Optimal Treatment by Invoking Biologic Clusters in Renal Cell Carcinoma (OPTIC RCC)
Vanderbilt-Ingram Cancer Center
Summary
This phase II trial tests whether using genetic testing of tumor tissue to select the optimal treatment regimen works in treating patients with clear cell renal cell (kidney) cancer that has spread to other places in the body (advanced or metastatic). The current Food and Drug Administration (FDA)-approved regimens for advanced kidney cancer fall into two categories. One treatment combination includes two immunotherapy drugs (nivolumab plus ipilimumab), which are delivered by separate intravenous infusions into a vein. The other combination is one immunotherapy drug (nivolumab infusion) plus an oral pill taken by mouth (cabozantinib). Nivolumab and ipilimumab are "immunotherapies" which release the brakes of the immune system, thus allowing the patient's own immune system to better kill cancer cells. Cabozantinib is a "targeted therapy" specifically designed to block certain biological mechanisms needed for growth of cancer cells. In kidney cancer, cabozantinib blocks a tumor's blood supply. The genetic (DNA) makeup of the tumor may affect how well it responds to therapy. Testing the makeup (genes) of the tumor, may help match a treatment (from one of the above two treatment options) to the specific cancer and increase the chance that the disease will respond to treatment. The purpose of this study is to learn if genetic testing of tumor tissue may help doctors select the optimal treatment regimen to which advanced kidney cancer is more likely to respond.
Description
PRIMARY OBJECTIVE: I. To improve objective response rate of front-line therapy in advanced renal cell carcinoma (RCC) by prospectively assigning ipilimumab/nivolumab or nivolumab/cabozantinib according to a patient's ribonucleic acid sequence (RNAseq)-defined biologic cluster. SECONDARY OBJECTIVE: I. To assess clinical outcome of cluster-assigned treatment in front-line metastatic renal cell carcinoma (mRCC). EXPLORATORY OBJECTIVE: I. To assess tissue and peripheral blood for pharmacodynamic correlations with response to treatment. OUTLINE: Patients are assigned to 1 of 2 arms. ARM I:…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Histological confirmation of RCC with a clear cell component * Advanced (not amenable to curative surgery or radiation therapy) or metastatic (American Joint Committee on Cancer \[AJCC\] stage IV) RCC * Patient can comprehend and sign the study informed consent form * Male or female \>= 18 years of age at the time of informed consent * Karnofsky performance status (KPS) of \>= 70% * No prior systemic therapy for RCC in the neoadjuvant, adjuvant or metastatic setting * At least one measurable lesion as defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 *…
Interventions
- DrugCabozantinib
Given PO
- BiologicalIpilimumab
Given IV
- BiologicalNivolumab
Given IV
Locations (6)
- City of Hope National Medical CenterDuarte, California
- Chao Family Comprehensive Cancer CenterOrange, California
- University Hospitals Seidman Cancer CenterCleveland, Ohio
- Cleveland ClinicCleveland, Ohio
- Vanderbilt University/Ingram Cancer CenterNashville, Tennessee
- University of Texas, Southwestern Medical CenterDallas, Texas