A Phase III Randomized Sequential Open-Label Study to Evaluate the Efficacy and Safety of Sorafenib Followed by Sunitinib Versus Sunitinib Followed by Sorafenib in the Treatment of First-Line Advanced / Metastatic Renal Cell Carcinoma
The results of three sequential retrospective studies (Sablin et al, ASCO 2007; Dham et al,
ASCO 2007; and Tamaskar et al, 2008) support the sequential administration of sorafenib and
sunitinib even though these two drugs have an overlap of targets. These results suggest the
lack of cross resistance between sorafenib and sunitinib. This study is a sequential,
randomized, open-label (1:1), multicenter phase III study starting in first-line of
metastatic / advanced RCC using in the experimental arm sorafenib until progression followed
by sunitinib and in the control arm sunitinib until progression followed by sorafenib.
Sorafenib-patients will switch to sunitinib and vice versa, with a treatment-free period of
at least one and up to maximum four weeks after confirmed first-line treatment failure, in
order to avoid additive toxicity. In general, the first-line treatment should be continued
until progression (RECIST). However, if patients do not tolerate the first-line medication
(sorafenib or sunitinib) because of toxicity, they may cross-over to the second-line therapy
(sunitinib or sorafenib) despite the lack of progression, if an appropriate attempt
according to a specific dose reduction / interruption scheme has been made to cope with the
toxicity and try to resume first line therapy, if deemed appropriate with a reduced dose. In
case of discontinuation of first-line treatment because of toxicity, patients will be
enrolled for the second-line treatment, only after nonhematological toxicity has resolved to
grade ≤1 and hematological toxicity to grade ≤2. As an exception, patients who refuse to be
treated further with the first-line regimen due to intolerability despite having no
progression may be crossed over to the second-line treatment, if they consent and are in
general compliance. Any crossover, also without progression, requires a CT scan, which is in
this case also considered the baseline scan for the second-line treatment. One cycle is of
six weeks duration. Patients will undergo a CT/MRI scan after every second cycle (i.e. after
12 weeks each), which will be evaluated according to RECIST criteria. There will be no
continuation of the same study medication beyond progression in both first- or second-line
therapy. After the study reached its primary endpoint cut off, i.e. after 231 disease
progressions under second-line therapy have occurred, clean data for these patients exist
and a statistical analysis has been performed data collection will be stopped. After that
the trial is terminated and a close out visit will be performed. Remaining patients will be
treated outside the study and will be censored in the analysis.
Interventional
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
total Progression Free Survival
Last patient last visit (LPLV) to June 2013
No
Germany: Federal Institute for Drugs and Medical Devices
09072008-13772
NCT00732914
January 2009
November 2013
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