The investigators reported previously that epigenetic activation of organic cation transporter (OCT2) by decitabine sensitizes RCC cells to oxaliplatin both in vitro and in xenografts. The objective of this phase II clinical trial is to investigate the efficacy and safety of sequential combination therapy with decitabine and oxaliplatin in patients with relapsed/metastatic renal cell carcinoma who progressed on standard of care.

CHUCAS-025 (Cancer Hospital, University of Chinese Academy of Sciences) is a phase II trial conducted at 3 investigative centres in the Zhejiang Province, China. Eligible patients are 18 to 75 years old with relapsed/metastatic renal cell carcinoma progressed on standard of care. Patients receive Decitabine 10 mg/day for 5 consecutive days (d1-5) plus Oxaliplatin 75mg/m2 2-week-cycle (d6, d20) within 4 weeks. One cycle is defined as 4 weeks of treatment and total of 6 cycles are designed for patients. Patients who experienced unacceptable toxicities or clinical or documented progressive disease are discontinued from the study. The duration of any objective response is measured from the date the initial response is observed to the date that disease progression is observed. Patients receiving 2 cycles of treatment are considered evaluable for response using Response Evaluation Criteria in Solid Tumors (RECIST). Disease assessment by the investigator include response assessment and diagnostic imaging and measuring of target lesions. All patients receive computed tomography and/or magnetic resonance imaging scans for assessing disease status. All patients were followed up until death from any cause.

Inclusion criteria

1. Age: 18 ~75 years old.
2. Patients who are diagnosed pathologically with relapsed/metastatic renal cell carcinoma have a disease progression on standard of care.
3. Performance status: Eastern Cooperative Oncology Group performance status ≦2.
4. Life expectancy more than 3 months.
5. Patients have adequate organ function, accord with following criteria: A. blood routine: Hemoglobin≥90g/L, absolute neutrophil count≥1.5×109/L, platelet count ≥ 80×109/L; B. Biochemical tests: total bilirubin is less than 1.5 times upper limit of normal, alanine aminotransferase and aspartate aminotransferase are less than 2.5 times upper limit of normal; C. creatinine less than 1.25 times upper limit of normal.
6. Patients agree to use adequate contraception in the period of trial and need negative pregnancy test in childbearing potential women.
7. Patients agree to receive treatment with epigenetic drugs.
8. Participant sign an institutional review board-approved, protocol-specific informed consent form in accordance with institutional guidelines.

Exclude criteria:

1. Female patients who are pregnant or breast feeding, or adults of reproductive potential who are not using effective birth control methods.
2. Organs failure.
3. ECOG >2.
4. Serious/active infection.
5. Autoimmune disorders or immunodeficiency diseases.
6. Patients with allergic constitution, or other disease need take drugs of immunosuppressant or corticosteroids.
7. Uncontrolled hypertension.
8. Myocardial ischemia (more than grade II ) or myocardial infarction or uncontrolled arrhythmia.
9. Cardiac insufficiency of grade III to IV according to NYHA criteria, or left ventricular ejection fraction (LVEF) <50%.
10. Coagulation disorders, tendency of haemorrhage, undergoing thrombolytic or anticoagulant therapy.
11. Unhealed wounds, or fractures.
12. With a history of psychotropic drug abuse or mental disorders.
13. Prior systemic therapies with any antitumor agents within 4 weeks.
14. With other uncurable cancers simultaneously.