Muscle-Invasive Bladder Carcinoma Clinical Trial
Official title:
A Phase II Trial of Risk Enabled Therapy After Neoadjuvant Immunochemotherapy for Bladder Cancer
Verified date | December 2023 |
Source | Fox Chase Cancer Center |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Neoadjuvant accelerated methotrexate/vinblastine/adriamycin/cisplatin (AMVAC) in combination with nivolumab is under evaluation for the treatment of muscle invasive bladder cancer (MIBC). Patients with pre-specified tumor mutations and complete clinical response with neoadjuvant therapy will preserve their bladders and go on active surveillance.
Status | Suspended |
Enrollment | 71 |
Est. completion date | November 2028 |
Est. primary completion date | May 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Male or female patients =18 years - Primary urothelial or predominantly urothelial carcinoma of the bladder confirmed from pathology report. Patients with some component of variant histology mixed with predominant urothelial carcinoma will be allowed. Upper tract urothelial carcinoma patients are not allowed. - Urothelial carcinoma of the prostatic urethra in men is allowed - Histologic evidence of muscularis propria invasion. - AJCC23 clinical stage T2-T3 N0M0. - No radiographic evidence of lymph node positive disease as per RECIST 1.1 (=15 mm short axis diameter). Lymph node positive disease is defined as clinical lymphadenopathy on staging CT or MRI greater than 1.4 cm in the short axis. If a lymph node is greater than 1.4 cm, it has to be biopsy proven negative for the patient to be eligible. - No metastatic disease (M0). - ECOG performance status 0, or 1. - Left ventricular ejection fraction = 50% by MUGA or ECHO within 6 months of study entry. - Negative pregnancy test in women of child bearing potential within 24 hours of study registration. If the pregnancy test is positive, the patient must not receive protocol treatment and must not be enrolled in the study. - Normal organ and bone marrow function (Leukocytes = 3,000/mcL, Absolute neutrophil count = 1,500/mcL, Platelets = 100,000/mcL, Total bilirubin = institutional upper limit of normal (ULN) unless patient has known Gilbert's disease, in which case an elevated bilirubin is allowed, AST(SGOT)/ALT(SGPT) = 2.5 X institutional ULN, Creatinine Clearance = 50 mL/min calculated using the Cockroft-Gault formula or measured with 24 hour urine collection) Exclusion Criteria: - Any component of small cell histology. - Prior systemic chemotherapy or radiation therapy for urothelial carcinoma or cytotoxic chemotherapy for another malignancy within 1 year of study entry are ineligible. Patients who received immunotherapy for non-muscle invasive bladder cancer will be excluded - Has a known additional malignancy that has had progression or has required active treatments in the last three years. Exceptions include basal cell carcinoma of the skin, squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer. A history of prostate cancer that was treated with surgery is acceptable, provided that the following criteria are met: Stage T2N0M0 or lower; PSA undetectable for 1 year while off androgen deprivation therapy. Patients on active surveillance for low grade prostate cancer are allowed to participate. - Patients who have received experimental agents within 4 weeks of study entry. - History of allergic reactions attributed to compounds of similar chemical or biologic composition to Methotrexate, Vinblastine, Doxorubicin or Cisplatin or other agents used in the study - Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection (defined by current oral or intravenous antibiotic therapy), symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. - Pregnant women are excluded from this study due to the potential for teratogenic or abortifacient effects of cytotoxic chemotherapy. - Known HIV-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with cytotoxic chemotherapy. In addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy. - Patients with hydronephrosis that has not been addressed with a documented assessment (i.e. normal GFR, no intervention necessary) or an intervention such as placement of a stent or nephrostomy tube. - Any condition requiring systemic treatment with corticosteroids (> 10 mg daily prednisone or equivalent) or other immunosuppressive medications within 14 days prior to first dose of study drug. Inhaled or topical steroids and adrenal replacement steroid doses > 10 mg daily prednisone or equivalent are permitted in the absence of active autoimmune disease. Use of steroids as pre-medication for contrast allergy prior to CT scans is permitted. It is acceptable to use steroids as pre-medication for AMVAC. - History of autoimmune disease including but not limited to myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis. - Prior treatment with CD137 agonists, anti-programmed death-1 (PD-1), or anti-PD-L1 therapeutic antibody or pathway-targeting agents. - Treatment with systemic immunostimulatory agents (including but not limited to interferons or interleukin [IL]-2) within 4 weeks or five half-lives of the drug, whichever is shorter, prior to enrolment. |
Country | Name | City | State |
---|---|---|---|
United States | UNC Lineberger Comprehensive Cancer Center | Chapel Hill | North Carolina |
United States | UT Southwestern Medical Center | Dallas | Texas |
United States | Fox Chase Cancer Center - Philadelphia | Philadelphia | Pennsylvania |
United States | Thomas Jefferson University Hospital | Philadelphia | Pennsylvania |
Lead Sponsor | Collaborator |
---|---|
Fox Chase Cancer Center |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Incidence of Metastasis-free survival (MFS) | MFS is defined as a recurrence of urothelial carcinoma that is >cN1 (more than one clinically suspicious pelvic lymph node) or surgically unresectable local recurrence (e.g., >cT4a) or M1 disease. | 2 years | |
Secondary | Number of days of Overall survival | Overall Survival (OS) will be defined as the number of days from study entry to death. Individuals who are alive at last contact will be censored on the date of last contact. | up to 5 years | |
Secondary | Number of days of Progression free survival | Progression Free Survival (PFS) for this study will be defined as the number of days from study entry to date of first evidence of tumor progression (presence of muscle invasive disease, nodal or distant recurrence) or until death from any cause, whichever comes first. Individuals that are alive and remain free of muscle invasive disease, nodal recurrence and distant disease recurrence will be censored on the date of last clinical visit. | up to 5 years | |
Secondary | Number of patients erporting Toxicity of neoadjuvant nivolumab and AMVAC therapy | Toxicity, AEs, SAEs for all patients that are associated with nivolumab or AMVAC will be collected/reported at each cycle and until 100 days after lastnivolumab/AMVAC. Toxicity, AEs, SAEs for the CRT arm specifically will be collected/reported as follows. Grade 1-5 toxicity at C1 (start of nivolumab/AMVAC), C2 (second cycle ofnivolumab/AMVAC), C3 (third cycle of nivolumab/AMVAC), start of chemoradiation, 1/2 completion chemoradiation, completion of chemoradiation, and up to 30 days after completion of chemoradiation. |
until 100 days after the last nivolumab/AMVAC |
Status | Clinical Trial | Phase | |
---|---|---|---|
Active, not recruiting |
NCT05097404 -
Clinical Utility of VI-RADS in Diagnosis of MIBC
|
||
Recruiting |
NCT05483868 -
A Phase 1, Open-label Trial of Belzupacap Sarotalocan (AU-011) in Bladder Cancer
|
Phase 1 | |
Not yet recruiting |
NCT04966130 -
Effect of Urinary Indwelling Time on Early Continence After Robot-assisted Radical Cystectomy With Orthotopic Ileal Neobladder.
|
||
Active, not recruiting |
NCT04610671 -
Study of CG0070 Combined With Nivolumab in Cisplatin Ineligible Patients With MIBC
|
Phase 1 | |
Recruiting |
NCT06341400 -
RC48 Combined With Toripalimab as Neoadjuvant Therapy for Cisplatin Ineligible MIBC Patients
|
Phase 1/Phase 2 | |
Recruiting |
NCT05203913 -
Cisplatin, Nab-paclitaxel, Nivolumab With Radiotherapy After Resection of Non-Metastatic Muscle Invasive Bladder Cancer
|
Phase 2 | |
Recruiting |
NCT05790850 -
Pre-Habilitation With Mindfulness and Exercise for Patients Undergoing Radical Cystectomy (PRIMER Trial)
|
N/A | |
Recruiting |
NCT05295992 -
Conventionally Fractionated Adaptive Radiation Therapy of Bladder Cancer an Individualized Approach
|
N/A | |
Recruiting |
NCT06215976 -
The Nephroprotective Effect of Metformin With Cisplatin in Bladder Cancer
|
Phase 4 | |
Recruiting |
NCT05028660 -
AURORAX-0093A: Glycosaminoglycan Profiling for Prognostication of Muscle-invasive Bladder Cancer - a Pilot Study
|
||
Not yet recruiting |
NCT04909775 -
Chemotherapy Combined With Tislelizumab as Bladder Sparing Option for Patients With Muscle Invasive Bladder Cancer
|
Phase 2 | |
Recruiting |
NCT04876313 -
An Open Label, Single-arm, Phase 2 Study of Neoadjuvant Nivolumab and Nab-paclitaxel Before Radical Cystectomy for Patients With Muscle-invasive Bladder Cancer (NURE-Combo)
|
Phase 2 | |
Not yet recruiting |
NCT04686149 -
a Genome-based Platform to Predict Patients That Can Achieve Bladder Preservation in Muscle Invasive Bladder Cancer Patients
|
||
Active, not recruiting |
NCT05630131 -
ctDNA in Subjects With Muscle-invasive Bladder Cancer Treated With Trimodality Therapy
|
||
Recruiting |
NCT06170177 -
Study on the Quality of Life and Pathological State in Patients Who Underwent Radical Cystectomy
|
||
Terminated |
NCT05221827 -
Clinical Performance Evaluation of the C2i-Test
|
||
Recruiting |
NCT06257017 -
Surveillance of the Genetic Signature in Circulating Tumor DNA for Guiding Adjuvant Chemotherapy in Urothelial Carcinoma: A Pilot Randomized Controlled Trial
|
Phase 2 | |
Recruiting |
NCT05767528 -
Clinical Study of Neoadjuvant Therapy Outcome Prediction of Muscle-invasive Bladder Cancer Based on PTC Drug Sensitivity Detection
|
||
Completed |
NCT04598724 -
Addressing Barriers to Palliative Care Use in Bladder Cancer
|
||
Recruiting |
NCT05975307 -
Treating Muscle-invasive Bladder Cancer With A Non-surgical Method Consisting of Anti-PD-1 Therapy and Chemoradiation
|
Phase 2 |