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Agrawal S , Haas NB , Bagheri M , Lane BR , Coleman J , Hammers H , Bratslavsky G , Chauhan C , Kim L , Krishnasamy VP , Marko J , Maher VE , Ibrahim A , Cross F Jr , Liu K , Beaver JA , Pazdur R , Blumenthal GM , Singh H , Plimack ER , Choueiri TK , Uzzo R , Apolo AB
Eligibility and Radiologic Assessment for Adjuvant Clinical Trials in Kidney Cancer
JAMA Oncol. 2020 Jan 1;6(1) :133-141
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Abstract
Purpose: To harmonize the eligibility criteria and radiologic disease assessment definitions in clinical trials of adjuvant therapy for renal cell carcinoma (RCC). Method: On November 28, 2017, US-based experts in RCC clinical trials, including medical oncologists, urologic oncologists, regulators, biostatisticians, radiologists, and patient advocates, convened at a public workshop to discuss eligibility for trial entry and radiologic criteria for assessing disease recurrence in adjuvant trials in RCC. Multiple virtual meetings were conducted to address the issues identified at the workshop. Results: The key workshop conclusions for adjuvant RCC therapy clinical trials were as follows. First, patients with non-clear cell RCC could be routinely included, preferably in an independent cohort. Second, patients with T3-4, N+M0, and microscopic R1 RCC tumors may gain the greatest advantages from adjuvant therapy. Third, trials of agents not excreted by the kidney should not exclude patients with severe renal insufficiency. Fourth, therapy can begin 4 to 16 weeks after the surgical procedure. Fifth, patients undergoing radical or partial nephrectomy should be equally eligible. Sixth, patients with microscopically positive soft tissue or vascular margins without gross residual or radiologic disease may be included in trials. Seventh, all suspicious regional lymph nodes should be fully resected. Eighth, computed tomography should be performed within 4 weeks before trial enrollment; for patients with renal insufficiency who cannot undergo computed tomography with contrast, noncontrast chest computed tomography and magnetic resonance imaging of the abdomen and pelvis with gadolinium should be performed. Ninth, when feasible, biopsy should be undertaken to identify any malignant disease. Tenth, when biopsy is not feasible, a uniform approach should be used to evaluate indeterminate radiologic findings to identify what constitutes no evidence of disease at trial entry and what constitutes radiologic evidence of disease. Eleventh, a uniform approach for establishing the date of recurrence should be included in any trial design. Twelfth, patient perspectives on the use of placebo, conditions for unblinding, and research biopsies should be considered carefully during the conduct of an adjuvant trial. Conclusions and Relevance: The discussions suggested that a uniform approach to eligibility criteria and radiologic disease assessment will lead to more consistently interpretable trial results in the adjuvant RCC therapy setting.
Notes
2374-2445 Agrawal, Sundeep Haas, Naomi B Bagheri, Mohammadhadi Lane, Brian R Coleman, Jonathan Hammers, Hans Bratslavsky, Gennady Chauhan, Cynthia Kim, Lauren Krishnasamy, Venkatesh P Marko, Jamie Maher, Virginia Ellen Ibrahim, Amna Cross, Frank Jr Liu, Ke Beaver, Julia A Pazdur, Richard Blumenthal, Gideon M Singh, Harpreet Plimack, Elizabeth R Choueiri, Toni K Uzzo, Robert Apolo, Andrea B Journal Article United States JAMA Oncol. 2019 Nov 21. pii: 2755432. doi: 10.1001/jamaoncol.2019.4117.