A Randomized, Controlled Phase III Study Investigating IMA901 Multipeptide Cancer Vaccine in Patients Receiving Sunitinib as First-line Therapy for Advanced/Metastatic Renal Cell Carcinoma

Inclusion Criteria:

1. Aged at least 18 years.

2. HLA type: HLA-A*02-positive

3. Metastatic and/or locally advanced RCC with clear cell histology (histological
confirmation by local pathologist required). NOTE: prior nephrectomy is NOT required.

4. Measurable and/or non-measurable tumor lesions as per RECIST 1.1

5. Patients who are candidates for a first-line therapy with sunitinib.

6. Favorable or intermediate risk according to the 6-score risk criteria in patients
treated with VEGF-targeted agents according to Heng [Heng et al. 2009]. The patient
has a favorable risk if none, or intermediate risk if one or two of the following
criteria apply (if three or more criteria apply the patient is not eligible):

1. Hemoglobin < LLN,

2. Serum corrected calcium > ULN,

3. Karnofsky performance status < 80%,

4. Time from initial diagnosis to initiation of therapy < 1 year,

5. Absolute neutrophil count > ULN,

6. Platelets > ULN.

7. Able to understand the nature of the study and give written informed consent.

8. Willingness and ability to comply with the study protocol for the duration of the
study.

9. Female patients who are post menopausal (no menstrual period for a minimum of 1
year), or surgically sterile (bilateral tubal ligation, bilateral oophorectomy, or
hysterectomy) or practice a medically acceptable method of birth control.

10. Male patients willing to use contraception (upon study entry and during the course of
the study or have undergone vasectomy.

Exclusion Criteria:

1. Prior systemic therapy for metastatic disease. (Note: prior adjuvant treatment for
non-metastatic disease is allowed, however adjuvant therapy must have been stopped ≥
1 year before Visit C).

2. History of or current brain metastases.

3. Abnormal ≥ CTC Grade 3 laboratory values for hematology (Hb, WBC, neutrophils,
lymphocytes, platelets), liver (serum bilirubin, ALAT or ASAT) and renal function
(serum creatinine).

4. Metastatic second malignancy.

5. Localized second malignancy expected to influence the patient's life span.

6. Patients with a history or evidence of systemic autoimmune disease, e.g., rheumatoid
arthritis, multiple sclerosis, systemic lupus erythematodes (SLE), scleroderma,
Sjögren's syndrome, Wegener's granulomatosis, Guillain-Barre syndrome.

7. Known active hepatitis B or C infection.

8. Known HIV infection.

9. Active infections requiring oral or intravenous antibiotics.

10. Any other known infection with a biological agent that can cause a severe disease and
poses a severe danger to lab personnel working on patients' blood or tissue.

11. Received study drug within any clinical study (including approved and experimental
drugs) within 4 weeks before sunitinib start.

12. Serious intercurrent illness, which according to the investigator, poses an undue
risk for the patient when participating in the trial, including, but not limited to,
any of the following:

- Clinically significant cardiovascular disease (e.g., uncontrolled hypertension;
clinically significant cardiac arrhythmia, clinically significant
QT-prolongation),

- New York Heart Association class III-IV congestive heart failure,

- Symptomatic peripheral vascular disease,

- Severe pulmonary dysfunction,

- Psychiatric illness or social situation that would preclude study compliance.

13. Less than 12 months since any of the following:

- Myocardial infarction,

- Severe or unstable angina,

- Coronary or peripheral artery bypass graft,

- Cerebrovascular event incl. transient ischemic attack,

- Pulmonary embolism / deep vein thrombosis (DVT).

14. Pregnancy or breastfeeding.

15. Any condition which in the judgment of the investigator would place the patient at
undue risk or interfere with the results of the study.