Renal cancer: JAVELIN Renal 101 trial

Abbreviations

No EU-CTR

Investigated (inv)
Comparator (comp)

AVEL+AXIT

SUNI

442

444

Phase:

3

Randomisation:

Open label

Primary tumour:

Renal

Subtype (biomarker):

Any

Stage:

meta

Line of therapy:

L1

Primary
AVEL+AXIT
SUNI
HR
p
PFS (PD-L1+)
13.8 mo
7.2 mo
0.61 (0.47-0.79)
<0.001
OS (PD-L1+)
Secondaries
AVEL+AXIT
SUNI
HR
p
PFS all
13.8 mo
8.4 mo
0.69 (0.56-0.84)
<0.001
ORR in PD-L1+
55.2%
25.5%
0.29
ORR
51.4%
25.7%
0.32
Time to response (PD-L1+ )
1.6 mo
3.0 mo
(all grades, %)
AVEL+AXIT
SUNI
p
Diarrhea
62.2
47.6
NA
Hypertension
49.5
36.0
NA
Fatigue
41.5
40.1
NA
Nausea
34.1
39.2
NA
PPE
33.4
33.7
NA
Dysphonia
30.6
3.2
NA
Hypothyroidism
24.9
13.9
NA
Cough
23.0
18.9
NA
Chills
15.9
7.5
NA
Dysgeusia
13.1
32.3
NA
Dizziness
11.8
10.7
NA
Anemia
6.0
23.0
NA
Thrombocytopenia
3.5
19.4
NA
Neutropenia
1.4
18.9
NA
  • Inclusion
  • Exclusion

- Histologically or cytologically confirmed advanced or metastatic RCC with clear cell component - Availability of a formalin-fixed, paraffin-embedded (FFPE) tumor tissue block from a de novo tumor biopsy during screening (biopsied tumor lesion should not be a RECIST target lesion). Alternatively, a recently obtained archival FFPE tumor tissue block (not cut slides) from a primary or metastatic tumor resection or biopsy can be provided if the following criteria are met: 1) the biopsy or resection was performed within 1 year of randomization AND 2) the patient has not received any intervening systemic anti-cancer treatment from the time the tissue was obtained and randomization onto the current study. If an FFPE tissue block cannot be provided as per documented regulations then, 15 unstained slides (10 minimum) will be acceptable - Availability of an archival FFPE tumor tissue from primary tumor resection specimen (if not provided per above). If an FFPE tissue block cannot be providedas per documented regulations 15 unstained slides (10 minimum) will be acceptable - At least one measureable lesion as defined by RECIST version 1.1 that has not been previously irradiated - Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 - Adequate bone marrow function, renal and liver functions.

- Prior systemic therapy directed at advanced or metastatic RCC - Prior adjuvant or neoadjuvant therapy for RCC if disease progression or relapse has occurred during or within 12 months after the last dose of treatment. - Prior immunotherapy with IL-2, IFN-α, or anti PD 1, anti PD L1, anti PD L2, anti CD137, or anti cytotoxic T lymphocyte associated antigen 4 (CTLA 4) antibody (including ipilimumab), or any other antibody or drug specifically targeting T cell co stimulation or immune checkpoint pathways - Prior therapy with axitinib and/or sunitinib as well as any prior therapies with other VEGF pathway inhibitors - Newly diagnosed or active brain metastasis - Known severe hypersensitivity reactions to monoclonal antibodies (Grade ≥3), any history of anaphylaxis, or uncontrolled asthma (ie, 3 or more features of partially controlled asthma Global Initiative for Asthma 2011) - Any of the following in the previous 12 months: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure, LVEF less than LLN, clinically significant pericardial effusion, cerebrovascular accident, transient ischemic attack - Any of the following in the previous 6 months: deep vein thrombosis or symptomatic pulmonary embolism - Vaccination within 4 weeks of the first dose of avelumab and while on trial is prohibited except for administration of inactivated vaccines (for example, inactivated influenza vaccines).

Characteristics
AVEL+AXIT
SUNI
Age & sex (overall populationdc-comma OP)
Median age (range)
62.0 (29.0–83.0)
61.0 (27.0–88.0)
Maledc-comma no.
316 (71.5%)
344 (77.5%)
Femaledc-comma no.
126 (28.5%)
100 (22.5%)
Age & sex (PD-L1+)
Median age (range)
62.0 (29.0–83.0)
60.5 (27.0–88.0)
Maledc-comma no.
203 (75.2%)
224 (77.2%)
Femaledc-comma no.
67 (24.8%)
66 (22.8%)
MSKCC prognostic risk group (OP)
Favorable
96 (21.7%)
100 (22.5%)
Intermediate
283 (64.0%)
293 (66.0%)
Poor
51 (11.5%)
45 (10.1%)
Not reported
12 (2.7%)
6 (1.4%)
MSKCC prognostic risk group (PD-L1+)
Favorable
52 (19.3%)
60 (20.7%)
Intermediate
180 (66.7%)
201 (69.3%)
Poor
33 (12.2%)
24 (8.3%)
Not reported
5 (1.9%)
5 (1.7%)
IMDC prognostic risk group (OP)
Favorable
94 (21.3%)
96 (21.6%)
Intermediate
271 (61.3%)
276 (62.2%)
Poor
72 (16.3%)
71 (16.0%)
Not reported
5 (1.1%)
1 (0.2%)
IMDC prognostic risk group (PD-L1+)
Favorable
52 (19.3%)
59 (20.3%)
Intermediate
173 (64.1%)
191 (65.9%)
Poor
44 (16.3%)
39 (13.4%)
Not reported
1 (0.4%)
1 (0.3%)
Previous nephrectomy
Yes (OP)
352 (79.6%)
355 (80.0%)
No (OP)
90 (20.4%)
89 (20.0%)
Yes (PD-L1+)
233 (86.3%)
252 (86.9%)
No (PD-L1+)
37 (13.7%)
38 (13.1%)
RECIST-defined tumor sites at baseline (OP)
1
181 (41.0%)
174 (39.2%)
2
148 (33.5%)
151 (34.0%)
3
67 (15.2%)
79 (17.8%)
≥4
35 (7.9%)
24 (5.4%)
RECIST-defined tumor sites at baseline (PD-L1dc-plus)
1
120 (44.4%)
118 (40.7%)
2
85 (31.5%)
101 (34.8%)
3
40 (14.8%)
50 (17.2%)
≥4
17 (6.3%)
10 (3.4%)
Ad-hoc:
no.pts inv.
no.pts comp.
AVEL+AXIT
SUNI
HR
p
CR (PD-L1+)
12
6
4.4%
2.1%
CR all
15
8
3.4%
1.8%
  • PFS (PD-L1+)
  • OS (PD-L1+)
analisys of PFS (PD-L1+)
AVEL+AXIT
SUNI
HR (95% CI)
Age
< 65 yr
0.60 (0.44-0.81)
≥ 65 yr
0.71 (0.46-1.09)
Sex
Male
0.56 (0.42-0.75)
Female
0.90 (0.55-1.47)
ECOG
0
0.56 (0.41-0.78)
1
0.73 (0.48-1.09)
Nephrectomy
Yes
0.63 (0.48-0.82)
No
0.63 (0.31-1.29)
MSKCC prognostic risk
Favorable
0.57 (0.30-1.08)
Intermediate
0.62 (0.46-0.84)
MSKCC prognostic risk
Poor
0.55 (0.28-1.08)
Smoking status
Never smoked
0.69 (0.47-1.01)
Current or former smoker
0.58 (0.42-0.82)
Body-mass index
<25
0.57 (0.38–0.86)
≥25
0.63 (0.45–0.87)
Geographic region
United States
0.58 (0.35–0.96)
Canada dc-and Western Europe
0.47 (0.30–0.74)
Geographic region
Rest of the world
0.78 (0.53–1.15)
analisys of OS (PD-L1+)
AVEL+AXIT
SUNI
HR (95% CI)