A Randomized Phase II Trial of Sunitinib/Gemcitabine or Sunitinib in Advanced Renal Cell Carcinoma With Sarcomatoid Features

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Histologically confirmed* renal cell carcinoma

- Disease of any subtype allowed

- Disease must have sarcomatoid features NOTE: *Patients must have a
paraffin-embedded tumor specimen from the kidney or metastatic site available
for central review and confirmation of tumor histology

- No collecting duct or medullary carcinoma

- Measurable advanced disease that is not resectable by surgery

- Patients with resected or radiated brain metastases or those treated with
stereotactic radiation therapy are eligible, provided they have been off steroids for
at least 2 weeks

PATIENT CHARACTERISTICS:

- ECOG performance status 0-2

- AGC ≥ 1,500/mm^3

- Platelet count ≥ 100,000/mm^3

- Hemoglobin ≥ 9.0 g/dL (transfusions allowed)

- Serum creatinine clearance ≥ 30 mL/min

- SGOT and SGPT ≤ 2.5 times ULN (≤ 5 times ULN in the presence of liver metastases)

- Total bilirubin ≤ 1.5 times ULN

- Baseline QTc interval < 500 msec on EKG

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception before and during study treatment

- Able to swallow pills

- No history of stroke within the past 6 months

- No clinically significant cardiovascular disease, defined as one of the following:

- Uncontrolled hypertension (BP > 150/100 mm Hg at the time of enrollment)

- Patients with hypertension and BP ≤ 150/100 mm Hg on stable
antihypertensive regimen are eligible

- History of myocardial infarction or unstable angina within the past 24 weeks

- NYHA class II-IV congestive heart failure, serious cardiac arrhythmia requiring
medication, or unstable angina pectoris

- Peripheral vascular disease ≥ grade II

- No ongoing ventricular cardiac dysrhythmias ≥ grade 2 as assessed by NCI CTCAE
version 4

- No patients with a history of serious ventricular arrhythmia (ventricular
tachycardia or ventricular fibrillation > 3 beats in a row)

- No patients with ongoing atrial fibrillation

- No pre-existing thyroid abnormality with thyroid-stimulating hormone that cannot be
maintained at less than or within the normal range with medication

- No serious concurrent illness or active infection that would jeopardize the ability
of the patient to receive study treatment

- No known HIV

- Patients with a history of prior malignancy are eligible provided they were treated
with curative intent and have been disease free for the time period considered
appropriate to not interfere with the outcome of this study

PRIOR CONCURRENT THERAPY:

- No prior systemic therapy for metastatic disease

- Patients who were randomized to placebo on an adjuvant study are eligible

- More than 2 weeks since prior radiotherapy and recovered

- Previously irradiated lesions must not be the sole site of disease

- More than 2 weeks since prior and no concurrent ketoconazole, dexamethasone,
dysrhythmic drugs (terfenadine, quinidine, procainamide, sotalol, probucol, bepridil,
indapamide, or flecainide), haloperidol, risperidone, rifampin, grapefruit, or
grapefruit juice

- Topical and inhaled steroids are allowed