Sunitinib and Erlotinib in Treating Patients With Unresectable or Metastatic Kidney Cancer

NCT ID: NCT00425386

Last Updated: 2017-05-03

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2006-08-31
• Study Completion Date: 2014-03-31

Brief Summary

RATIONALE: Sunitinib and erlotinib may stop the growth of tumor cell by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Giving sunitinib together with erlotinib may kill more tumor cells.

PURPOSE: This phase II trial is studying the best dose of erlotinib when given together with sunitinib and to see how well they work in treating patients with unresectable or metastatic kidney cancer.

Detailed Description

OBJECTIVES:

Primary

• Determine the maximum tolerated dose of erlotinib hydrochloride when administered with sunitinib malate in patients with unresectable or metastatic renal cell carcinoma.
• Determine the 8-month progression-free survival of patients treated with this regimen.

Secondary

• Determine the safety of sunitinib malate and erlotinib hydrochloride in these patients.
• Determine the duration of response in these patients.
• Determine the proportion of patients whose best overall response is complete response, partial response, stable disease, or progressive disease.
• Determine the overall survival of patients treated with this regimen.
• Determine the maximum percent reduction in tumor measurement in patients treated with this regimen.
• Collect blood and tissue from these patients for future correlative studies.

OUTLINE: This is an open-label, multicenter, dose-escalation study of erlotinib hydrochloride.

Patients receive oral sunitinib malate once daily on days 1-28 and oral erlotinib hydrochloride once daily on days 1-42. Treatment repeats every 6 weeks in the absence of disease progression or unacceptable toxicity.

Cohorts of 3-6 patients receive escalating doses of erlotinib hydrochloride until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose at which 33% of patients experience dose-limiting toxicity. Once the MTD is determined, patients are treated with erlotinib hydrochloride at the MTD and sunitinib malate.

Patients undergo blood and tumor specimen collection periodically during study for future correlative studies.

PROJECTED ACCRUAL: A total of 49 patients will be accrued for this study.

Conditions

Kidney Cancer

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Erlotinib and Sunitinib

Drug: erlotinib hydrochloride Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily;

1. 100 mg/day, continuous daily; 1.5= 125 mg/day, continuous daily;

2. 150 mg/day, continuous daily

Drug: sunitinib malate Will be administered at 50 mg daily, 4 weeks on, 2 weeks off

Group Type: EXPERIMENTAL

erlotinib hydrochloride

Intervention Type: DRUG

Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily;

1. 100 mg/day, continuous daily; 1.5= 125 mg/day, continuous daily;

2. 150 mg/day, continuous daily

sunitinib malate

Intervention Type: DRUG

Will be administered at 50 mg daily, 4 weeks on, 2 weeks off

biopsy

Intervention Type: PROCEDURE

Paraffin block (or unstained slides) of the primary tumor and/or metastatic lesions (as available) and a plasma sample for future correlative studies will be collected. A paraffin block (or at least 10 unstained slides, each of 10 micromillimeter thickness) from the original paraffin-embedded biopsy material taken at the diagnosis will be stored at 4 degrees Celsius.

Interventions

erlotinib hydrochloride

Dose Level 0 = 50 mg/day, continuous daily; 0.5= 75 mg/day, continuous daily;

1. 100 mg/day, continuous daily; 1.5= 125 mg/day, continuous daily;

2. 150 mg/day, continuous daily

Intervention Type: DRUG

sunitinib malate

Will be administered at 50 mg daily, 4 weeks on, 2 weeks off

Intervention Type: DRUG

biopsy

Paraffin block (or unstained slides) of the primary tumor and/or metastatic lesions (as available) and a plasma sample for future correlative studies will be collected. A paraffin block (or at least 10 unstained slides, each of 10 micromillimeter thickness) from the original paraffin-embedded biopsy material taken at the diagnosis will be stored at 4 degrees Celsius.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed renal cell carcinoma with a component of clear cell or papillary carcinoma

• Unresectable or metastatic disease (radiologically or clinically confirmed)
• Measurable disease (≥ 1 site)
• No known brain metastasis that has not been adequately treated with radiotherapy and/or surgery

PATIENT CHARACTERISTICS:

• Eastern Cooperative Oncology Group (ECOG) performance status 0-2
• Absolute neutrophil count ≥ 1,500/mm³
• Platelet count ≥ 100,000/mm³
• No grade 3 hemorrhage within the past 4 weeks
• Bilirubin ≤ 1.5 times upper limit of normal (ULN)
• Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) ≤ 2.5 times ULN (< 5 times ULN if due to underlying disease)
• No chronic liver disease (i.e., chronic active hepatitis or cirrhosis)
• Creatinine ≤ 1.5 times ULN
• None of the following cardiovascular conditions within the past 12 months:

• Myocardial infarction
• Severe/unstable angina
• Coronary/peripheral artery bypass graft
• Symptomatic congestive heart failure
• Cerebrovascular accident or transient ischemic attack
• Pulmonary embolism
• Ongoing cardiac dysrhythmia ≥ grade 2
• Atrial fibrillation of any grade
• Prolongation of the corrected QT (QTc) interval to > 450 msec for males or to > 470 msec for females
• Left Ventricular Ejection Fraction (LVEF) normal by Multigated Acquisition (MUGA) or echocardiogram
• No hypertension uncontrolled with medical therapy
• No other active malignancy within the past 5 years except basal cell skin cancer or cervical carcinoma in situ
• No uncontrolled adrenal insufficiency
• No uncontrolled hypothyroidism
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 3 months after completion of study treatment
• No severe and/or uncontrolled medical disease (i.e., uncontrolled diabetes, chronic renal disease, or active uncontrolled infection)
• No impaired gastrointestinal (GI) function or GI disease that may significantly alter the absorption of study drugs
• No other severe acute or chronic medical or psychiatric condition or laboratory abnormality that would preclude study participation

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• More than 4 weeks since prior major surgery
• More than 4 weeks since prior cytotoxic chemotherapy (6 weeks for nitrosoureas or mitomycin C)
• More than 4 weeks since prior radiotherapy
• No prior radiotherapy to > 25% of the bone marrow
• More than 28 days since prior investigational agents
• No prior sunitinib malate
• No prior anti-epidermal growth factor receptor therapy (e.g., erlotinib hydrochloride, panitumumab, cetuximab, or gefitinib)
• No concurrent therapeutic warfarin

• Low-dose oral warfarin ≤ 2 mg daily for deep vein thrombosis prophylaxis is allowed after the maximum tolerated dose of erlotinib hydrochloride is determined
• No concurrent Hypericum perforatum (St. John's wort)
• No concurrent chemotherapy or biologic therapy
• No other concurrent anticancer therapy
• No other concurrent investigational agents

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Cancer Institute (NCI)

NIH

Sponsor Role: collaborator

OHSU Knight Cancer Institute

OTHER

Sponsor Role: lead

Responsible Party

Christopher Ryan

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Christopher W. Ryan, MD

Role: STUDY_CHAIR

OHSU Knight Cancer Institute

Locations

University of Southern California

Los Angeles, California, United States

Providence Cancer Center at Providence Portland Medical Center

Portland, Oregon, United States

OHSU Knight Cancer Institute

Portland, Oregon, United States

Salem Hospital

Salem, Oregon, United States

Countries

United States

References

Ryan CW, Curti BD, Pattee KJ, et al.: A dose-escalation phase II study of sunitinib (S) plus erlotinib (E) in advanced renal carcinoma (RCC). [Abstract] American Society of Clinical Oncology 2008 Genitourinary Cancers Symposium, Feb 14-16, 2008, San Francisco, CA. A-361, 2008.

Reference Type: RESULT

Feng Z, Curti BD, Quinn DI, Strother JM, Chen Z, Agnor R, Beer TM, Ryan CW. A Phase II, Single-arm Trial of Sunitinib and Erlotinib in Advanced Renal Cell Carcinoma. Clin Genitourin Cancer. 2022 Oct;20(5):415-422. doi: 10.1016/j.clgc.2022.04.018. Epub 2022 May 5.

Reference Type: DERIVED

PMID: 35688679 (View on PubMed)

Other Identifiers

P30CA069533

Identifier Type: NIH

Identifier Source: secondary_id

View Link

OHSU-2683

Identifier Type: OTHER

Identifier Source: secondary_id

OHSU-SOL-06051-LM

Identifier Type: OTHER

Identifier Source: secondary_id

CDR0000526204

Identifier Type: -

Identifier Source: org_study_id