E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
metastatic renal cell carcinoma |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10038410 |
E.1.2 | Term | Renal cell carcinoma recurrent |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To compare TKI258 vs. sorafenib with respect to progression-free survival (PFS) determined by central radiology assessment in patients with metastatic renal cell cancer (mRCC) after failure of anti-angiogenic (VEGF-targeted and mTOR inhibitor) therapies. |
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E.2.2 | Secondary objectives of the trial |
Key Secondary:
•To compare TKI258 vs. sorafenib with respect to overall survival (OS)
Other Secondary:
•To assess TKI258 vs. sorafenib with respect to:
•Time to definitive worsening of Karnofsky performance status (KPS)
•PFS determined by local review of tumor assessments
•Overall response rate (ORR) by central and local radiology review
•Safety
•Patient-reported outcomes (PROs), including:
1.Disease-related symptoms using the Functional assessment of cancer therapy-Kidney Symptom Index-Disease Related Symptoms (FKSI-DRS)
2.Quality of Life (QoL) using the EORTC QLQ-C30 questionnaire
•To characterize the pharmacokinetics of TKI258 in patients with mRCC
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
The sub-study is listed within the main protocol and thus has the same date and version. The title and objectives of the sub-study is listed in section 7.11.3 of the main protocol:
7.11.3 Optional pharmacogenetics
In order to understand the genetic contribution to variability in disposition of TKI258 in humans, the genetic variants of drug targets, metabolizing enzymes and transporters will be evaluated using blood samples from patients who have agreed to participate in this analysis after signing the additional biomarker consent. Genotyping of drug targets (including but not limited to VEGF/VEGFRs, FGF/FGFRs), drug metabolizing enzymes (like UGT1A1 and CYP1A2) and transporters may also be evaluated. |
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E.3 | Principal inclusion criteria |
1. Written informed according to local guidelines must be obtained before any study assessments are performed.
2. Age ≥ 18 years old.
3. Patients with metastatic renal cell carcinoma (mRCC) with histological or cytological confirmation of clear cell carcinoma or a component of clear cell
4. Patients must have received one and only one prior VEGF-targeted therapy and one and only one prior mTOR inhibitor. One prior systemic VEGF targeted therapy could be sunitinib, or pazopanib, or axitinib, or tivozanib or bevacizumab and one prior mTOR inhibitor could be either everolimus or temsirolimus or ridaforolimus.
Patients receiving adjuvant VEGF targeted therapy or mTOR inhibitors may have this treatment count as part of one prior VEGF or one prior mTOR therapy if disease progression occurred on or within 6 months of stopping the adjuvant treatment
5. Prior treatment with cytokines and anti-cancer vaccines is permitted.
6. Patients must have had disease progression on or within 6 months of stopping the last therapy
( VEGF-targeted agent and/or the mTOR inhibitor therapy).
7. Patients must have at least one measurable lesion at baseline (according to RECIST 1.1) using Computer Tomography (CT) Scan or Magnetic Resonance Imaging (MRI). If skin lesions are selected as target lesions at baseline, follow procedure specified on Section 7.6.4.
8. Karnofsky performance status ≥ 70%
9. Patients must have the following laboratory values:
• Absolute Neutrophil Count (ANC) ≥ 1.5 x 109/L
• Platelets ≥ 100 x 109/L
• Hemoglobin (Hgb) > 9 g/dL
• Serum total bilirubin: ≤ 1.5 x ULN
• ALT and AST ≤ 3.0 x ULN (Patients with or without liver metastases)
• Serum creatinine ≤ 1.5 x ULN
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E.4 | Principal exclusion criteria |
1. Patients who have previously received sorafenib therapy in the
neoadjuvant, adjuvant or metastatic setting
2. Patients who have previously received TKI258 or other FGFR
inhibitors such as brivanib in the neoadjuvant, adjuvant or metastatic
setting
3. Patients with brain metastases or any history of brain metastases.
Radiological imaging (e.g. CT or MRI scan) of the brain is required at
screening/baseline
4. Patients with another primary malignancy within 3 years prior to
starting study treatment, with the exception of adequately treated basal
cell carcinoma, squamous cell carcinoma or other non-melanomatous
skin cancer, or in-situ carcinoma of the uterine cervix
5. Patients who have received the last administration of an anticancer
targeted small molecule therapy ≤ 2 weeks prior to starting study
treatment (e.g. sunitinib, pazopanib, axitinib, everolimus, temsirolimus),
or who have not recovered from the side effects of such therapy
6. Patients who have received the last administration of nitrosurea or
mitomycin-C ≤ 6 weeks prior to starting study treatment, or who have not recovered from the side effects of such therapy
7. Patients who have received the last administration of an anticancer
monoclonal antibody, immunotherapy, or chemotherapy (except
nitrosureas and mitomycin-C) ≤ 4 weeks prior to starting study
treatment or who have not recovered from the side effects of such
therapy
8. Patients who have received radiotherapy ≤ 4 weeks prior to starting
the study treatment or who have not recovered from radiotherapyrelated
toxicities. Palliative radiotherapy for bone lesions ≤ 2 weeks
prior to starting study treatment is allowed.
9. Patients who have undergone major surgery (e.g., intra-thoracic,
intra-abdominal or intra-pelvic) ≤ 4 weeks prior to starting study
treatment or who have not recovered from side effects of such therapy
10. Patients with a history of pulmonary embolism (PE), or untreated
deep venous thrombosis (DVT) within the past 6 months.
11. Patients with any of the following concurrent severe and/or
uncontrolled medical conditions which could compromise participation in
the study:
• Impaired cardiac function or clinically significant cardiac diseases,
including any of the following:
- History or presence of serious uncontrolled ventricular arrhythmias
- Clinically significant resting bradycardia
- LVEF assessed by 2-D echocardiogram (ECHO) < 50% or lower limit of
normal (which ever is higher) or multiple gated acquisition scan (MUGA)
< 45% or lower limit of normal (which ever is higher),
- Any of the following within 6 months prior to starting study treatment:
myocardial infarction (MI), severe/unstable angina, Coronary Artery
Bypass Graft (CABG), Congestive Heart Failure (CHF), Cerebrovascular
Accident (CVA), Transient Ischemic Attack (TIA)
- Uncontrolled hypertension defined by a SBP ≥ 160 mm Hg and/or DBP
≥ 100 mm Hg, with or without anti-hypertensive medication. Initiation
or adjustment of antihypertensive medication (s) is allowed prior to
study entry.
• Impairment of gastrointestinal (GI) function or GI disease that may
significantly alter the absorption of TKI258 (e.g. ulcerative diseases,
uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or
small bowel resection)
• Cirrhosis, chronic active hepatitis or chronic persistent hepatitis
• Known diagnosis of human immunodeficiency virus (HIV) infection.
HIV testing is not mandatory but it should be performed if locally
required.
• Patients who are currently receiving full dose anticoagulation
treatment with therapeutic doses of warfarin or anti-platelet therapy.
Treatment with locally accepted low dose of acetylsalicyclic acid (i.e., 81
mg or 100 mg daily) to prevent cardiovascular events or strokes is
allowed
• Other concurrent severe and/or uncontrolled concomitant medical
conditions that could cause unacceptable safety risks or compromise
compliance with the protocol
12. Pregnant or breast-feeding women
13. Women of child-bearing potential, who are biologically able to
conceive, not employing two forms of highly effective contraception.
14. Fertile males not willing to use contraception, as stated above
Other protocol defined exclusion criteria may apply.
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E.5 End points |
E.5.1 | Primary end point(s) |
PFS is defined as the time from date of randomization to the date of first documented disease progression (based on central radiology assessment) or death due to any cause. If a patient has not had an event, PFS will be censored at the date of last adequate tumor assessment according to RECIST 1.1 |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Post-baseline evaluations will be performed on Day 1 Week 9, and
subsequently on Day 1 every 8 weeks (± 1 week) during the 1st year of
study treatment and every 12 weeks (± 1 week) thereafter and at the
end of the study |
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E.5.2 | Secondary end point(s) |
Key Secondary:
• OS as defined as the time from date of randomization to the date of
death due to any cause. If a patient is not known to have died, survival
will be censored at the last date of contact. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 77 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 2 |