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Trial record 1 of 22 for:    RAPPORT | Phase 2
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Stereotactic Radiotherapy and Anti-PD1 Antibody (Pembrolizumab) for Oligometastatic Renal Tumours (RAPPORT)

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ClinicalTrials.gov Identifier: NCT02855203
Recruitment Status : Active, not recruiting
First Posted : August 4, 2016
Last Update Posted : September 16, 2020
Sponsor:
Information provided by (Responsible Party):
Peter MacCallum Cancer Centre, Australia

Brief Summary:
This investigator driven study will examine the safety, efficacy and biological effects of combining pembrolizumab (MK-3475) an antibody targeted against anti-programmed cell death 1 (PD-1), with stereotactic ablative body radiotherapy (SABR) for oligometastatic renal cell carcinoma (RCC). The investigators hypothesise that the safety profile of this combination will be clinically acceptable.

Condition or disease Intervention/treatment Phase
Renal Cell Carcinoma Radiation: Stereotactic Ablative Body Radiosurgery (SABR) Drug: Pembrolizumab Phase 1 Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 30 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Stereotactic Radiotherapy and Anti-PD1 Antibody (Pembrolizumab) for Oligometastatic Renal Tumours
Actual Study Start Date : October 20, 2016
Estimated Primary Completion Date : October 2020
Estimated Study Completion Date : October 2020


Arm Intervention/treatment
Experimental: SABR + Pembrolizumab
SABR treatment (18Gy-20Gy/1#) followed by 200mg pembrolizumab IV once every 3 weeks for a total of 8 cycles
Radiation: Stereotactic Ablative Body Radiosurgery (SABR)
18-20Gy in 1 fraction

Drug: Pembrolizumab
Pembrolizumab at a dose of 200mg IV, 3-weekly will be delivered for a duration of 6 months, commencing 5 days (+/- 3 days) from the last dose of SABR.




Primary Outcome Measures :
  1. Toxicities measured using CTCAE version 4.03 [ Time Frame: Up to 24 months after SABR treatment ]

Secondary Outcome Measures :
  1. Overall survival [ Time Frame: From start of treatment until the date of death from any cause assessed up to the date when the last patient has their 12 months assessment ]
  2. Time to local progression (TTLP) [ Time Frame: From start of treatment until the date of first local progression or until the date of death from any cause, whichever occurs first, assessed up to the date when the last patient has their 12 months assessment ]
  3. Distant progression free survival (DPFS) [ Time Frame: From start of treatment until the date of first distant progression or until the date of death from any cause, whichever occurs first, assessed up to the date when the last patient has their 12 months assessment ]
  4. Overall response assessed using RECIST 1.1 [ Time Frame: Assessed at 3, 6, 12 and 24 months ]
  5. Pain assessed using the Numerical Pain Rating Scale [ Time Frame: Assessed 3-monthly until 24 months after end of SABR treatment ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Has provided written informed consent for the trial.
  2. Be at least 18 years of age on day of signing informed consent.
  3. Have oligometastases (1-5 metastases), and measurable disease based on RECIST 1.1.
  4. Participants must have a histologically or cytologically confirmed metastatic renal cell carcinoma. Oligometastatic lesions do not need to be biopsied but they must be clinically consistent to represent metastatic disease.
  5. Patient can either be treatment naïve or have previously received up to 2 lines of systemic treatment (eg. Pazopanib or Sunitinib). The total number of metastases throughout the pre-trial period should not number more than 5.
  6. Must have had surgical consideration for metastasectomy and thought appropriate for SABR due to medical inoperability, technical factors or patient declining surgery.
  7. Must have at least one metastasis for which SABR is technically deliverable.
  8. Be willing to provide archival tissue from a previously biopsied or excised primary or metastatic RCC lesion (if available). If safe to do so, a request for newly obtained specimen (obtained up to 4 weeks prior to initiation of treatment) will be made, however participation for this biopsy is entirely optional.
  9. Have a performance status of 0-2 on the ECOG Performance Scale
  10. Demonstrate adequate organ function as defined below all screening labs should be performed within 10 days of registration.

    • Absolute neutrophil count (ANC) - ≥1.5 X 10^9/L
    • Platelets - ≥100 X 10^9/L
    • Hemoglobin - ≥90 g/L or ≥5.6 mmol/L without transfusion or EPO dependency (within 7 days of assessment)
    • Serum creatinine OR Measured or calculated creatinine clearance (GFR can also be used in place of creatinine or CrCl) - ≤1.5 X upper limit of normal (ULN) OR ≥60 mL/min for participant with creatinine levels > 1.5 X institutional ULN
    • Serum total bilirubin - ≤ 1.5 X ULN OR Direct bilirubin ≤ ULN for participants with total bilirubin levels > 1.5 ULN
    • AST (SGOT) and ALT (SGPT) - ≤ 2.5 X ULN OR ≤ 5 X ULN for participants with liver metastases
    • Albumin - >2.5 mg/dL
    • International Normalized Ratio (INR) or Prothrombin Time (PT) - ≤1.5 X ULN unless participant is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants
    • Activated Partial Thromboplastin Time (aPTT) - ≤1.5 X ULN unless participant is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants
  11. Life expectancy > 12 months.
  12. Be willing and able to comply with all study requirements, including treatment, attending assessments and follow-up.
  13. Female participant of childbearing potential should have a negative urine or serum pregnancy within 72 hours prior to receiving the first dose of study medication. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
  14. Female participants of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 120 days after the last dose of study medication (see Section 9.4.2: Contraception). Participants of childbearing potential are those who have not been surgically sterilized or have not been free from menses for > 1 year.
  15. Male participants should agree to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy

Exclusion Criteria:

  1. Based on clinician assessment of disease volume and rate of progression of patient's tumor deposits, the patient requires immediate TKI therapy.
  2. Has had previous high dose radiotherapy (biological equivalent of 30Gy in 10#) to an area to be treated which includes vertebral bodies (see below).

    Note: Previous high dose radiotherapy is defined as a biological equivalent dose to above that of 30 Gy in 10 fractions using an alpha/beta ratio [82] of 3. Where a patient has received radiotherapy to an equivalent or lower dose than defined above, stereotactic radiotherapy of the area may be considered. In doing so, assessment of the volume and total dose received by any overlap region must be made, and documented by generating a cumulative plan incorporating both the previous and current treatment fields. It is the treating radiation oncologist's responsibility to review both the current plan and the cumulative plan inclusive of previous radiotherapy.

  3. Has evidence of untreated or active intracranial metastases. Patients who have had fully resected brain metastasis or those controlled by stereotactic radiotherapy are eligible as long as they are not requiring corticosteroids for symptomatic control.
  4. Has evidence of Spinal Cord Compression.
  5. Has a Spinal Instability Neoplastic Score ≥ 7 unless lesion reviewed by a neurosurgical service and considered stable (see Appendix 3).
  6. Requires surgical fixation of bone lesion for stability. This must be performed before enrollment into the trial.
  7. Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days of registration.
  8. Has a known history of active TB (Bacillus Tuberculosis).
  9. Hypersensitivity to pembrolizumab or any of its excipients.
  10. Has had a prior anti-cancer monoclonal antibody (mAb) within 4 weeks of registration or who has not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events due to agents administered more than 4 weeks earlier.
  11. Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks of registration or who has not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events due to a previously administered agent.

    Note: Participants with ≤ Grade 2 neuropathy are an exception to this criterion and may qualify for the study.

    Note: If participant received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy.

  12. Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer.
  13. Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids within 7 days of registration. This exception does not include carcinomatous meningitis which is excluded regardless of clinical stability.
  14. Has active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
  15. Has known history of, or any evidence of active, non-infectious pneumonitis.
  16. Has an active infection requiring systemic therapy.
  17. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the participant's participation for the full duration of the trial, or is not in the best interest of the participant to participate, in the opinion of the treating investigator.
  18. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
  19. Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit through 120 days after the last dose of trial treatment.
  20. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent.
  21. Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
  22. Has known active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is detected).
  23. Has received a live vaccine within 30 days of registration

Information from the National Library of Medicine

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): NCT02855203


Locations
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Australia, Queensland
Princess Alexandra Hospital
Woolloongabba, Queensland, Australia, 4102
Sponsors and Collaborators
Peter MacCallum Cancer Centre, Australia
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Responsible Party: Peter MacCallum Cancer Centre, Australia
ClinicalTrials.gov Identifier: NCT02855203    
Other Study ID Numbers: 15/143
First Posted: August 4, 2016    Key Record Dates
Last Update Posted: September 16, 2020
Last Verified: September 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Additional relevant MeSH terms:
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Carcinoma, Renal Cell
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Kidney Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Kidney Diseases
Urologic Diseases
Pembrolizumab
Antineoplastic Agents, Immunological
Antineoplastic Agents