- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05969496
Neoadjuvant Pembrolizumab and Axitinib in Renal Cell Carcinoma With Inferior Vena Cava Tumor Thrombus (NEOPAX)
Neoadjuvant Pembrolizumab and Axitinib in Renal Cell Carcinoma With Associated Inferior Vena Cava Tumor Thrombus (NEOPAX)
Study Overview
Status
Intervention / Treatment
Detailed Description
Patients will receive the combination of Axitinib 5 mg orally twice daily (can be increased to 7 mg twice daily after 2 weeks, and further to 10 mg twice daily as tolerated) and Pembrolizumab 200 mg IV every 21 days. This combination will be given for a total of 12 weeks (4 cycles). A radiographic assessment will be done up to 12 weeks (4 cycles of therapy) to evaluate the primary endpoint of IVC TT response. Patients will undergo a definitive surgery per treating urologist within 2 weeks (+/- 7 days) after the end of treatment scan.
During the course of the trial, patient-related health outcomes using Kidney Cancer validated questionnaires with FKSI-DRS and FKSI-19 will also be obtained. These are validated paper questionnaires that will be given to each patient on study visits while receiving neoadjuvant therapy.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Matthew Lee
- Phone Number: 720-848-0630
- Email: matthew.lee@cuanscutz.edu
Study Locations
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Colorado
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Aurora, Colorado, United States, 80045
- Recruiting
- University of Colorado Cancer Center
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Contact:
- Elizabeth Kessler
- Phone Number: 720-848-0170
- Email: elizabeth.kessler@cuanschutz.edu
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Provision to sign and date the consent form.
- Stated willingness to comply with all study procedures and be available for the duration of the study.
- Participant self-identified gender ages >/= 18 years old is acceptable and appropriate if they meet other inclusion criteria.
- Histologically proven clear cell component RCC.
- An upfront candidate for definitive surgery per treating Urologist.
- Suitable for and willing to undergo nephrectomy (either cytoreductive or with curative intent) per treating urologist.
- T Stage of any of the following: cT3b, cT3c, cT4
- N stage of any of the following: cN0 or cN1
- M stage of any of the following: cM0 or cM1
- ECOG performance status 0 - 2.
- Urinalysis <2+ protein. If dipstick is ≥2+ then a 24-hour urine collection should be performed, and the patient may enter the trial if urinary protein is <2g per 24 hours.
- All participants who have reproductive potential must have a negative serum or urine pregnancy test within a maximum of 14 days prior to starting trial treatment.
Reproductive potential is defined as the following:
Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply:
- Women <50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy)
- Women ≥50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses >1 year ago, had chemotherapy-induced menopause with last menses >1 year ago, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy
- For males with reproductive potential, use effective birth control during treatment with Axitinib and Pembrolizumab is recommended.
Exclusion Criteria:
- Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to enrollment.
- Has had major surgery within 4 weeks or received radiation therapy within 1 week prior to enrollment to the study.
- Has had prior treatment with any anti-programmed cell death (anti-PD-1) or programmed cell death ligand 1 (PD-L1), or an antibody targeting any other immune-regulatory receptors or mechanisms.
- Has received prior systemic anti-cancer therapy for RCC with vascular endothelial growth factor (VEGF)/VEGF receptors (VEGFR).
- Has a history of severe hypersensitivity reaction (e.g., generalized rash/erythema, hypotension, bronchospasm, angioedema, or anaphylaxis) to Axitinib.
- Has a diagnosis of immunodeficiency OR is receiving a systemic steroid therapy greater than Prednisone 10 mg daily or a steroid equivalent, or any other form of immunosuppressive therapy within 7 days prior to enrollment to the study except in the case of central nervous system (CNS) metastases.
- Has an active autoimmune disease requiring systemic treatment within the past 2 years OR a documented history of clinically severe autoimmune disease. Note: Participants with vitiligo, Sjogren's syndrome, Type 1 diabetes, resolved childhood asthma/atopy, hypothyroidism or adrenal or pituitary insufficiency who are stable on hormone replacement are not excluded.
- Has a known additional malignancy that has progressed or has required active treatment in the last 3 years. Note: Basal cell carcinoma of the skin, squamous cell carcinoma of the skin, superficial bladder cancer, or carcinoma in situ such as breast cancer in situ, thyroid cancer (papillary, hurthle cell or follicular), or localized prostate cancer are acceptable if they have undergone potentially curative therapy.
- Has known active CNS metastases and/or carcinomatous meningitis.
- Has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis.
- ALT or AST above 3 times the upper limit of normal
- Has received a live virus vaccine within 30 days of enrollment to the study.
- Active GI bleeding, as evidenced by hematemesis, hematochezia, or melena in the past 3 months without evidence of resolution documented by endoscopy or colonoscopy.
- Intraluminal metastatic lesion with suspected bleeding, inflammatory bowel disease, ulcerative colitis or other GI condition associated with increased risk of perforation.
- Has QT interval corrected for heart rate (QTc) ≥480 msec.
Has a history of any of the following cardiovascular conditions within 12 months of enrollment to the study:
- Myocardial infarction
- Unstable angina pectoris
- Cardiac angioplasty or stenting
- Coronary/peripheral artery bypass graft
- Class III or IV congestive heart failure per New York Heart Association
- Cerebrovascular accident or transient ischemic attack
- Has poorly controlled hypertension defined as systolic blood pressure (SBP) ≥150 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg on 3 or more dose optimized anti- hypertensive medication.
- Has evidence of inadequate wound healing per treating physician discretion.
- Has active bleeding disorder or other history of significant bleeding episodes within 30 days of enrollment to the study.
- Has current use (within 7 days of enrollment) or anticipated need for treatment with drugs or foods that are known to be strong cytochrome P450 (CYP3A4/5) inhibitors.
- Has current use (within 7 days of enrollment) or anticipated need for treatment with drugs that are known strong CYP3A4/5 inducers, including but not limited to carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, and St. John's wort; or drugs that are known with proarrhythmic potential.
- Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the study by subject self-report.
- Has had a prior solid organ transplant.
- Is pregnant or breastfeeding or expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 120 days after the last dose of study drug.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Combination Pembrolizumab and Axitinib
Neoadjuvant therapy with the combination of Pembrolizumab and Axitinib will be given for eligible RCC patients with an IVC TT for a total of 12 weeks.
Patients will then undergo imaging with a contrast enhanced, diffusion weighted imaging MRI of the abdomen to evaluate the IVC TT response.
A CT chest will also be done to ensure there is no progression of disease.
Patients can undergo definitive surgery per treating Urologist within 2 weeks (+/- 7 days) after end of treatment scan.
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Axitinib is a potent oral, vascular endothelial growth factor, c-kit and platelet derived growth factor inhibitor.
Other Names:
Pembrolizumab is a type of immunotherapy.
It stimulates the body's immune system to fight cancer cells.
Pembrolizumab targets and blocks a protein called PD-1 on the surface of certain immune cells called T-cells.
Blocking PD-1 triggers the T-cells to find and kill cancer cells.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Evaluate Change in IVC Tumor Thrombus Extent Based on the Mayo Classification
Time Frame: baseline and 12 weeks
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baseline and 12 weeks
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Evaluate a change in IVC TT Size from Baseline
Time Frame: baseline and 12 weeks
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o Evaluation of IVC TT anteroposterior and transverse diameter will also be measured at baseline and the end of treatment at 12 weeks.
The baseline largest diameter will be subtracted to the largest diameter as the end of treatment divided by the baseline largest diameter will be computed to evaluate the percentage change in the IVC TT size.
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baseline and 12 weeks
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Evaluate Surgical Complications after the Neoadjuvant Combination of Pembrolizumab and Axitinib Among Patients with RCC with IVC TT
Time Frame: Date of surgery up to 30 days post operative or date of hospital discharge whichever occurs first
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Date of surgery up to 30 days post operative or date of hospital discharge whichever occurs first
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Safety profile of the combination of Axitinib and Pembrolizumab
Time Frame: baseline to 30 days post operative
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Catalogue o Any grade adverse event o Grade 3 or higher adverse event possibly, probably, or definitely related to study therapy All treatment related adverse events will be assessed using the Common Terminology Criteria for Adverse Events v5.0 |
baseline to 30 days post operative
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1 year Progression Free Survival
Time Frame: baseline, 3 months, 6 months, 9 months, 12 months from study enrollment
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Progression-free survival is defined as any clinical or radiographic progression or death from any cause one year after enrollment in the study
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baseline, 3 months, 6 months, 9 months, 12 months from study enrollment
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1 year Overall Survival
Time Frame: 12 months from study enrollment
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One year- Overall survival.
Overall survival is defined as death from any cause one year after enrollment in the study
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12 months from study enrollment
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Elizabeth E Kessler, MD, University of Colorado, Denver
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Urologic Neoplasms
- Urogenital Neoplasms
- Neoplasms by Site
- Kidney Diseases
- Urologic Diseases
- Adenocarcinoma
- Neoplasms, Glandular and Epithelial
- Embolism and Thrombosis
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Kidney Neoplasms
- Carcinoma, Renal Cell
- Carcinoma
- Thrombosis
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antineoplastic Agents
- Antineoplastic Agents, Immunological
- Protein Kinase Inhibitors
- Immune Checkpoint Inhibitors
- Pembrolizumab
- Axitinib
Other Study ID Numbers
- 22-1669.cc
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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