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Advanced Non-clear Cell Renal Cell CarcinomaPhase 2ASPENNCT01108445

Phase II Study of Afinitor vs. Sutent in Patients With Metastatic Non-Clear Cell Renal Cell Carcinoma

A Phase 2 study testing Everolimus and Sunitinib in people with Advanced Non-clear Cell Renal Cell Carcinoma, run by Duke University at 18 sites in 3 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

To compare the anti-tumor activity of everolimus and sunitinib in subjects with metastatic renal cell carcinoma (mRCC) with non-clear cell pathology. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Everolimus and Sunitinib
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
131 participants
Where
18 sitesin 3 countries
Study dates
Sep 2010to Apr 2015
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Histologically confirmed advanced Renal Cell Carcinoma (RCC), with non-clear cell pathology.
  • RCC tumor tissue available for correlative sciences, from either primary or metastatic site or both.
  • At the time of screening, at least 4 weeks since prior palliative radiation therapy and/or major surgery, and resolution of all toxic effects of prior therapy to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE; version 4.0) Grade 1.
  • Subject must have radiographic evidence of metastatic disease with at least 1 measurable per RECIST 1.1 criteria (Attachment 1)].
  • Age > 18 years.
  • Adequate laboratory values
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  • Karnofsky Performance Status ≥ 60 (Attachment 2).
  • Life expectancy of at least 3 months.
  • Written, signed, dated, and witnessed Institutional Review Board (IRB) or Institutional Ethics Committee (IEC) approved informed consent form (ICF) before any screening procedures are performed.

Who cannot join

  • Subjects with a history of or active central nervous system (CNS) metastases.
  • Prior systemic therapy for RCC, including mTOR and anti-angiogenic therapy, chemotherapy, biologic or experimental therapy.
  • Subjects with collecting duct, medullary, small cell, oncocytoma, or lymphoma-type pathology.
  • Subjects receiving known strong CYP3A4 isoenzyme inhibitors and/or inducers.
  • Major surgery, open biopsy, traumatic injury, or radiotherapy within 4 weeks of the screening visit.
  • Subjects who have not recovered from prior biopsy, surgery, traumatic injury, and/or radiation therapy.
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  • Presence of a non-healing wound or ulcer.
  • Grade 3 hemorrhage within the past month.
  • Hypertension with systolic blood pressure of >180 mm Hg and/or diastolic pressure >100 mm Hg.
  • Subjects with American Heart Association (AHA) Class 2-4 heart disease or any history of congestive heart failure with an ejection fraction <50%, or history of unstable angina, myocardial infarction, coronary artery bypass graft, cerebrovascular accident, transient ischemic attack, or pulmonary embolism within 6 months of entry.
  • Diabetes mellitus with glycosylated hemoglobin A1c (HbgA1c) > 10% despite therapy.
  • A history of interstitial pneumonitis.
  • Subjects with active autoimmune disorder(s) being treated with immunosuppressive agents within 4 weeks prior to the screening visit.
  • Subjects receiving immunosuppressive agents and those with chronic viral/bacterial/fungal illnesses such as human immunodeficiency virus (HIV).
  • Patients who have receive immunization with attenuated live vaccines within one week of study entry or during study period.
  • Patients with active infection(s), active antimicrobial therapy or serious intercurrent illness.
  • History of other prior malignancy in past 5 years.
  • Pregnant or nursing women.
  • Major medical/psychiatric illness that, in the investigator's judgment, will substantially increase the risk associated with the subject's participation in this study, including inability to absorb oral medications and history of noncompliance to medical regimens.
  • Known hypersensitivity to any of the components in everolimus or sunitinib product
  • Subjects taking agents that significantly prolong the QTc interval are not eligible.
  • Proteinuria with a spot urine protein/creatinine ratio >2 or 24 hour urine protein >2 grams per 24 hours.
  • Severely impaired lung function as defined as spirometry and Carbon Monoxide Diffusing Capacity (DLCO) that is 50% of the normal predicted value and/or O2 saturation that is 88% or less at rest on room air.
  • Advanced liver disease such as cirrhosis or severe hepatic impairment (Child-Pugh class C).

Trial locations and contacts

18 sites in 3 countries.

18 sites in 3 countries

United States9 sites
  • University of Chicago

    Chicago, Illinois, 60637

  • Cleveland Clinic

    Cleveland, Ohio, 44195

  • Karmanos Cancer Institute/Wayne State University

    Detroit, Michigan, 48201

  • Duke Univeristy Medical Center

    Durham, North Carolina, 27708

  • Indiana University Melvin and Bran Simon Cancer Center

    Indianapolis, Indiana, 46202

  • SCRI

    Nashville, Tennessee, 37203

  • The Vanderbilt Clinic, Henry-Joyce Cancer Center

    Nashville, Tennessee, 37212

  • Oregon Health & Science University

    Portland, Oregon, 97239

  • Washington Univ in St. Louis-School of Medicine

    St Louis, Missouri, 63110

Other trials in United States

United Kingdom6 sites
  • Cambridge Cancer Trials Centre

    Cambridge, England, CB2 0QQ

  • Beatson West Scotland Cancer Centre

    Glasgow, Scottland, G12 0YN

  • Churchill Hospital

    Headington, Oxford, OX3 7LJ

  • The Royal Marsden NHS

    London, England, 8W3 6JJ

  • The Christie Hospital NHS

    Manchester, England, M20 4BX

  • Weston Park Hospital

    Sheffield, England, S10 2SJ

Other trials in United Kingdom

Canada3 sites
  • London Health Sciences Center

    London, Ontario, N6A-4L6

  • BC Cancer Agency

    Vancouver, British Columbia, V5Z 4E6

  • CancerCare Manitoba, Med Onc, Dept Hem and Onc

    Winnipeg, Manitoba, R3E 0V9

Other trials in Canada

About this study

Official title: A Randomized Phase II Study of Afinitor (RAD001) vs. Sutent (Sunitinib) in Patients With Metastatic Non-Clear Cell Renal Cell Carcinoma (ASPEN)

To compare the anti-tumor activity of everolimus and sunitinib in subjects with metastatic renal cell carcinoma (mRCC) with non-clear cell pathology.

Read the detailed description

This will be an international (USA, Canada, and UK) open-label, outpatient, multicenter, randomized study of treatment with RAD001 (everolimus (Afinitor®) or sunitinib (Sutent®) in subjects with mRCC and non-clear cell histology. Special emphasis is placed on papillary and chromophobe histologies while sarcomatoid clear cell variants, medullary, and collecting duct carcinomas will be excluded (see eligibility). Subjects may continue receiving study drugs until disease progression, unacceptable toxicities, or withdrawal of consent, for a maximum of 24 months. Continuation of study assigned treatment will be allowed beyond 24 months at the discretion of the sponsor. Stratification variables will include histology (papillary vs. chromophobe) and Motzer risk criteria (0, 1-2, and 3). Tumor progression will be assessed locally and by independent review, in strict accordance with Response Evaluation Criteria in Solid Tumors (RECIST 1.1) criteria measured every 12 weeks. At the time of progression, subjects will be taken off study other than simple administrative mortality follow-up. Primary pathologic samples and plasma/urine angiokine levels at baseline and over time will be collected and stored centrally for biomarker analysis.

Being tested
Everolimus, Sunitinib
Keywords
cancer, kidney cancer, sutent, everolimus, renal cancer, papillary renal cell, chromophobe renal cell, papillary, chromophobe
Medical subject headings
Neoplasms, Kidney Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EverolimusDrug

    Also called Afinitor, everolimus, RAD001

    Subjects in this treatment arm will receive everolimusRAD001 10 mg orally once daily by mouth on days 1 through 42 for each 42 day cycle.

  • SunitinibDrug

    Also called Sutent

    50 mg daily by mouth on days 1 through 28 of each 42 day cycle.

Study groups in NCT01108445
Study groupRoleWhat they receive
RAD001Active comparatorSubjects in this treatment arm will receive everolimus/RAD001 10 mg orally once daily by mouth on days 1 through 42 for each 42 day cycle.
Receives: Drug: Everolimus
SunitinibActive comparatorSubjects in this treatment arm will take sunitinib 50 mg daily by mouth on days 1 through 28 of each 42 day cycle.
Receives: Drug: Sunitinib

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Anti-tumor Activity as Measured by Median Progression Free Survival Time

    The primary objective will be to compare the anti-tumor activity of everolimus and sunitinib in subjects with mRCC with non-clear cell pathology, as measured by progression-free survival (PFS) following treatment initiation according to RECIST 1.1 criteria. Progressive disease is defined as at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

    Measured: 24 Months

Secondary outcomes (14)
  1. Progression Free Survival Rates

    6-, 12-, and 24-month rates of PFS in each arm will be compared for each treatment arm. Progressive disease is defined as at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

    Measured: 6, 12 and 24 months

  2. PFS Expressed in Months

    Progression-free survival (PFS) expressed in months as compared to an historic control (interferon-treated clear cell RCC control arm from the sunitinib phase III study). Progressive disease is defined as at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

    Measured: 24 months

  3. Overall Response Rate

    Defined as complete response [CR] and partial response [PR] by RECIST 1.1 criteria in each treatment arm.Overall Response Rate (ORR) = CR + PR. Complete Response (CR) is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Partial Response (PR) is at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

    Measured: 24 months

  4. Percentage of Participants With Stable Disease (SD)

    Percentage of participants with stable disease during treatment is defined as stable disease [SD] by RECIST 1.1 criteria as calculated in each treatment arm. Stable Disease (SD) is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.

    Measured: Baseline to 36 months

  5. 12 Week Clinical Benefit Rate as Percentage

    Rate of complete or partial response or stable disease by the RECIST 1.1 criteria lasting ≥ 12 weeks prior to progression. Benefit rate is defined as complete response [CR] and partial response [PR] and stable disease [SD] by RECIST 1.1 criteria in each treatment arm. Benefit rate = CR + PR + SD. Complete Response (CR) is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Partial Response (PR) is at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.

    Measured: Baseline to 36 months

  6. Overall Survival Rates

    To compare overall survival (OS) rates at 6, 12, 24, and 36 months and over time in each treatment arm.

    Measured: 6, 12, 24, 36 months

  7. Best Tumor Shrinkage as a Percentile in Each Arm

    To compare the best tumor shrinkage as a percentile in each treatment arm. The percentile change at each follow up visit is calculated by measuring the percentage change in the Sum of lesion measurement from baseline. The best tumor shrinkage is lowest percentile change. A decrease is indicated by a negative percentage.

    Measured: 24 months

  8. Median Duration of Response (CR, PR, and SD)

    To compare the median duration of response (CR, PR, and SD) in each treatment arm. According to RECIST 1.1, Complete Response (CR) is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Partial Response (PR) is at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.

    Measured: 24 months

  9. Median OS

    To compare the median OS in each treatment arm.

    Measured: Up to 40 months

  10. Time-to-new Metastatic Disease in Each Treatment Arm

    To compare the time-to-new metastatic disease in each treatment arm, defined from the date of first study agent administration to the onset of a new evaluable site of disease, excluding the primary site and all sites documented at baseline

    Measured: 36 months

  11. Percentage of Participants With Adverse Events

    To assess toxicities associated with everolimus or sunitinib using NCI CTC version 4.0 criteria

    Measured: 24 months

  12. Change in Quality-of-life

    To compare change in quality-of-life, as measured by the FACT-KSI scale at baseline and cycle 3 day 1 per subject in each treatment arm. Functional Assessment of Cancer Therapy Kidney Symptom Index. FKSI is a questionnaire for FACT-Kidney Symptom Index used to assess QoL/participant-reported outcomes for participants diagnosed with renal cell cancer. The FKSI contained 15 questions each ranging from 0 (not at all) to 4 (very much) so that FKSI ranged between 0-60 where higher scores reflects better functioning and fewer symptoms.

    Measured: baseline, cycle 3 day 1

  13. Change in Quality-of-life

    To compare change in quality-of-life, as measured by the FACT-KSI scale at baseline and cycle 6 day1 per subject in each treatment arm. Functional Assessment of Cancer Therapy Kidney Symptom Index. FKSI is a questionnaire for FACT-Kidney Symptom Index used to assess QoL/participant-reported outcomes for participants diagnosed with renal cell cancer. The FKSI contained 15 questions each ranging from 0 (not at all) to 4 (very much) so that FKSI ranged between 0-60 where higher scores reflects better functioning and fewer symptoms.

    Measured: baseline, cycle 6 day 1

  14. Change in Quality-of-life

    To compare change in quality-of-life, as measured by the FACT-KSI scale at baseline and end of treatment per subject in each treatment arm. Functional Assessment of Cancer Therapy Kidney Symptom Index. FKSI is a questionnaire for FACT-Kidney Symptom Index used to assess QoL/participant-reported outcomes for participants diagnosed with renal cell cancer. The FKSI contained 15 questions each ranging from 0 (not at all) to 4 (very much) so that FKSI ranged between 0-60 where higher scores reflects better functioning and fewer symptoms.

    Measured: baseline, up to 40 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Apr 2010 (estimated)
  2. Study startSep 2010
  3. Primary completionFeb 2015
  4. Study completionApr 2015

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
131 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01108445
Sponsor's protocol ID
Pro00020714
Other IDs
CRAD001L2402T
Acronym
ASPEN
Status last verified
Sep 2017
First submitted
20 Apr 2010
Last updated
16 Jan 2018
Data monitoring committee
Yes

Publications

  • Aldin A, Besiroglu B, Adams A, Monsef I, Piechotta V, Tomlinson E, Hornbach C, Dressen N, Goldkuhle M, Maisch P, Dahm P, Heidenreich A, Skoetz N. First-line therapy for adults with advanced renal cell carcinoma: a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2023 May 4;5(5):CD013798. doi: 10.1002/14651858.CD013798.pub2.

    PubMed 37146227
  • Armstrong AJ, Halabi S, Eisen T, Broderick S, Stadler WM, Jones RJ, Garcia JA, Vaishampayan UN, Picus J, Hawkins RE, Hainsworth JD, Kollmannsberger CK, Logan TF, Puzanov I, Pickering LM, Ryan CW, Protheroe A, Lusk CM, Oberg S, George DJ. Everolimus versus sunitinib for patients with metastatic non-clear cell renal cell carcinoma (ASPEN): a multicentre, open-label, randomised phase 2 trial. Lancet Oncol. 2016 Mar;17(3):378-388. doi: 10.1016/S1470-2045(15)00515-X. Epub 2016 Jan 13.

    PubMed 26794930
  • Winquist E, Rodrigues G. Open clinical uro-oncology trials in Canada. Can J Urol. 2012 Dec;19(6):6587-91. No abstract available.

    PubMed 23228299

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Everolimus and Sunitinib in people with Advanced Non-clear Cell Renal Cell Carcinoma, run by Duke University at 18 sites in 3 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 24 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Jan 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 18 sites in United States, United Kingdom, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 20 Jun 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Anti-tumor Activity as Measured by Median Progression Free Survival Time (time frame: 24 Months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01108445, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Jan 2018.

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