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Sunitinib or Sorafenib in Treating Patients With Kidney Cancer That Was Removed By Surgery
This study is ongoing, but not recruiting participants.

First Received on May 16, 2006.   Last Updated on September 2, 2010   History of Changes
Sponsor: Eastern Cooperative Oncology Group
Collaborators: National Cancer Institute (NCI)
Cancer and Leukemia Group B
Southwest Oncology Group
NCIC Clinical Trials Group
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00326898
  Purpose

RATIONALE: Sunitinib and sorafenib 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 or sorafenib after surgery may kill any tumor cells that remain after surgery. It is not yet known whether sunitinib is more effective than sorafenib or placebo in treating kidney cancer.

PURPOSE: This randomized phase III trial is studying sunitinib to see how well it works compared to sorafenib or placebo in treating patients with kidney cancer that has been removed by surgery.


Condition Intervention Phase
Kidney Cancer
Drug: sorafenib tosylate
Drug: sunitinib malate
Other: placebo
Phase III

Study Type: Interventional
Study Design: Allocation: Randomized
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: ASSURE: Adjuvant Sorafenib or Sunitinib for Unfavorable Renal Carcinoma

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Disease-free survival [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall survival [ Designated as safety issue: No ]
  • Quality of life [ Designated as safety issue: No ]

Estimated Enrollment: 1923
Study Start Date: May 2006
Estimated Primary Completion Date: April 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm A
Patients receive oral sunitinib malate once daily for 4 weeks followed by rest for 2 weeks and oral placebo for sorafenib twice daily for 6 weeks.
Drug: sunitinib malate
Given orally
Other: placebo
Given orally
Experimental: Arm B
Patients receive oral sorafenib twice daily for 6 weeks and oral placebo for sunitinib malate once daily for 4 weeks followed by rest for 2 weeks..
Drug: sorafenib tosylate
Given orally
Other: placebo
Given orally
Placebo Comparator: Arm C
Patients receive oral placebo for sorafenib as in arm A and oral placebo for sunitinib malate as in arm B.
Other: placebo
Given orally

Detailed Description:

OBJECTIVES:

Primary

  • Compare the disease-free survival of patients with locally advanced renal cell carcinoma treated with adjuvant sunitinib malate vs sorafenib vs placebo after radical or partial nephrectomy.

Secondary

  • Compare overall survival of patients treated with these regimens.
  • Define the toxicity of prolonged administration of sunitinib malate or sorafenib in these patients.
  • Assess angiogenesis markers in tissue, blood, and urine as predictors of disease-free survival and therapeutic benefit.
  • Assess the frequency of oncogene and tumor suppressor gene mutations as predictors of disease-free survival and therapeutic benefit.
  • Assess tumor and genetic polymorphisms as predictors of disease-free survival and therapeutic benefit.
  • Use DNA methylation profiles as predictors of outcome and therapeutic benefit.
  • Correlate polymorphisms in drug-metabolizing enzymes with steady-state concentrations of sorafenib or sunitinib malate in selected patients.
  • Study the effect of vascular endothelial growth factor-targeted therapy on circulating endothelial cells and circulating endothelial progenitors.
  • Evaluate cardiac function in a subset of patients.
  • To prospectively assess patient-reported fatigue in order to compare the magnitude and trajectory of fatigue in patients treated with this regimen.
  • To evaluate the PROMIS Fatigue-SF1 and to calibrate it with the established, validated FACIT-Fatigue scale.

OUTLINE: This is a randomized, double-blind, multicenter study. Patients who have not had surgical resection undergo radical or partial nephrectomy first. Patients are then stratified according to risk (intermediate high-risk vs very high-risk), histology (clear cell vs non-clear cell [except collecting duct or medullary]), ECOG performance status (0 vs 1), and the type of nephrectomy (laparoscopic vs open). Patients are randomized to 1 of 3 treatment arms.

  • Arm A: Patients receive oral sunitinib malate once daily for 4 weeks followed by rest for 2 weeks and oral placebo for sorafenib twice daily for 6 weeks.
  • Arm B: Patients receive oral sorafenib twice daily for 6 weeks and oral placebo for sunitinib malate once daily for 4 weeks followed by rest for 2 weeks.
  • Arm C: Patients receive oral placebo for sorafenib as in arm A and oral placebo for sunitinib malate as in arm B.

In all arms, treatment repeats every 6 weeks for up to 9 courses in the absence of disease progression or unacceptable toxicity.

Tumor tissue is collected prior to or during nephrectomy. Blood and urine samples are collected at baseline and periodically during study for biomarker correlative studies.

Patients complete quality of life questionnaires, the FACIT-fatigue scale and the Patient Reported Outcomes Measurement Information System (PROMIS) fatigue form, at baseline, and after courses 2 and 4 of treatment.

After completion of study treatment, patients are followed periodically for 9 years.

PROJECTED ACCRUAL: A total of 1,923 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed renal cell carcinoma, including any of the following subtypes:

    • Clear cell carcinoma
    • Nonclear cell carcinoma

      • No collecting duct or medullary carcinomas
  • Meets 1 of the following risk categories:

    • Intermediate high-risk disease

      • pT1b, G3-4 N0 (or pNX where clinically N0) M0
      • pT2, G1-2 N0 (or pNX where clinically N0) M0
      • pT2, G3-4 N0 (or pNX where clinically N0) M0
      • pT3a, G1-2 (as long as pT3a is not due to adrenal involvement) N0 (or pNX where clinically N0) M0
      • Patients with microvascular invasion of the renal vein of pT1a-pT3a (as long as pT3a is not due to adrenal involvement and grade 1-2) N0 (or pNX where clinically N0) M0
    • Very high-risk disease

      • pT3a, G3-4 (or any grade pT3a if due to adrenal involvement) N0 (or pNX where clinically N0) M0
      • pT3b-c G any N0 (or pNX where clinically N0) M0
      • pT4 G N0 (or pNX where clinically N0) M0 any
      • pT any G any N+
      • Patients with microvascular invasion of the renal vein with above other characteristics
  • Planning to start study treatment between 4-12 weeks after radical or partial nephrectomy

    • Underwent full surgical resection (i.e., radical or partial nephrectomy) by either open or laparoscopic technique within the past 3-10 weeks

      • Clinical evidence of lymph node positivity requires complete regional lymphadenectomy
      • All surgical specimens must have negative margins
    • Planning to undergo the above surgical resection AND meets all of the following criteria:

      • Primary intact renal cell carcinoma, eligible for nephrectomy with curative intent
      • pT1b-4, N0 or any fully resectable N (i.e., N1-2), M0 disease by radiologic criteria, meeting any of the following criteria:

        • Tumors ≥ 4 cm
        • Macroscopic fully resectable nodes
        • Surgically resectable renal vein thrombus
        • Surgically resectable inferior vena caval thrombus by radiologic criteria
      • Multifocal ipsilateral renal cell carcinoma allowed provided fully resectable and does not exceed inclusion criteria
  • No evidence of residual or metastatic renal cell cancer by chest, abdomen, and pelvic CT scan with oral and IV contrast (or MRI scan of the abdomen and pelvis with gadolinium and a CT scan of the chest with or without IV contrast) within 4 weeks of randomization (after radical or partial nephrectomy)

    • Patients unable to tolerate either gadolinium or IV contrast should not participate in this study
  • No history of distant metastases

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-1
  • Absolute granulocyte count ≥ 1,500/mm³
  • Platelet count ≥ 100,000/mm³
  • Creatinine ≤ 2.0 times upper limit of normal (ULN) OR creatinine clearance ≥ 30 mL/min
  • Bilirubin ≤ 1.5 times ULN
  • SGOT and SGPT ≤ 2.5 times ULN
  • Absolute baseline LVEF ≥ 50% by MUGA within 4 weeks of randomization
  • No other malignancy within the past 5 years except basal cell or squamous cell skin cancer, in situ cervical cancer, or ductal or lobular carcinoma in situ of the breast
  • No serious intercurrent illness, including, but not limited to, any of the following:

    • Clinically significant cardiovascular disease(e.g., uncontrolled hypertension, myocardial infraction, or unstable angina)
    • New York Heart Association class II-IV congestive heart failure
    • Peripheral vascular disease ≥ grade 2
    • Psychiatric illness or social situation that would preclude study compliance
  • At least 6 months since any of the following:

    • Myocardial infarction
    • Severe or unstable angina
    • Coronary or peripheral artery bypass graft
    • Symptomatic congestive heart failure
    • Cerebrovascular accident
    • Transient ischemic attack
    • Pulmonary embolism
  • No ongoing ventricular cardiac dysrhythmias ≥ grade 2
  • No ongoing atrial fibrillation
  • No history of serious ventricular arrhythmia (i.e., ventricular tachycardia or ventricular fibrillation ≥ 3 beats in a row)
  • QTc interval < 500 msec by baseline EKG
  • No uncontrolled hypertension (i.e., diastolic blood pressure ≥ 100 mm Hg despite optimal medical therapy)
  • No pre-existing thyroid abnormality with thyroid stimulating hormone that cannot be maintained in the normal range with medication
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No known HIV infection
  • Able to swallow pills

PRIOR CONCURRENT THERAPY:

  • Recovered from prior surgery
  • No prior anticancer therapy for renal cell carcinoma in either the adjuvant or neoadjuvant setting, including any of the following:

    • Metastectomy
    • Radiotherapy to the renal bed
  • At least 2 weeks since prior and no concurrent treatment with any of the following*:

    • Cytochrome P450 enzyme-inducing antiepileptic drugs (phenytoin, carbamazepine, or phenobarbital)
    • Hypericum perforatum (St. John's wort)
    • Ketoconazole
    • Dexamethasone
    • Dysrhythmic drugs (i.e., terfenadine, quinidine, procainamide, sotalol, probucol, bepridil, indapamide, or flecainide)
    • Haloperidol
    • Risperidone
    • Rifampin
    • Grapefruit juice or grapefruit NOTE: * Topical and inhaled steroids are allowed
  • Concurrent participation in protocol ECOG-E1Y03 allowed
  • No other concurrent investigational anticancer agents
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00326898

  Show 813 Study Locations
Sponsors and Collaborators
Eastern Cooperative Oncology Group
Cancer and Leukemia Group B
Southwest Oncology Group
NCIC Clinical Trials Group
Investigators
Study Chair: Naomi S. Balzer-Haas, MD Abramson Cancer Center of the University of Pennsylvania
Investigator: Keith T. Flaherty, MD Abramson Cancer Center of the University of Pennsylvania
Investigator: Robert Uzzo, MD Fox Chase Cancer Center
Study Chair: Christopher J. Kane, MD University of California, San Francisco
Study Chair: Christopher G. Wood, MD M.D. Anderson Cancer Center
Study Chair: Michael A.S. Jewett, MD Princess Margaret Hospital, Canada
  More Information

Additional Information:
No publications provided

Responsible Party: Robert L. Comis, ECOG Group Chair's Office
ClinicalTrials.gov Identifier: NCT00326898     History of Changes
Other Study ID Numbers: CDR0000478976, ECOG-E2805, CALGB-E2805, SWOG-E2805, CAN-NCIC-E2805
Study First Received: May 16, 2006
Last Updated: September 2, 2010
Health Authority: United States: Food and Drug Administration

Keywords provided by National Cancer Institute (NCI):
clear cell renal cell carcinoma
stage I renal cell cancer
stage II renal cell cancer
stage III renal cell cancer
stage IV renal cell cancer
papillary renal cell carcinoma

Additional relevant MeSH terms:
Carcinoma, Renal Cell
Kidney Neoplasms
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Kidney Diseases
Urologic Diseases
Sorafenib
Sunitinib
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors

ClinicalTrials.gov processed this record on February 09, 2012