Clinical Drug Experience Knowledgebase

Criteria

Inclusion Criteria:

Age ≥ 18 years
Advanced disease histologically assessed as RCC, with predominantly clear cell histology
Metastatic disease (measurable or non-measurable) that can be monitored throughout the course of study participation per iRECIST
Subjects who are candidates for standard first-line therapy
Time from initial RCC diagnosis to initiation of systemic treatment (Nivolumab+Ipilimumab) of <1 year
Karnofsky Performance Status (KPS) ≥ 70%
Resolution of all acute toxic effects of prior radiotherapy or surgical procedures to Grade ≤ 1 according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0

Adequate hematologic function, as defined by central laboratory values for all three of the following criteria:

Absolute neutrophil count (ANC) LLN, and
Platelets 75,000/mm3 or 75.0 x 109/L, and
Hemoglobin (Hgb) 8.0 g/dL

Adequate renal function, as defined by either of the following criteria:

Serum creatinine 1.5 x upper limit of normal (ULN),
OR, if serum creatinine greater than 1.5 x ULN, estimated glomerular filtration rate (eGFR) 30 mL/min

Adequate hepatic function, as defined by both of the following:

Total serum bilirubin 1.5 x ULN
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) 2.5 x ULN or, AST and ALT 5 x ULN if liver function abnormalities are due to underlying malignancy

Adequate coagulation function as defined by either of the following criteria:

INR < 1.5 x ULN
For subjects receiving warfarin or LMWH, the subjects must, in the investigator's opinion, be clinically stable with no evidence of active bleeding while receiving anticoagulant therapy. The INR for these patients may exceed 1.5 x ULN if that is the goal of anticoagulant therapy.
Negative serum pregnancy test for female subjects with reproductive potential, and agreement of all male and female subjects of reproductive potential to use a reliable form of contraception during the study and for 12 weeks after the last dose of study drug
Normal ECG or clinically non-significant finding(s) at Screening, in the Investigator's opinion
Able to abstain from taking prohibited drugs, either prescription or non-prescription, during the treatment phase of the study
Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures
Signed and dated informed consent document indicating that the subject (or legally acceptable representative) has been informed of all pertinent aspects of the trial prior to enrollment

Exclusion Criteria:

Prior history of malignancy within the preceding 3 years, except for adequately treated in situ carcinomas or non-melanoma skin cancer, adequately treated early stage breast cancer, superficial bladder cancer, and non-metastatic prostate cancer with a normal PSA.
History of or known brain metastases, spinal cord compression, or carcinomatous meningitis, or evidence of brain or leptomeningeal disease

Patients will be excluded if they have <2 of the following risk factors at Screening:

Time from diagnosis to systemic treatment < 1 year
Hgb < LLN
Corrected calcium > 10.0 mg/dL
KPS < 80%
Neutrophils > ULN
Platelets > ULN
NCI CTCAE Grade 3 hemorrhage < 28 days before Visit 1 (Week 0)

Clinically significant cardiovascular conditions within 3 months prior to Randomization, which in the Investigator's opinion prohibits the initiation of standard targeted therapy, initiating with sunitinib, including:

Cardiac angioplasty
Myocardial infarction
Unstable angina
Coronary artery by-pass graft or stenting
Class III or IV congestive heart failure (CHF), per NYHA Classification NOTE: Patients with left ventricular ejection fraction (LVEF) < LLN as assessed by either echocardiography or multiple gated acquisition (MUGA) scan, who are asymptomatic and are NOT classified as having NYHA Class III or IV CHF, may be eligible but should be monitored for LVEF changes while on sunitinib therapy as recommended in the current sunitinib prescribing information.
Symptomatic peripheral vascular disease
Cerebrovascular accident (CVA) or transient ischemic attack (TIA)
Symptomatic or uncontrolled pulmonary embolism or deep vein thrombosis (DVT)
Uncontrolled cardiac dysrhythmias of NCI CTCAE Grade ≥ 2, or prolongation of the QTc for males > 450 msec and for females > 470 msec as corrected by either the Fridericia or Bazett formula
Uncontrolled or untreated atrial fibrillation
Poorly controlled hypertension, defined as a systolic blood pressure (SBP), ≥ 150 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg NOTE: Initiation of antihypertensive medication(s) is permitted prior to study entry. Blood pressure must be re-assessed on 2 occasions separated by at least 1 hour. Mean SBP/DBP values must be less than 150/90 for eligibility.
Evidence of active bleeding or a bleeding diathesis at Screening

Significant gastrointestinal abnormalities:

Any history of major resection of the stomach or small bowel with ongoing impaired healing.
Malabsorption syndrome with active symptoms in the Investigator's opinion, within 3 months prior to Randomization
Active peptic ulcer, which cannot be appropriately managed in the Investigator's opinion, within 3 months prior to Randomization
Intra-luminal bleeding lesions within 3 months prior to Randomization
History of abdominal fistula or intra-abdominal abscess within 3 months prior to Randomization
Pre-existing thyroid abnormality with thyroid function that cannot be appropriately managed with medication, in the Investigator's opinion.

Active autoimmune disease or condition requiring chronic immunosuppressive therapy, such as rheumatoid arthritis, systemic lupus erythematous, multiple sclerosis, organ transplant recipient, etc.

NOTE: Abnormal laboratory values for autoimmunity markers in the absence of other signs/symptoms of autoimmune disease are not exclusionary.

Clinically significant infections, including human immunodeficiency virus (HIV), syphilis, and active hepatitis B or C
Current treatment with an investigational therapy on another clinical trial
Pregnancy or breastfeeding
Any serious medical condition or illness considered by the investigator to constitute an unwarranted high risk for investigational treatment