Bladder Cancer Clinical Trial
Official title:
A Randomized Trial of Celecoxib and Rosiglitazone, Alone and in Combination, in Patients With Early Stage Non-Invasive Bladder Carcinoma Undergoing Cystoscopic Surveillance and in Patients With Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy
RATIONALE: Celecoxib may stop the growth of tumor cells by blocking the enzymes necessary
for their growth and by stopping blood flow to the tumor. Rosiglitazone may help tumor cells
develop into normal bladder cells.
PURPOSE: This randomized clinical trial is studying how well giving celecoxib together with
rosiglitazone works in treating patients who are undergoing cystoscopic surveillance
(screening) for early-stage noninvasive (carcinoma in situ) carcinoma (cancer) of the
bladder or radical cystectomy for muscle-invasive carcinoma (cancer has spread into the
muscle layer of bladder tissue) of the bladder.
OBJECTIVES:
Primary
- Determine whether rosiglitazone and celecoxib, administered alone or in combination,
cause changes in the expression of effector molecules, peroxisome
proliferator-activated receptor-γ (PPAR-γ) and cyclo-oxygenase-1 (COX-1), in patients
with early-stage non-invasive carcinoma of the bladder undergoing cystoscopic
surveillance or in patients with muscle-invasive carcinoma of the bladder undergoing
radical cystectomy.
Secondary
- Determine whether these regimens result in changes in the expression of downstream
effector molecules that mediate cellular proliferation and apoptosis in these patients.
- Determine the relationship between tissue levels of biomarkers of drug effect,
proliferation, and apoptosis and the systemic biomarkers of response to treatment, in
terms of COX-2 activity and the levels of the endogenous PPAR-γ ligand, in patients
treated with these regimens.
- Determine the toxicity of these regimens in these patients.
- Determine the frequency of recurrence and the time to progression in patients
undergoing cystoscopic surveillance.
OUTLINE: This is a randomized, pilot, cohort study. Patients are assigned to 1 of 2 cohorts
according to disease stage (Ta, Tis, T1, N0, M0 vs T2-4, NX, M0).
- Stage 1:
- Cohort 1: Patients receive oral celecoxib twice daily and oral rosiglitazone once
daily for 1 year in the absence of disease progression or unacceptable toxicity.
- Cohort 2: Patients receive oral celecoxib twice daily and oral rosiglitazone once
daily for 14 days. Patients then undergo cystectomy.
- Stage 2: Patients are randomized into 1 of 2 treatment arms.
- Arm I:
- Cohort 1: Patients receive oral celecoxib twice daily for 1 year in the
absence of disease progression or unacceptable toxicity.
- Cohort 2: Patients receive oral celecoxib twice daily for 14 days. Patients
then undergo cystectomy.
- Arm II:
- Cohort 1: Patients receive oral rosiglitazone once daily for 1 year in the
absence of disease progression or unacceptable toxicity.
- Cohort 2: Patients receive oral rosiglitazone once daily for 14 days.
Patients then undergo cystectomy.
Patients in cohort 1 (in both stages) undergo cystoscopic surveillance every 3 months.
PROJECTED ACCRUAL: A total of 120 patients (20 per cohort in study stage 1; 40 per treatment
arm [20 per cohort in each arm] in study stage 2) will be accrued for this study within
12-18 months.
;
Allocation: Randomized, Primary Purpose: Treatment
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