Open-label, interventional, multi-centre, randomized phase II study. Cancer studied is non-metastatic muscle invasive bladder cancer (MIBC). Avelumab administered every 2 weeks is used as neoadjuvant therapy in subjects with urothelial muscle invasive bladder cancers in combination with standard chemotherapy or alone.
Open-label, interventional, multi-centre, randomized phase II study. Cancer studied is non-metastatic muscle invasive bladder cancer (MIBC) Patients (male or female) will receive avelumab every 2 weeks in combination with standard chemotherapy or alone. There are 2 cohorts of patients. Cohort with patients cisplatin-ineligible will receive either avelumab alone or in combination with paclitaxel-gemcitabine chemotherapy. Cohort with patients cisplatin-eligible will receive either methotrexate, vinblastine, doxorubicine and cisplatin in combination with avelumab or cisplatin, gemcitabine in combination with avelumab. The estimated number of subjects to screen is 183 patients for an estimated number of 166 patients enrolled for 150 evaluable patients: 26 patients in the paclitaxel, gemcitabine in combination with avelumab arm (cisplatin-ineligible patients) 26 patients in avelumab alone arm (cisplatin-ineligible patients) 49 patients in cisplatin gemcitabine + avelumab arm (cisplatin-eligible patients) 49 patients in methotrexate, vinblastine, doxorubicine and cisplatin + avelumab arm (cisplatin-eligible patients) AVELUMAB: Avelumab will be administered at a dose of 10 milligram per kilogram (mg/kg) 1-hour intravenous (iv) infusion once every 2 weeks. Dose reductions are not allowed. Depending on the treatment arm, Avelumab will be given associated with chemotherapy or alone for a maximum of 4 administrations. DD-MVAC: DD-MVAC consists of Methotrexate 30 mg/m2 iv day 1, Vinblastine 3 mg/m2 iv day 2, Cisplatin 70 mg/m2 iv day 2 and Doxorubicin 30 mg/m2 iv day 2. Each cycle is given every 2 weeks for a maximum of 4 administrations. Pegfilgrastim 6 mg subcutaneous (SQ) 24-48 hours after completion of chemotherapy will be given. Chemotherapy is associated with Avelumab 10 mg/kg iv given on day 2 every 2 weeks. CG: CG consists of Gemcitabine 1000 mg/m2 iv in day 1 and day 8 and Cisplatin 70 mg/m2 iv in day 1. Each cycle is given every 3 weeks for a maximum of 4 administrations. Pegfilgrastim 6 mg subcutaneous (SQ) 24-48 hours after completion of chemotherapy will be given. Chemotherapy is associated with Avelumab 10 mg/kg iv given on day 1 every 2 weeks. PG: PG consists of Paclitaxel 80 mg/m2 iv in day 1 and day 15 and Gemcitabine 1000 mg/m2 iv in day 1 and day 15. Each cycle is repeated every 4 weeks for a maximum of 4 administrations. Chemotherapy is associated with Avelumab 10 mg/kg i.v. given every on day 1 every 2 weeks. For patients receiving neoadjuvant chemotherapy treatment, the surgery (cystectomy or nephroureterectomy associated to lymphadenectomy) will be performed within 3-6 weeks after the last administration of neoadjuvant chemotherapy treatment. For patients receiving avelumab alone, the surgery will be performed 2 weeks (+7 days) after the last administration of avelumab. Any delay in surgery (\> 6 weeks after the last chemotherapy administration or \>3 weeks after the last administration of avelumab alone) for any reason, needs to be discussed with the PI/Sponsor. For all patients, neoadjuvant treatment will be stopped if there is evidence of progression of disease (by RECIST 1.1 or investigator's decision) or unacceptable toxicity according to the investigator. In this situation, the investigator will decide if it is needed to proceed directly with the surgery. The end of study will be declared when all the following criteria will have been met: * The study ends after last visit of the last patient remaining in the study. * The trial is mature for the analysis of the endpoints as defined in the protocol, if the trial reaches its endpoints. * The database has been fully cleaned and frozen for all analyses.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
137
Chemotherapy with or without avelumab followed by surgery
Cystectomy 3 to 6 weeks after last administration of chemotherapy
Chemotherapy 4 cycles of 3 weeks
UZAntwerpen
Edegem, Antwerpen, Belgium
Centre Hospitalier Universitaire et Psychiatrique de Mons-Borinage
Mons, Hainaut, Belgium
Institut Jules Bordet
Brussels, Belgium
Grand Hôpital de Charleroi
Gilly, Belgium
To determine the pathologic complete response (ypT0/Tis ypN0) following neoadjuvant treatment in patients with non-metastatic MIBC.
\- Outcome measure: Pathological complete response is defined as the absence of invasive carcinoma (ypT0/Tis) disease and the absence of microscopic lymph node metastases (ypN0) on the final surgical specimen.
Time frame: during surgery
To determine the pathologic response rate (<ypT2N0)
Outcome measure: Pathologic response is defined as the absence of muscle invasive carcinoma (\<ypT2N0 disease) on the final surgical specimen.
Time frame: during surgery
Assessment of the toxicity profile of regimen using the adverse events reported: NCI CTCAE v4.03
Outcome measure: adverse events reported during the study according to NCI CTCAE v4.03
Time frame: through study completion, an average of 3 months
Assessment of local or distant recurrence
Outcome measure: invasive disease-free survival (iDFS) rate. iDFS period is defined as a time between the surgery (or last treatment dose if no surgery) and the date of diagnosis of local or distant recurrence, or secondary primary malignancy
Time frame: at 12 and 36 months after surgery (or at 12 and 36 months after last treatment dose if no surgery was performed)
Assessment of overall survival
overall survival (OS) rate. Overall survival is defined as a time between the surgery (or last treatment dose if no surgery) and the day of death (due to any causes) or day of last news
Time frame: minimum 36 months FU after surgery (or after last treatment dose if no surgery).
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Chemotherapy 4 cycles of 2 weeks
Chemotherapy 2 cycles of 4 weeks
CHU de Liège Sart Tilman
Liège, Belgium
CHU Namur - Sainte Elisabeth
Namur, Belgium
Centre Oscar Lambret
Lille, France
Groupe Hospitalier Paris Saint Joseph
Paris, France
Hôpital Saint Louis
Paris, France
Hôpitaux universitaires de Strasbourg
Strasbourg, France