About this trial
This phase II trial tests the effect of RP2 and tivozanib in treating patients with renal cell cancer that has spread from where it first started (primary site) to other places in the body (metastatic) and that is growing, spreading, or getting worse (progressive) after receiving immunotherapy with immune checkpoint inhibitors (ICIs). RP2 is a herpes simplex virus (a viral infection commonly known as the "cold sore virus") that has been changed to infect and destroy tumor cells and to activate (turn on) the human immune system to attack the tumor cells. Tivozanib hydrochloride blocks certain proteins, which may help keep tumor cells from growing. It may also prevent the growth of new blood vessels that tumors need to grow. Tivozanib hydrochloride is a type of tyrosine kinase inhibitor and a type of antiangiogenesis agent. Giving RP2 and tivozanib may be safe, tolerable, and/or effective in treating patients with metastatic renal cell cancer that has progressed after receiving immunotherapy with ICIs.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Documented informed consent of the participant and/or legally authorized representative
Assent, when appropriate, will be obtained per institutional guidelines
Must be willing to consent to provide fresh tumor biopsy sample or archival tumor biopsy sample obtained within 90 days before the first dose of study treatment
If unavailable, exceptions may be granted with study principal investigator (PI) approval
Disqualifiers
Received a live vaccine within 28 days before the first dose of study treatment
Note: Seasonal influenza vaccines for injection or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are generally inactivated vaccines and are allowed. Live/attenuated vaccines (such as the intranasal influenza vaccines) are not allowed
Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks before the first dose of study treatment
Note: Patients who have entered the follow-up phase of an investigational study may participate if it has been 4 weeks after the last dose of the previous investigational agent
Trial design
Single group
Treatments tested in this trial
Biopsy Procedure
Procedure/SurgeryUndergo tumor biopsies
Biospecimen Collection
Procedure/SurgeryUndergo urine and blood sample collection
Computed Tomography
Procedure/SurgeryUndergo CT
Sturlimogene Erparepvec
Biological/VaccineGiven intratumorally
Tivozanib
DrugGiven PO
Treatment groups
Trial outcomes
Primary outcomes
Objective response rate
Will be defined as the proportion of patients who achieve a complete response (CR) or partial response (PR) per the Response Evaluation Criteria in Solid Tumors version (v) 1.1. Will be calculated as the number of patients with CR or PR divided by the total number of treated and evaluable subjects. Will be summarized with 80% confidence intervals.
Secondary outcomes
Progression-free survival (PFS)
Will be analyzed using Kaplan-Meier survival methods. Median PFS and corresponding 80% confidence intervals will be reported. Cox proportional hazards modeling may be used to estimate hazard ratios and corresponding confidence intervals, though formal comparisons are not powered. Results will be interpreted in an exploratory context.
Overall survival (OS)
Will be analyzed using Kaplan-Meier methods. Median OS and associated 80% confidence intervals will be reported. Cox proportional hazards modeling may be used to estimate hazard ratios. Findings will be considered descriptive and interpreted cautiously due to the single-arm nature of the trial.
Incidence of adverse events (AEs)
AEs including grade 3 or greater AEs, serious AEs, and treatment-related AEs , immune-related AEs (irAEs), and AEs leading to treatment discontinuation will be assessed per Common Terminology Criteria for Adverse Events v 5.0. Will be summarized using descriptive statistics. Time to onset and resolution of irAEs will also be explored when applicable.
Baseline characteristics
Descriptive statistics and graphical summaries will be used to characterize the baseline demographic and clinical features of the study population, including measures of central tendency (mean, median) and frequency distributions for categorical variables.
Sponsors and contacts
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City of Hope Medical Center
Lead sponsor
National Cancer Institute (NCI)
Collaborator
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