Bevacizumab and Interleukin-2 in Treating Patients With Metastatic Kidney Cancer

Phase 2 Trial of Sequential Bevacizumab Then Subcutaneous Interleukin-2 in Metastatic Renal Cancer

This phase II trial is studying how well giving bevacizumab together with interleukin-2 works in treating patients with metastatic kidney cancer. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. Interleukin-2 may stimulate the white blood cells to kill tumor cells. Giving bevacizumab together with interleukin-2 may kill more tumor cells.

Study Overview

• Status: Completed
• Conditions: Recurrent Renal Cell Carcinoma; Stage IV Renal Cell Cancer
• Intervention / Treatment: Other: Laboratory Biomarker Analysis; Biological: Bevacizumab; Biological: Aldesleukin

Detailed Description

PRIMARY OBJECTIVES:

I. Determine the frequency of major response in patients with metastatic renal cell cancer treated with bevacizumab and interleukin-2.

SECONDARY OBJECTIVES I. Compare the median progression-free survival and median overall survival of patients treated with this regimen with risk-stratified historical controls from published risk models.

OUTLINE:

Patients receive bevacizumab IV over 30-90 minutes on day 1 in weeks 1, 3, 5, 7, 9, and 11. Patients also receive interleukin-2 subcutaneously on days 1-5 in weeks 5-10. Treatment repeats every 12 weeks for up to 2 courses in the absence of disease progression or unacceptable toxicity. Patients with stable or responding disease then receive bevacizumab alone in weeks 1, 3, 5, 7, 9, and 11. Courses with bevacizumab alone repeat every 12 weeks in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed at 30 days and then every 3 months for at least 2 years.

PROJECTED ACCRUAL: Approximately 10-38 patients will be accrued for this study within 21 months.

• Study Type: Interventional
• Enrollment (Actual): 19
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Florida
    • Tampa, Florida, United States, 33612
      • Moffitt Cancer Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Histologically or cytologically confirmed renal cell cancer

  • Metastatic disease
  • More than 75% clear cell histology
• Measurable disease, defined as ≥ 1 unidimensionally measurable lesion ≥ 20 mm by conventional techniques OR ≥ 10 mm by spiral CT scan
• No prior refractory disease, defined as clinical or radiologic progression, during or within 3 months after completion of prior interleukin-2 (IL-2)

• Nominally "good" or "intermediate" risk disease, meeting ≥ 4 out of 5 of the following criteria:

  • Hemoglobin > 10 g/dL (except for patients with hereditary hemoglobinopathy)
  • ECOG performance status 0-1 (required)

  • Calcium normal (corrected)

    • Patients with hypercalcemia due to malignancy allowed provided it has been controlled for > 1 month
  • Primary tumor treated or resected by complete nephrectomy, partial nephrectomy, radiofrequency ablation, or other local ablation
  • Lactic dehydrogenase < 1.5 times upper limit of normal (ULN)
• No history of or current brain or CNS metastasis by CT scan or MRI within the past 30 days
• Performance status - ECOG 0-1
• More than 4 months
• Absolute neutrophil count ≥ 1,500/mm^3
• Platelet count ≥ 75,000/mm^3
• No history of bleeding diathesis
• PTT < 1.5 times ULN
• INR < 1.5
• Bilirubin ≤ 1.5 times ULN
• AST and ALT ≤ 2.5 times ULN
• No chronic hepatitis B or C
• Creatinine ≤ 2.0 mg/dL
• No proteinuria* by dipstick urinalysis
• Urine protein ≤ 1,000 mg by 24-hour urine collection
• No symptomatic congestive heart failure
• No uncontrolled hypertension, defined as systolic blood pressure (BP) > 160 mm Hg and diastolic BP > 90 mm Hg
• No cardiac arrhythmia
• No peripheral vascular disease ≥ grade 2
• No clinically significant peripheral artery disease

• None of the following arterial thromboembolic events within the past 6 months:

  • Transient ischemic attack
  • Cerebrovascular accident
  • Unstable angina pectoris
  • Myocardial infarction
• Not pregnant
• No nursing during and for 3 months after completion of study treatment
• Negative pregnancy test
• Fertile patients must use effective contraception before, during, and for 3 months after completion of study treatment
• No active infection requiring parenteral antibiotics
• No known HIV positivity
• No history of allergic reaction to antibody drugs or IL-2
• No psychiatric illness or social situation that would preclude study compliance
• No non-healing wound or fracture
• No insulin-dependent diabetes
• No other uncontrolled illness
• No other malignancy requiring active treatment within the past 2 years except nonmelanoma skin cancer
• No prior bevacizumab
• At least 6 months since prior immunotherapy containing IL-2
• At least 2 months since prior investigational antibodies
• More than 4 weeks since prior conventional cytotoxic chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered
• No concurrent corticosteroids except replacement corticosteroids for adrenal insufficiency OR inhaled steroids for chronic obstructive pulmonary disease, asthma, or allergic rhinitis
• More than 3 weeks since prior radiotherapy and recovered
• No prior radiotherapy to the only site of measurable disease unless there has been subsequent disease progression
• More than 4 weeks since prior major surgery
• At least 24 hours since prior minor surgical procedure, placement of vascular access device, or fine needle aspiration
• At least 30 days since prior and no other concurrent investigational agents

• More than 10 days since prior anticoagulants

  • Low-dose anticoagulants for maintenance of vascular access device patency allowed
• No concurrent therapeutic warfarin, including warfarin for treatment of deep vein thrombosis or pulmonary embolism
• No other concurrent anticancer therapy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Treatment (bevacizumab, aldesleukin); Patients receive bevacizumab IV over 30-90 minutes on day 1 in weeks 1, 3, 5, 7, 9, and 11. Patients also receive interleukin-2 subcutaneously on days 1-5 in weeks 5-10. Treatment repeats every 12 weeks for up to 2 courses in the absence of disease progression or unacceptable toxicity. Patients with stable or responding disease then receive bevacizumab alone in weeks 1, 3, 5, 7, 9, and 11. Courses with bevacizumab alone repeat every 12 weeks in the absence of disease progression or unacceptable toxicity.

Other: Laboratory Biomarker Analysis; Correlative studies; Biological: Bevacizumab; Given IV; Other Names: Avastin; Anti-VEGF; Anti-VEGF Humanized Monoclonal Antibody; Anti-VEGF rhuMAb; Bevacizumab Biosimilar BEVZ92; Bevacizumab Biosimilar BI 695502; Immunoglobulin G1 (Human-Mouse Monoclonal rhuMab-VEGF Gamma-Chain Anti-Human Vascular Endothelial Growth Factor), Disulfide With Human-Mouse Monoclonal rhuMab-VEGF Light Chain, Dimer; Recombinant Humanized Anti-VEGF Monoclonal Antibody; rhuMab-VEGF; Biological: Aldesleukin; Given subcutaneously; Other Names: Proleukin; 125-L-Serine-2-133-interleukin 2; r-serHuIL-2; Recombinant Human IL-2; Recombinant Human Interleukin-2

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Evaluable Participants With Complete Response (CR) and Partial Response (PR) at One Year	Major response according to Response Evaluation Criteria In Solid Tumors (RECIST). CR: Disappearance of all target lesions; Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. PR: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Evaluable Participants With Overall Survival (OS) at 2 Years	Overall Survival tabulation at 2 years from start of treatment.	2 years from start of treatment
Number of Evaluable Participants With Progression Free Survival (PFS)	Progression Free Survival tabulation at 1 year and at 2 years. Progressive Disease (PD): Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.	Up to 2 years
Pearson Correlation Coefficients of Dendritic Cell (DC):Immature Cell (ImC) Ratio With DC Function	Dendritic cell (DC) phenotype or functionality. Pearson correlation coefficients of DC:ImC ratio with DC function were to be computed and tested for departure from zero. Those with major responses were to be compared to those without major responses with respect to baseline DC:ImC ratio, baseline DC functional assay, post-treatment DC:ImC ratio and post-treatment DC functional assay using pooled t tests.	At baseline, at days 4-5, 9-10 (of course 1), and at the end of treatment
Number of Participants With Possibly Related Serious Adverse Events (SAEs)	Number of Participants with Serious Adverse Events (SAEs) Possibly Related to Study Treatment. Toxicity as assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 3.0	Up to 30 days after completion of treatment

Collaborators and Investigators

• Sponsor: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Mayer Fishman, Moffitt Cancer Center

Study record dates

Study Major Dates

• Study Start: March 1, 2005
• Primary Completion (Actual): June 1, 2012
• Study Completion (Actual): August 1, 2013

Study Registration Dates

• First Submitted: August 2, 2005
• First Submitted That Met QC Criteria: August 2, 2005
• First Posted (Estimate): August 4, 2005

Study Record Updates

• Last Update Posted (Estimate): June 30, 2015
• Last Update Submitted That Met QC Criteria: June 3, 2015
• Last Verified: December 1, 2013

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms by Histologic Type; Neoplasms; Urologic Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Kidney Diseases; Urologic Diseases; Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Kidney Neoplasms; Carcinoma, Renal Cell; Physiological Effects of Drugs; Anti-Infective Agents; Peripheral Nervous System Agents; Antiviral Agents; Anti-HIV Agents; Anti-Retroviral Agents; Analgesics; Sensory System Agents; Analgesics, Non-Narcotic; Antineoplastic Agents; Immunologic Factors; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; Aldesleukin; Antibodies; Immunoglobulins; Bevacizumab; Antibodies, Monoclonal; Antineoplastic Agents, Immunological; Immunoglobulin G; Interleukin-2; Endothelial Growth Factors
• Other Study ID Numbers: NCI-2012-02663 (Registry Identifier: CTRP (Clinical Trial Reporting Program)); P30CA076292 (U.S. NIH Grant/Contract); CDR0000434852; NCI-6438; MCC-IRB-102782; MCC 13921 (Other Identifier: Moffitt Cancer Center); 6438 (Other Identifier: CTEP)