This study is being done with patients with advanced kidney cancer (also called renal cell carcinoma or RCC). This is a research study involving the use of the drug Nivolumab (also known as Opdivo®). Nivolumab is an anti-PD-1 antibody. It works by attaching to and blocking a molecule called PD-1. PD-1 is a protein that is present on different types of cells in the immune system and controls parts of the immune system by shutting it down. Antibodies that block PD-1 can potentially prevent PD-1 from shutting down the immune system, thus allowing it to recognize and help destroy cancer cells. In many countries (including the United States, European Union and Japan) Nivolumab is approved to treat certain cancer types. The purpose of the study is to test the safety and effectiveness of nivolumab in patients with advanced RCC when given intermittently. Nivolumab is approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced kidney cancer, non small cell lung cancer, classical Hodgkin Lymphoma and Metastatic Melanoma. Nivolumab is FDA-approved for advanced RCC because has been shown to shrink RCC tumors that have spread outside the kidney.
Primary Objective: \- To determine the feasibility of intermittent nivolumab therapy in patients with metastatic renal cell carcinoma. Secondary Objectives: * To determine the clinical outcome (overall response rate (ORR), progressive free survival (PFS), overall survival (OS)) in metastatic renal cell carcinoma patients treated with intermittent nivolumab therapy. * To evaluate the toxicity of intermittent nivolumab therapy in patients with metastatic renal cell carcinoma. Correlative Objective \- Investigate correlations between baseline and post-treatment immunomodulatory cells \[specifically, myeloid-derived suppressor cells (MDSC) regulatory T cells (Treg), cluster of differentiation 4 (CD4) and cluster of differentiation 8 (CD8), T Cells, T-cell receptor (TCR) repertoire and time off therapy.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
26
Nivolumab monotherapy will be administered dosed at 480mg IV over 30 minutes for all patients every 4 weeks, regardless of weight (when given in combination with ipilimumab, the dose of nivolumab is 3mg/kg every 3 weeks). Tumor assessed after 12 weeks If tumor decreases by 10% or more, then hold drug for 12 week and test tumor again. Continue treatment if tumor is not decreased by 10% or more.
Ipilimumab is dosed at 1mg/kg over 30 minutes every 3 weeks
Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
Cleveland, Ohio, United States
the proportion of patients who receive intermittent therapy
For cohort I: Assess feasibility of an intermittent dosing schedule, where feasibility is defined in terms of the proportion of patients eligible for intermittent therapy who actually receive it. An underlying acceptance rate of \>80% is arbitrarily considered necessary in order to accept the intermittent schedule as feasible whereas an acceptance rate \<50% is considered evidence that the intermittent schedule is not feasible
Time frame: Expected duration 5.5 months
Rate of participants who maintain CR/PR off therapy for at least 9 months
For cohort II: Rate of participants who maintain CR/PR off therapy for at least 9 months
Time frame: Up to 9 months after treatment
Change in tumor burden
Time frame: Expected duration 5.5 months
Objective Response
Number of patients with tumor response per the RECIST 1.1 Criteria: Complete response (CR) is defined as the disappearance of all target lesions. Any pathological lymph nodes (whether target or non target) must have reduction in short axis to \<10 mm. Partial response (PR) is defined as a greater than or equal to 30% decrease in the sum of the longest dimensions of the target lesions Progressive disease (PD) is defined as a greater than or equal to 20% increase in the sum of the longest dimensions of the target lesions, or the appearance of one or more new lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. Stable disease (SD) is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD
Time frame: Expected duration 5.5 months
Length of Progression Free Survival
Time from enrollment in the study to progression, when progression is defined as a greater than or equal to 20% increase in the sum of the longest dimensions of the target lesions taking as a reference the smallest sum of the longest dimensions recorded since the treatment started, or the appearance of one or more new lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm.
Time frame: Expected duration 5.5 months
Percent of patients who experience grade 3 AE or higher with re-induction ipi/nivo
Estimate toxicity rate in participants undergoing reinduction with ipilimumab/nivolumab as measured by percent of patients who experience grade 3 AE or higher
Time frame: up to 100 days after end of treatment
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