TITAN RCC (0216-ASG) is a Phase 2, open-label study of nivolumab monotherapy with additional nivolumab/ipilimumab "boost" cycles in previously untreated and pretreated (2nd line), advanced or metastatic renal cell carcinoma (mRCC) subjects with intermediate and high risk disease according to IMDC.
The primary object is to estimate the Objective response rate (ORR) based on investigator assessment using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 of the TITAN regimen in untreated (1st line) and pretreated (2nd line) subjects with International Metastatic RCC Database Consortium (IMDC) intermediate and high risk, advanced Renal cell carcinoma (RCC) with clear cell component
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
200
* Induction: Mono-Therapy with Nivolumab (240 mg i.V. / Q2W x 8) * If CR/PR: Nivolumab Maintenance Mono-Therapy (240 mg i.V. / Q2W) * If SD/PD: Nivolumab/Ipilimumab "Boost 1+2"-Combination Therapy (Nivo 3 mg/kg i.V. and Ipi 1 mg/kg i.V. / Q3W x 2) * If CR/PR: Nivolumab Maintenance Mono-Therapy (240 mg i.V. / Q2W) * If SD/PD: Nivolumab/Ipilimumab "Boost 3+4"-Combination Therapy (Nivo 3 mg/kg i.V. and Ipi 1 mg/kg i.V. / Q3W x 2) * If CR/PR/SD: Nivolumab Maintenance Mono-Therapy (240 mg i.V. / Q2W)
Objective Response Rate (ORR)
(RECIST 1.1) by CT or MRI measured at week 8 (+/- 1 week) and week 16 (+/- 1 week), 28 (+/- 1 week) and then every 12 weeks (+/- 1 week). The primary objective will be measured by the primary endpoint of ORR (based on investigator assessments) among all treated subjects, first line subjects and second line subjects. It is defined as the number of subjects with a best overall response of CR or PR divided by the number of all treated subjects, first line subjects or second line subjects. Best overall response is defined as the best response designation, as determined by investigator, recorded between the date of first dose and the date of objectively documented immunotherapy resistance per RECIST v1.1 or the date of subsequent therapy, whichever occurs first. For subjects without documented immunotherapy refractory disease or subsequent therapy, all available response designations will contribute to the ORR determination.
Time frame: until 30 weeks after last patient first treatment, LPFT
General considerations: RR, TTR, DoR, PFS, TIR (Time to Immunotherapy Resistance), OS
All as assessed by investigators among all treated subjects, first line subjects, and second line subjects. Furthermore, patients with IMDC intermediate and high risk will be analysed separately.
Time frame: until 30 weeks after last patient first treatment, LPFT
Remission Rates during TITAN treatment: RR1, RR2, RR2SD, RR3
1. RR1: Number of patients with CR/PR during nivolumab monotherapy (induction and maintenance, the latter only including protocol defined pseudoprogressors) divided by all treated patients. 2. RR2: Remission rate after progression during nivolumab monotherapy. It is defined as the number of patients with CR/PR after receiving nivolumab/ipilimumab "boost" cycles for initial progression during nivolumab monotherapy divided by all patients receiving "boosts" for this situation. 3. RR2SD: Remission rate after stable disease during nivolumab monotherapy. It is defined as the number of patients with CR/PR after receiving nivolumab/ipilimumab "boost" cycles for initial stable disease during nivolumab monotherapy divided by all patients receiving "boosts" for this situation. 4. RR3 is the subsequent remission event to RR2 for patients undergoing repeated nivolumab/ipiliumumab "boost" according to the algorithm described above.
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Ordensklinikum Linz Barmherzige Schwestern
Linz, Austria
AKH Wien Universitätsklinik für Innere Medizin I
Vienna, Austria
ZNA Middelheim
Antwerp, Belgium
CHR Verviers
Verviers, Belgium
Fakultní nemocnice Hradec Králové
Hradec Králové, Czechia
Fakultní nemocnice Olomouc
Olomouc, Czechia
FN Motol
Prague, Czechia
Všeobecné fakultní nemocnice
Prague, Czechia
CHD Vendée
La Roche-sur-Yon, France
Centre Hôpitalier Lyon Sud
Lyon, France
...and 25 more locations
Time frame: until 30 weeks after last patient first treatment, LPFT
Time to Immunotherapy Resistance: TIR
Subjects with disease progression despite 4 nivolumab/ipilimumab combination "boost" cycles or within 3 months after the last "boost" cycle will be considered immunotherapy resistant.
Time frame: Time from first dosing date to the date of documented tumor progression based on investigator assessments (per RECIST 1.1) despite 4 "boost" cycles or within 3 months after the last "boost" cycle, or death due to any cause.
Time-to-Response: TTR
TTR may be recorded several times per patient.
Time frame: Time from first dosing date or initiation of nivolumab/ipilimumab "boost" cycles to the date of the first confirmed response thereafter, as assessed by the IRC.
Duration of Response: DOR
DOR may be recorded multiple times per patient.
Time frame: Time from first confirmed response (CR or PR) to the date of the documented progressive disease as determined using RECIST 1.1 criteria or death due to any cause, whichever occurs first.
Overall survival:OS
OS is defined as the time from first dosing date to the date of death. A subject who has not died will be censored at last known date alive.
Time frame: Time from first dosing date to the date of death. A subject who has not died will be censored at last known date alive.
Safety: Adverse events assessment
Treatment Emergent Adverse Events according to CTC 4
Time frame: Continuously: Treatment Visit day 1/week 1 until Survival Visits/Follow-up Visits
Safety: Frequency of abnormal laboratory parameters
Treatment Period: Within 72 hrs prior to re-dosing to include CBC w/ differential, AST, ALT, ALP, T.Bili, BUN or serum urea level, creatinine. Ca, Mg, Na, K, Cl, LDH, glucose, amylase, lipase, TSH (with reflexive Free T4 and Free T3). Follow-up Period: On site/local CBC w/differential, AST, ALT, ALP, T.Bili, BUN or serum urea level, creatinine and TSH for X01, repeat at X02 if study drug related toxicity persists.
Time frame: Screening Visit until Survival Visits/Follow-up Visits
Patient reported outcomes
NCCN-FACT FKSI-19 (Version 2)
Time frame: Treatment Visit day 1/week 1 until Survival Visits/Follow-up Visits 1 and 2
Exploratory objectives: Immune monitoring
* To monitor immunogenicity of nivolumab and nivolumab/ipilimumab "boosts" with regard to prediction of response as well as immune related adverse events, including: * frequency, differentiation and activation of blood-circulating CD4+ and CD8+ T cells (CD27, CD28, CD45RA, CD45RO, CD57, CD95, CD69, CD25, IFN-γ, TNF- α, IL-4, IL 17, IL-10, CD107a) * frequency of blood-circulating dendritic cells (HLA-DR, slan, CD1c, CD11c, CD123, CD141, CD303), myeloid-derived suppressor cells (HLA-DR, CD11b, CD14, CD15, CD33), and regulatory T cells (FoxP3, CD25, CD45RA, CD127) * expression of molecules involved in immune checkpoint modulation (ICOS, PD-1, PD-L1, CTLA-4) on blood-circulating dendritic cells and T cells * To determine the presence of autoantibodies in the serum of RCC patients * To explore the expression of PD-L1 and PD-L2 in tumor tissues of mRCC patients and correlation with efficacy parameters
Time frame: Taken together with Laboratory Tests: Prior to induction (Baseline), Prior to Nivo dose 4, Prior to Nivo dose 8, Prior to 6th nivo maintenance dosing