Circulating and Urinary Exosomal miRNA as Predictors of Treatment Response in Advanced Kidney Cancer (EXO-RENAL2)

February 20, 2026 updated by: Institute of Oncology Ljubljana

The Role of Monitoring of the Circulating and Urinary Exosomal miRNA for Prediction of Response to Treatment in Patients With Advanced Kidney Cancer (EXO-RENAL2)

This study investigates the role of circulating and urinary exosomal microRNAs (miRNAs) as potential biomarkers for predicting response to systemic therapy in patients with advanced renal cell carcinoma. Patients receiving immune checkpoint inhibitors or targeted therapies are followed during the first 16 weeks of treatment. Blood and urine samples are collected at predefined time points for analysis of exosome-associated miRNAs. Imaging assessments are performed as part of routine clinical follow-up. The aim of the study is to identify exosomal miRNA profiles associated with treatment response and to support the development of non-invasive predictive biomarkers in advanced kidney cancer.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Advanced renal cell carcinoma is commonly treated with immune checkpoint inhibitors and targeted therapies; however, patient response is heterogeneous and reliable predictive biomarkers are limited. Exosomes are extracellular vesicles released by cells into body fluids and contain molecular cargo such as microRNAs (miRNAs), which may reflect tumor biology and immune response. Circulating and urinary exosomal miRNAs represent promising non-invasive biomarkers that could support early prediction of treatment response.

This prospective clinical study evaluates changes in the expression of selected exosome-associated miRNAs in blood and urine and their association with response to systemic therapy in patients with advanced renal cell carcinoma. Eligible participants include patients treated in the first- or second-line setting with immune checkpoint inhibitors or targeted agents. Participants provide blood samples (approximately 10 mL) at four predefined time points and urine samples (approximately 50 mL) at two predefined time points during the first 16 weeks of therapy. Samples are processed according to a standardized protocol including centrifugation and storage at low temperature until further analysis.

Laboratory procedures include isolation of extracellular vesicles from plasma and urine, quantification of extracellular vesicles using nanoparticle tracking analysis, and isolation of exosome-associated miRNA followed by quantitative PCR (qPCR) for selected target miRNAs. Quality assessment of samples is performed, including evaluation of hemolysis and additional purity controls.

Clinical data and radiological imaging results collected during routine clinical management are used to assess treatment response. The primary objective is to identify associations between exosomal miRNA expression patterns and treatment response during early therapy. The study aims to contribute to the development of minimally invasive biomarkers for prediction of therapy response in advanced kidney cancer and to improve patient stratification for systemic treatment.

Study Type

Interventional

Enrollment (Actual)

91

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Slovenia
      • Ljubljana, Slovenia, 1000
        • Institute of Oncology Ljubljana

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adults (≥18 years)
  • Histologically confirmed advanced or metastatic renal cell carcinoma
  • Receiving systemic treatment with immune checkpoint inhibitors and/or targeted therapy (first- or second-line therapy)
  • Ability to provide blood and urine samples according to the study protocol
  • Written informed consent

Exclusion Criteria:

  • Age <18 years
  • Inability to provide required blood and urine samples
  • Inability to provide informed consent
  • Any condition preventing participation according to investigator assessment

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Exosomal miRNA Monitoring During Systemic Therapy
Diagnostic test: Circulating and Urinary Exosomal miRNA Analysis
Blood and urine samples are collected at predefined time points during the first 16 weeks of systemic therapy. Exosomes (extracellular vesicles) are isolated from plasma and urine, quantified, and exosome-associated microRNAs are extracted and analyzed using quantitative PCR (qPCR). The intervention is performed to evaluate exosomal miRNA profiles as predictive biomarkers of treatment response in advanced renal cell carcinoma.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Circulating Exosomal miRNA Relative Expression (ΔCt) Measured by Quantitative PCR
Time Frame: Baseline to Week 16
Change from baseline to Week 16 in selected circulating exosome-associated microRNA expression levels measured in plasma using quantitative polymerase chain reaction (qPCR). Expression is quantified as relative cycle threshold values (ΔCt).
Baseline to Week 16
Radiological Response Rate Assessed by RECIST 1.1
Time Frame: Week 16
Radiological treatment response at Week 16 assessed using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Response categories include Complete Response (CR), Partial Response (PR), Stable Disease (SD), and Progressive Disease (PD). Outcome reported as proportion of patients in each response category.
Week 16
Spearman Correlation Coefficient Between Change in Circulating Exosomal miRNA Expression (ΔCt) and Radiological Response (RECIST 1.1)
Time Frame: Week 16
Spearman correlation coefficient (rho) between change from baseline to Week 16 in circulating exosomal miRNA relative expression levels (ΔCt, measured by qPCR) and radiological treatment response at Week 16 assessed using RECIST version 1.1.
Week 16

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Institute of Oncology Ljubljana

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 1, 2022

Primary Completion (Actual)

December 31, 2022

Study Completion (Actual)

December 31, 2024

Study Registration Dates

First Submitted

February 12, 2026

First Submitted That Met QC Criteria

February 20, 2026

First Posted (Actual)

February 27, 2026

Study Record Updates

Last Update Posted (Actual)

February 27, 2026

Last Update Submitted That Met QC Criteria

February 20, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • OI-EXO-RENAL2-2022
  • ERID-KSOPKR-0083/2021 (Other Identifier: Commission for the Professional Evaluation of Clinical Research Protocols (KSOPKR))

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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