This phase I trial is studying the side effects and best dose of dalteparin when given
together with sunitinib malate in treating patients with metastatic or unresectable kidney
cancer. Anticoagulants, such as dalteparin, help prevent blood clots and have been shown to
increase survival in patients with cancer. Anticoagulants may also prevent the formation of
new blood vessels. Sunitinib malate may stop the growth of tumor cells by blocking some of
the enzymes needed for cell growth and by inhibiting new blood vessels and blocking blood
flow to the tumor. Giving dalteparin together with sunitinib malate may starve tumors and
kill more tumor cells
Inclusion Criteria:
- Patients must have histologically confirmed metastatic or unresectable renal cell
carcinoma
- Renal carcinoma patients with predominant clear-cell histology are eligible;
papillary renal cell carcinoma, oncocytoma, collecting duct tumors and transitional
cell carcinoma are NOT eligible
- No prior systemic treatments for metastatic disease are permitted, including
antiangiogenic therapy, immunotherapy, chemotherapy and investigational therapy
- Prior palliative radiation to metastatic lesion(s) is permitted, provided there is at
least one measurable and/or evaluable lesion(s) that has not been irradiated
- Radiation therapy must be completed > 4 weeks prior to registration
- Patients must have measurable disease, defined as at least one lesion that can be
accurately measured in at least one dimension as >= 20 mm with conventional
techniques or as approximately >= 10 mm with spiral computed tomography (CT) scan
(Response Evaluation Criteria in Solid Tumors [RECIST] 1. 0 criteria)
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2 Leukocytes >
3,000/mm^3 Absolute neutrophil count > 1,500/mm^3 Platelets > 100,000/mm^3 Total
bilirubin < 1. 5 x laboratory upper limit of normal (ULN) Aspartate aminotransferase
(AST)(serum glutamic oxaloacetic transaminase [SGOT])/ alanine transaminase
(ALT)(serum glutamic pyruvic transaminase [SGPT]) < 2. 5 x laboratory ULN Creatinine <
1. 5 x laboratory ULN Prothrombin time (PT)/international normalized ratio (INR) < 1. 5
Urine protein < 1+; if > 1+, 24 hour urine protein should be obtained and should be <
1000 mg
- Women of child-bearing potential must agree to use adequate contraception (hormonal
or barrier method of birth control; abstinence) prior to study entry and for the
duration of study participation
- Should a woman become pregnant or suspect she is pregnant while participating in this
study, she should inform her treating physician immediately
- Ability to understand and the willingness to sign a written informed consent document
- Except for Dalteparin that will be administered as a study drug, the patients should
not take any other anticoagulants or antiplatelet agents during the study, including
but not limited to nonsteroidal anti-inflammatory drugs (NSAID) (any dose of
aspirin), warfarin or other anticoagulants
Exclusion Criteria:
- Patients may not be receiving any other investigational agents
- Patients with known central nervous system (CNS) metastases; patients should have a
head CT/magnetic resonance imaging (MRI) within 4 weeks prior to treatment
initiation; any imaging abnormality indicative of CNS metastases will exclude the
patient from the study
- Patients with a "currently active" second malignancy other than non-melanoma skin
cancers are not eligible; patients are not considered to have a "currently active"
malignancy if they have completed anti-cancer therapy and are considered by their
physician to be at less than 30% risk of relapse
- Patients with a large (> 2 cm) pulmonary lesion involving the trachea or one of the
main bronchus and any endobronchial lesion
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to dalteparin
- Evidence of bleeding diathesis within last 6 months
- Serious or non-healing wound, ulcer or bone fracture or active peptic ulceration
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure (New York Association Class II, III,
or IV), angina pectoris requiring nitrate therapy, recent myocardial infarction (<
the last 6 months), cardiac arrhythmia, history of cerebrovascular accident (CVA)
within 6 months (thrombotic or hemorrhagic), hypertension (defined as blood pressure
of > 160 mmHg systolic and/or > 90 mm Hg diastolic on medication), hemorrhagic
retinopathy, history of peripheral vascular disease, or psychiatric illness/social
situations that would limit compliance with study requirements
- Patients with an ejection fraction < 50% by multi gated acquisition scan (MUGA) scan
are not eligible
- Pregnant women are excluded from this study because sunitinib is an angiogenesis
inhibitor agent with the potential for teratogenic or abortion inducing effects
- History of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess
within 28 days prior to day 1 therapy
- Invasive procedures defined as:
- Major surgical procedure, open biopsy, or significant traumatic injury within 6 weeks
prior to day 1 therapy
- Anticipation of need for major surgical procedures during the course of the study
- Core biopsy within 7 days prior to start therapy
