Entinostat in Combination With Aldesleukin in Treating Patients With Metastatic Kidney Cancer
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| ClinicalTrials.gov Identifier: NCT01038778 |
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Recruitment Status :
Active, not recruiting
First Posted : December 24, 2009
Results First Posted : February 24, 2021
Last Update Posted : December 13, 2022
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| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Clear Cell Renal Cell Carcinoma Metastatic Kidney Carcinoma Stage III Renal Cell Cancer AJCC v7 Stage IV Renal Cell Cancer AJCC v7 | Biological: Aldesleukin Procedure: Computed Tomography Drug: Entinostat Radiation: Fludeoxyglucose F-18 Other: Laboratory Biomarker Analysis Other: Pharmacological Study Procedure: Positron Emission Tomography | Phase 1 Phase 2 |
PRIMARY OBJECTIVES:
I. To evaluate the safety and tolerability of high dose interleukin 2 (aldesleukin) in combination with entinostat in patients with metastatic renal cell carcinoma (RCC). (Phase I) II. To monitor toxicity and estimate the efficacy of high dose aldesleukin combined with entinostat in patients with metastatic RCC. (Phase II)
SECONDARY OBJECTIVES:
I. To compare the time-to-tumor progression, progression-free survival and overall survival of patients with metastatic RCC treated with high dose aldesleukin combined with entinostat to the historical data of patients treated with high dose aldesleukin alone. (Phase II) II. To assess the toxicity of high dose aldesleukin combined with entinostat. (Phase II) III. To evaluate entinostat pharmacodynamics (PD) in blood and tumor samples. (Phase II) IV. To measure the association between baseline laboratory parameters (e.g. cluster of differentiation [CD]4+, CD8+, CD4+/forkhead box P3 [Foxp3]), tumor blood metabolism, and a variety of response variables (e.g. toxicity, response and survival). (Phase II) V. To explore the relationship between entinostat exposure with PD endpoints (e.g. toxicity and histone acetylation in peripheral blood mononuclear cells or peripheral blood mononuclear cells [PBMNCs] and changes in T cell subset population). (Phase II) VI. To evaluate the modulation of tumor metabolism by fluorodeoxyglucose (FDG, fludeoxyglucose F 18) positron emission tomography (PET)/computed tomography (CT) scan. (Phase II)
OUTLINE: This is a phase I, dose-escalation study of entinostat followed by a phase II study.
Patients receive entinostat orally (PO) every 2 weeks beginning on day -14 and high-dose aldesleukin intravenously (IV) every 8 hours on days 1-5 and 15-19. Cycles repeat every 84 days* in the absence of disease progression or unacceptable toxicity.
NOTE: *Patients with evidence of tumor shrinkage may receive up to 3 cycles of high-dose aldesleukin therapy. Patients with stable disease by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 criteria, but without evidence of tumor shrinkage after two cycles will receive only entinostat until disease progression is documented.
After completion of study treatment, patients are followed up at 30 days and then every 3 months thereafter.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 47 participants |
| Allocation: | N/A |
| Intervention Model: | Single Group Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | Phase I/II Study of High Dose Interleukin 2, Aldesleukin, in Combination With the Histone Deacetylase Inhibitor Entinostat in Patients With Metastatic Renal Cell Carcinoma |
| Actual Study Start Date : | October 29, 2009 |
| Actual Primary Completion Date : | May 22, 2019 |
| Estimated Study Completion Date : | July 17, 2023 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: Treatment (entinostat, aldesleukin)
Patients receive entinostat PO every 2 weeks beginning on day -14 and high-dose aldesleukin IV every 8 hours on days 1-5 and 15-19. Cycles repeat every 84 days* in the absence of disease progression or unacceptable toxicity. NOTE: *Patients with evidence of tumor shrinkage may receive up to 3 cycles of high-dose aldesleukin therapy. Patients with stable disease by RECIST version 1.0 criteria, but without evidence of tumor shrinkage after two cycles will receive only entinostat until disease progression is documented. |
Biological: Aldesleukin
Given IV
Other Names:
Procedure: Computed Tomography Undergo FDG-PET/CT
Other Names:
Drug: Entinostat Given PO
Other Names:
Radiation: Fludeoxyglucose F-18 Undergo FDG-PET/CT
Other Names:
Other: Laboratory Biomarker Analysis Correlative studies Other: Pharmacological Study Correlative studies Procedure: Positron Emission Tomography Undergo FDG-PET/CT
Other Names:
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- Dose-limiting Toxicities of Entinostat When Combined With Aldesleukin Within the Phase I [ Time Frame: 84 days ]Number of dose-limiting toxicities of entinostat when combined with aldesleukin within the Phase I MEASUREMENT OF EFFECT Patients underwent CT scans at week 11 (+/- 7 days) of each cycle during aldesleukin administration and then every 8-12 weeks (+/- 2 weeks). Response Evaluation Criteria in Solid Tumors (RECIST V.1.0)
- Overall Response Rate (Complete Plus Partial) (Phase II) [ Time Frame: Up to 12 months ]
The proportion of patients who have a partial or complete response to treatment evaluated by RECIST V.1.0 criteria.
MEASUREMENT OF EFFECT Patients underwent CT scans at week 11 (+/- 7 days) of each cycle during aldesleukin administration and then every 8-12 weeks (+/- 2 weeks). Response Evaluation Criteria in Solid Tumors (RECIST V.1.0)
- Incidence of Toxicity (Phase I) [ Time Frame: 84 days ]Count of participants with grade 4 toxicity. The frequency and grade of toxicities will be tabulated for each dose level.
- Progression-free Survival [ Time Frame: up to 12-months after the last subject enrolls ]
The median progression-free survival (PFS) was estimated using standard Kaplan-Meier methods, where estimates of the median were obtained with 95% confidence intervals (CIs). PFS was defined as the time from the start of treatment to progression or death due to any cause or last follow-up, patients who did not progress or die were censored.
MEASUREMENT OF EFFECT Patients underwent CT scans at week 11 (+/- 7 days) of each cycle during aldesleukin administration and then every 8-12 weeks (+/- 2 weeks). Response Evaluation Criteria in Solid Tumors (RECIST V.1.0)
- Overall Survival [ Time Frame: up to 12-months after the last subject enrolls ]The 3-year overall survival (OS) rate was estimated using standard Kaplan-Meier methods, where estimates of the median were obtained with 95% confidence intervals (CIs). OS was defined as the time from the start of treatment to death due to any cause or last follow-up, patients who did not die were censored.
- Time-to-tumor Progression [ Time Frame: up to 12-months after the last subject enrolls ]The median time to tumor progression (TTP) was estimated using standard Kaplan-Meier methods, where estimates of the median were obtained with 95% confidence intervals (CIs). TTP was defined as the time from the start of treatment to progression or last follow-up. Patients that did not progress were censored.
- Incidence of Toxicities [ Time Frame: Up to 30 days ]The number of participants with serious adverse events.
- Changes in the Level of Specific T Lymphocytes [ Time Frame: Baseline to approximately 4 weeks post-treatment, up to 1 year ]Mean percent change from baseline of T lymphocytes.
- Changes in Tumor Metabolisms by FDG Positron Emission Tomography (PET)/Computed Tomography (CT) Scan [ Time Frame: Baseline to approximately 5 weeks post-treatment ]For binary predictors, the sensitivity and specificity with 95% confidence intervals will be reported. T tests will be used to compare the mean change between responders and non-responders. If there are sufficient numbers of responders, partial responders and non-responders an ANOVA will be used to compare changes in these three groups. If complete data are obtained for CD4+CD25^hi T cells at multiple time points post treatment, repeated measures ANOVA will be performed to evaluate data for trends over time.
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patients must have pathological diagnosis of renal cell carcinoma that is metastatic or surgically unresectable; the histology must be clear cell carcinoma or predominant clear cell carcinoma
- Patients may have received up to two prior therapies including vascular endothelial growth factor (VEGF), mammalian target of rapamycin (mTOR) and programmed cell death (PD)-1/PD ligand 1 (L1) inhibitors; prior palliative radiation to metastatic lesion(s) is permitted, provided there is at least one measurable and/or evaluable lesion(s) that has not been irradiated
- Patients must have measurable or evaluable disease
- Eastern Cooperative Oncology Group (ECOG) performance status 0
- Life expectancy of greater than 6 months
- Hemoglobin >= 12 g/dL
- Leukocytes >= 3,000/mm^3
- Absolute neutrophil count >= 1,500/mm^3
- Platelets >= 100,000/mm^3
- Total bilirubin =< 1.5 x laboratory upper limit of normal
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x laboratory upper limit of normal
- Creatinine =< 1.5 x laboratory upper limit of normal or calculated creatinine clearance of >= 50 ml/min
- Lactate dehydrogenase (LDH) within normal limits (WNL)
- Corrected calcium =< 10 mg/dL
- Prothrombin time (PT)/international normalized ratio (INR) =< 1.5
- Urine protein < 1+; if >= 1+, 24 hour urine protein should be obtained and should be < 1000 mg
- Forced expiratory volume in 1 second (FEV1) >= 2.0 liters or >= 75% of predicted for height and age; (pulmonary function tests [PFTs] are required for patients over 50 or with significant pulmonary or smoking history)
- No evidence of congestive heart failure, symptoms of coronary artery disease, myocardial infarction less than 6 months prior to entry, serious cardiac arrhythmias, or unstable angina; patients who are over 40 or have had previous myocardial infarction greater than 6 months prior to entry will be required to have a negative or low probability cardiac stress test for cardiac ischemia
- No history of cerebrovascular accident or transient ischemic attacks
- The effects of entinostat on the developing human fetus at the recommended therapeutic dose are unknown; for this reason Women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately; men with female partners of child bearing potential must also agree to use adequate contraception
- Ability to understand and the willingness to sign a written informed consent document
Exclusion Criteria:
- Patients who have received more than two prior therapies
- Concurrent use of valproic acid is not allowed
- Patients may not be receiving any other investigational agents
- Patients with untreated central nervous system (CNS) metastases; patients should have a head CT/magnetic resonance imaging (MRI) within 28 days prior to treatment initiation; patients with previously excised/gamma knifed solitary or oligometastases and controlled disease are eligible
- Any medical condition that would preclude adequate evaluation of the safety and toxicity of the study combination
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure (New York Association class II, III, or IV), angina pectoris requiring nitrate therapy, recent myocardial infarction (< the last 6 months), cardiac arrhythmia, history of cerebrovascular accident (CVA) within 6 months, hypertension (defined as blood pressure of > 160 mmHg systolic and/or > 90 mmHg diastolic on medication) history of peripheral vascular disease, or psychiatric illness/social situations that would limit compliance with study requirements
- Patients with a history of allergy to entinostat or other medications that have a benzamide structure (i.e. tiapride, remoxipride, and clebopride)
- Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with entinostat
- Human immunodeficiency virus (HIV)-positive patients receiving combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with entinostat. In addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy; appropriate studies will be undertaken in patients receiving combination anti-retroviral therapy when indicated
- Serious or non-healing wound, ulcer or bone fracture
- Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to day 1 therapy
- Anticipation of need for major surgical procedures during the course of the study
- Left ventricular ejection function < 45%
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01038778
| United States, California | |
| USC / Norris Comprehensive Cancer Center | |
| Los Angeles, California, United States, 90033 | |
| United States, Maryland | |
| Johns Hopkins University/Sidney Kimmel Cancer Center | |
| Baltimore, Maryland, United States, 21287 | |
| United States, New York | |
| Roswell Park Cancer Institute | |
| Buffalo, New York, United States, 14263 | |
| United States, Ohio | |
| Ohio State University Comprehensive Cancer Center | |
| Columbus, Ohio, United States, 43210 | |
| Principal Investigator: | Saby George | Roswell Park Cancer Institute |
Documents provided by National Cancer Institute (NCI):
| Responsible Party: | National Cancer Institute (NCI) |
| ClinicalTrials.gov Identifier: | NCT01038778 |
| Obsolete Identifiers: | NCT01043159 |
| Other Study ID Numbers: |
NCI-2012-02900 NCI-2012-02900 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ) CDR0000662915 I 145208 7870 ( Other Identifier: Roswell Park Cancer Institute ) 7870 ( Other Identifier: CTEP ) P30CA016056 ( U.S. NIH Grant/Contract ) R21CA137649 ( U.S. NIH Grant/Contract ) U01CA062505 ( U.S. NIH Grant/Contract ) U01CA070095 ( U.S. NIH Grant/Contract ) U01CA076576 ( U.S. NIH Grant/Contract ) UM1CA186691 ( U.S. NIH Grant/Contract ) UM1CA186712 ( U.S. NIH Grant/Contract ) UM1CA186717 ( U.S. NIH Grant/Contract ) |
| First Posted: | December 24, 2009 Key Record Dates |
| Results First Posted: | February 24, 2021 |
| Last Update Posted: | December 13, 2022 |
| Last Verified: | November 2022 |
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Carcinoma Carcinoma, Renal Cell Kidney Neoplasms Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Adenocarcinoma Urologic Neoplasms Urogenital Neoplasms Neoplasms by Site Kidney Diseases Urologic Diseases Aldesleukin Deoxyglucose Interleukin-2 |
Entinostat Fluorodeoxyglucose F18 Histone Deacetylase Inhibitors Antineoplastic Agents Analgesics, Non-Narcotic Analgesics Sensory System Agents Peripheral Nervous System Agents Physiological Effects of Drugs Anti-HIV Agents Anti-Retroviral Agents Antiviral Agents Anti-Infective Agents Radiopharmaceuticals Molecular Mechanisms of Pharmacological Action |