INCLUSION CRITERIA:
Patients must meet all the following criteria to be eligible for study enrolment:
Histologically confirmed clear cell renal cell carcinoma (to be confirmed at the Dept. of Pathology, CCR,NCI).
Patients must have advanced disease (metastatic or unresectable) disease.
Measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as greater than or equal to 20 mm with conventional techniques or as greater than or equal to 10 mm with spiral CT scan. See section 6.2 for the evaluation of measurable disease.
Prior therapy:
1. All patients must have either received prior sunitinib or sorafenib (discontinued for disease progression or unacceptable toxicity) or be unable to receive these agents. Patients who have discontinued sunitinib or sorafenib for life threatening toxicities that are also known to occur with vandetanib (such as skin, GI toxicities, bowel perforation etc.) will not be eligible.
2. All patients must have failed high dose IL-2, be ineligible to receive this agent or decline this therapy.
Age greater than or equal to 18 years.
Life expectancy greater than 3 months.
Performance status ECOG 0-2.
Patients must have normal organ and marrow function as defined below: WBC count greater than or equal to 3,000/microL, absolute neutrophil count greater than or equal to 1,500/microL, platelet count greater than or equal to 100,000/microL, serum creatinine less than or equal to 1.5 times upper limit of reference range or measured 24 hr. creatinine clearance greater than or equal to 50 ml/min, AST and ALT less than 2.5 times upper limit of reference range, total bilirubin less than 1.5 times upper limit of reference range (less than 3 times upper limit of reference range in patients with Gilbert's disease), alkaline phosphatase less than or equal to 2.5 times upper limit of reference range (or less than or equal to 5 times upper limit of reference range if considered to be related to liver metastases by the PI)
Recovery from acute toxicity of prior treatment for RCC (to less than or equal to grade 1 CTCAE v3.0).
At least 4 weeks from completion of major surgery and a healed surgical incision.
Negative pregnancy test (within 7 days of enrolment).
Ability to understand and the willingness to sign a written informed consent document.
EXCLUSION CRITERIA:
Prior malignancy of other histology, with the exception of cervical carcinoma in situ or adequately treated basal or squamous cell carcinoma of the skin, or any other malignancy for which the patient has not required active treatment for more than three years. Patients with VHL disease will be excluded from this study.
Patients may not be receiving any other investigational agents or have received treatment with a non-approved or investigational drug within 30 days before Day 1 of study treatment.
Patients with known brain metastases (except when adequately treated greater than or equal to 6 months before enrollment with no evidence of recurrence).
Use of 5HT-3 antagonists because of the potential effect on QTc interval.
Any concurrent medication that may cause QTc prolongation or induce Torsades de Pointes (Appendix C). Drugs listed in Appendix C, Table 2, that in the investigator's opinion cannot be discontinued, are allowed, but must be monitored closely.
Clinically significant cardiac event (including symptomatic heart failure, myocardial infarction or angina) within 3 months of entry or presence of any cardiac disease that in the opinion of the Principal Investigator increases the risk of ventricular arrhythmia. Patients with a history a major cardiac event more than 3 months prior to enrolment will be evaluated by a cardiologist to assess cardiac status and potential for increased risk with ZD6474 therapy.
History of clinically significant arrhythmia [including multifocal premature ventricular contraction (PVC), bigeminy, trigeminy, ventricular tachycardia] that is symptomatic or requires treatment (CTCAE grade 3) or symptomatic/ asymptomatic sustained ventricular tachycardia.
Uncontrolled atrial fibrillation. Atrial fibrillation controlled on medication is not excluded.
Presence of Left bundle branch block.
Previous history of QTc prolongation while taking other medications that required discontinuation of that medication.
Congenital long QT syndrome or first degree relative with unexplained sudden death under the age of 40 years.
QTc with Bazett's correction that is unmeasurable, or greater than or equal to 480 msec on screening ECG. If a patient has QTc greater than or equal to 480 msec on screening ECG, the screen ECG may be repeated twice (at least 24 hours apart). The average QTc from the three screening ECGs must be less than 480 msec in order for the patient to be eligible for the study). Patients who are receiving a drug that has a risk of QTc prolongation (see Appendix C, Group/Table 2) are excluded if QTc is greater than or equal to 460 msec.
Potassium concentration less than 4.0 mEq/L, calcium (ionized calcium or adjusted for albumin), or magnesium concentrations outside normal limits despite optimal supplementation/correction.
Left ventricular ejection fraction less than 45 percent measured by multiple gated acquisition scan (MUGA) or echocardiogram (ECHO).
Hypertension not controlled by medical therapy (systolic blood pressure greater than 150 mmHg or diastolic blood pressure greater than 100 mmHg).
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
Patient known to be HIV-positive and requiring antiretroviral therapy.
Currently active diarrhea that may affect the ability of the patient to absorb ZD6474 or tolerate further diarrhea.
Pregnant women are excluded from this study because ZD6474 is an anti-angiogenic agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with ZD6474, breastfeeding should be discontinued if the mother is treated with ZD6474.
Any known hypersensitivity to ZD 6474 or other excipients of ZD6474.
Concomitant medications that are potent inducers of CYP3A4 function, such as rifampin, rifabutin, phenytoin, carbamazapine, barbiturates such as phenobarbital, or St. John's Wort (See Appendix D).
National Institutes of Health Clinical Center
Bethesda, Maryland 20892. Last update: 09/15/2008