Clinical Trials Logo

Clinical Trial Summary

NiSAR is a Ph.D. study and consists of three substudies. Renal cancer is one of the most deadly urologic malignancies and accounts for 900 new cases and 300 deaths per year. An increase in the use of imaging diagnostics has yielded a rise in the incidental detection of small renal masses (SRM), meaning tumors <4cm (T1a). Kidney biopsies are the gold standard for diagnosing SRM but has an inherent risk of infections, retroperitoneal bleeding and in rare cases loss of kidney function. This is problematic since up to 30% of SRM are benign.

This Ph.D. consists of three studies that all aim to develop new minimally invasive modalities for diagnosing SRM. Patients eligible for these studies are diagnosed with SRM at one of the departments of Urology in the southern region of Denmark. Studies 1 and 2 aims to find circulating biomarkers, in the form of DNA and messenger ribonucleic acid (mRNA) contained in micro vesicles secreted into blood by renal cell cancers and find changes in biomarkers levels after surgery. Study 3 aim to determine the potential of multiplanar MRI (mpMRI) to discriminate between benign and malign SRM. Potentially this can lead to a fundamental change of the way urologists diagnose and monitor SRM and renal cell cancer in general.

The investigators will also build a research biobank for future research.


Clinical Trial Description

Study 1:

Trial objective:

Identification of biomarkers in blood and urine and to set the basis for a minimally invasive diagnostic program for SRM.

Method:

Sample collection:

All blood samples will be collected in ethylendiamin-tetraacetate (EDTA) containing tubes. two samples are then centrifugated at 2000 G for 10 minutes to isolate plasma, which then are stored at -80oC. The remaining 2 samples are stored at -80oC as is. Total nucleic acid (TNA) will be extracted from concentrated urine and plasma samples as previously described using a NucliSENS easy MAG instrument. Extracted TNA will then be used for targeted immune- and oncologic profiling (mutations and expression) using next generation sequencing (NGS)-based RNA and DNA sequencing.

The additional core sample from kidney tumor will be stored without preservatives for NGS-based DNA and RNA-seq analysis.

Study 2:

Trial objective:

Identification of changes in circulating biomarkers after curative treatment in patients with biopsy verified renal cancer.

Methods:

Patient recruitment:

Patients will be enrolled in study 2 in the same manner as study 1.

Sample collection:

In addition to the first four samples four additional blood samples (20 ml) will be taken 1 month and 6 months after curative treatment from each patient. All samples will be coded and given an ID according to patient´s CPR number using the RedCap informatic coding system.

Sample storage, preparation and analysis:

Blood and urine samples will be handled in the same manner as in study 1. Statistical Analysis for study 1 and 2:

Exploratory analysis of the data will be performed on molecular expression levels of specific sequences identified, an unsupervised hierarchical clustering will be fit and heat maps will be produced. Properties of clustered elements will be further matched with histopathological results to search for histological aggregation patterns.

Expression levels of the sequences identified, in blood and urine will be compared by means of Whitney U test and Kruskal-Wallis test. Changes in levels of expression from pre-operative to post-operative will be evaluated with Friedman´s ANOVA and subsequent post-hoc pairwise comparison with Wilcoxon's signed rank test with Bonferroni correction.

Receiver operating characteristic curve analysis will be further performed on pre-operative samples, to test for validity of the assays for each marker to discriminate between benignant histology and malignancy, with a cut-off for area under curve (AUC) of 0.75.

Sample size The minimal sample size required for achieving a statistical power of 80% with a significance level of 0.05 and an expected dropout rate of 15% will be 155 patients.

Calculations for sample size have been computed with the GPower software (Düsseldorf, DE).

Study 3:

Trial objective:

To investigate the diagnostic value of mpMRI in determining malignancy in SRM.

Method:

Patient recruitment:

After providing a written consent a mpMRI will be scheduled at the same day but prior to the primary biopsy. All mpMRIs will be performed locally and the pictures transferred to Odense University Hospital where a specialist radiologist, will examine the scans in a blinded fashion, meaning that he will be ignorant to the pathologist´s diagnosis. The result will be stored in a coded RedCAP database.

MpMRIs are performed according to a standard protocol and include the following sequences: T1 (with reduced affinity for fatty tissue) +/- contrast, diffusion weighted sequences and wash in/wash out. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT03667885
Study type Observational [Patient Registry]
Source Odense University Hospital
Contact Anders Ullmann U Frey, Ph.D student
Phone 26846961
Email freyen60@gmail.com
Status Recruiting
Phase
Start date March 1, 2019
Completion date September 2020

See also
  Status Clinical Trial Phase
Active, not recruiting NCT04987203 - Study to Compare Tivozanib in Combination With Nivolumab to Tivozanib Monotherapy in Subjects With Renal Cell Carcinoma Phase 3
Recruiting NCT06391879 - Establishment of a Multidimensional Prediction Model for the Natural Course of VHL Disease-related Renal Cell Carcinoma
Completed NCT02526017 - Study of Cabiralizumab in Combination With Nivolumab in Patients With Selected Advanced Cancers Phase 1
Recruiting NCT05059444 - ORACLE: Observation of ResiduAl Cancer With Liquid Biopsy Evaluation
Terminated NCT03655613 - APL-501 or Nivolumab in Combination With APL-101 in Locally Advanced or Metastatic HCC and RCC Phase 1/Phase 2
Active, not recruiting NCT03170960 - Study of Cabozantinib in Combination With Atezolizumab to Subjects With Locally Advanced or Metastatic Solid Tumors Phase 1/Phase 2
Withdrawn NCT05418387 - A Social Support Intervention to Improve Treatment Among Hispanic Kidney and Liver Cancer Patients in Arizona N/A
Recruiting NCT04623502 - An Investigation of Kidney and Urothelial Tumor Metabolism in Patients Undergoing Surgical Resection and/or Biopsy N/A
Completed NCT02853344 - Study of Pembrolizumab (MK-3475) Monotherapy in Locally Advanced/Metastatic Renal Cell Carcinoma (MK-3475-427/KEYNOTE-427) Phase 2
Terminated NCT04088500 - A Study of Combination Nivolumab and Ipilimumab Retreatment in Patients With Advanced Renal Cell Carcinoma Phase 2
Completed NCT05070637 - Circulating Tumor Cell Reducing No-touch Nephrectomy N/A
Active, not recruiting NCT03634540 - A Trial of Belzutifan (PT2977, MK-6482) in Combination With Cabozantinib in Patients With Clear Cell Renal Cell Carcinoma (ccRCC) (MK-6482-003) Phase 2
Not yet recruiting NCT06049030 - A Study of HS-10516 in Patients With Advanced Clear Cell Renal Cell Carcinoma Phase 1
Completed NCT03652077 - A Safety and Tolerability Study of INCAGN02390 in Select Advanced Malignancies Phase 1
Completed NCT01358721 - Phase I Biomarker Study (BMS-936558) Phase 1
Active, not recruiting NCT04503148 - Anesthesia and Cancer Study: Renal Cell Carcinoma N/A
Completed NCT02386826 - INC280 Combined With Bevacizumab in Patients With Glioblastoma Multiforme Phase 1
Not yet recruiting NCT05808608 - A Study of AK104 Plus Axitinib in Advanced/Metastatic Special Pathological Subtypes of Renal Cell Carcinoma Phase 1/Phase 2
Withdrawn NCT03323710 - Study of Propranolol Plus Sunitinib in First-line Treatment of Metastatic Renal Cell Carcinoma Phase 2
Not yet recruiting NCT02787915 - DC1s-CTL Cellular Therapy for Renal Cell Carcinoma Phase 1/Phase 2