August 18, 2016
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November 10, 2016
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April 26, 2021
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May 31, 2017
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February 15, 2021 (Final data collection date for primary outcome measure)
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ORR evaluation according to molecular groups (ccRCC1 to 4) and assigned treatment [ Time Frame: 54 months ] ORR evaluation according to molecular groups (ccRCC1 to 4) and assigned treatment (nivolumab monotherapy, nivolumab combined with ipilimumab, or TKI: sunitinib or pazopanib), based on Investigator assessments.
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ORR evaluation according to molecular groups (ccRCC1 to 4) and assigned treatment (nivolumab monotherapy, nivolumab combined with ipilimumab, or TKI: sunitinib or pazopanib), based on Investigator assessments. [ Time Frame: 36 months ]
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- Progression-free survival (PFS) [ Time Frame: 54 months ]
progression-free survival (PFS) in subjects with previously untreated mRCC according to molecular groups and assigned treatment, based on Investigator radiological assessments.
- Overall Survival [ Time Frame: 54 months ]
To evaluate OS in subjects with previously untreated mRCC according to molecular groups and assigned treatment.
- Objective response rate at 22 weeks [ Time Frame: at 22 weeks ]
To evaluate objective response rate at 22 weeks as a surrogate of other endpoints according to molecular groups and assigned treatment.
- Duration of treatment (DOT) [ Time Frame: 54 months ]
To evaluate the duration of treatment (DOT) of nivolumab combined with ipilimumab or nivolumab alone or cabozantinib in subjects with previously untreated mRCC according to their molecular subgroup (1&4 vs 2&3).
- Duration of response (DOR) [ Time Frame: 54 months ]
To evaluate the duration of response (DOR) of nivolumab combined with ipilimumab or nivolumab alone or cabozantinib in subjects with previously untreated mRCC according to their molecular subgroup (1&4 vs 2&3).
- Number of Participants With Treatment-Related Adverse Events [ Time Frame: 54 months ]
To estimate the incidence of AEs associated with nivolumab combined with ipilimumab or nivolumab alone or cabozantinib in all treated subjects with previously untreated mRCC.
- Gene expression of immune population markers [ Time Frame: at baseline at progression (36 months maximum) ]
To assess gene expression of immune population markers in the primary tumor as well as in the metastases before beginning treatment, and at progression if safely achievable.populations (CD3, CD8...) and regulatory markers (PD-1, LAG-3…) within the primary tumor, and metastases whenever possible, using frozen and FFPE tumor tissue.
- Gene expression levels obtained from FFPE [ Time Frame: at the end of the study (36 months) ]
Gene expression levels obtained from FFPE tumor tissue (exploratory method) will be compared to those obtained with frozen tumor tissue (standard method).
- Functional status of peripheral blood lymphocytes (PBL) [ Time Frame: at baseline, at cycle 2 and at progression (36 months maximum) ]
To assess the functional status of peripheral blood lymphocytes (PBL) by flow cytometry, before treatment initiation, during treatment, and at progression.
- Association between non-immune tissue and circulating biomarkers and outcomes [ Time Frame: 36 months maximum ]
To explore the association between non-immune tissue and circulating biomarkers and outcomes (ORR, ORR at 22 weeks, OS and PFS).
- Mutation and methylation analysis of circulating tumor DNA [ Time Frame: 36 months maximum ]
The initial rate of ctDNA and its evolution will be correlated to the clinical evolution of patients and progression-free survival.
- Genetic and epigenetic alterations [ Time Frame: 36 months maximum ]
To identify genetic and epigenetic alterations associated with either response or resistance to immune checkpoint inhibitors and tyrosine kinase inhibitors.
- association between immune cells composing tumor microenvironment and response and/or resistance [ Time Frame: 36 months maximum ]
To evaluate the association between immune cells composing tumor microenvironment and response and/or resistance to immune checkpoint inhibitors or tyrosine kinase inhibitors.
- additional genetic and epigenetic tumor alterations [ Time Frame: 36 months maximum ]
To evaluate additional genetic and epigenetic tumor alterations at resistance/progression or after resection of residual mass.
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- Progression-free survival (PFS) [ Time Frame: 36 months ]
progression-free survival (PFS) in subjects with previously untreated mRCC according to molecular groups and assigned treatment, based on Investigator radiological assessments.
- Overall Survival [ Time Frame: 36 months ]
To evaluate OS in subjects with previously untreated mRCC according to molecular groups and assigned treatment.
- Objective response rate at 22 weeks [ Time Frame: at 22 weeks ]
To evaluate objective response rate at 22 weeks as a surrogate of other endpoints according to molecular groups and assigned treatment.
- Duration of treatment (DOT) [ Time Frame: 36 months ]
To evaluate the duration of treatment (DOT) of nivolumab combined with ipilimumab or nivolumab alone or cabozantinib in subjects with previously untreated mRCC according to their molecular subgroup (1&4 vs 2&3).
- Duration of response (DOR) [ Time Frame: 36 months ]
To evaluate the duration of response (DOR) of nivolumab combined with ipilimumab or nivolumab alone or cabozantinib in subjects with previously untreated mRCC according to their molecular subgroup (1&4 vs 2&3).
- Number of Participants With Treatment-Related Adverse Events [ Time Frame: 36 months ]
To estimate the incidence of AEs associated with nivolumab combined with ipilimumab or nivolumab alone or cabozantinib in all treated subjects with previously untreated mRCC.
- Gene and protein expression of immune populations (CD3, CD8...) and regulatory markers (PD-1, LAG-3…) [ Time Frame: at baseline, at week 6, and at progression (36 months maximum) ]
To evaluate the association between exploratory biomarkers and outcomes; Exploratory biomarkers include: gene and protein expression of immune populations (CD3, CD8...) and regulatory markers (PD-1, LAG-3…) within the primary tumor, and metastases whenever possible, using frozen and FFPE tumor tissue.
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Not Provided
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Not Provided
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A BIOmarker Driven Trial With Nivolumab and Ipilimumab or VEGFR tKi in Naïve Metastatic Kidney Cancer
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A Phase 2 BIOmarker Driven Trial With Nivolumab and Ipilimumab or VEGFR tKi in Naïve Metastatic Kidney Cancer
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Disease and Stage: naïve metastatic kidney cancer.
A multicenter, randomized, a Phase 2 BIOmarker driven trial with Nivolumab and Ipilimumab or VEGFR tKi in naïve metastatic Kidney cancer
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Research Hypothesis: Molecular groups of ccrcc will define patients who will respond to nivolumab alone, nivolumab combined with ipilimumab, or VEGFR-TKI (sunitinib or pazopanib) in subjects with previously untreated metastatic renal cell carcinoma (mRCC).
Conditions:
- Advanced or metastatic RCC: previously untreated in metastatic setting.
- Frozen tumor samples available for molecular group determination.
- Determination of molecular subgroup prior to randomization.
Product(s):
- ARM A: nivolumab alone administered IV over 60 minutes at 240 mg every 2 weeks (molecular group 1 and 4).
- ARM B : Nivolumab administered IV over 60 minutes at 3 mg/kg combined with ipilimumab administered IV over 30 minutes at 1 mg/kg every 3 weeks for 4 doses followed by nivolumab administered IV over 60 minutes at 240 mg every 2 weeks
starting from the Cycle 7 possibility to switch from nivolumab 240 mg every 2 weeks to 480 mg every 4 weeks according to the Investigator's preference (Arm A and B),
- ARM C: TKI (molecular group 2 and 3), pazopanib or sunitinib according to investigator's choice until disease progression, unacceptable toxicity or other reasons specified in the protocol.
Biological assessments:
Molecular groups (1 to 4) will be determined for all patients from frozen tumor tissue samples or from fresh tumor samples immediately stored in "RNA later" medium.
Further exploratory biological assessments will be performed in order to define predictive biomarkers of response to N+I, N alone or TKI (sunitinib or pazopanib) by analyzing tumor specimens and blood samples:
- To assess gene expression of immune population markers in the primary tumor as well as in the metastases before beginning treatment, and at progression if safely achievable.
- Gene expression analysis will be performed from frozen and FFPE tumor tissue in order to compare the two methods.
- To assess the density and phenotype of selected immune populations (CD8, CD3/CD20, PD-1, TIM-3, LAG3, FoxP3) as well as the phenotype of tumor cells (PD-L1, PD-L2) by immunohistochemistry (IHC) in the primary tumor and metastases, before treatment initiation and at progression if safely achievable.
- To assess the functional status of peripheral blood lymphocytes (PBL) by flow cytometry, before treatment initiation, during treatment, and at progression.
- To quantify plasmatic angiogenesis-related (i.e. VEGF-A, VEGF-C its soluble receptors VEGFR-1 and 2 and co-receptors neuropilin 1 and 2, angiopoietins, SDF-1, PDGFs…)) and endothelial cell-derived molecules (i.e. endoglin, VE-cadherin) before treatment initiation, during treatment, and at progression.
- To correlate plasmatic angiogenesis-related molecules with tumor vascularization studied by immunofluorescence (IF) and a multi-spectral analyzer (Vectra technology) on tumor tissue.
- To investigate a predictive role of the response of CXCL7 and sCD146 to TKI, nivolumab and/or nivolumab+ipilimumab.
- To determine whether the mutation and methylation analysis of circulating tumor DNA can be used as predictive biomarker of response, resistance to treatment or progression.
- Identify genetic and epigenetic alterations associated with either response or resistance to immune checkpoint inhibitors and tyrosine kinase inhibitors
- Evaluate association between immune cells composing tumor microenvironment and response and/or resistance to immune checkpoint inhibitors or tyrosine kinase inhibitors
- Evaluate additional genetic and epigenetic tumor alterations at resistance/progression or after resection of residual mass.
Statistical Considerations:
An adaptative design will be used to ensure that conclusions can be made with a limited number of patients in each molecular group, which is the major constraint of the study.
Sample Size: Approximately 150 patients are planned to be treated. Given an expected failure rate of molecular grouping of less than 20%, 150-200 patients must be included.
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Interventional
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Phase 2
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Allocation: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Treatment
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Clear Cell Metastatic Renal Cell Carcinoma
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- Drug: Nivolumab
For Arms 1A and 4A:
Nivolumab alone administered IV over 60 minutes at 240 mg every 2 weeks until disease progression, unacceptable toxicity or other reasons specified in the protocol.
For Arms 1B, 2B, 3B and 4B:
Nivolumab administered IV over 60 minutes at 3 mg/kg combined with ipilimumab administered IV over 30 minutes at 1 mg/kg every 3 weeks for 4 doses followed by nivolumab administered IV over 60 minutes at 240 mg every 2 weeks until disease progression, unacceptable toxicity or other reasons specified in the protocol.
Starting from the Cycle 7 possibility to switch from nivolumab 240 mg every 2 weeks to 480 mg every 4 weeks according to the Investigator's preference.
- Drug: Ipilimumab
For Arms 1B, 2B, 3B and 4B:
Ipilimumab administered IV over 30 minutes at 1 mg/kg every 3 weeks combined with Nivolumab administered IV over 60 minutes at 3 mg/kg for 4 doses until disease progression, unacceptable toxicity or other reasons specified in the protocol.
- Drug: Pazopanib
For Arms 2C and 3C (TKI pazopanib or sunitinib):
Pazopanib 800 mg orally QD until disease progression, unacceptable toxicity or other reasons specified in the protocol
Other Name: Votrient
- Drug: Sunitinib
For Arms 2C and 3C (TKI pazopanib or sunitinib):
Sunitinib 50 mg orally QD until disease progression, unacceptable toxicity or other reasons specified in the protocol
Other Name: Sutent
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- Experimental: ccRCC molecular subgroup 1: 1A
ccRCC molecular subgroup 1 -> randomisation: subjects with ccRCC1 treated with nivolumab 240mg IV every 2 weeks until disease progression, unacceptable toxicity or other reasons specified in the protocol.
Starting from the Cycle 7 possibility to switch from nivolumab 240 mg every 2 weeks to 480 mg every 4 weeks according to the Investigator's preference.
Intervention: Drug: Nivolumab
- Experimental: ccRCC molecular subgroup 1: 1B
ccRCC molecular subgroup 1 -> randomisation: subjects with ccRCC1 treated with nivolumab 3 mg/kg IV combined with ipilimumab 1 mg/kg IV every 3 weeks for 4 doses then nivolumab 240mg IV every 2 weeks until disease progression, unacceptable toxicity or other reasons specified in the protocol.
Starting from the Cycle 7 possibility to switch from nivolumab 240 mg every 2 weeks to 480 mg every 4 weeks according to the Investigator's preference.
Interventions:
- Drug: Nivolumab
- Drug: Ipilimumab
- Experimental: ccRCC molecular subgroup 4: 4A
ccRCC molecular subgroup 4 -> randomisation: subjects with ccRCC1 treated with nivolumab 240mg IV every 2 weeks until disease progression, unacceptable toxicity or other reasons specified in the protocol.
Starting from the Cycle 7 possibility to switch from nivolumab 240 mg every 2 weeks to 480 mg every 4 weeks according to the Investigator's preference.
Intervention: Drug: Nivolumab
- Experimental: ccRCC molecular subgroup 4: 4B
ccRCC molecular subgroup 4 -> randomisation: subjects with ccRCC1 treated with nivolumab 3 mg/kg IV combined with ipilimumab 1 mg/kg IV every 3 weeks for 4 doses then nivolumab 240mg IV every 2 weeks until disease progression, unacceptable toxicity or other reasons specified in the protocol.
Starting from the Cycle 7 possibility to switch from nivolumab 240 mg every 2 weeks to 480 mg every 4 weeks according to the Investigator's preference.
Interventions:
- Drug: Nivolumab
- Drug: Ipilimumab
- Experimental: ccRCC molecular subgroup 2: 2C
ccRCC molecular subgroup 2 -> randomisation: TKI (sunitinib 50mg daily or Pazopanib 800mg daily) according to investigator's choice until disease progression, unacceptable toxicity or other reasons specified in the protocol.
Interventions:
- Drug: Pazopanib
- Drug: Sunitinib
- Experimental: ccRCC molecular subgroup 2: 2B
ccRCC molecular subgroup 2 -> randomisation: subjects with ccRCC1 treated with nivolumab 3 mg/kg IV combined with ipilimumab 1 mg/kg IV every 3 weeks for 4 doses then nivolumab 240mg IV every 2 weeks until disease progression, unacceptable toxicity or other reasons specified in the protocol.
Starting from the Cycle 7 possibility to switch from nivolumab 240 mg every 2 weeks to 480 mg every 4 weeks according to the Investigator's preference.
Interventions:
- Drug: Nivolumab
- Drug: Ipilimumab
- Experimental: ccRCC molecular subgroup 3: 3B
ccRCC molecular subgroup 3 -> randomisation: subjects with ccRCC1 treated with nivolumab 3 mg/kg IV combined with ipilimumab 1 mg/kg IV every 3 weeks for 4 doses then nivolumab 240mg IV every 2 weeks until disease progression, unacceptable toxicity or other reasons specified in the protocol.
Starting from the Cycle 7 possibility to switch from nivolumab 240 mg every 2 weeks to 480 mg every 4 weeks according to the Investigator's preference.
Interventions:
- Drug: Nivolumab
- Drug: Ipilimumab
- Experimental: ccRCC molecular subgroup 3: 3C
ccRCC molecular subgroup 3 -> randomisation: TKI (sunitinib 50mg daily or Pazopanib 800mg daily) according to investigator's choice until disease progression, unacceptable toxicity or other reasons specified in the protocol.
Interventions:
- Drug: Pazopanib
- Drug: Sunitinib
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- Vano YA, Elaidi R, Bennamoun M, Chevreau C, Borchiellini D, Pannier D, Maillet D, Gross-Goupil M, Tournigand C, Laguerre B, Barthelemy P, Coquan E, Gravis G, Houede N, Cancel M, Huillard O, Beuzeboc P, Fournier L, Mejean A, Cathelineau X, Doumerc N, Paparel P, Bernhard JC, de la Taille A, Bensalah K, Tricard T, Waeckel T, Pignot G, Braychenko E, Caruso S, Sun CM, Verkarre V, Lacroix G, Moreira M, Meylan M, Bougouin A, Phan L, Thibault-Carpentier C, Zucman-Rossi J, Fridman WH, Sautes-Fridman C, Oudard S. Nivolumab, nivolumab-ipilimumab, and VEGFR-tyrosine kinase inhibitors as first-line treatment for metastatic clear-cell renal cell carcinoma (BIONIKK): a biomarker-driven, open-label, non-comparative, randomised, phase 2 trial. Lancet Oncol. 2022 May;23(5):612-624. doi: 10.1016/S1470-2045(22)00128-0. Epub 2022 Apr 4.
- Epaillard N, Simonaggio A, Elaidi R, Azzouz F, Braychenko E, Thibault C, Sun CM, Moreira M, Oudard S, Vano YA. BIONIKK: A phase 2 biomarker driven trial with nivolumab and ipilimumab or VEGFR tyrosine kinase inhibitor (TKI) in naive metastatic kidney cancer. Bull Cancer. 2020 Jun;107(5S):eS22-eS27. doi: 10.1016/S0007-4551(20)30283-6.
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Completed
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200
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150
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February 15, 2021
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February 15, 2021 (Final data collection date for primary outcome measure)
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Key Inclusion Criteria:
- Histological confirmation of RCC with a clear-cell component. Patients with TFE3 or TFEB translocation proven by cytogenetic analysis or by fluorescence in situ hybridization (FISH) are eligible.
- Metastatic (American Joint Committee on Cancer [AJCC] Stage IV) RCC
- No prior systemic therapy for mRCC
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) of ≤2
- Measurable disease as per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
- Frozen tumor samples (primary tumor and/or metastasis biopsies) must be available and received by the central laboratory (Cordelier Research Center) to determine molecular groups. (Note: fine needle aspiration [FNA] and bone metastases samples are not acceptable for submission).
- Molecular group has to be determined prior to randomization.
- Formalin-fixed, paraffin-embedded (FFPE) tumor tissue available for biomarker (gene expression and immunohistochemistry (IHC)) analysis.
Key Exclusion Criteria:
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Sexes Eligible for Study: |
All |
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18 Years and older (Adult, Older Adult)
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No
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Contact information is only displayed when the study is recruiting subjects
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France
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NCT02960906
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BIONIKK
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Yes
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Studies a U.S. FDA-regulated Drug Product: |
No |
Studies a U.S. FDA-regulated Device Product: |
No |
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Association Pour La Recherche des Thérapeutiques Innovantes en Cancérologie
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Same as current
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Association Pour La Recherche des Thérapeutiques Innovantes en Cancérologie
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Same as current
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Not Provided
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Principal Investigator: |
Yann-Alexandre VANO, MD |
Hôpital Européen Georges Pompidou; Oncology department of Pr Stéphane OUDARD |
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Association Pour La Recherche des Thérapeutiques Innovantes en Cancérologie
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April 2021
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