Safety and Efficacy of Bevacizumab Plus RAD001 Versus Interferon Alfa-2a and Bevacizumab for the First-line Treatment in Adult Patients With Kidney Cancer - Full Text View

Purpose

To estimate the difference in efficacy and safety of bevacizumab and RAD001 compared to bevacizumab and interferon alfa-2a for first-line treatment of patients with metastatic carcinoma of the kidney.

Condition	Intervention	Phase
Carcinoma, Renal Cell Adenocarcinoma, Renal Cell Nephroid Carcinoma, Hypernephroid	Drug: RAD001(everolimus) Drug: interferon alfa-2a Drug: bevacizumab	Phase 2


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	A Randomized, Open-label, Multi-center Phase II Study to Compare Bevacizumab Plus RAD001 Versus Interferon Alfa-2a Plus Bevacizumab for the First-line Treatment of Patients With Metastatic Clear Cell Carcinoma of the Kidney

Resource links provided by NLM:

Drug Information available for: Interferon Sirolimus Interferon Alfa-2a Interferon Alfa-2b Everolimus Temsirolimus Bevacizumab

Genetic and Rare Diseases Information Center resources: Kidney Cancer Renal Cancer Clear Cell Renal Cell Carcinoma Epithelial-myoepithelial Carcinoma

U.S. FDA Resources

Further study details as provided by Novartis:

Primary Outcome Measures:

Progression-free Survival (PFS) of Participants Who Received RAD001 Plus Bevacizumab Versus Participants Who Received IFN Plus Bevacizumab [ Time Frame: Time from randomization to the date of radiological progressive disease as per independent central review, death from any cause, or last tumor assessment, reported between date of first participant randomized until 31Dec2011, cutoff date. ] [ Designated as safety issue: No ]
Tumor response and disease progression were assessed using response evaluation criteria in solid tumors (RECIST), version 1.0. All target and non-target lesions identified at baseline were assessed using the same method, CT scan with contrast or MRI with contrast, throughout the trial. All scans were reviewed by independent, central radiology. Disease progression was defined as: 1) a 20% increase in the sum of the longest diameter of all target lesions, taking as reference the smallest sum of the longest diameters of all target lesions recorded at or after baseline or 2) the appearance of a new lesions or 3) the unequivocal progression of non-target lesions overall.

Secondary Outcome Measures:

Overall Survival (OS) Treatment Effect in Participants Who Received RAD001 Plus Bevacizumab Versus Participants Who Received IFN Plus Bevacizumab [ Time Frame: Time from randomization to the date of death from any cause, reported between date of first participant randomized and up to 2 years after the last participant randomized (data cutoff: 30Aug2012) ] [ Designated as safety issue: No ]
Overall survival (OS) was defined as the time of randomization to the date of death due to any cause.
Best Overall Response in Participants Who Received RAD001 Plus Bevacizumab Versus Participants Who Received IFN Plus Bevacizumab [ Time Frame: Time from first participant randomized until 31Dec2011, cutoff date. ] [ Designated as safety issue: No ]
Overall response is defined as the number of participants having achieved confirmed Complete Response (CR) + Partial Response (PR). Confirmed CR = at least two determinations of CR at least 4 weeks apart before progression. Confirmed PR = at least two determinations of PR or better at least 4 weeks apart before progression. CR required a disappearance of all target and non-target lesions. PR required at least a 30% decrease in the sum of the longest diameters of all target lesions, taking as a reference the baseline sum of the longest diameters. Disease progression was defined as: 1) a 20% increase in the sum of the longest diameter of all target lesions, taking as reference the smallest sum of the longest diameters of all target lesions recorded at or after baseline or 2) the appearance of a new lesions or 3) the unequivocal progression of non-target lesions overall.
Response Duration Differences in Participants Who Received RAD001 Plus Bevacizumab Versus Participants Who Received IFN Plus Bevacizumab [ Time Frame: Time from first documented response date of radiological progressive disease as per independent central review, death due to underlying cancer, or last tumor assessment, reported between date of first participant randomized until 31Dec2011, cut-off date. ] [ Designated as safety issue: No ]
The duration of response, applied only to participants with best overall response at CR or PR, is defined as the number of days between the date of first documented response (CR or PR) and the date of the event: radiological progression as per central review or death due to underlying cancer, whichever occurs first. If no event, participant is censored at the last adequate assessment.
Number of Participants Who Experienced Adverse Events (AEs), Serious Adverse Events and Deaths [ Time Frame: From the first participant randomized until the last patient discontinued the study treatment + 28 days ] [ Designated as safety issue: Yes ]
Participants were monitored for adverse events, serious adverse events and deaths throughout the study. Participants were assessed continuously at each 28-day cycle.
Time to Definitive Deterioration of the Functional Assessment of Cancer Therapy Kidney Symptom Index, Disease Related Symptoms (FKSI-DRS) Risk Score by at Least 2 Score Units [ Time Frame: Time from randomization to the date of definitive deterioration (defined as no later increase above the threshold observed during the study), or date of last assessment, reported between date of first patient randomized until 31Dec2011 ] [ Designated as safety issue: No ]
The analysis of this outcome measure was based on the FKSI-DRS scale which is a validated disease-related symptom index containing 9 items that measure symptoms predominantly related to kidney cancer. Each item is scored on a 5-point scale (0 = not at all; 4 = very much). If at least 5 of the 9 questions have been answered, the FKSI-DRS total score is calculated by subtracting nine times the mean of the scores of the answered items from 36. Participants with less than 5 out of the 9 questions answered will have a missing FKSI-DRS total score. The FKSI-DRS total score ranges from 0 (most severe symptoms) to 36 (no symptoms). Definitive deterioration is defined as a decrease by at least 2 units compared to baseline, with no later increase above this threshold observed during the study. A single measure reporting a decrease of at least 2 units was considered definitive only if it is the last one available for the participant.
Time to Definitive Deterioration of the Global Health Status and the Physical Functioning (PF) Subscale Scores of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) by at Least 10% [ Time Frame: Time from randomization to the date of definitive deterioration (defined as no later increase above the threshold observed during the study), or date of last assessment, reported between date of first participant randomized until 31Dec2011 ] [ Designated as safety issue: No ]
The EORTC QLQ-C30 contains 30 items. These include five functional scales (physical, role, emotional, social and cognitive functioning), three symptom scales (fatigue, pain, nausea, and vomiting), a global health status/QoL scale, and six single items (dyspnea, diarrhea, constipation, anorexia, insomnia and financial impact). The PF subscale consists of 5 questions each scored from 1 (not at all) to 4 (very much). The score for the PF subscale and global health status range from 0 to 100, with a higher score representing a high level of functioning/high quality of life. Definitive deterioration by at least 10% is defined as a decrease in score by at least 10% compared to baseline, with no later increase above this threshold observed during the course of the study. A single measure reporting a decrease of at least 10% is considered definitive only if it is the last one available for the participant.
Duration of Exposure of RAD001 in Participants Randomized to the Treatment Combination of RAD001 and Bevacizumab [ Time Frame: From the date of the first participant treated until the last patient discontinued the study treatment + 28 days ] [ Designated as safety issue: Yes ]
This outcome measure was assessed continuously.


Enrollment:	365
Study Start Date:	November 2008
Study Completion Date:	April 2013
Primary Completion Date:	December 2011 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: bevacizumab, RAD001 (everolimus) Participants received oral everolimus 10 mg qd plus intravenous bevacizumab 10mg/kg every 2 weeks	Drug: RAD001(everolimus) 10 mg qd Other Name: Afinitor Drug: bevacizumab 10 mg/kg every 2 weeks
Active Comparator: bevacizumab, interferon alfa-2a (IFN) Participants received subcutaneous IFN dose escalated from 3 MIU (million international unit) during week 1, 6 MIU during week 2, and 9 MIU during week 3 of treatment and subsequently (if tolerated), 3 times per week plus intravenous bevacizumab 10 mg/kg every 2 weeks	Drug: interferon alfa-2a dose escalated from 3 MIU (million international unit) during week 1, 6 MIU during week 2, and 9 MIU during week 3 Drug: bevacizumab 10 mg/kg every 2 weeks

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patients with metastatic renal cell carcinoma
Patients with at least one measurable lesion
Patients with progressive metastatic renal cell carcinoma
Patients who had a prior partial or complete nephrectomy
Patients with a Karnofsky Performance Status ≥70%.
Adequate bone marrow function
Adequate liver function
Adequate renal function
Adequate coagulation profile

Exclusion Criteria:

4 weeks post-major surgery
Patients who had radiation therapy within 28 days prior to start of study
Patients in need for major surgical procedure during the course of the study.
Patients with a serious non-healing wound, ulcer, or bone fracture.
Patients with a history of seizure(s) not controlled with standard medical therapy.
Patients who have received prior systemic treatment for their metastatic RCC.
Patients who received prior therapy with VEGF pathway inhibitor
Patients who have previously received systemic mTOR inhibitors
Patients with a known hypersensitivity RAD001 (everolimus) or other rapamycins or to its excipients.
Patients with history or current central nervous system (CNS) metastases or spinal cord compression.
Patients with a history of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to study enrollment.
Patients with proteinuria at screening.
Patients with inadequately controlled hypertension
Patients receiving ongoing or with recent need for full therapeutic dose of oral or parenteral anticoagulants or chronic daily treatment with aspirin
Patients receiving chronic systemic treatment with corticosteroids or another immunosuppressive agent.
Patients with a known history of HIV
Patients with hypersensitivity to interferon alfa-2a or any component of the product.
Patients with an active, bleeding diathesis or coagulopathy or recurrent thromboembolism
Patients who have any severe and/or uncontrolled medical conditions or other conditions
Left Ventricular Ejection Fraction < lower limit of institutional normal assessed by ECHO or MUGA
Patients who have a history of another primary malignancy ≤ 3 years
Female patients who are pregnant or breast feeding
Patients who are using other investigational agents or who had received investigational drugs ≤ 4 weeks prior to study treatment start.
Patients unwilling to or unable to comply with the protocol

Other protocol-defined inclusion/exclusion criteria may apply

Contacts and Locations

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Please refer to this study by its ClinicalTrials.gov identifier: NCT00719264

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Sponsors and Collaborators

Novartis Pharmaceuticals

Roche Pharma AG

Investigators


Study Director:	Novartis Pharmaceuticals	Novartis Pharmaceuticals

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Ravaud A, Barrios CH, Alekseev B, Tay MH, Agarwala SS, Yalcin S, Lin CC, Roman L, Shkolnik M, Anak O, Gogov S, Pelov D, Louveau AL, Melichar B. RECORD-2: phase II randomized study of everolimus and bevacizumab versus interferon α-2a and bevacizumab as first-line therapy in patients with metastatic renal cell carcinoma. Ann Oncol. 2015 Jul;26(7):1378-84. doi: 10.1093/annonc/mdv170. Epub 2015 Apr 7.


Responsible Party:	Novartis Pharmaceuticals
ClinicalTrials.gov Identifier:	NCT00719264 History of Changes
Other Study ID Numbers:	CRAD001L2201 2008-000077-38
Study First Received:	July 15, 2008
Results First Received:	April 4, 2014
Last Updated:	May 27, 2015
Health Authority:	United States: Food and Drug Administration Belgium: Federal Agency for Medicines and Health Products, FAMHP Brazil: Ministry of Health Czech Republic: State Institute for Drug Control Egypt: Ministry of Health and Population France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis) Germany: Ministry of Health Hong Kong: Department of Health Hungary: National Institute of Pharmacy Italy: Ministry of Health Korea: Food and Drug Administration Netherlands: The Central Committee on Research Involving Human Subjects (CCMO) Russia: Ministry of Health of the Russian Federation Singapore: Health Sciences Authority Slovakia: State Institute for Drug Control South Africa: Medicines Control Council Spain: Spanish Agency of Medicines Switzerland: Swissmedic Taiwan: Department of Health Thailand: Ministry of Public Health Turkey: Ministry of Health United Kingdom: Medicines and Healthcare Products Regulatory Agency

Keywords provided by Novartis:


Renal cell carcinoma, Adults, Bevacizumab, RAD001 Everolimus, Interferon	Clear Roferon Avastin Nephrectomy newly diagnosed

Additional relevant MeSH terms:


Carcinoma Adenocarcinoma Carcinoma, Renal Cell Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Kidney Neoplasms Urologic Neoplasms Urogenital Neoplasms Neoplasms by Site Kidney Diseases Urologic Diseases Bevacizumab Everolimus Sirolimus	Interferons Interferon-alpha Angiogenesis Inhibitors Angiogenesis Modulating Agents Growth Substances Physiological Effects of Drugs Growth Inhibitors Antineoplastic Agents Antiviral Agents Anti-Infective Agents Immunologic Factors Immunosuppressive Agents Anti-Bacterial Agents Antibiotics, Antineoplastic Antifungal Agents

ClinicalTrials.gov processed this record on September 30, 2016