Everolimus With or Without Bevacizumab in Treating Patients With Advanced Kidney Cancer That Progressed After First-Line Therapy

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Basic Trial Information

PhaseTypeStatusAgeSponsorProtocol IDs
Phase IIIBiomarker/Laboratory analysis, TreatmentClosed18 and overNCINCI-2011-02603
CDR0000684313, CALGB 90802, U10CA180821, U10CA031946, NCT01198158

Trial Description

Summary

This randomized phase III trial studies giving everolimus together with bevacizumab to see how well it works compared to everolimus alone in treating patients with advanced kidney cancer that progressed after first-line therapy. Everolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as bevacizumab, can interfere with tumor growth by blocking the ability of tumor cells to grow and spread. Everolimus and bevacizumab may also stop the growth of kidney cancer by blocking blood flow to the tumor. It is not yet known whether giving everolimus together with bevacizumab is better than everolimus alone in treating patients with advanced kidney cancer that has progressed after first-line therapy.

Further Study Information

PRIMARY OBJECTIVES:

l. To compare the overall survival of patients receiving bevacizumab plus everolimus and everolimus alone among patients with advanced renal cell carcinoma progressing after first line vascular epidermal growth factor receptor (VEGFR)-tyrosine kinase inhibitor (TKI) treatment.

SECONDARY OBJECTIVES:

I. To compare the progression-free survival and proportion who experience an objective response (defined as complete clinical response [cCR] + partial response [PR]) in patients with advanced renal cell carcinoma receiving bevacizumab plus everolimus and everolimus alone.

II. To compare grade 3 or higher toxicity in patients receiving each treatment regimen.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive everolimus orally (PO) once daily (QD) on days 1-28.

ARM II: Patients receive everolimus PO QD on days 1-28 and bevacizumab intravenously (IV) over 30-90 minutes on days 1 and 15.

In both arms, courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 8 weeks until disease progression and then every 6 months for up to 5.5 years.

Eligibility Criteria

Inclusion Criteria:

  • Renal cell carcinoma with some component of clear cell histology
  • Metastatic or unresectable disease
  • Must have been treated with at least 1 prior VEGFR tyrosine kinase inhibitor treatment and have progressed or have been intolerant to treatment
  • No prior systemic therapy with a vascular endothelial growth factor (VEGF) binding agent (e.g., bevacizumab)
  • No prior systemic therapy with any mechanistic target of rapamycin (mTOR) inhibitor (e.g., sirolimus, temsirolimus, everolimus)
  • Prior cytokine therapy is allowed
  • Any systemic therapy must be completed at least 4 weeks prior to registration
  • >= 2 weeks since any prior radiation (including palliative)
  • Patients must not have had a major surgical procedure, open biopsy, or significant traumatic injury within 4 weeks prior to study registration, and must have fully recovered from any such procedure
  • The following are not considered to be major procedures: thoracentesis, paracentesis, port placement, laparoscopy, thoracoscopy, bronchoscopy, endoscopic ultrasonographic procedures, mediastinoscopy, skin biopsies, incisional biopsies and routine dental procedures
  • Patients must have measurable disease by RECIST criteria; lesions that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 2 cm with conventional techniques or as >= 1 cm with spiral computed tomography (CT) scan
  • No active brain metastases: patients with treated, stable brain metastases for at least three months are eligible as long as they meet the following criteria:
  • Treated brain metastases are defined as having no ongoing requirement for steroids and no evidence of progression or hemorrhage after treatment for at least 3 months, as ascertained by clinical examination and brain imaging (magnetic resonance imaging [MRI] or CT) (stable dose of anticonvulsants are allowed); treatment for brain metastases may include whole brain radiotherapy (WBRT), radiosurgery (RS; Gamma Knife, linear accelerator [LINAC], or equivalent) or a combination as deemed appropriate by the treating physician; patients with central nervous system (CNS) metastases treated by neurosurgical resection or brain biopsy performed within 3 months prior to day 1 are not eligible
  • Baseline brain imaging (MRI/CT) is required
  • No serious non-healing wound, ulcer, or bone fracture
  • No arterial thrombotic events within 6 months of registration:
  • Including transient ischemic attack (TIA), cerebrovascular accident (CVA), peripheral arterial thrombus, unstable angina or angina requiring surgical or medical intervention in the past 6 months, or myocardial infarction (MI); patients with clinically significant peripheral artery disease (i.e., claudication on less than one block), significant vascular disease (i.e., aortic aneurysm, history of aortic dissection), or any other arterial thrombotic event are ineligible
  • Patients who have experienced a deep venous thrombosis or pulmonary embolus within the past 6 months must be on stable therapeutic anticoagulation to be enrolled to this study
  • Patients receiving anti-platelet agents and prophylactic anticoagulation are eligible
  • No inadequately controlled hypertension: (defined as a blood pressure of >= 160 mmHg systolic and/or >= 90 mmHg diastolic on medication), or any prior history of hypertensive crisis or hypertensive encephalopathy
  • No known severe impairment of lung function, defined as >= grade 2 dyspnea or cough, or either:
  • Requirement of supplemental oxygen, or
  • In cases where pulmonary function or pulse oximetry tests have been obtained, forced expiratory volume of the lung in one second (FEV1) or forced vital capacity (FVC) are < 50% of predicted, or single breath diffusing capacity of the lung for carbon monoxide (DLCO) is < 35% of predicted or resting room oxygen saturation is less than 90%
  • No active or severe liver disease (e.g. acute or chronic hepatitis, cirrhosis)
  • No positive serology for anti-hemoglobin C (HBC) or anti-hepatitis C virus (HCV) antibodies; hepatitis B virus (HBV) seropositive patients (hepatitis B surface antigen [HBsAg] positive) are eligible if they are closely monitored for evidence of active HBV infection by HBV deoxryribonucleic acid (DNA) testing and agree to receive suppressive therapy with lamivudine or other HBV-suppressive therapy until at least 4 weeks after the last dose of everolimus
  • No New York Heart Association (NYHA) class >= 2 congestive heart failure
  • No active bleeding or chronic hemorrhagic diathesis or increased risk for bleeding: Including but not limited to history of major bleeding within 6 months (e.g. gastrointestinal, lung, CNS sites; or required transfusion support)
  • No history of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess within 6 months prior to the initiation of treatment
  • No ongoing immunosuppressive therapy: including chronic systemic treatment with corticosteroids (>= 10 mg/day prednisone equivalent)
  • Archival tissue must be available for submission: though it is optional patients to choose to participate in the correlative substudies or not
  • Patients who are pregnant or nursing are not eligible
  • Women of child bearing potential must have a negative serum or urine pregnancy test within 16 days prior to registration
  • Women of child-bearing potential include:
  • Any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy, bilateral tubal ligation or bilateral oophorectomy) or is not postmenopausal (defined as amenorrhea >= 12 consecutive months)
  • Women on hormone replacement therapy (HRT) with documented serum follicle stimulating hormone (FSH) level > 35m IU/mL
  • Women who are using oral, implanted or injectable contraceptive hormones or mechanical products such as an intrauterine device or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy or practicing abstinence or where partner is sterile (e.g., vasectomy)
  • Performance status Eastern Cooperative Oncology Group (ECOG) 0-2 or Karnofsky score >= 60%
  • Granulocytes >= 1,500/μL
  • Platelet count >= 100,000/μL
  • Calculated creatinine clearance >= 30 mL/minute (modified Cockroft and Gault formula)
  • Bilirubin =< 1.5 x upper limits of normal
  • Aspartate aminotransferase (AST) =< 2.5 x upper limits of normal (ULN)
  • Fasting serum triglycerides =< 200 mg/dL
  • Serum cholesterol =< 300 mg/dL
  • Fasting serum glucose =< 1.5 x ULN
  • Urine protein to creatinine ratio < 1.0 or urine protein =< 1+

Trial Contact Information

Trial Lead Organizations/Sponsors

National Cancer Institute

    George Philips, Principal Investigator

    Trial Sites

    U.S.A.

    California
    Los Angeles

    Kaiser Permanente Medical Center - Los Angeles

    Han A Koh
    Ph: 626-564-3455

    San Diego

    Kaiser Permanente - Mission

    Han A Koh
    Ph: 626-564-3455

    Santa Clara

    Kaiser Permanente Medical Center - Santa Clara Homestead Campus

    Louis Fehrenbacher
    Ph: 626-564-3455

    Florida
    Orange Park

    Integrated Community Oncology Network - Orange Park

    Linda Struhar-Sylvester
    Ph: 904-861-8574
    Email: info@icononcology.com

    Hawaii
    Aiea

    Kapiolani Medical Center at Pali Momi

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    Honolulu

    Cancer Research Center of Hawaii

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    Hawaii Medical Center - East

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    Kapiolani Medical Center for Women and Children

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    OnCare Hawaii, Incorporated - Kuakini

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    OnCare Hawaii, Incorporated - Lusitana

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    Queen's Cancer Institute at Queen's Medical Center

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    Straub Clinic and Hospital, Incorporated

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    Kailua

    Castle Medical Center

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    Lihue

    Kauai Medical Clinic

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    Wailuku

    Maui Memorial Medical Center

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    Pacific Cancer Institute - Maui

    Jeffrey L. Berenberg
    Ph: 808-586-2979

    Indiana
    Beech Grove

    St. Francis Hospital and Health Centers - Beech Grove Campus

    Howard M. Gross
    Ph: 765-983-3000

    Fort Wayne

    Fort Wayne Medical Oncology and Hematology

    Sreenivasa Rao Nattam
    Ph: 260-484-8830
    Email: ledgar@fwmoh.com

    Radiation Oncology Associates Southwest

    Bharat H. Barai
    Ph: 219-736-2800

    North Carolina
    Concord

    Batte Cancer Center at Northeast Medical Center

    James Grier Wall
    Ph: 704-355-2884

    Durham

    Duke Cancer Institute

    Jeffrey Crawford
    Ph: 888-275-3853

    North Dakota
    Bismarck

    Bismarck Cancer Center

    John T Reynolds
    Ph: 701-323-5760
    Email: tfischer@mohs.org

    Oregon
    Clackamas

    Clackamas Radiation Oncology Center

    Alison K Conlin
    Ph: 503-215-6412

    Milwaukie

    Providence Milwaukie Hospital

    Alison K Conlin
    Ph: 503-215-6412

    Newberg

    Providence Newberg Medical Center

    Alison K Conlin
    Ph: 503-215-6412

    Oregon City

    Willamette Falls Hospital

    Alison K Conlin
    Ph: 503-215-6412

    Portland

    CCOP - Columbia River Oncology Program

    Alison K Conlin
    Ph: 503-215-6412

    Providence Cancer Center at Providence Portland Medical Center

    Alison K Conlin
    Ph: 503-215-6412

    Providence St. Vincent Medical Center

    Alison K Conlin
    Ph: 503-215-6412

    Pennsylvania
    Abington

    Rosenfeld Cancer Center at Abington Memorial Hospital

    Willard G. Andrews
    Ph: 215-481-2402

    Bryn Mawr

    Bryn Mawr Hospital

    Paul B. Gilman
    Ph: 484-476-2649
    Email: wellenbachj@mlhs.org

    Paoli

    Cancer Center of Paoli Memorial Hospital

    Paul B. Gilman
    Ph: 484-476-2649
    Email: wellenbachj@mlhs.org

    Wynnewood

    CCOP - Main Line Health

    Paul B. Gilman
    Ph: 484-476-2649
    Email: wellenbachj@mlhs.org

    Lankenau Cancer Center at Lankenau Hospital

    Paul B. Gilman
    Ph: 484-476-2649
    Email: wellenbachj@mlhs.org

    Washington
    Vancouver

    Southwest Washington Medical Center Cancer Center

    Alison K Conlin
    Ph: 503-215-6412

    West Virginia
    Huntington

    Edwards Comprehensive Cancer Center at Cabell Huntington Hospital

    Maria-Rosalia B. Tria Tirona
    Ph: 304-399-6617

    Wisconsin
    Appleton

    Fox Valley Hematology and Oncology - East Grant Street

    Avi Bar-Lev
    Ph: 920-749-1171

    Link to the current ClinicalTrials.gov record.
    NLM Identifier NCT01198158
    ClinicalTrials.gov processed this data on May 20, 2015

    Note: Information about this trial is from the ClinicalTrials.gov database. The versions designated for health professionals and patients contain the same text. Minor changes may be made to the ClinicalTrials.gov record to standardize the names of study sponsors, sites, and contacts. Cancer.gov only lists sites that are recruiting patients for active trials, whereas ClinicalTrials.gov lists all sites for all trials. Questions and comments regarding the presented information should be directed to ClinicalTrials.gov.