The purpose of this study is to evaluate the safety and feasibility of a treatment holiday strategy directed by CD70-targeted immuno-PET/CT in patients with metastatic clear cell renal cell carcinoma (mccRCC). Specifically, the study aims to assess whether patients who achieve both anatomical disease control and metabolic response after 12 months of first-line PD-1/PD-L1 ICI + VEGFR-TKI combination therapy can safely pause their treatment, improve quality of life without compromising therapeutic efficacy.
Current first-line therapy for advanced renal cell carcinoma (RCC) combines tyrosine kinase inhibitors (TKIs) with immune checkpoint inhibitors (ICIs). Although effective, continuous treatment often results in cumulative toxicities, significant financial burdens, and potential overtreatment for patients. While intermittent therapy shows promise in maintaining efficacy while mitigating adverse events, conventional CT relies on morphological changes and lacks the sensitivity to distinguish viable tumor tissue from post-treatment fibrosis or necrosis, hindering precise decision-making for treatment cessation. CD70 is a transmembrane protein highly expressed in over 80% of mccRCCs. CD70-targeted immuno-PET/CT, utilizing specific single-domain antibodies, provides a superior molecular imaging tool outperforming FDG-PET and allows for accurate assessment of treatment response to guide intermittent therapy. In this multi-center, single-arm, phase II trial, mccRCC patients with IMDC favorable or intermediate risk will be enrolled to receive standard first-line ICI plus TKI combination therapy for 12 months (± 1 months) in the absence of disease progression or unacceptable toxicity. After that, patients will be evaluated using both CT (RECIST 1.1) and CD70 immuno-PET/CT (PERCIST criteria). Patients achieving sustained disease control on CT combined with Complete Metabolic Response (CMR) or Partial Metabolic Response (PMR) on CD70 immuno-PET/CT will qualify to pause all systemic treatments and enter treatment holiday. A per-lesion evaluation principle will be applied for baseline heterogeneous lesions. Patients fail to achieve the predefined criteria will continue first-line systemic therapy until disease progression or unacceptable toxicity. During the treatment holiday, patients will undergo anatomical and molecular monitoring including CT scans every 8-12 weeks and CD70 immuno-PET/CT every 24 weeks. Original regimen will be immediately restarted upon the occurrence of anatomical progression (RECIST 1.1), metabolic flare (PERCIST), or clinical symptom deterioration. Peripheral blood, other biological samples, and health-related quality of life questionnaires will be collected at different time points during the trial for future analyses.This study aims to establish a multidimensional decision-making framework to optimize the balance between survival benefits and quality of life in advanced RCC.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
75
All participants will receive first-line PD-1/PD-L1 inhibitor + VEGFR-TKI combination therapy for 12 months (±1 month).
Patients who achieve the predefined criteria after 12 months of treatment will discontinue both drugs and enter a closely monitored treatment holiday. Upon radiographic or clinical progression, the previous systemic therapy will be reintroduced according to the protocol and investigator's discretion.
Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
Nanjing, Jiangsu, China
Treatment-free survival (TFS) rate
Defined as the proportion of patients who are alive without having restarted the original therapy at 12 months following discontinuation of the combination therapy.
Time frame: 12 months after treatment discontinuation
Overall survival (OS)
Time from enrollment to date of death due to any cause.
Time frame: From treatment initiation until 3 years of follow-up
Progression free survival (PFS)
Time from enrollment to first documented disease progression or death, whichever occurs first.
Time frame: From treatment initiation until 3 years of follow-up
Overall safety profile
Frequency and severity of adverse events (AEs) and serious adverse events (SAEs) graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 criteria.
Time frame: From treatment initiation until 3 years of follow-up
Patient-reported outcome (PRO) - Health-related quality of life measured by NCCN FKSI-19
Measured by the NCCN functional assessment of cancer therapy-kidney symptom index (FKSI-19), a 19-item scale assessing treatment-related symptoms and side effects for kidney cancer patients.
Time frame: From treatment initiation until 2 years of follow-up
Patient-reported outcome (PRO) - Health-related quality of life measured by EORTC QLQ-C30
Measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), a 30-item instrument assessing various domains of physical, emotional, and social functioning for cancer patients.
Time frame: From treatment initiation until 2 years of follow-up
Patient-reported outcome (PRO) - General Health status measured by EQ-5D-5L
Measured by the "5-Level EuroQol Group's 5-Dimension" (EQ-5D-5L) questionnaire which comprises the EQ-5D index evaluating health across five dimensions and the EQ-VAS which is a 0-100 visual scale for self-rated overall health.
Time frame: From treatment initiation until 2 years of follow-up
Patient-reported outcome (PRO) - Anxiety and depression status measured by HADS
Measured by the Hospital Anxiety and Depression Scale (HADS) which contains 14 items with 7 items measuring anxiety level and 7 items measuring depression level.
Time frame: From treatment initiation until 2 years of follow-up
Quality-adjusted life years (QALYs)
The quality-adjusted time without symptoms or toxicity (Q-TWiST) integrates data from patient-reported outcomes (PROs) into survival calculations. It quantifies the utility-weighted sum of mean time across three health states: time with all-cause grade 3/4 toxicity prior to progression, time without grade 3/4 toxicity or symptoms of progression, and time after progression.
Time frame: From treatment initiation until 2 years of follow-up
Cost-effectiveness
Measured by the incremental cost-effectiveness ratio (ICER) to provide the ratio of incremental cost per additional quality-adjusted life year (QALY).
Time frame: From treatment initiation until 2 years of follow-up
Duration of response (DoR)
Time from first documented complete metabolic response (CMR) or partial metabolic response (PMR) to progression or death.
Time frame: From treatment discontinuation until 2 years of follow-up
Distribution of treatment modality after progression
Proportion of participants receiving surveillance, focal treatment, or systemic therapy after disease progression.
Time frame: From treatment discontinuation until 2 years of follow-up
Objective response rate (ORR) after restarting treatment
Proportion of participants achieving objective response within 6 months of restarting therapy after progression.
Time frame: From treatment discontinuation until 2 years of follow-up
Time to subsequent therapy initiation
Time from treatment discontinuation to the start of subsequent systemic therapy or death, whichever occurs first.
Time frame: From treatment discontinuation until 2 years of follow-up
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