Researchers are looking for new ways to treat muscle-invasive bladder cancer (MIBC). MIBC is a type of cancer that has not spread from the muscles in the bladder to other parts of the body. MIBC is treated by having surgery to remove the bladder (cystectomy). Not all people choose to have surgery and want to keep their bladder using other treatments. Chemoradiotherapy (CRT)- is a type of non-surgical treatment for MIBC which combines Chemotherapy (a treatment with medicine to destroy cancer cells or stop them growing) and Radiation therapy (a treatment that uses beams of intense energy \[like X-rays\] to shrink or get rid of tumors). Pembrolizumab is an immunotherapy, which is a treatment that helps the immune system fight cancer. A placebo looks like the study medicine but has no study medicine in it. Using a placebo helps researchers better understand if the study medicine works. The goal of this study is to learn: 1. If a study medicine pembrolizumab given with Chemoradiotherapy (CRT) can help people live longer without their cancer growing, spreading, or coming back compared to placebo given with CRT. 2. About the safety and how well people tolerate CRT alone or in combination with pembrolizumab.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
520
400 mg of IV (intravenous) pembrolizumab once every 6 weeks.
64 Gy of radiation administered to participant's bladder only. Thirty-two fractions will be administered over 6.5 weeks.
64 Gy of radiation administered to participant's bladder and pelvic nodes. Thirty-two fractions will be administered over 6.5 weeks.
55 Gy of radiation administered to participant's bladder only. Twenty fractions will be administered over 4 weeks.
35 mg of cisplatin per cubic meter of body volume, administered once weekly via IV infusion.
5-FU administered via IV infusion at a dose of 500 mg per cubic meter of body volume on Days 1-5 and 22-26.
MMC administered via IV infusion at a dose of 12 mg per cubic meter of body volume on Day 1.
Gemcitabine administered via IV infusion at a dose of 27 mg per cubic meter of body volume twice weekly.
Placebo to intravenous (IV) pembrolizumab administered once every 6 weeks.
Washington Cancer Institute at MedStar Washington Hospital Center ( Site 0041)
Washington D.C., District of Columbia, United States
Bay Pines VA Medical Center ( Site 0055)
Bay Pines, Florida, United States
AdventHealth Orlando-AdventHealth Medical Group Hematology & Oncology at Orlandoc ( Site 0004)
Orlando, Florida, United States
Norton Cancer Institute ( Site 0044)
Louisville, Kentucky, United States
Pikeville Medical Center ( Site 0009)
Pikeville, Kentucky, United States
Bladder Intact Event-Free Survival (BI-EFS)
BI-EFS is defined as the time from randomization to any of the following events: residual/recurrent MIBC post-chemoradiotherapy (CRT), nodal or distant metastases as assessed by computerized tomography (CT) and CT urography (CTU) or magnetic resonance urography (MRU) per blinded independent central review (BICR) and/or biopsy results assessed by central pathology review, radical cystectomy, or death due to any cause. If biopsy is not feasible due to participant safety, the imaging alone will be sufficient. The BI-EFS for all participants will be presented.
Time frame: Up to approximately 76 months
Overall Survival (OS)
Time from randomization to death due to any cause.
Time frame: Up to approximately 7 years
Metastasis-Free Survival (MFS)
MFS is defined as the time from randomization to the first documented occurrence of nodal or distant metastases as assessed by CT and CTU or MRU per BICR and/or biopsy results assessed by central pathology review If biopsy is not feasible due to participant safety, the imaging alone will be sufficient.
Time frame: Up to approximately 7 years
Time to Occurrence of Non-Muscle-Invasive Bladder Cancer (NMIBC)
Time to occurrence of low-grade disease, defined as the time from randomization until the development of NMIBC, will be presented.
Time frame: Up to approximately 7 years
Number of Participants Who Experienced an Adverse Event (AE)
An AE is any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. The number of participants who experience an AE will be presented.
Time frame: Up to approximately 7 years
Number of Participants Who Discontinued Study Intervention Due to an AE
An AE is any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. The number of participants who discontinue study treatment due to an AE will be presented.
Time frame: Up to approximately 1 year
Change from Baseline in the Global Health Status/Quality of Life (Items 29 and 30) Combined Score on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30)
The EORTC-QLQ-C30 is a 30-item questionnaire developed to assess the quality of life of cancer patients. Participant responses to the questions "How would you rate your overall health during the past week?" and "How would you rate your overall quality of life during the past week?" are scored on a 7-point scale (1=Very Poor to 7=Excellent). A higher score indicates a better overall outcome. The change from baseline in Global Health Status/Quality of Life (EORTC QLQ-C30 Items 29 and 30) combined score will be presented.
Time frame: Baseline and up to approximately 2 years
Change from Baseline in Physical Functioning (Items 1-5) Combined Score on the EORTC QLQ-C30
EORTC-QLQ-C30 is a 30-item questionnaire developed to assess the quality of life of cancer patients. Participant responses to 5 questions about their physical functioning are scored on a 4-point scale (1=Not at All to 4=Very Much). A higher score indicates a better quality of life. The change from baseline in Physical Functioning (EORTC QLQ-C30 Items 1-5) combined score will be presented.
Time frame: Baseline and up to approximately 2 years
Change from Baseline in Urinary, Bowel, and Sexual Domains of the Bladder Cancer Index (BCI)
The BCI is a validated, condition-specific health questionnaire assessing quality of life among participants with bladder cancer. The BCI contains 36 items which assess 3 domains (urinary, bowel, and sexual) with function and bother subdomains. Scores range from 0 to 100 with higher scores corresponding to better functioning and health-related quality of life. The change from baseline in the combined scores of the urinary, bowel, and sexual domains of the BCI will be presented.
Time frame: Baseline and up to approximately 2 years
Change from Baseline in the Visual Analog Score (VAS) of the European Quality of Life (EuroQoL)-5 Dimensions, 5-level Questionnaire (EQ-5D-5L)
The EQ-5D-5L VAS records the respondent's self-rated health on a 10 cm vertical, visual analogue scale. It is rated by the respondent on a scale 0 to 100, with 0 being "the worst health you can imagine" and 100 being "the best health you can imagine". The change from baseline in EQ-5D-5L VAS will be presented.
Time frame: Baseline and up to approximately 2 years
Time to Cystectomy
Time to cystectomy is defined as time from a participant's randomization to date of cystectomy.
Time frame: Up to approximately 7 years
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Baltimore VA Medical Center ( Site 0054)
Baltimore, Maryland, United States
Washington University ( Site 0003)
St Louis, Missouri, United States
Summit Medical Group Cancer Center ( Site 6008)
Florham Park, New Jersey, United States
John Theurer Cancer Center at Hackensack University Medical Center ( Site 0005)
Hackensack, New Jersey, United States
New York Oncology Hematology P.C ( Site 0024)
Albany, New York, United States
...and 124 more locations