SAbR For Oligometastatic Renal Cell Carcinoma

University of Texas Southwestern Medical Center23 enrolled

Overview

Hypothesis: Stereotactic ablative body radiation (SAbR) prolongs progression-free survival for patients with oligometastatic kidney cancer (RCC) and delays the initiation of systemic therapy. Primary Objectives: • To evaluate the delay in time to start of systemic therapy (TTST) as a surrogate of progression free survival (PFS), defined as the time from the first day of SAbR to start of systemic therapy. Secondary Objective: * To evaluate the modified progression-free survival (mPFS) for patients with oligometastatic renal cell carcinoma who are treated with SAbR. * To evaluate the overall survival (OS) * To evaluate the cancer specific survival (CSS) * To evaluate the local control rate of irradiated lesions. * To measure the health-related quality of life (HRQOL).

The study is a prospective single institution phase II single-arm open-label trial evaluating SAbR in patients with newly diagnosed oligometastatic RCC. Problem Statements: * Can local therapy (SAbR) safely delay the start of systemic therapy? * Safely delaying the start of systemic therapy can have significant quality of life benefits for patients since systemic therapy has significant side effects. * Can SAbR be curative in truly oligometastatic RCC patients? Primary Endpoint: • Time to start of systemic therapy (TTST) defined as the time from the first day of SAbR to start of systemic therapy. Secondary Endpoint: * Modified progression-free survival (mPFS) is defined as the survival interval without development of \>3 sites of new metastasis, new sites of metastases that are not amenable to SAbR treatment, a total of \>6 sites of metastasis that required SAbR, local failure at SAbR-treated site, or development of brain metastasis. * Overall Survival * Local control * Toxicity * HRQOL Sample Size: 23 Patients will be enrolled. Statistical Analysis: Time to event will be estimated using the Kaplan-Meier approach along with the 95% confidence interval.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Metastatic renal cell carcinoma with limited measurable extracranial metastases (Limited metastases, or oligometastases, defined as ≤3 sites of metastasis). * Radiographic evidence of metastatic disease. CT should be performed within 30 days of registration. * Pathology confirmation of Renal cell carcinoma. * Prior surgery, or radiation is permitted. * Age ≥ 18 years. * Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, and for 90 days after Radiation treatment has been completed . Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria: * Has not undergone a hysterectomy or bilateral oophorectomy; or * Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months). * Ability to understand and the willingness to sign a written informed consent and agrees to undergo image studies and follow up Exclusion Criteria: * Subjects with brain metastasis as assessed by contrast MRI or contrast CT scans(contrast recommended). * Subjects with previous history of brain metastasis. * Subjects that received prior systemic therapy for kidney cancer in the past 1 year, except one line of immuno- or cytokine therapy (e.g. prior IL-2); systemic therapy for other cancers does not apply to this exclusion criteria * Subjects with ≥3 unfavorable prognostic factors defined by Motzer et al. (1999), (KPS \<80% or ECOG\>1, Hgb \< LLN, LDH \>1.5x normal, corrected serum calcium \>10mg/dl and absence of prior nephrectomy), Patients with 0, 1-2, and ≥3 factors had time to death of 20 months, 10 months and 4 months. * Subjects with life expectancy \< 6 months. * Subjects receiving any other investigational agents * Subjects must not be pregnant due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants.

Outcomes

Primary Outcomes

Percentage of Participants With Delay in Time to Start of Systemic Therapy (TTST)

The percentage of participants with more than 1 year time to systemic therapy (TTST) will be reported for this outcome. Initiation of systemic therapy \>1 year (delay in time) is a surrogate of progression free survival (PFS) and is defined as the time from the first day of SAbR to start of systemic therapy.

Time frame: 1 Year

Secondary Outcomes

Modified Progression-free Survival (mPFS) for Patients Who Are Treated With SAbR

Modified progression-free survival (mPFS) for patients with oligometastatic renal cell carcinoma who are treated with SAbR. Modified progression-free survival (mPFS) is defined as the survival interval without development of \>3 sites of new metastasis, new sites of metastases that are not amenable to SAbR treatment, a total of \>6 sites of metastasis that required SAbR, local failure at SAbR-treated site, or development of brain metastasis, with the definition of new metastasis and local failure (progression) as defined by RECIST. "Metastasis" in this entire protocol refers to extra-cranial metastasis unless otherwise specified.

Time frame: 5.7 years

Progression-free Survival on Systemic Therapy (PFS-ST)

To evaluate progression on next line of systemic therapy as defined by RECIST 1.1 starting from mPFS (modified progression free survival). Response and progression will be evaluated in this study using the new international criteria proposed by the Response Evaluation Criteria in Solid Tumors (RECIST v 1.1) Committee \[Eur J Cancer. 2009;45(2):228-247\]. Changes in only the largest diameter (unidimensional measurement) of the tumor lesions are used in the RECIST v1.1 criteria.

Time frame: 5.7 years

Overall Survival (OS)

Overall survival (OS), which is defined as the time between date of registration and the date of death due to any cause.

Time frame: 5.7 years

Cancer Specific Survival (CSS)

Cancer specific survival is defined as the time between date of registration and the date of death due to renal cell carcinoma.

Time frame: 5.7 years

Local Control

Radiographic progression with \>30% increase in the longest diameter of the treated lesions.

Time frame: 5.7 years

Median Response Duration

Median response duration is defined as the time between the date a response (CR or PR) was first seen until date of progression. Response and progression will be evaluated in this study using the new international criteria proposed by the Response Evaluation Criteria in Solid Tumors (RECIST v 1.1) Committee \[Eur J Cancer. 2009;45(2):228-247\]. Changes in only the largest diameter (unidimensional measurement) of the tumor lesions are used in the RECIST v1.1 criteria.

Time frame: 1.8 years

Time to Development of New Lesions

Interval time to development of new lesions that can be treated with additional local therapy- title would be this or a shortened version of it. Time to event will be estimated using the Kaplan-Meier approach along with the 95% confidence interval.

Time frame: 5.7 years

Time to Disease Progression That Cannot be Treated

To measure the time interval from registration to time to disease progression that cannot be treated with further local therapy and need to initiate or switch systemic therapy. Time to event will be estimated using the Kaplan-Meier approach along with the 95% confidence interval.

Time frame: 5.7 years

Toxicity Measurement

Severity or Toxicity will be assessed according to the National Cancer Institute (NCI) Common Toxicity Criteria for Adverse Events (CTCAE), version 5.0. Events have been counted if they are considered related to the investigational intervention included "possible," "probable," and "definite." To ensure transparency, all AEs with "unlikely" or greater attribution are included.

Time frame: 5.7years

Change in Health-related Quality of Life (HRQOL) FACT-G

HRQOL will be measured using FACT-G questionnaire responses from baseline to certain time points (3, 9, 15,21,27,33 months) until the completion of follow ups. FACT-G is a measure that sums the functional wellbeing (FWB), physical wellbeing (PWB), the social/family well-being (S/FWB), and emotional wellbeing (EMB).FACT-G total score range (0-108); Higher values indicate a better HRQOL.

Time frame: [Baseline-3mon (months)];(Baseline-9mon.);(Baseline-15mon.); (Baseline-21mon.);(Baseline-27mon.);(Baseline-33mon.)

Change in Health-related Quality of Life (HRQOL) EQ-VAS

HRQOL will be measured using EQ-VAS (EuroQol- Visual analog scale) questionnaire at baseline and at specific timepoints (3,9,15,21,27,33 months) until the completion of follow ups. The EQ-VAS is a global measure of patient perception of their health ranging from 0-100, with 0 being the worst health they can imagine, and 100 being the best health they can imagine.

Time frame: [Baseline-3mon (months)];(Baseline-9mon.);(Baseline-15mon.); (Baseline-21mon.);(Baseline-27mon.);(Baseline-33mon.)

Change in Health-related Quality of Life (HRQOL) EQ-5D at 3 Months

HRQOL will be measured using EQ-5D (EuroQol- 5 Dimension) questionnaire at baseline and at certain specific timepoints (3,9,15,21,27,33 months) until the completion of follow ups. EQ-5D-5L is a self-assessed, health related, quality of life questionnaire. The scale measures quality of life on a 5-component scale including the domains - mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

Time frame: Baseline, 3months

Change in Health-related Quality of Life (HRQOL) EQ-5D at 9 Months

Time frame: Baseline, 9 months

Change in Health-related Quality of Life (HRQOL) EQ-5D at 15 Months

Time frame: Baseline, 15 months

Change in Health-related Quality of Life (HRQOL) EQ-5D at 21 Months

Time frame: Baseline, 21 months

Change in Health-related Quality of Life (HRQOL) EQ-5D at 27 Months

Time frame: Baseline, 27 months

Change in Health-related Quality of Life (HRQOL) EQ-5D at 33 Months

Time frame: Baseline, 33 months

Change in Health-related Quality of Life (HRQOL) FKSI

HRQOL will be measured using FKSI questionnaire at baseline and at certain specific timepoints (3,9,15,21,27,33 months) until the completion of follow ups. FKSI adds to the FACT-G (27 items) by including 15 items specific to kidney cancer patients. FKSI is a questionnaire for FACT-Kidney Symptom Index used to assess QoL/participant-reported outcomes for participants diagnosed with renal cell cancer. The FKSI contained 15 questions each ranging from 0 (not at all) to 4 (very much) so that FKSI ranged between 0-60 where higher scores reflects better functioning and fewer symptoms.

Time frame: [Baseline-3mon (months)];(Baseline-9mon.);(Baseline-15mon.); (Baseline-21mon.);(Baseline-27mon.);(Baseline-33mon.)

SAbR For Oligometastatic Renal Cell Carcinoma

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes