Kidney Cancer Clinical Trial
Official title:
Randomized Phase III Trial Comparing Immediate Versus Deferred Nephrectomy in Patients With Synchronous Metastatic Renal Cell Carcinoma
RATIONALE: Sunitinib malate may stop the growth of tumor cells by blocking some of the
enzymes needed for cell growth and by blocking blood flow to the tumor. Giving sunitinib
malate before surgery may make the tumor smaller and reduce the amount of normal tissue that
needs to be removed. Giving sunitinib malate after surgery may kill any tumor cells that
remain after surgery. It is not yet known whether undergoing immediate surgery or surgery
after sunitinib malate is more effective in treating patients with metastatic kidney cancer.
PURPOSE: This randomized phase III trial is studying immediate surgery to see how well it
works compared with surgery after sunitinib malate in treating patients with metastatic
kidney cancer.
OBJECTIVES:
- To determine if immediate versus deferred nephrectomy has an effect on disease control
in patients with resectable, synchronous, metastatic renal cell carcinoma treated with
sunitinib malate.
- To identify potential response criteria based on histopathology and molecular research
on tumor tissue.
OUTLINE: This is a multicenter study. Patients are stratified according to WHO performance
status (0 vs 1), number of metastatic sites (1 vs 2 or more), and institution. Patients are
randomized to 1 of 2 treatment arms.
- Arm I (immediate nephrectomy): Patients undergo cytoreductive nephrectomy. Beginning 4
weeks after surgery, patients receive oral sunitinib malate once daily on days 1-28.
Treatment with sunitinib malate repeats every 6 weeks for 4 courses in the absence of
disease progression or unacceptable toxicity.
- Arm II (deferred nephrectomy): Patients receive oral sunitinib malate once daily on
days 1-28. Treatment repeats every 6 weeks for 3 courses in the absence of disease
progression or unacceptable toxicity. About 1 day after completion of sunitinib malate,
patients undergo cytoreductive nephrectomy. Patients then receive oral sunitinib malate
once daily on days 1-28. Treatment repeats every 6 weeks for 2 courses in the absence
of disease progression or unacceptable toxicity.
Some patients undergo tumor tissue collection at baseline and at time of surgery to assess
possible differences in gene expression. Patients also undergo blood sample collection
periodically to evaluate the potential impact of serum proteins on the clinical outcome.
Samples are then stored for future studies.
After completion of study treatment, patients are followed periodically.
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