This research study is studying the effects of adding a certain type of immunotherapy to standard bladder-directed radiation as a treatment for muscle-invasive urothelial carcinoma of the bladder. The drug in this study is: Avelumab (also known as BAVENCIO®)
This research study is a Phase II clinical trial. Phase II clinical trials test the safety and effectiveness of an investigational drug to learn whether the drug works in treating a specific disease. "Investigational" means that the drug is being studied. The FDA (the U.S. Food and Drug Administration) has not approved the use of avelumab and bladder-directed radiation together for this specific disease but avelumab has been approved for other uses. While bladder-directed radiation is a standard treatment option for muscle-invasive urothelial carcinoma of the bladder, the use of avelumab in combination with bladder radiation in patients with urothelial carcinoma of the bladder is investigational. Radiation is used in the treatment of muscle-invasive bladder cancer, and avelumab has been approved by the FDA in patients with more advanced stages of this disease. Avelumab is a form of immunotherapy, which means it is designed to help the immune system fight cancer cells together with standard cancer treatments like radiation. Avelumab is currently approved by the FDA for the treatment of metastatic Merckel cell carcinoma (mMCC) and platinum-refractory metastatic urothelial carcinoma. The purpose of this study is to test whether the combination of immunotherapy and bladder directed radiation is effective in treating muscle-invasive bladder cancer. The study will also measure other outcomes such as participant's overall health and quality of life during and after treatment. In addition, the investigators will determine if certain biomarkers are correlated with outcomes following treatment with immunotherapy and radiation.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
14
Dana-Farber Cancer Institute
Boston, Massachusetts, United States
Brigham and Women's Hospital
Boston, Massachusetts, United States
Complete Clinical Response Rate
Measured by the complete clinical response rate at 3 months following completion of radiation, followed by every 3 months until 2 years after registration, then every 6 months up to a maximum of 3 years after registration. Clinical response is assessed by cystoscopy, urine cytology, and CT Chest/Abdomen/Pelvis. No evidence of disease on these assessments at a given time point suggests a Complete Clinical Response at that time point.
Time frame: 3 months following completion of radiation; then every 3 months until 2 years after registration; then every 6 months up to a maximum of 3 years after registration
Overall Survival
Overall Survival (OS)
Time frame: 3 years
Progression Free Survival
Progression Free Survival (PFS) as assessed by imaging, cystoscopy, and cytology.
Time frame: 3 years
Metastases-free Survival
Metastases-free survival (MFS) as assessed by imaging.
Time frame: 3 years
Locoregional Recurrence Rate
Locoregional recurrence rate (LRR) as assessed by imaging.
Time frame: 3 years
Change in Quality of Life Outcomes
Quality of Life Outcomes (QoL) as measured by patient report on questionnaires. Patients are given a statement and must assign a number to assess how the statement applies to them in the past 7 days. 0=Not at all; 1=A little bit; 2=Somewhat; 3=Quite a bit; 4=Very much. QoLs were collected at baseline, end of radiation, 3 months post-radiation completion, then every 3 months through year 2 after treatment. Median scores and interquartile ranges were calculated for baseline, 3 months post-radiation completion, and 2 years post-treatment. 3 months post-RT was selected to coincide with the primary outcome timeframe. Year 2 was selected due to the number of patients that reached this point during follow up; most patients did not surpass year 2. Higher score means worse outcome for questions regarding diarrhea, urinary frequency \& burning, and being bothered by treatment. Higher score means better outcome for questions regarding being content with quality of life and control over bowels.
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Time frame: Baseline; 3 months following completion of radiation; 2 years after treatment