Immediate Surgery or Surgery After Sunitinib Malate in Treating Patients With Metastatic Kidney Cancer

NCT ID: NCT01099423

Last Updated: 2017-02-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

99 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-04-30

Study Completion Date

2017-05-31

Brief Summary

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RATIONALE: Sunitinib malate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Giving sunitinib malate before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving sunitinib malate after surgery may kill any tumor cells that remain after surgery. It is not yet known whether undergoing immediate surgery or surgery after sunitinib malate is more effective in treating patients with metastatic kidney cancer.

PURPOSE: This randomized phase III trial is studying immediate surgery to see how well it works compared with surgery after sunitinib malate in treating patients with metastatic kidney cancer.

Detailed Description

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OBJECTIVES:

* To determine if immediate versus deferred nephrectomy has an effect on disease control in patients with resectable, synchronous, metastatic renal cell carcinoma treated with sunitinib malate.
* To identify potential response criteria based on histopathology and molecular research on tumor tissue.

OUTLINE: This is a multicenter study. Patients are stratified according to WHO performance status (0 vs 1), number of metastatic sites (1 vs 2 or more), and institution. Patients are randomized to 1 of 2 treatment arms.

* Arm I (immediate nephrectomy): Patients undergo cytoreductive nephrectomy. Beginning 4 weeks after surgery, patients receive oral sunitinib malate once daily on days 1-28. Treatment with sunitinib malate repeats every 6 weeks for 4 courses in the absence of disease progression or unacceptable toxicity.
* Arm II (deferred nephrectomy): Patients receive oral sunitinib malate once daily on days 1-28. Treatment repeats every 6 weeks for 3 courses in the absence of disease progression or unacceptable toxicity. About 1 day after completion of sunitinib malate, patients undergo cytoreductive nephrectomy. Patients then receive oral sunitinib malate once daily on days 1-28. Treatment repeats every 6 weeks for 2 courses in the absence of disease progression or unacceptable toxicity.

Some patients undergo tumor tissue collection at baseline and at time of surgery to assess possible differences in gene expression. Patients also undergo blood sample collection periodically to evaluate the potential impact of serum proteins on the clinical outcome. Samples are then stored for future studies.

After completion of study treatment, patients are followed periodically.

Conditions

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Kidney Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Immediate nephrectomy

Surgery followed by Sunitinib

Group Type ACTIVE_COMPARATOR

gene expression analysis

Intervention Type GENETIC

biologic sample preservation procedure

Intervention Type OTHER

laboratory biomarker analysis

Intervention Type OTHER

therapeutic conventional surgery

Intervention Type PROCEDURE

Deferred nephrectomy

Sunitinib (3 cycles) followed by surgery followed by Sunitinib

Group Type EXPERIMENTAL

timing of surgery

Intervention Type PROCEDURE

gene expression analysis

Intervention Type GENETIC

biologic sample preservation procedure

Intervention Type OTHER

laboratory biomarker analysis

Intervention Type OTHER

Interventions

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timing of surgery

Intervention Type PROCEDURE

gene expression analysis

Intervention Type GENETIC

biologic sample preservation procedure

Intervention Type OTHER

laboratory biomarker analysis

Intervention Type OTHER

therapeutic conventional surgery

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Serum albumin CTCAE v 4.0 grade 2 or worse
* Serum LDH \> 1.5 times upper limit of normal
* Liver metastases
* Symptoms at presentation due to metastases
* Retroperitoneal lymph node involvement
* Supra-diaphragmatic lymph node involvement
* Clinical stage T3 or T4 disease
* No clinical signs of CNS involvement

PATIENT CHARACTERISTICS:

* See Disease Characteristics
* WHO performance status 0-1
* Life expectancy \> 3 months
* WBC \> 3.0 x 10\^9/L
* Platelet count \> 100 x 10\^9/L
* Hemoglobin \> 10.0 g/dL
* PT/PTT or INR ≤ 1.2 times upper limit of normal (ULN)
* Bilirubin ≤ 1.5 times ULN
* ALT ≤ 2.5 times ULN (≤ 5 times ULN if liver lesions)
* Serum calcium \< 10.0 mg/dL
* Calculated or measured creatinine clearance \> 30 mL/min
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception 2 weeks before and during study treatment
* LVEF normal by MUGA scan or ECHO
* 12-lead ECG normal
* No serious cardiac illness (myocardial infarction and/or treatable or untreatable angina pectoris not responding to treatment) within the past 12 months
* No uncontrolled, high BP (≥ 150/100 mm Hg) despite optimal medical therapy
* No current pulmonary disease
* No active or uncontrolled infections, serious illnesses, malabsorption syndrome, or medical conditions, including patients with a history of chronic alcohol abuse, hepatitis, HIV, and/or cirrhosis
* No malignancies within the past 5 years except renal cell carcinoma, basal or squamous cell carcinoma of the skin, carcinoma in situ of the cervix, resected incidental prostate cancer staged pT2 with Gleason Score ≤ 6 and postoperative PSA \< 0.5 ng/mL, or patients with any history of malignancies who are disease-free for more than 5 years
* No psychological, familial, sociological, or geographical condition potentially hampering compliance with the study protocol and follow-up schedule

PRIOR CONCURRENT THERAPY:

* Prior local radiotherapy for bone lesions allowed
* No prior systemic therapy for metastatic RCC
* No prior partial or total nephrectomy
* No concurrent systemic corticosteroid and/or other immunosuppressive systemic therapies
* No concurrent radiotherapy, except palliative radiotherapy
* No concurrent participation in another clinical trial testing treatments for any disease including renal cell carcinoma
* No other concurrent investigational or systemic therapy for metastatic RCC
Minimum Eligible Age

18 Years

Maximum Eligible Age

120 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Wales Cancer Trials Unit

OTHER

Sponsor Role collaborator

Canadian Urologic Oncology Group

OTHER

Sponsor Role collaborator

Institute of Cancer Research, United Kingdom

OTHER

Sponsor Role collaborator

European Organisation for Research and Treatment of Cancer - EORTC

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Axel Bex

Role: STUDY_CHAIR

The Netherlands Cancer Institute

John B.A.G. Haanen

Role: STUDY_CHAIR

The Netherlands Cancer Institute

Locations

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Onze Lieve Vrouw Ziekenhuis

Aalst, , Belgium

Site Status

Cliniques Universitaires St. Luc

Brussels, , Belgium

Site Status

Hôpitaux Universitaires Bordet-Erasme - Institut Jules Bordet

Brussels, , Belgium

Site Status

Universitair Ziekenhuis Gent

Ghent, , Belgium

Site Status

Virga Jesse Hospital

Hasselt, , Belgium

Site Status

AZ Groeninghe - Campus Loofstraat

Kortrijk, , Belgium

Site Status

AZ Damiaan - Campus Sint-Jozef

Ostend, , Belgium

Site Status

Queen Elizabeth II Health Sciences Centre

Halifax, Nova Scotia, Canada

Site Status

CHUM - Pavillon Saint-Luc

Montreal, Quebec, Canada

Site Status

Montreal General Hospital

Montreal, , Canada

Site Status

The Ottawa Hospital, The Integrated Cancer Program- General Campus

Ottawa, , Canada

Site Status

University Health Network - Oci / Princess Margaret Hospital

Toronto, , Canada

Site Status

Diamond Health Care Centre

Vancouver, , Canada

Site Status

San Camillo Forlanini Hospitals

Roma, , Italy

Site Status

Jeroen Bosch Ziekenhuis

's-Hertogenbosch, , Netherlands

Site Status

Academisch Medisch Centrum - Universiteit van Amsterdam

Amsterdam, , Netherlands

Site Status

The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis

Amsterdam, , Netherlands

Site Status

Vrije Universiteit Medisch Centrum

Amsterdam, , Netherlands

Site Status

University Medical Center Groningen

Groningen, , Netherlands

Site Status

Academisch Ziekenhuis Maastricht

Maastricht, , Netherlands

Site Status

Radboud University Nijmegen Medical Centre

Nijmegen, , Netherlands

Site Status

Universitair Medisch Centrum - Academisch Ziekenhuis

Utrecht, , Netherlands

Site Status

Royal United Hospital

Bath, , United Kingdom

Site Status

University Hospitals Bristol NHS Foundation Trust - Bristol Haematology And Oncology Centre

Bristol, , United Kingdom

Site Status

St. James'S University Hospital

Leeds, , United Kingdom

Site Status

Barts and The London NHS Trust - St. Bartholomew'S Hospital

London, , United Kingdom

Site Status

Imperial College Healthcare NHS Trust - Charing Cross Hospital

London, , United Kingdom

Site Status

Christie NHS Foundation Trust

Manchester, , United Kingdom

Site Status

Singelton Hospital

Swansea, , United Kingdom

Site Status

Countries

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Belgium Canada Italy Netherlands United Kingdom

References

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Bex A, Mulders P, Jewett M, Wagstaff J, van Thienen JV, Blank CU, van Velthoven R, Del Pilar Laguna M, Wood L, van Melick HHE, Aarts MJ, Lattouf JB, Powles T, de Jong Md PhD IJ, Rottey S, Tombal B, Marreaud S, Collette S, Collette L, Haanen J. Comparison of Immediate vs Deferred Cytoreductive Nephrectomy in Patients With Synchronous Metastatic Renal Cell Carcinoma Receiving Sunitinib: The SURTIME Randomized Clinical Trial. JAMA Oncol. 2019 Feb 1;5(2):164-170. doi: 10.1001/jamaoncol.2018.5543.

Reference Type DERIVED
PMID: 30543350 (View on PubMed)

Leon L, Garcia-Figueiras R, Suarez C, Arjonilla A, Puente J, Vargas B, Mendez Vidal MJ, Sebastia C. Recommendations for the clinical and radiological evaluation of response to treatment in metastatic renal cell cancer. Target Oncol. 2014 Mar;9(1):9-24. doi: 10.1007/s11523-013-0304-7. Epub 2013 Dec 12.

Reference Type DERIVED
PMID: 24338498 (View on PubMed)

Winquist E, Rodrigues G. Open clinical uro-oncology trials in Canada. Can J Urol. 2012 Dec;19(6):6587-91. No abstract available.

Reference Type DERIVED
PMID: 23228299 (View on PubMed)

Other Identifiers

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EU-21022

Identifier Type: -

Identifier Source: secondary_id

PFIZER-EORTC-30073

Identifier Type: -

Identifier Source: secondary_id

EORTC-30073

Identifier Type: -

Identifier Source: org_study_id

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