| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
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| E.1.1.1 | Medical condition in easily understood language |
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| E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
| MedDRA Classification |
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 20.0 |
| E.1.2 | Level | PT |
| E.1.2 | Classification code | 10067946 |
| E.1.2 | Term | Renal cell carcinoma |
| 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 | No |
| E.2 Objective of the trial |
| E.2.1 | Main objective of the trial |
The RAMPART trial is aiming to address two research questions:
1. Does treatment with either durvalumab alone or a combination of durvalumab and tremelimumab delay the cancer from coming back compared with the current standard-of-care (active monitoring) in patients with kidney cancer who underwent surgery and are at intermediate or high risk of recurrence?
2. Does treatment with either durvalumab alone or a combination of durvalumab and tremelimumab increase life expectancy compared with current standard-of-care (active monitoring) in patients with kidney cancer who underwent surgery and are at intermediate or high risk of recurrence?
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| E.2.2 | Secondary objectives of the trial |
There are a number of secondary research questions that the RAMPART trial is aiming to address:
1. Does treatment with either durvalumab alone or a combination of durvalumab and tremelimumab delay the cancer from spreading outside the kidneys?
2. Does treatment with either durvalumab alone or a combination of durvalumab and tremelimumab reduces the chances of dying from kidney cancer?
3. How does treatment with either durvalumab alone or a combination of durvalumab and tremelimumab affect the quality of life of patients?
4. What side effects are experienced in patients undergoing treatment with either durvalumab alone or a combination of durvalumab and tremelimumab?
5. What are patients' preferences when it comes to treatments affecting the immune system? |
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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 |
All patients will be approached at the time of consent for the collection of a baseline EDTA blood sample and provision of an archival FFPE tumour sample for biomarker testing for PD-1/PD-L1 marker expression. PD-L1 testing has been requested by the Food and Drug Administration as a key aspect of the trial during the initial scientific advice consultation with the regulatory agency.
Several translational sub-studies are being considered by the by the Trial Development Group for future development; the full umbrella of translational research associated with the main study will be detailed in a separate protocol to be submitted to the Ethics Committee in a separate instance. |
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| E.3 | Principal inclusion criteria |
1.Histologically proven RCC (all cell types of RCC are eligible, except for pure oncocytoma, collecting duct, medullary and transitional cell cancer [TCC]); no evidence of residual macroscopic disease on post-operative CT scan after resection of RCC. Patients with treated bilateral synchronous RCCs are eligible.
2.At the start of recruitment patients with Leibovich score 3-11 will be eligible for randomisation. MRC CTU will monitor accrual and stop recruiting intermediate risk patients (Leibovich Score 3-5) after three years or when intermediate risk patients contribute 25% of the total accrual target, whichever is earlier. Recruitment of patients with Leibovich Score 6 11 will continue until the accrual target is reached.
3.Patients should have had surgery at least 28 days but no more than 91 days prior to randomisation date.
4. Post-operative scans should be performed within 28 days prior to randomisation
5.WHO Performance Status 0 or 1.
6.Patient has archival FFPE pathology tissue available, and agrees to provide at least one sample (FFPE tumour block from nephrectomy, or a minimum of 10 unstained slides), as well as a baseline EDTA blood sample for future translational research
7.Adequate normal organ and marrow function
a.Haemoglobin ≥9.0g/dL (transfusions will be allowed within 2 weeks of randomisation in order to achieve the entry criteria).
b.Absolute neutrophil count (ANC) ≥1.5 x 109/L (≥1500 per mm3).
c.Platelet count ≥100 x 109 (≥100,000 per mm3).
d.Bilirubin ≤1.5 x ULN (This will not apply to subjects with confirmed Gilbert’s syndrome (i.e., persistent or recurrent hyperbilirubinemia that is predominantly unconjugated in the absence of haemolysis or hepatic pathology), who will be allowed only in consultation with their physician).
e.AST/ALT ≤2.5 x ULN.
f.Calculated Creatinine Clearance level >40mL/min by Cockcroft Gault formula
8.12-lead ECG on which QTcF must be <470 ms. In case of clinically significant ECG abnormalities, including a QTcF value ≥470 ms, two additional 12-lead ECGs should be obtained over a brief period (e.g., 30 minutes) to confirm the finding.
9. Patient must weight ≥30Kg at the time of randomisation
10.Subjects must be ≥ 18 years in age.
11.Written Informed Consent obtained from the patient
12.Both men and women enrolled in this trial must use adequate contraception during the treatment phase of the study and for 6 months afterwards. Egg donation, sperm donation and breastfeeding must be avoided.
13. Evidence of post-menopausal status or negative urinary or serum pregnancy test for female pre menopausal patients. Women will be considered post-menopausal if they have been amenorrhoeic for 12 months without an alternative medical cause. The following age specific requirements apply:
a. Women <50 years of age will be considered post-menopausal if they have been amenorrhoeic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinising hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilisation (bilateral oophorectomy or hysterectomy).
b. Women ≥50 years of age will be considered post-menopausal if they have been amenorrhoeic 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 sterilisation (bilateral oophorectomy, bilateral salpingectomy, or hysterectomy).
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| E.4 | Principal exclusion criteria |
1.Previous diagnosis of RCC.
2.Metastatic or macroscopic residual disease.
3.Patients with a single pulmonary nodule ≥5mm diameter are not eligible unless the nodule has had a definite benign diagnosis. Patients with multiple small, less than 5 mm nodules may be eligible if nodules have been shown to be radiologically stable for at least 8 weeks.
4.Prior anticancer treatment (other than nephrectomy) for RCC.
5. Any unresolved toxicity NCI CTCAE Grade ≥2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria
a. Patients with Grade ≥2 neuropathy will be evaluated on a case-by-case basis after consultation with the Study Physician.
b. Patients with irreversible toxicity not reasonably expected to be exacerbated by treatment with durvalumab or tremelimumab may be included only after consultation with the Study Physician.
6. History of another primary malignancy except for:
a) Malignancy treated with curative intent and with no known active disease ≥5 years before the first dose of IP and of low potential risk for recurrence.
b) Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease.
c) Adequately treated carcinoma in situ without evidence of disease.
7. History of leptomeningeal carcinomatosis.
8. Concurrent enrolment in another clinical study, unless it is an observational (non interventional) clinical study or during the follow up period of an interventional study.
9. Major surgical procedure (as defined by the Investigator) within 28 days prior to the start of treatment. Local surgery of isolated lesions for palliative intent is acceptable.
10. Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab or tremelimumab, with the exceptions of intranasal and inhaled corticosteroids or systemic corticosteroids at physiological doses, which are not to exceed 10 mg/day of prednisone, or an equivalent corticosteroid.
11. Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [e.g., colitis or Crohn's disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc]). The following are exceptions to this criterion:
a. Patients with vitiligo or alopecia
b. Patients with hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone replacement
c. Any chronic skin condition that does not require systemic therapy
d. Patients without active disease in the last 5 years may be included but only after consultation with the RAMPART Trial Management Team
e. Patients with coeliac disease controlled by diet alone
12. A history of immunodeficiency syndrome. Please consult the MRC CTU at UCL on an individual basis if there is any uncertainty.
13. History of allogeneic organ transplant.
14. Uncontrolled intercurrent illness including, but not limited to:
a. Ongoing or active infection
b. Symptomatic congestive heart failure
c. Uncontrolled hypertension
d. Unstable angina pectoris
e. Uncontrolled cardiac arrhythmia
f. Active peptic ulcer disease or gastritis
g. Active bleeding diatheses
h. Psychiatric illness or social situations that would limit compliance with study requirements or compromise the ability of the subject to give written informed consent.
15.Active infection including
a. Tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice)
b. Hepatitis B (known positive HBV surface antigen (HBsAg) result)
c. Hepatitis C
d. Human immunodeficiency virus (positive HIV 1/2 antibodies). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti HBc] and absence of HBsAg) are eligible.
Note: Patients positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA.
16. Receipt of live attenuated vaccine within 30 days prior to the start of treatment. Note: Patients, if enrolled, should not receive live vaccine while receiving investigational medicinal product and up to 30 days after the last dose of investigational medicinal product.
17. Pregnant or breastfeeding patients.
18. Any condition that, in the opinion of the investigator, would interfere with evaluation of study treatment or interpretation of patient safety or study results.
19. Known allergy or hypersensitivity to durvalumab or tremelimumab, or any of their excipients.
20. Previous investigational medicinal product assignment in the present study.
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| E.5 End points |
| E.5.1 | Primary end point(s) |
The RAMPART trial has two co-primary outcome measures
1. Disease Free Survival (DFS)
2. Overall Survival (OS)
DFS is defined as the interval from randomisation to first evidence of local recurrence, new primary RCC, distant metastases, or death from any cause, whichever occurs first.
OS is defined as all-cause mortality, the time from randomisation to death from any cause (including RCC).
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| E.5.1.1 | Timepoint(s) of evaluation of this end point |
Estimated timelines for interim analyses: Disease Free Survival
C vs A and B vs A (Overwhelming Benefit) = 4.75 years
C vs A (Lack of Benefit) = 4.75 years
B vs A (Lack of Benefit) = 4.75 years
B vs A (Overwhelming Benefit)= 6.25 years
B vs A (Lack of Benefit)= 6.25 years
B vs A (Overwhelming Benefit)= 8 years
Estimated timelines for primary analyses
Disease Free Survival
Arm C vs A = 6.25 years
Arm B vs A = 10.5 years
Overall survival (high-risk patients only)
Arm C vs A = 13.25 years
Arm B vs A = 20.5 years
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| E.5.2 | Secondary end point(s) |
1. Metastasis Free Survival (MFS) defined as the interval from randomisation to first evidence of metastases or death from RCC
2. RCC specific survival time
3. Quality of Life
4. Toxicity
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| E.5.2.1 | Timepoint(s) of evaluation of this end point |
Secondary outcomes will be analysed and reported at an appropriate time, which may be at the same time as the analysis and reporting of the primary outcomes.
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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 | No |
| E.6.4 | Safety | Yes |
| E.6.5 | Efficacy | Yes |
| E.6.6 | Pharmacokinetic | No |
| E.6.7 | Pharmacodynamic | No |
| E.6.8 | Bioequivalence | No |
| E.6.9 | Dose response | No |
| E.6.10 | Pharmacogenetic | No |
| 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 | No |
| 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) | No |
| E.8.2.2 | Placebo | No |
| E.8.2.3 | Other | Yes |
| E.8.2.3.1 | Comparator description |
| Active Monitoring (current standard-of-care) |
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| E.8.2.4 | Number of treatment arms in the trial | 2 |
| E.8.3 |
The trial involves single site in the Member State concerned
| No |
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
| E.8.4.1 | Number of sites anticipated in Member State concerned | 70 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 20 |
| 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 | No |
| 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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| The trial will close when all patients have completed follow-up and all data queries have been resolved. |
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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 | 20 |
| E.8.9.1 | In the Member State concerned months | 0 |
| E.8.9.1 | In the Member State concerned days | 0 |
| E.8.9.2 | In all countries concerned by the trial years | 20 |
| E.8.9.2 | In all countries concerned by the trial months | 0 |
| E.8.9.2 | In all countries concerned by the trial days | 0 |
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