or PR) up to first documented progression or death due to any cause, whichever occurs first (up to approximately 3 years)
Population: All treated participants who have measurable disease at baseline and at least one on-study assessment
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab + Ipilimumab | Duration of Response (DoR) | NA Months |
Objective Response Rate (ORR)
Objective Response Rate (ORR) was defined as the number of participants with a best overall response of confirmed Complete Response (CR) or Partial Response (PR) (per RECIST 1.1 criteria) divided by the number of all treated participants. RECIST 1.1 = Response Evaluation Criteria in Solid Tumors. CR= Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR= At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: From first dose up to 100 days after last dose (up to approximately 15 months)
Population: All response evaluable participants - a total of 16 participants were excluded from all response evaluable participants population as they did not have measurable disease at baseline or at least 1 evaluable on-study assessment
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Nivolumab + Ipilimumab | Objective Response Rate (ORR) | 37.6 Percentage of participants |
The Number of Participants Who Received Immune-Modulating Medication
Immune modulating medications are medications entered on an immune modulating medication form or available from the most current pre-defined list of immune modulating medications. This list is revisited whenever UMC WHO releases a new version and updated accordingly.
Time frame: From first dose up to 100 days after last dose (up to approximately 15 months)
Population: All treated participants
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nivolumab + Ipilimumab | The Number of Participants Who Received Immune-Modulating Medication | 38 Participants |
Time to Onset of High Grade Immune-Mediated Adverse Event (IMAE)
Time to onset is defined as the time between the day of the first dose of study treatment and the onset date of the earliest AE (Grades 3-5) in this category. All IMAEs that occurred between first dose and 100 days past last dose are recorded. IMAEs are a type of adverse event that occurs when the immune system reacts against the body's own tissues. IMAE analyses includes events, regardless of causality, which occurred during the study and follow-up. Only participants who received immune-modulating medication for treatment of the event are reported, with the exception of endocrine events, which will be included regardless of treatment since these events are often managed without immunosuppression. High grade (Grades 3 through 5) IMAEs are reported. IMAEs are graded on a scale from 1 to 5, in which Grade 3 is severe or medically significant but not immediately life-threatening; Grade 4 events may require hospitalization; Grade 5 events are fatal.
Time frame: From first dose until onset of IMAE (up to approximately 15 months)
Population: All treated participants who experienced at least 1 IMAE
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Nivolumab + Ipilimumab | Time to Onset of High Grade Immune-Mediated Adverse Event (IMAE) | ADRENAL INSUFFICIENCY | 9.9 Weeks |
| Nivolumab + Ipilimumab | Time to Onset of High Grade Immune-Mediated Adverse Event (IMAE) | PNEUMONITIS | 7.29 Weeks |
| Nivolumab + Ipilimumab | Time to Onset of High Grade Immune-Mediated Adverse Event (IMAE) | NEPHRITIS AND RENAL DYSFUNCTION | 20.00 Weeks |
| Nivolumab + Ipilimumab | Time to Onset of High Grade Immune-Mediated Adverse Event (IMAE) | RASH | 29.21 Weeks |
Time to Resolution of High Grade Immune-Mediated Adverse Event (IMAE)
Time to resolution of IMAEs is defined as the longest time from onset to complete resolution or improvement to the grade at baseline among all clustered AEs experienced by the participant in this category per adverse event criteria category. Events which worsened into grade 5 events (death) or have a resolution date equal to the date of death are considered unresolved. If a clustered AE is considered as unresolved, the resolution date will be censored to the last known alive date. Improvement to the grade at baseline implies that all different events in the clustered adverse event should at least have improved to the corresponding (i.e. with same preferred term) baseline grade. High grade (Grades 3 through 5) IMAEs are reported. IMAEs are graded on a scale from 1 to 5, in which Grade 3 is severe or medically significant but not immediately life-threatening; Grade 4 events may require hospitalization; Grade 5 events are fatal.
Time frame: From first dose until resolution of IMAE (up to approximately 15 months)
Population: All treated participants who experienced at least 1 IMAE that was resolved. Participants who experienced an IMAE that did not resolve were censored.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Nivolumab + Ipilimumab | Time to Resolution of High Grade Immune-Mediated Adverse Event (IMAE) | ADRENAL INSUFFICIENCY | 1.1 Weeks |
| Nivolumab + Ipilimumab | Time to Resolution of High Grade Immune-Mediated Adverse Event (IMAE) | RASH | 10.07 Weeks |
Time to Response (TTR)
TTR is defined as the time from the date of first dose to the date of the first confirmed documented response (CR or PR). For the non-responders, TTR was censored at the maximum time of response + 1 day of all participants. CR= Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. PR= At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: From first dose to the date of CR or PR (up to approximately 15 months)
Population: All confirmed responders
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab + Ipilimumab | Time to Response (TTR) | 2.79 Months |