Is your age between 18 yrs and 85 yrs? |
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Gender: Male or Female |
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Do you have Renal Cell Carcinoma? |
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Do you have any of these conditions: Kidney Cancer or Renal Cell Cancer or Malignant neoplasm of kidney or Malignant Adenoma or clear cell renal cell carcinoma or Renal Cell Carcinoma or ...? |
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Histologically confirmed renal cell carcinoma with clear cell histology ( mixed histology with clear cell component is accepted) |
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Patient should have either locally advanced or metastatic disease |
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No prior anti-cancer therapy |
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Age 18 years |
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Life expectancy of 3 months or more |
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Measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) criteria version 1.1 |
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Performance status 0-2 by ECOG scale |
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Patients with controlled brain metastasis are accepted |
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Adequate renal function: serum creatinine 2 times the institutional upper limit of normal |
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Adequate hepatic function: total bilirubin within normal institutional limits, serum AST and ALT levels 2 times the institutional upper limit of normal or 5 times the institutional upper limit of normal of elevated because of liver involvement |
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Coagulation (PT 1.5 times the institutional upper limit of normal) |
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Adequate hematological values: leukocyte count 3.0 x 109/L, an absolute neutrophil count 1.5 x 109/L, a platelet count 100 x 109/L and hemoglobin 9.0 g/dL |
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Urine dipstick for proteinuria <1+, patients discovered to have 1+ on dipstick urinanalysis at baseline should have urine protein/urine creatinine ratio 1 |
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Singed written informed consent before enrolment |
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Patient should have unresectable disease ( for both the primary tumor and the metastasis) |
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Inability to comply with the protocol therapy |
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Uncontrolled hypertension defined as BP more than 160 systolic and or more than 100 diastolic despite adequate treatment at the time of treatment initiation |
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Severe cardiovascular disease (congestive heart failure NYHA III or IV, unstable angina pectoris, myocardial infarction, significant arrhythmias or Transient ischemic attack (TIA) or cerebrovascular accident (CVA) in the last 6 months |
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Major bleeding disorder, significant traumatic injury or recent major surgery within 28 days of starting therapy. Or minor surgery (FNA/Core biopsy) within 7 days of starting therapy |
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History of abdominal abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months |
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Pre-existing thyroid abnormality |
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Concurrent proarrhythmic medications including terfenadine, quinidine, procainamide, disopyramide, sotalol, bepridil, haloperidol, risperidone, indapamide and flecainide |
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Recent significant hemoptysis (1/2 tea spoon red blood within last month) |
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Concurrent medication that either CYP 450 3A4 inducers or inhibitors |
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Concurrent use of proarrhythmic medications including terfenadine, quinidine, procainamide, disopyramide, sotalol, probucol, bepridil, haloperidol, risperidone, indapamide and flecainide |
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Pregnancy or breast feeding, or patient refusal to use appropriate contraception for female patients in childbirth age |
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Previous malignancy within 5 years, except adequately treated non melanomatous skin cancer or in situ cervical cancer |
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Psychiatric or mental disorder, precluding understanding of the information of the trial related topics and giving valid informed consent |
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Any psychological, familial, geographic or social circumstances which could impair the patient ability to participate in the trial and comply with follow up |
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Any circumstance which might impair the patient's ability to comply with an out-patient regimen |
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Active uncontrolled infection |
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Serious underlying medical condition (in the judgment of the investigator) which could impair the ability of the patient to participate in the trial |
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Treatment with other experimental drugs within 30 days of entry into the trial |
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Treatment with other anti-cancer therapy |
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Legal incapacity |
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Significant proteinuria (urine protein: creatinine ratio > 1.0) |
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