This is a phase 2 trial seeking to define the safety and activity of gemcitabine, cisplatin, plus nivolumab as neoadjuvant therapy in patients with muscle-invasive bladder cancer and to define the role of clinical complete response in predicting benefit in patients opting to avoid cystectomy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
76
Nivolumab 360mg will be administered on Day 1 of each 21 day cycle for four 21-day cycles. Based on response and a balanced patient-physician discussion, subjects may receive nivolumab 240 mg for 8 cycles (cycle = 14 days).
Gemcitabine 1000mg/m\^2 will be administered on Days 1 and 8 for four 21-day cycles.
Cisplatin 70mg\^m2 will be administered on Day 1 for four 21-day cycles.
City of Hope
Duarte, California, United States
Univerity of Southern California
Los Angeles, California, United States
Icahn School of Medicine: Tisch Cancer Institute at Mount Sinai Medical Center
New York, New York, United States
Oregon Health & Science University
Portland, Oregon, United States
Clinical Complete Response (CCR) Rate
Clinical complete response rate will be defined as the percentage of patients who achieved cT0 or cTa disease after gemcitabine, cisplatin, plus nivolumab.
Time frame: 24 months
Predict Benefit From Treatment
Determine the ability of clinical complete response (cT0 or cTa) to predict benefit from treatment.Benefit will be defined as a pathologic complete response (\<pT1) in patients undergoing cystectomy and 2 year metastasis-free in patients pursuing surveillance. The positive predictive value of CCR with 95% confidence interval are presented in Outcome Measure Data Table. Positive predictive value is the ratio of patients truly diagnosed as positive to all those who had positive test results.
Time frame: 24 months
Adverse Events
The frequency and severity of all grade 3+ treatment-emergent adverse events occurring in at least 10% of patients are reported by CTCAEv4 term and grade.
Time frame: AE had been recorded from time of signed informed consent until 100 days after discontinuation of study drug(s) or until a new anti-cancer treatment starts, whichever occurs first, up to a maximum of 13 months.
Bladder Intact Overall Survival
Bladder-intact overall survival is defined as the time from initiation of treatment until death or cystectomy.
Time frame: Up to a maximum of 60 months
Recurrence-free Survival
Recurrence-free survival is defined as the time from initiation of treatment to death or recurrence, depending on which occurs first
Time frame: Up to a maximum of 60 months
Pathologic Complete Response Rate in Patients Undergoing Cystectomy
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Penn Medicine Abramson Cancer Center
Philadelphia, Pennsylvania, United States
Huntsman Cancer Institute University of Utah
Salt Lake City, Utah, United States
University of Wisconsin
Madison, Wisconsin, United States
Pathologic complete response rate in patients undergoing radical cystectomy is defined as the proportion of patients with \<pT1
Time frame: Up to a maximum of 53 months
Association Between a Prespecified Panel of Genomic Biomarkers and Benefit From Treatment in Patients Achieving a Clinical Complete Response.
Benefit will be defined as a pathologic complete response (p\<T1) in patients undergoing cystectomy and 2 years metastasis-free in patients pursuing surveillance. The positive predictive value of CCR with or without genomic alterations in baseline TURBT tissue for a composite outcome measure of 2-year bladder-intact survival in patients forgoing immediate cystectomy or \<ypT1N0 in patients undergoing immediate cystectomy are presented with 95% confidence interval in Outcome Measure Data Table. Positive predictive value is the ratio of patients truly diagnosed as positive to all those who had positive test results.
Time frame: 24 months
Overall Survival
Overall survival is defined as the time from initiation of treatment to death.
Time frame: Up to a maximum of 60 months