Bevacizumab and Aldesleukin in Treating Patients With Metastatic Clear Cell Carcinoma of the Kidney

Jorge A. Garcia, MD

Status and phase

Completed

Phase 2

Conditions

Kidney Cancer

Treatments

Biological: aldesleukin

Biological: bevacizumab

Study type

Interventional

Funder types

Other

NIH

Identifiers

NCT00853021

CASE8804 (Other Identifier)

P30CA043703 (U.S. NIH Grant/Contract)

7493 (Other Identifier)

Details and patient eligibility

About

RATIONALE: Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. Biological therapies, such as aldesleukin, may stimulate the immune system in different ways and stop tumor cells from growing. Giving bevacizumab together with aldesleukin may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving bevacizumab together with aldesleukin works in treating patients with metastatic clear cell carcinoma of the kidney.

Full description

OBJECTIVES:

Primary

To evaluate the effect of the combination of bevacizumab and aldesleukin on progression-free survival of patients with good- or intermediate-risk metastatic clear cell renal cell carcinoma.

Secondary

To determine the objective response rate in patients receiving this regimen. To determine the time to progression in patients receiving this regimen. To evaluate immunomodulatory effects of this regimen in patients To evaluate the toxicity of this regimen in these patients.

OUTLINE: Patients receive bevacizumab IV over 30-90 minutes on days -14, 1, 15, 29, and 42 and aldesleukin subcutaneously on days 1-5, 8-12, 15-19, 22-26, 29-33, and 36-40. Courses repeat every 8 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity. Patients achieving complete response after completion of study therapy may receive 1 additional course of therapy.

After completion of study therapy, patients are followed periodically.

Enrollment

26 patients

Sex

All

Ages

18 to 120 years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

Histologically or cytologically confirmed renal cell carcinoma (RCC) of clear cell histology with or without sarcomatoid features
- Metastatic disease
- No non-clear cell RCC (i.e., papillary, collecting-duct, or chromophobe)
Good- or intermediate-risk category as defined by having ≤ 2 of the following factors:
- No prior nephrectomy
- Karnofsky performance status < 80%
- Hemoglobin < 12 g/dL
- Corrected calcium > 10.0 mg/dL
- LDH > 1.5 times upper limit of normal (ULN)
Must have undergone a nephrectomy at least 28 days ago
Measurable or evaluable disease by RECIST
No significant effusions and/or ascites
No prior or concurrent brain or CNS metastasis

PATIENT CHARACTERISTICS:

ECOG performance status 0-1
Life expectancy of ≥ 3 months
WBC ≥ 3,000/mm^3
Platelet count ≥ 100,000/mm^3
Hemoglobin ≥ 9.5 g/dL
Creatinine ≤ 2.0 mg/dL
Total bilirubin ≤ 1.5 mg/dL
AST ≤ 5.0 times ULN
Alkaline phosphatase ≤ 2.5 times ULN (≤ 10 times ULN with bone metastasis)
Calcium ≤ 12 mg/dL
Urine protein:creatinine ratio ≤ 1.0
INR ≤ 1.5 (unless receiving warfarin therapy)
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No uncontrolled seizure disorder
No known HIV positivity
No local or systemic infections requiring IV antibiotics within the past 28 days
No significant traumatic injury in the past 28 days
No serious non-healing wound, ulcer, or acute bone fracture
No evidence of bleeding diathesis or coagulopathy
No other malignancy except basal cell or squamous cell carcinoma of the skin, carcinoma in-situ of the uterine cervix, or any malignancy treated with curative intent and in complete remission for > 3 years
No history of serious systemic or severe cardiovascular disease, including any of the following:
- Arterial thromboembolic event (including transient ischemic attack)
- Cerebrovascular accident
- Unstable angina
- Myocardial infarction within the past 6 months
- Uncontrolled hypertension (BP > 160/110 mm Hg on medication)
- Uncontrolled cardiac arrhythmia
- Congestive heart failure
- Angina pectoris
- NYHA class III-IV cardiovascular disease
- Peripheral vascular disease ≥ grade II
No history of abdominal fistula and/or bowel or gastric perforation within the past 6 months
No history of other diseases, metabolic dysfunction, or physical or laboratory examination findings giving reasonable suspicion of a disease or condition that contraindicate the use of investigational drugs, or that might affect the interpretation of study results, or that render patient at high-risk for treatment complications

PRIOR CONCURRENT THERAPY:

See Disease Characteristics
No prior organ allografts
No prior systemic therapy for metastatic clear cell renal cell carcinoma
At least 4 weeks since prior radiotherapy and recovered
- Radiotherapy for control of pain from skeletal lesions allowed within the past 28 days
More than 12 months since prior adjuvant therapy
More than 7 days since prior fine-needle aspirations or core biopsies
More than 28 days since prior and no concurrent major surgery requiring general anesthesia or open biopsy
No concurrent aspirin, corticosteroids (except at replacement doses), barbiturates, or other investigational agents