Clinical Trials /

Sitravatinib and Nivolumab in Treating Patients With Advanced or Metastatic Kidney Cancer

NCT03015740

Description:

This phase I/II trial studies the side effects of sitravatinib and how well it works with nivolumab in treating patients with kidney cancer that has spread to other places in the body. Sitravatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving sitravatinib and nivolumab may work better in treating patients with kidney cancer.

Related Conditions:
  • Clear Cell Renal Cell Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Sitravatinib and Nivolumab in Treating Patients With Advanced or Metastatic Kidney Cancer
  • Official Title: Phase I/II Trial of MGCD516 Combined With Nivolumab in Patients With Advanced Clear Cell Renal Cell Cancer That Progressed on Prior VEGF-Targeted Therapy

Clinical Trial IDs

  • ORG STUDY ID: 2016-0332
  • SECONDARY ID: NCI-2017-00324
  • SECONDARY ID: 2016-0332
  • SECONDARY ID: P30CA016672
  • NCT ID: NCT03015740

Conditions

  • Clear Cell Renal Cell Carcinoma
  • Metastatic Kidney Carcinoma
  • Stage III Renal Cell Cancer AJCC v7
  • Stage IV Renal Cell Cancer AJCC v7

Interventions

DrugSynonymsArms
NivolumabBMS-936558, MDX-1106, NIVO, ONO-4538, OpdivoTreatment (sitravatinib, nivolumab)
SitravatinibMGCD516Treatment (sitravatinib, nivolumab)

Purpose

This phase I/II trial studies the side effects of sitravatinib and how well it works with nivolumab in treating patients with kidney cancer that has spread to other places in the body. Sitravatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving sitravatinib and nivolumab may work better in treating patients with kidney cancer.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To determine the toxicities (defined as a grade 3 or 4 National Cancer Institute [NCI]
      non-hematologic or hematologic adverse event, within 12 weeks from treatment initiation), and
      efficacy (defined as achieving complete remission, partial remission, or stable disease
      within 6 weeks) of sitravatinib (MGCD516) when administered orally (PO) daily in combination
      with standard dose nivolumab 240 mg/kg every 2 weeks.

      SECONDARY OBJECTIVES:

      I. To estimate the overall survival (OS), progression-free survival (PFS) times, objective
      response rates (ORR), and quality of life (QOL) of patients with advanced clear cell renal
      cell cancer (RCC) treated with the combination of MGCD516 and nivolumab.

      II. Evaluate potential biomarkers for patient stratification and treatment response,
      including genetic analysis, serum cytokines and chemokines, as well as tumor antigen-specific
      immune responses, such as antibody and T cell responses, as surrogates for anti-tumor
      activity.

      OUTLINE:

      Patients receive sitravatinib PO once daily (QD) on days 1-14 and receive nivolumab
      intravenously (IV) over 60 minutes on day 1 starting cycle 2. Cycles repeat every 14 days for
      cycles 1-6 and then every 28 days for subsequent cycles in the absence of disease progression
      or unacceptable toxicity. Patients who receive at least 6 infusions of nivolumab with no dose
      limiting toxicities (DLTs) related to nivolumab, may then receive nivolumab every 4 weeks.

      After completion of study treatment, patients are followed up at 30 days and then every 3
      months.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (sitravatinib, nivolumab)ExperimentalPatients receive sitravatinib PO QD on days 1-14 and receive nivolumab IV over 60 minutes on day 1 starting cycle 2. Cycles repeat every 14 days for cycles 1-6 and then every 28 days for subsequent cycles in the absence of disease progression or unacceptable toxicity. Patients who receive at least 6 infusions of nivolumab with no DLTs related to nivolumab, may then receive nivolumab every 4 weeks.
  • Nivolumab
  • Sitravatinib

Eligibility Criteria

        Inclusion Criteria:

          -  Patients with histologically or cytologically confirmed metastatic/advanced clear cell
             RCC, or RCC with a clear cell component, who have received 1 or 2 prior
             anti-angiogenic therapy regimens (+/- cytokine therapy with interleukin-2 or
             interferon-alfa) in the advanced or metastatic setting; examples of anti-angiogenic
             agents include, but are not limited to, sorafenib, sunitinib, pazopanib, axitinib, and
             bevacizumab

          -  There must be evidence of progression on or after last treatment regimen received and
             within 6 months of enrollment

          -  Patients must have at least one measurable site of disease, defined as a lesion that
             can be accurately measured in at least one dimension (longest diameter to be recorded)
             and measures >= 15 mm with conventional techniques or >= 10 mm with more sensitive
             techniques such as magnetic resonance imaging (MRI) or spiral computed tomography (CT)
             scan; if the patient has had previous radiation to the marker lesion(s), there must be
             evidence of progression since the radiation

          -  Karnofsky performance status >= 70

          -  Hemoglobin >= 9 g/dl (treatment allowed) (within 14 days prior to study entry)

          -  Absolute neutrophil count >= 1,500/uL (within 14 days prior to study entry)

          -  Platelets >= 100,000/uL (within 14 days prior to study entry)

          -  Total bilirubin =< 1.5 mg/dl (within 14 days prior to study entry)

          -  Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) or
             alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x
             institutional upper limit of normal (ULN), except in known hepatic metastasis, wherein
             may be < 5 x ULN (within 14 days prior to study entry)

          -  Serum creatinine =< 1.5 x ULN (as long as patient does not require dialysis); a) may
             receive transfusion b) if creatinine is not < 1.5 x ULN, then calculate by
             Cockcroft-Gault methods or local institutional standard and creatinine clearance
             (CrCl) must be >= 40 mL/kg/1.73 m^2 (within 14 days prior to study entry)

          -  International normalized ratio (INR) and partial thromboplastin time (PTT) =< 1.5 x
             ULN within 14 days prior to study entry; therapeutic anticoagulation with warfarin is
             allowed if target INR =< 3 on a stable dose of warfarin or on a stable dose of low
             molecular weight (LMW) heparin for > 2 weeks (14 days) at the time of enrollment

          -  Female patients of childbearing potential (not postmenopausal for at least 12 months
             and not surgically sterile) must have a negative serum or urine pregnancy test
             (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin
             [HCG]) within 14 days before study entry; pregnancy test must be repeated if performed
             > 14 days before starting study drug

          -  Women must not be breastfeeding

          -  Patients with a history of major psychiatric illness must be judged (by the treating
             physician) able to fully understand the investigational nature of the study and the
             risks associated with the therapy

          -  Patients with controlled brain metastases are allowed on protocol if they had solitary
             brain metastases that was surgically resected or treated with radiosurgery or gamma
             knife, without recurrence or edema for 1 month (4 weeks)

        Exclusion Criteria:

          -  Patients must not have any other malignancies within the past 2 years except for in
             situ carcinoma of any site, or adequately treated (without recurrence post-resection
             or post-radiotherapy) carcinoma of the cervix or basal or squamous cell carcinomas of
             the skin or active non-threatening second malignancy that would not, in the
             investigator's opinion, potentially interfere with the patient's ability to
             participate and/or complete this trial; examples include but not limited to:
             urothelial cancer grade Ta or T1, adenocarcinoma of the prostate treated by active
             surveillance

          -  Patients currently receiving anticancer therapies or who have received anticancer
             therapies within 2 weeks (14 days) from enrollment into this study (including
             chemotherapy and targeted therapy) are excluded; also, patients who have completed
             palliative radiation therapy more than 14 days prior to the first dose of MGCD516 are
             eligible

          -  Patients, who have had a major surgery or significant traumatic injury (injury
             requiring > 4 weeks [28 days] to heal) within 4 weeks (28 days) of start of study
             drug, patients who have not recovered from the side effects of any major surgery
             (defined as requiring general anesthesia) or patients that are expected to require
             major surgery during the course of the study

          -  Patients who have been previously treated with mTOR inhibitors such as everolimus and
             temsirolimus, or with c-MET inhibitors such as cabozantinib

          -  Patients who have organ allografts

          -  Known or suspected autoimmune disease; patients with a history of inflammatory bowel
             disease (including Crohn's disease and ulcerative colitis) and autoimmune disorders
             such as rheumatoid arthritis, systemic progressive sclerosis (scleroderma), systemic
             lupus erythematosus or autoimmune vasculitis (e.g., Wegener's granulomatosis) are
             excluded from this study; patients with a history of Hashimoto's thyroiditis only
             requiring hormone replacement, type I diabetes, or psoriasis not requiring systemic
             treatment, or conditions not expected to recur in the absence of an external trigger
             are allowed to participate

          -  Known history of testing positive for human immunodeficiency virus (HIV) or known
             acquired immunodeficiency syndrome (AIDS)

          -  Any underlying medical condition, which in the opinion of the investigator, will make
             the administration of study drug hazardous or obscure the interpretation of adverse
             events, such as a condition associated with frequent diarrhea, uncontrolled nausea,
             vomiting, malabsorption syndrome or small bowel resection that may significantly alter
             the absorption of MGCD516

          -  Patients must not have received prior anticancer therapy with any immune checkpoint
             inhibitors such as anti-CLTA-4, anti-PD1, or anti-PD-L1

          -  Patients receiving any concomitant systemic therapy for renal cell cancer are excluded

          -  Patients must not be scheduled to receive another experimental drug while on this
             study

          -  Patients who are on high dose steroid (e.g., > 10 mg prednisone daily or equivalent)
             or other more potent immune suppression medications (e.g., infliximab); topical,
             inhaled, intra-articular, ocular, or intranasal corticosteroids (with minimal systemic
             absorption) are allowed; a brief course (=< 48 hours) of systemic corticosteroids for
             prophylaxis (e.g., from contrast dye allergy) is permitted

          -  Patients who have any severe and/or uncontrolled medical conditions or other
             conditions that could affect their participation in the study such as: symptomatic
             congestive heart failure of New York Heart Association class III or IV; unstable
             angina pectoris, symptomatic congestive heart failure, myocardial infarction within 6
             months of start of study drug, serious uncontrolled cardiac arrhythmia or any other
             clinically significant cardiac disease; severely impaired lung function as defined as
             oxygen (O2) saturation that is 88% or less at rest on room air; uncontrolled diabetes
             as defined by blood glucose > 200 mg/dl (11.1 mmol/l); systemic fungal, bacterial,
             viral, or other infection that is not controlled (defined as exhibiting ongoing
             signs/symptoms related to the infection and without improvement) despite appropriate
             antibiotics or other treatment; liver disease such as cirrhosis or chronic active
             hepatitis; positive test for hepatitis B virus (HBV) using HBV surface antigen (HBV
             sAg) test or positive test for hepatitis C virus (HCV) using HCV ribonucleic acid
             (RNA) or HCV antibody test indicating acute or chronic infection

          -  Patients must not have history of other diseases, metabolic dysfunction, physical
             examination finding, or clinical laboratory finding giving reasonable suspicion of a
             disease or condition that contraindicates the use of MGCD516 or nivolumab or that
             might affect the interpretation of the results of the study or render the subject at
             high risk from treatment complications

          -  Patients should not receive immunization with attenuated live vaccines within one week
             (7 days) of study entry or during study period

          -  Uncontrolled brain or leptomeningeal metastases, including patients who continue to
             require glucocorticoids for brain or leptomeningeal metastases

          -  Female patients who are pregnant or breast feeding, or adults of reproductive
             potential who are not using effective birth control methods; if barrier contraceptives
             are being used, these must be continued throughout the trial by both sexes; hormonal
             contraceptives are not acceptable as a sole method of contraception; (women of
             childbearing potential must have a negative urine or serum pregnancy test within 14
             days prior to study entry; pregnancy test must be repeated if performed > 14 days
             before administration of MGCD516)

          -  Any patients who cannot be compliant with the appointments required in this protocol
             must not be enrolled in this study

          -  Concurrent therapy with medications known to significantly prolong the QT interval
             and/or associated with increased risk for Torsade de Pointes arrhythmia; the principal
             investigator (PI) is the final arbiter in questions related to eligibility

          -  Patients with left ventricular ejection fraction (LVEF) < 40%
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of adverse events
Time Frame:Up to 12 weeks
Safety Issue:
Description:Defined as National Cancer Institute grade 3 or 4 liver, lung, gastrointestinal or endocrine toxicity, or myelosuppression.

Secondary Outcome Measures

Measure:Progression free survival time
Time Frame:Up to 6 years
Safety Issue:
Description:Unadjusted distributions of the time-to-event outcomes will be estimated using the method of Kaplan and Meier and their relationship to prognostic covariates will be evaluated by Bayesian piecewise exponential survival regression.
Measure:Overall survival time
Time Frame:Up to 6 years
Safety Issue:
Description:Unadjusted distributions of the time-to-event outcomes will be estimated using the method of Kaplan and Meier and their relationship to prognostic covariates will be evaluated by Bayesian piecewise exponential survival regression.
Measure:Objective response rate
Time Frame:Up to 6 years
Safety Issue:
Description:Unadjusted distributions of the time-to-event outcomes will be estimated using the method of Kaplan and Meier and their relationship to prognostic covariates will be evaluated by Bayesian piecewise exponential survival regression.
Measure:The Functional Assessment of Cancer Therapy (FACT) will be used to measure cancer-specific health-related quality of life
Time Frame:Up to 6 years
Safety Issue:
Description:The Medical Outcomes Study 12-item short-form survey (SF-12) will be used to measure general quality of life

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

June 17, 2020