ACTIVE_NOT_RECRUITING

A Study of Cabozantinib and Nivolumab With Radiation Therapy for People With Renal Cell Carcinoma That Has Spread to the Brain

Conditions

Metastatic Renal Cell Carcinoma Brain Metastases Cabozantinib Nivolumab Stereotactic Radiosurgery (SRS)23-138

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Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

The purpose of this study is to find out whether the combination of cabozantinib, nivolumab, and radiation therapy is a safe and effective treatment that causes few or mild side effects in people with renal cell cancer that has spread to the brain. The researches will also look at how the study treatment affects the quality of life of participants. They will measure the quality of life by having participants complete questionnaires.

Official Title

Phase 1b Study of the Safety of Concurrent Cabozantinib and Nivolumab With Radiation Therapy for Brain Metastases in Patients With Metastatic Renal Cell Carcinoma

Quick Facts

Study Start:2023-11-10

Study Completion:2027-11

Study Type:Not specified

Phase:Not Applicable

Enrollment:Not specified

Status:ACTIVE_NOT_RECRUITING

Study ID

NCT06132945

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:18 Years

Sexes Eligible for Study:ALL

Accepts Healthy Volunteers:No

Standard Ages:ADULT, OLDER_ADULT

Inclusion Criteria	Exclusion Criteria
1. Unresectable advanced or metastatic clear cell or non-clear cell RCC; all histologies acceptable except for chromophobe RCC 2. Brain metastases present, meeting the following criteria: 1. At least 1 brain metastasis measuring ≥0.5cm in any dimension (intracranial RANO-BM measurable disease required) 2. SRS is indicated per treating radiation oncologist 3. Surgical intervention for brain metastases is not planned 3. Able to undergo MRI Brain assessments for radiation planning. 4. Availability of archival tissue that enables the definitive diagnosis of RCC, accompanied by an associated pathology report. If archival tissue cannot be obtained, PI to provide documented confirmation patient can still enroll onto the study. Specimens can be collected by surgical resection or biopsy of the primary tumor or biopsy or resection of a metastatic lesion. 5. Age ≥18 years 6. KPS ≥ 80 7. Adequate hematologic and end organ function, defined by the following laboratory results obtained within 28 days prior to the first study treatment: 1. ANC ≥ 1500 cells/μL (without granulocyte colony stimulating factor support within 4 weeks prior to Cycle 1, Day 1) 2. WBC counts ≥ 2500/μL 3. Absolute lymphocyte count ≥ 500/μL 4. Platelet count ≥100,000/μL (without transfusion within 4 weeks prior to Cycle 1, Day 1) 5. Hemoglobin ≥9.0 g/dL o Patients may be transfused or receive erythropoietic treatment to meet this criterion. 8. AST, ALT, and alkaline phosphatase ≤ 2.5 x ULN, with the following exceptions: 1. Patients with documented liver metastases: AST and/or ALT ≤ 5 x ULN 2. Patients with documented liver or bone metastases: alkaline phosphatase ≤ 5 x ULN 9. Serum bilirubin ≤ 1.5 x ULN 10. Patients with known Gilbert disease who have serum bilirubin level ≤ 3 x ULN may be- enrolled. 11. INR and aPTT ≤ 1.5 x ULN 12. Creatinine ≤ 1.5 x ULN or Calculated Creatinine clearance ≥ 30mL/min by institutional standard measurement 13. For women who are not postmenopausal (12 months of amenorrhea) or surgically sterile (absence of ovaries and/or uterus): agreement to use two adequate methods of contraception, including at least one method with a failure rate of ≥ 1% per year 14. If any Grade ≥1 toxicities occurred in relation to prior treatment, patients must have recovered to baseline or ≤ Grade 1 unless adverse events are clinically insignificant or stable on supportive medication if needed.	1. Prior treatment with cabozantinib for RCC 2. Receipt of any small molecule kinase inhibitor (including investigational) or VEGFtargeted therapy within 2 weeks before the first dose of study treatment 3. Patients requiring whole brain radiotherapy (WBRT). 4. Any prior brain radiotherapy within 28 days prior to enrollment 5. Incomplete healing from prior radiotherapy as determined by the treating radiation oncologist or treating investigator 6. Diagnosis of autoimmune condition that may worsen during immune checkpoint blockade, with the following exceptions: 7. Any active or suspected autoimmune disease requiring systemic steroids \> 10 mg daily prednisone (or equivalent) or other immunosuppression, except for: * those not expected to reoccur * Chronic physiologic replacement of ≤10mg prednisone (or equivalent) for treatment of adrenal insufficiency * Steroids required for pre-medication reactions * Local steroid use is permitted (e.g. intranasal, topical, inhaled, or local steroid injection, i.e. intra-articular) 8. Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures 9. Uncontrolled hypercalcemia (≥ 1.5 mmol/L ionized calcium or Ca ≥ 12 mg/dL or corrected serum calcium ≥ ULN) or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy or denosumab 10. Participation in an experimental drug study within 28 days of study enrollment 11. Pregnant and lactating women 12. History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins 13. Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class II or greater), myocardial infarction within the previous 3 months, unstable arrhythmias, unstable angina, or EF \< 50% 14. Uncontrolled hypertension (\>140 mm Hg systolic or \>90 mm Hg diastolic) despite optimal antihypertensive treatment 15. QTcF \> 500 msec within 28 days before the first dose of study treatment 16. Major surgical procedure within 14 days prior to Cycle 1, Day 1 or anticipation of need for a major surgical procedure during the course of the study 17. History of stroke or transient ischemic attack within 6 months prior to Cycle 1, Day 1 18. Significant vascular disease (e.g., aortic aneurysm requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior to Cycle 1, Day 1 19. Evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation) 20. Clinical signs or symptoms of gastrointestinal obstruction or requirement for routine parenteral hydration, parenteral nutrition, or tube feeding 21. Evidence of abdominal free air not explained by paracentesis or recent surgical procedure 22. Serious, non-healing or dehiscing wound, active ulcer, or untreated bone fracture 23. Concomitant anticoagulation with coumarin agents, direct thrombin inhibitors, factor Xa inhibitor betrixaban, or platelet inhibitors. Other anticoagulants are allowed. 24. Abdominal fistula, GI perforation, bowel obstruction, or intra-abdominal abscess within 6 months before first dose of study treatment. 25. Cavitating pulmonary lesion(s) or known endotracheal or endobronchial disease manifestation 26. Lesions invading or encasing major blood vessels 27. Uncompensated or symptomatic hypothyroidism 28. History of solid organ or allogeneic stem cell transplant 29. Clinically significant active infection including HIV, Hepatitis B, Hepatitis C, acute COVID-19 infection, or other * For patients with HIV infection, clinically significant/exclusionary features include: detectable viral load, CD4+ T cell count \<300 cells/microL, or history of opportunistic infection * For patients with HBV infection, clinically significant/exclusionary features include: HBV surface antigen positivity, detectable HBV DNA by polymerase chain reaction (PCR). Patients with prior HBV infection (HBV core Ab positive, HBV DNA undetectable by PCR, HBV surface antigen negative) are eligible for the study if they are already stable on entecavir or tenofovir 30. Inability to swallow tablets 31. Previously identified allergy or hypersensitivity to components of the treatment 32. Malignancy that requires anti-cancer directed therapy within the last 3 years. Exceptions include those cancers that are considered cured by local therapy (e.g. Basal cell carcinoma, squamous cell carcinoma, ductal carcinoma in situ of breast, bladder, or cervix) or other cancers that have low malignant potential and do not require systemic therapy (e.g. Gleason grade \<6 prostate adenocarcinoma) 33. Patients in whom nivolumab treatment is not otherwise feasible (for example, for financial reasons)

Inclusion Criteria

Exclusion Criteria

1. Unresectable advanced or metastatic clear cell or non-clear cell RCC; all histologies acceptable except for chromophobe RCC
2. Brain metastases present, meeting the following criteria:
1. At least 1 brain metastasis measuring ≥0.5cm in any dimension (intracranial RANO-BM measurable disease required)
2. SRS is indicated per treating radiation oncologist
3. Surgical intervention for brain metastases is not planned
3. Able to undergo MRI Brain assessments for radiation planning.
4. Availability of archival tissue that enables the definitive diagnosis of RCC, accompanied by an associated pathology report. If archival tissue cannot be obtained, PI to provide documented confirmation patient can still enroll onto the study. Specimens can be collected by surgical resection or biopsy of the primary tumor or biopsy or resection of a metastatic lesion.
5. Age ≥18 years
6. KPS ≥ 80
7. Adequate hematologic and end organ function, defined by the following laboratory results obtained within 28 days prior to the first study treatment:
1. ANC ≥ 1500 cells/μL (without granulocyte colony stimulating factor support within 4 weeks prior to Cycle 1, Day 1)
2. WBC counts ≥ 2500/μL
3. Absolute lymphocyte count ≥ 500/μL
4. Platelet count ≥100,000/μL (without transfusion within 4 weeks prior to Cycle 1, Day 1)
5. Hemoglobin ≥9.0 g/dL o Patients may be transfused or receive erythropoietic treatment to meet this criterion.
8. AST, ALT, and alkaline phosphatase ≤ 2.5 x ULN, with the following exceptions:
1. Patients with documented liver metastases: AST and/or ALT ≤ 5 x ULN
2. Patients with documented liver or bone metastases: alkaline phosphatase ≤ 5 x ULN
9. Serum bilirubin ≤ 1.5 x ULN
10. Patients with known Gilbert disease who have serum bilirubin level ≤ 3 x ULN may be- enrolled.
11. INR and aPTT ≤ 1.5 x ULN
12. Creatinine ≤ 1.5 x ULN or Calculated Creatinine clearance ≥ 30mL/min by institutional standard measurement
13. For women who are not postmenopausal (12 months of amenorrhea) or surgically sterile (absence of ovaries and/or uterus): agreement to use two adequate methods of contraception, including at least one method with a failure rate of ≥ 1% per year
14. If any Grade ≥1 toxicities occurred in relation to prior treatment, patients must have recovered to baseline or ≤ Grade 1 unless adverse events are clinically insignificant or stable on supportive medication if needed.

1. Prior treatment with cabozantinib for RCC
2. Receipt of any small molecule kinase inhibitor (including investigational) or VEGFtargeted therapy within 2 weeks before the first dose of study treatment
3. Patients requiring whole brain radiotherapy (WBRT).
4. Any prior brain radiotherapy within 28 days prior to enrollment
5. Incomplete healing from prior radiotherapy as determined by the treating radiation oncologist or treating investigator
6. Diagnosis of autoimmune condition that may worsen during immune checkpoint blockade, with the following exceptions:
7. Any active or suspected autoimmune disease requiring systemic steroids \> 10 mg daily prednisone (or equivalent) or other immunosuppression, except for:
* those not expected to reoccur
* Chronic physiologic replacement of ≤10mg prednisone (or equivalent) for treatment of adrenal insufficiency
* Steroids required for pre-medication reactions
* Local steroid use is permitted (e.g. intranasal, topical, inhaled, or local steroid injection, i.e. intra-articular)
8. Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures
9. Uncontrolled hypercalcemia (≥ 1.5 mmol/L ionized calcium or Ca ≥ 12 mg/dL or corrected serum calcium ≥ ULN) or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy or denosumab
10. Participation in an experimental drug study within 28 days of study enrollment
11. Pregnant and lactating women
12. History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
13. Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class II or greater), myocardial infarction within the previous 3 months, unstable arrhythmias, unstable angina, or EF \< 50%
14. Uncontrolled hypertension (\>140 mm Hg systolic or \>90 mm Hg diastolic) despite optimal antihypertensive treatment
15. QTcF \> 500 msec within 28 days before the first dose of study treatment
16. Major surgical procedure within 14 days prior to Cycle 1, Day 1 or anticipation of need for a major surgical procedure during the course of the study
17. History of stroke or transient ischemic attack within 6 months prior to Cycle 1, Day 1
18. Significant vascular disease (e.g., aortic aneurysm requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior to Cycle 1, Day 1
19. Evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation)
20. Clinical signs or symptoms of gastrointestinal obstruction or requirement for routine parenteral hydration, parenteral nutrition, or tube feeding
21. Evidence of abdominal free air not explained by paracentesis or recent surgical procedure
22. Serious, non-healing or dehiscing wound, active ulcer, or untreated bone fracture
23. Concomitant anticoagulation with coumarin agents, direct thrombin inhibitors, factor Xa inhibitor betrixaban, or platelet inhibitors. Other anticoagulants are allowed.
24. Abdominal fistula, GI perforation, bowel obstruction, or intra-abdominal abscess within 6 months before first dose of study treatment.
25. Cavitating pulmonary lesion(s) or known endotracheal or endobronchial disease manifestation
26. Lesions invading or encasing major blood vessels
27. Uncompensated or symptomatic hypothyroidism
28. History of solid organ or allogeneic stem cell transplant
29. Clinically significant active infection including HIV, Hepatitis B, Hepatitis C, acute COVID-19 infection, or other
* For patients with HIV infection, clinically significant/exclusionary features include: detectable viral load, CD4+ T cell count \<300 cells/microL, or history of opportunistic infection
* For patients with HBV infection, clinically significant/exclusionary features include: HBV surface antigen positivity, detectable HBV DNA by polymerase chain reaction (PCR). Patients with prior HBV infection (HBV core Ab positive, HBV DNA undetectable by PCR, HBV surface antigen negative) are eligible for the study if they are already stable on entecavir or tenofovir
30. Inability to swallow tablets
31. Previously identified allergy or hypersensitivity to components of the treatment
32. Malignancy that requires anti-cancer directed therapy within the last 3 years. Exceptions include those cancers that are considered cured by local therapy (e.g. Basal cell carcinoma, squamous cell carcinoma, ductal carcinoma in situ of breast, bladder, or cervix) or other cancers that have low malignant potential and do not require systemic therapy (e.g. Gleason grade \<6 prostate adenocarcinoma)
33. Patients in whom nivolumab treatment is not otherwise feasible (for example, for financial reasons)

Contacts and Locations

Principal Investigator

Ritesh Kotecha, MD

PRINCIPAL_INVESTIGATOR

Memorial Sloan Kettering Cancer Center

Study Locations (Sites)

Memorial Sloan Kettering Basking Ridge (All Protocol Activities)

Basking Ridge, New Jersey, 07920

United States

Memorial Sloan Kettering Monmouth (All Protocol Activities)

Middletown, New Jersey, 07748

United States

Memorial Sloan Kettering Bergen (All Protocol Activities)

Montvale, New Jersey, 07645

United States

Memorial Sloan Kettering Cancer Suffolk - Commack (All Protocol Activities)

Commack, New York, 11725

United States

Memorial Sloan Kettering Westchester (All Protocol Activities)

Harrison, New York, 10604

United States

Memorial Sloan Kettering Cancer Center (All Protocol Activities)

New York, New York, 10065

United States

Memorial Sloan Kettering Nassau (All Protocol Activities)

Uniondale, New York, 11553

United States

Collaborators and Investigators

Sponsor: Memorial Sloan Kettering Cancer Center

Ritesh Kotecha, MD, PRINCIPAL_INVESTIGATOR, Memorial Sloan Kettering Cancer Center

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2023-11-10

Study Completion Date2027-11

Study Record Updates

Study Start Date2023-11-10

Study Completion Date2027-11

Terms related to this study

Keywords Provided by Researchers

Cabozantinib
Nivolumab
Stereotactic Radiosurgery (SRS)
23-138

Additional Relevant MeSH Terms

Metastatic Renal Cell Carcinoma
Brain Metastases