Immediate Surgery or Surgery After Sunitinib Malate in Treating Patients With Metastatic Kidney Cancer
Kidney Cancer
Conditions: official terms
Carcinoma, Renal Cell - Kidney Neoplasms
Conditions: Keywords
clear cell renal cell carcinoma, stage IV renal cell cancer
Study Type
Study Phase
Phase 3
Study Design
Allocation: Randomized, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Name: timing of surgery Type: Procedure
Name: gene expression analysis Type: Genetic
Name: biologic sample preservation procedure Type: Other
Name: laboratory biomarker analysis Type: Other
Name: therapeutic conventional surgery Type: Procedure
Overall Status
RATIONALE: Sunitinib malate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Giving sunitinib malate before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving sunitinib malate after surgery may kill any tumor cells that remain after surgery. It is not yet known whether undergoing immediate surgery or surgery after sunitinib malate is more effective in treating patients with metastatic kidney cancer.

PURPOSE: This randomized phase III trial is studying immediate surgery to see how well it works compared with surgery after sunitinib malate in treating patients with metastatic kidney cancer.
Detailed Description

- To determine if immediate versus deferred nephrectomy has an effect on disease control in patients with resectable, synchronous, metastatic renal cell carcinoma treated with sunitinib malate.

- To identify potential response criteria based on histopathology and molecular research on tumor tissue.

OUTLINE: This is a multicenter study. Patients are stratified according to WHO performance status (0 vs 1), number of metastatic sites (1 vs 2 or more), and institution. Patients are randomized to 1 of 2 treatment arms.

- Arm I (immediate nephrectomy): Patients undergo cytoreductive nephrectomy. Beginning 4 weeks after surgery, patients receive oral sunitinib malate once daily on days 1-28. Treatment with sunitinib malate repeats every 6 weeks for 4 courses in the absence of disease progression or unacceptable toxicity.

- Arm II (deferred nephrectomy): Patients receive oral sunitinib malate once daily on days 1-28. Treatment repeats every 6 weeks for 3 courses in the absence of disease progression or unacceptable toxicity. About 1 day after completion of sunitinib malate, patients undergo cytoreductive nephrectomy. Patients then receive oral sunitinib malate once daily on days 1-28. Treatment repeats every 6 weeks for 2 courses in the absence of disease progression or unacceptable toxicity.

Some patients undergo tumor tissue collection at baseline and at time of surgery to assess possible differences in gene expression. Patients also undergo blood sample collection periodically to evaluate the potential impact of serum proteins on the clinical outcome. Samples are then stored for future studies.

After completion of study treatment, patients are followed periodically.
Criteria for eligibility
Healthy Volunteers: No
Maximum Age: N/A
Minimum Age: 18 Years
Gender: Both

- Histologically confirmed renal cell cancer (RCC)

- Clear-cell subtype with a resectable asymptomatic in situ primary

- Asymptomatic primary is defined as the absence of symptoms* which can be exclusively assigned to the primary tumor such as flank pain and/or gross hematuria necessitating blood transfusion NOTE: *Para-neoplastic symptoms cannot be assigned to the primary tumor alone in metastatic disease, they are not included in this definition.

- No symptomatic primary tumor necessitating nephrectomy

- Resectable primary tumor

- Bulky locoregional lymph node metastases larger than the primary tumor allowed provided resectability of the lymph nodes is surgically feasible

- Metastatic RCC

- Distant metastases are not completely resectable at the time of surgery or during an additional intervention

- No multiple distant lesions at one site

- No bone-only metastases

- Measurable disease, both primary and metastatic, according to RECIST 1.1 criteria

- Planning to receive sunitinib malate as background therapy

- Patients with > 3 of the following surgical risk factors are not eligible:

- Serum albumin CTCAE v 4.0 grade 2 or worse

- Serum LDH > 1.5 times upper limit of normal

- Liver metastases

- Symptoms at presentation due to metastases

- Retroperitoneal lymph node involvement

- Supra-diaphragmatic lymph node involvement

- Clinical stage T3 or T4 disease

- No clinical signs of CNS involvement


- See Disease Characteristics

- WHO performance status 0-1

- Life expectancy > 3 months

- WBC > 3.0 x 10^9/L

- Platelet count > 100 x 10^9/L

- Hemoglobin > 10.0 g/dL

- PT/PTT or INR ≤ 1.2 times upper limit of normal (ULN)

- Bilirubin ≤ 1.5 times ULN

- ALT ≤ 2.5 times ULN (≤ 5 times ULN if liver lesions)

- Serum calcium < 10.0 mg/dL

- Calculated or measured creatinine clearance > 30 mL/min

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception 2 weeks before and during study treatment

- LVEF normal by MUGA scan or ECHO

- 12-lead ECG normal

- No serious cardiac illness (myocardial infarction and/or treatable or untreatable angina pectoris not responding to treatment) within the past 12 months

- No uncontrolled, high BP (≥ 150/100 mm Hg) despite optimal medical therapy

- No current pulmonary disease

- No active or uncontrolled infections, serious illnesses, malabsorption syndrome, or medical conditions, including patients with a history of chronic alcohol abuse, hepatitis, HIV, and/or cirrhosis

- No malignancies within the past 5 years except renal cell carcinoma, basal or squamous cell carcinoma of the skin, carcinoma in situ of the cervix, resected incidental prostate cancer staged pT2 with Gleason Score ≤ 6 and postoperative PSA < 0.5 ng/mL, or patients with any history of malignancies who are disease-free for more than 5 years

- No psychological, familial, sociological, or geographical condition potentially hampering compliance with the study protocol and follow-up schedule


- Prior local radiotherapy for bone lesions allowed

- No prior systemic therapy for metastatic RCC

- No prior partial or total nephrectomy

- No concurrent systemic corticosteroid and/or other immunosuppressive systemic therapies

- No concurrent radiotherapy, except palliative radiotherapy

- No concurrent participation in another clinical trial testing treatments for any disease including renal cell carcinoma

- No other concurrent investigational or systemic therapy for metastatic RCC
Onze Lieve Vrouw Ziekenhuis
Aalst, Belgium
Status: Recruiting
Cliniques Universitaires St. Luc
Brussels, Belgium
Status: Recruiting
Hôpitaux Universitaires Bordet-Erasme - Institut Jules Bordet
Brussels, Belgium
Status: Recruiting
Universitair Ziekenhuis Gent
Gent, Belgium
Status: Recruiting
Virga Jesse Hospital
Hasselt, Belgium
Status: Recruiting
AZ Groeninghe - Campus Loofstraat
Kortrijk, Belgium
Status: Recruiting
AZ Damiaan - Campus Sint-Jozef
Oostende, Belgium
Status: Recruiting
Queen Elizabeth II Health Sciences Centre
Halifax, Nova Scotia, Canada
Status: Recruiting
CHUM - Pavillon Saint-Luc
Montreal,, Quebec, Canada
Status: Recruiting
Montreal General Hospital
Montreal, Canada
Status: Recruiting
The Ottawa Hospital, The Integrated Cancer Program- General Campus
Ottawa, Canada
Status: Recruiting
University Health Network - Oci / Princess Margaret Hospital
Toronto, Canada
Status: Recruiting
Diamond Health Care Centre
Vancouver, Canada
Status: Recruiting
San Camillo Forlanini Hospitals
Roma, Italy
Status: Recruiting
Jeroen Bosch Ziekenhuis
's-Hertogenbosch, Netherlands
Status: Recruiting
Academisch Medisch Centrum - Universiteit van Amsterdam
Amsterdam, Netherlands
Status: Recruiting
The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis
Amsterdam, Netherlands
Status: Recruiting
Vrije Universiteit Medisch Centrum
Amsterdam, Netherlands
Status: Recruiting
University Medical Center Groningen
Groningen, Netherlands
Status: Recruiting
Academisch Ziekenhuis Maastricht
Maastricht, Netherlands
Status: Recruiting
Radboud University Nijmegen Medical Centre
Nijmegen, Netherlands
Status: Recruiting
Universitair Medisch Centrum - Academisch Ziekenhuis
Utrecht, Netherlands
Status: Recruiting
Royal United Hospital
Bath, United Kingdom
Status: Recruiting
University Hospitals Bristol NHS Foundation Trust - Bristol Haematology And Oncology Centre
Bristol, United Kingdom
Status: Recruiting
St. James'S University Hospital
Leeds, United Kingdom
Status: Recruiting
Barts and The London NHS Trust - St. Bartholomew'S Hospital
London, United Kingdom
Status: Recruiting
Imperial College Healthcare NHS Trust - Charing Cross Hospital
London, United Kingdom
Status: Recruiting
Christie NHS Foundation Trust
Manchester, United Kingdom
Status: Recruiting
Singelton Hospital
Swansea, United Kingdom
Status: Recruiting
Start Date
April 2010
European Organisation for Research and Treatment of Cancer - EORTC
European Organisation for Research and Treatment of Cancer - EORTC
Record processing date processed this data on July 28, 2015 page