A Phase II Study of Nivolumab With Ipilimumab and Cabozantinib in Patients With Untreated Renal Cell Carcinoma Brain Metastases
A Phase II Study of Nivolumab with Ipilimumab and Cabozantinib in Patients with Untreated Renal Cell Carcinoma Brain Metastases
• Signed Informed Consent Form (ICF)
• Ability and willingness to comply with the requirements of the study protocol
• Age ≥18 years
• Life expectancy \>12 weeks
• Asymptomatic and off steroids for at least 10 days except patients: who have mild symptoms from intracranial disease that do not affect their performance status
• Prior therapies for extracranial metastatic renal cell carcinoma as long as it did not include anti- CTLA-4 or cabozantinib or MET inhibitors
• Patients with histologically confirmed metastatic renal cell carcinoma and at least one measurable intracranial target lesion for which all of the following criteria are met:
• \- Previously untreated or progressive after previous local therapy(limited to SRS and surgery)
⁃ Immediate local therapy clinically not indicated or patient is not a suitable candidate to receive immediate local therapy.
⁃ 5mm to 30mm, as determined by MRI with contrast.
• Adequate hematologic and essential organ function, defined by the following laboratory results obtained within 14 days prior to the first study treatment (C1D1)
‣ Absolute neutrophil count (ANC) ≥1500 cells/µL
⁃ White blood cell (WBC) counts \>2500/µ -- Lymphocyte count ≥500/µL
⁃ Platelet count ≥ 100,000/µL;
⁃ Hemoglobin ≥9.0 g/dL
⁃ Serum albumin≥2.8g/dl
⁃ Total bilirubin ≤1.5×upper limit of normal (ULN) with the following exception:
• Patients with known Gilbert disease who have serum bilirubin level ≤3×ULN may be enrolled.
• \- Alanine aminotransferase (ALT) ≤ 3x upper limit of normal (ULN).
⁃ Aspartate aminotransferase (AST) ≤ 3x upper limit of normal (ULN).
⁃ Alkaline phosphatase ≤5×ULN in patients with documented bone metastases.
⁃ Serum creatinine ≤ 1.5x ULN or calculated creatinine clearance ≥ 40mL/min (≥ 0.675mL/sec) using the Cockcroft-Gault equation: Males: (140 - age) x weight (kg)/(serum creatinine \[mg/dL\] × 72)Females: \[(140 - age) x weight (kg)/(serum creatinine \[mg/dL\] × 72)\] × 0.85
⁃ Urine protein/creatinine ratio (UPCR) ≤ 1 mg/mg (≤ 113.2 mg/mmol), or 24-h urine protein ≤ 1 g.
• For female patients of childbearing potential and male patients with partners of childbearing potential, agreement (by patient and/or partner) to use highly effective form(s) of contraception (i.e., one that results in a low failure rate \[\<1% per year\] when used consistently and correctly) and to continue its use for at least 12 months after the last dose of Cabozantinib and Nivolumab
⁃ Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 2 (see Appendix 5)
⁃ INR and aPTT ≤1.5×ULN within 7 days prior to study enrollment 12. Recovery to baseline or ≤ Grade 1 CTCAE v5 from toxicities related to any prior treatments, unless AE(s) are clinically nonsignificant and/or stable on supportive therapy.