RATIONALE: Combinations of biological substances in denileukin diftitox may be able to carry tumor-killing substances directly to kidney cancer cells. Interleukin-2 may stimulate the white blood cells to kill kidney cancer cells. Giving denileukin diftitox together with interleukin-2 may kill more tumor cells. PURPOSE: This randomized phase I trial is studying the side effects of denileukin diftitox and interleukin-2 in treating patients with metastatic kidney cancer.
OBJECTIVES: Primary * Determine the toxic effects of denileukin diftitox and high-dose interleukin-2 in patients with metastatic renal cell cancer. Secondary * Perform transforming growth factor (TGF)-beta promoter and TGF-beta receptor genotyping to search for variants that may be associated with tumor response to therapy. * Determine the overall response rate (partial and complete) in patients treated with this regimen. * Determine the time to progression in patients treated with this regimen. OUTLINE: This is a randomized, pilot study. The first 3 patients enrolled in the study receive high-dose interleukin-2 (IL-2) IV over 15 minutes, 3 times daily, on days 1-5 and 15-19 and denileukin diftitox IV over 15-60 minutes once daily on days 8-10. If no dose-limiting toxicity occurs after receiving denileukin diftitox, subsequent patients are randomized to 1 of 2 treatment arms. * Arm I: Patients receive denileukin diftitox (at a higher dose than for the first 3 patients enrolled in the study) IV over 15-60 minutes once daily on days -4 to -2 and high-dose IL-2 IV over 15 minutes, 3 times daily, on days 1-5 and 15-19. * Arm II: Patients receive high-dose IL-2 as in arm I and denileukin diftitox (at a higher dose than for the first 3 patients enrolled in the study) IV over 15-60 minutes at a higher dose once daily on days 8-10. All patients may receive additional treatment with IL-2 alone in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed periodically for at least 4 years. PROJECTED ACCRUAL: A total of 13 patients will be accrued for this study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
The IL-2 is given as a 15-minute infusion through an intravenous catheter (I.V.), a small plastic tube that is put into your vein for the time you are receiving the study treatment. IL-2 is given through the I.V. once every 8 hours for 5 days (days 1-5). A second 5 day cycle of IL-2 will begin on the 15th day (days 15-19). This is one complete cycle (days 1-19) of IL-2 treatment
Denileukin diftitox will be administered once daily as a 15 to 60 minute infusion for 3 consecutive days.
Robert H. Lurie Comprehensive Cancer Center at Northwestern University
Chicago, Illinois, United States
The primary objective is to assess for toxicity
To assess the toxicity
Time frame: After each cycle of therapy and 30 days after the last treatment.
The secondary objectives are to investigate differences in peak and duration of the expansion of CD4+, CD8+, CD4+CD 25+ and CD56+(dim and bright)CD25+ cells
To investigate differences in peak and duration.
Time frame: Follow-up measurements must have met the SD criteria at least once after study entry at a minimum interval of 8 weeks.
To investigate the effects of denileukin diftitox in combination with IL-2 on plasma TGF-beta levels
To investigate the effects of denileukin diftitox
Time frame: Cohort 1: Denileukin diftitox dose of 6μg/kg/ Days 1, 2, 3, 4, and 5. Cohort 2 Denileukin diftitox dose of 9μg/kg given 4, 3, 2, and 1 days prior to 1st day of each cycle. Cohort 3: Denileukin diftitox dose of 9μg/kg given days 8 and 9.
To perform TGF-beta promoter and TGF-beta receptor genotyping prior to the start of treatment to search for variants that may be associated with tumor response to therapy.
To perform TGF-beta promoter and TGF-beta receptor genotyping
Time frame: Cohort 1: Plasma TGF-beta levels to be given on day. Cohort 2: plasma TGF-beta levels to be given at day 1. Cohort 3: plasma TGF-beta levels given on days 1 through 5.
Overall response rate and time to progression
Overall response rate will be assessed.
Time frame: CT scans and other pertinent studies will be performed at week 10 to assess response.
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