Clinical Trials /

Sitravatinib and Nivolumab for the Treatment of Metastatic or Advanced Clear Cell Renal Cell Cancer

NCT04904302

Description:

This phase II trial investigates the effect of sitravatinib and nivolumab in treating patients with clear cell renal cell cancer that has spread to other places in the body (metastatic/advanced). 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 kill more tumor cells.

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

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Sitravatinib and Nivolumab for the Treatment of Metastatic or Advanced Clear Cell Renal Cell Cancer
  • Official Title: A Phase II Trial of Sitravatinib Plus Nivolumab in Patients With Metastatic Clear Cell Renal Cell Carcinoma Who Progressed on Prior Treatment Acronym: SNAPI (Sitravatinib and Nivolumab After Prior Immunotherapy)

Clinical Trial IDs

  • ORG STUDY ID: 2021-0057
  • SECONDARY ID: NCI-2021-03344
  • SECONDARY ID: 2021-0057
  • NCT ID: NCT04904302

Conditions

  • Advanced Clear Cell Renal Cell Carcinoma
  • Metastatic Clear Cell Renal Cell Carcinoma
  • Stage IV Renal Cell Cancer AJCC v8

Interventions

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

Purpose

This phase II trial investigates the effect of sitravatinib and nivolumab in treating patients with clear cell renal cell cancer that has spread to other places in the body (metastatic/advanced). 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 kill more tumor cells.

Detailed Description

      PRIMARY OBJECTIVE:

      I. To determine the objective response rate (ORR) and disease control rate (DCR) at 24 weeks
      of sitravatinib 100 milligrams (mg) by mouth (PO) daily plus nivolumab 480 mg intravenously
      (IV) every 4 weeks in patients with metastatic renal cell carcinoma (mRCC) who progress on
      prior PD-1 or PD-L1 immune checkpoint inhibitors (CPIs), cabozantinib, or lenvatinib, as
      defined by the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1).

      SECONDARY OBJECTIVES:

      I. To estimate the overall survival (OS), progression-free survival (PFS), duration of
      response (DOR), and 1-year OS of sitravatinib plus nivolumab in the same population.

      II. To determine the safety, tolerability, and impact on health-related quality of life of
      sitravatinib plus nivolumab in patients with mRCC who progress on PD-1/PD-L1 CPIs,
      cabozantinib, or lenvatinib as defined by National Cancer Institute (NCI) Common Terminology
      Criteria for Adverse Events (CTCAE) version 5.0.

      EXPLORATORY OBJECTIVE:

      I. To assess how the immune landscape, transcriptome, and genome change after contemporary
      first-line treatment via tumor tissue biopsy obtained at time of enrollment, 4 weeks after
      treatment with sitravatinib plus nivolumab, and at time of progression, as well as blood
      sample collection.

      OUTLINE:

      Patients receive sitravatinib PO once daily (QD) and nivolumab IV over 30 minutes on day 1.
      Cycles repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up every 3 months.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (sitravatinib, nivolumab)ExperimentalPatients receive sitravatinib PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.
  • 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 lines of
             treatment in the advanced or metastatic setting, and the most recent treatment must
             include a PD-1 or PD-L1 CPI, cabozantinib, or lenvatinib. Examples of acceptable prior
             regimens include: nivolumab plus ipilimumab (cohort A), pembrolizumab plus axitinib,
             avelumab plus axitinib, or VEGF-targeted monotherapy followed by nivolumab monotherapy
             (cohort B), or cabozantinib or lenvatinib with or without everolimus, received alone
             sequentially before PD-1/PD-L1 inhibitors, or in combination with CPIs (cohort C)

          -  There must be evidence of progression on or after treatment (at any point after
             completing prior therapy) with a PD-1/PD-L1-containing regimen as the last treatment
             received 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

          -  Age >= 18 years

          -  Hemoglobin >= 9 g/dl (treatment allowed)

               -  May receive transfusion

          -  Absolute neutrophil count >= 1,000/uL

          -  Platelets >= 75,000/uL

          -  Total bilirubin =< 1.5 mg/dL

               -  For patients with Gilbert's disease, total bilirubin should =< 3 mg/dL (=< 51.3
                  umol/L)

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) or
             alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 2.5 X
             institutional upper limit of normal (ULN), except in known hepatic metastasis, wherein
             may be < 5 x ULN

          -  Serum Creatinine =< 1.5 x ULN (as long as patient does not require dialysis)

               -  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

          -  Institutional normalized ratio (INR) and partial thromboplastin time (PTT) =< 1.5 x
             ULN prior to study entry. Therapeutic anticoagulation is permitted if: on a stable
             dose of low molecular weight heparin (LMWH) for > 2 weeks (14 days) at the time of
             enrollment or on a direct oral anticoagulant (DOAC) for > 2 weeks at 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]) 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, 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 sitravatinib
             are eligible

          -  Patients who had a major surgery or significant traumatic injury (injury requiring >
             28 days to heal) within 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 with a prior history of grade 3 or worse immune-related adverse events
             attributed to CPIs (PD-1, PD-L1, or CTLA-4), except endocrine adverse events with
             appropriate hormone replacement or asymptomatic amylase/lipase elevations

          -  Active or prior documented autoimmune disease, as follows:

               -  Inflammatory bowel disease (eg, Crohn's disease, ulcerative colitis)

               -  Interstitial lung disease (ILD), drug-induced ILD, radiation pneumonitis that
                  required steroid treatment, or any evidence of clinically active ILD.

               -  Other medically important autoimmune disease within 2 years before first dose of
                  study treatment. Note: Patients with type 1 diabetes, vitiligo, Graves' disease
                  requiring only hormone replacement, residual hypothyroidism requiring only
                  hormone replacement, or psoriasis or Sjogren's syndrome not requiring systemic
                  treatment are permitted

          -  Immunocompromising conditions, as follows:

               -  Known acute or chronic human immunodeficiency virus (HIV) infection

               -  History of primary immunodeficiency

               -  History or allogeneic transplant

               -  Current or prior use of immunosuppressive medication within 28 days before the
                  first dose of study treatment, with the exception of topical, ocular, intranasal,
                  and inhaled corticosteroids, or systemic corticosteroids at an equivalent dose =<
                  10 mg of prednisone daily

          -  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 sitravatinib

          -  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 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 02 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 sitravatinib 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 a patient can become
             pregnant or father a child, appropriate birth control methods, including a
             double-barrier method (2 methods at the same time), are required while on study and
             for 23 weeks (females) or 31 weeks (males) after you stop receiving the study drugs.
             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 sitravatinib)

          -  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:Objective response rate
Time Frame:At 24 weeks
Safety Issue:
Description:Will be defined as complete response + partial response. Will be defined by the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1).

Secondary Outcome Measures

Measure:Overall survival
Time Frame:At 1 year
Safety Issue:
Description:Kaplan-Meier survival curves will be generated. Cox regression models will be fitted to assess the association between prognostic variables, and the survival endpoints.
Measure:Progression free survival
Time Frame:At 1 year
Safety Issue:
Description:Kaplan-Meier survival curves will be generated. Cox regression models will be fitted to assess the association between prognostic variables, and the survival endpoints.
Measure:Duration of response
Time Frame:At 1 year
Safety Issue:
Description:Kaplan-Meier survival curves will be generated. Cox regression models will be fitted to assess the association between prognostic variables, and the survival endpoints.
Measure:Incidence of adverse events
Time Frame:Up to 6 years
Safety Issue:
Description:Will be assessed by National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Will be summarized using descriptive statistics (e.g., frequency, 95% confidence interval) by type and grade.
Measure:Health-related quality-of-life (QOL)
Time Frame:Up to 24 weeks
Safety Issue:
Description:Will be assessed using the Functional Assessment of Cancer Therapy- Kidney Symptom Index- Disease Related Symptoms questionnaire. Descriptive statistics (e.g., means, ranges, standard deviations) will be computed, together with ninety-five percent confidence intervals for the means. Proportions of subjects falling outside normative ranges for the stress and QOL measures will also be calculated. Values for the standardized scales will be compared to normative data and patients receiving other types of cancer therapy. Graphical methods (e.g., boxplots and histograms) will be employed to more closely examine the distributions of the measures at each time point. Change scores for the stress and QOL measures will be computed as the simple differences between the baseline measure and subsequent evaluations. Paired t-tests will be used to evaluate the change of the stress and QOL measures between different time points.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

June 15, 2021