The main objective of this trial is to evaluate the efficacy of the combo Sacituzumab govitecan (SG) + Zimberelimab (AB 122) (ZIM) + Domvanalimab (AB 154) (DOM), measured as pathologic complete response (pCR) rates, in the perioperative setting in patients with Muscle Invasive Bladder Cancer (MIBC) who are either unfit for platinum-based chemotherapy or unwilling to receive that therapy.
This is an open label, multicenter, single arm, phase II clinical trial, which aims to evaluate the effects of perioperative treatment with sacituzumab govitecan, zimberelimab and domvanalimab in patients with confirmed histological diagnosis of urothelial bladder carcinoma pT2-T4a cN0-1 cM0 non-eligible or who refuse to receive cisplatin-based neoadjuvant chemotherapy. Patients who are eligible to participate in the study will receive 3 cycles of sacituzumab govitecan, zimberelimab and domvanalimab every 3 weeks prior to cystectomy, unless there are signs of unacceptable toxicity, progressive disease or the patient requests withdrawal from the study. Patients who do not achieve a pCR or that achieving a pCR still have positive ctDNA will also complete an adjuvant phase of the study consisting of 12 additional cycles of zimberelimab and domvanalimab. To progressively test the safety of the proposed combination, this study has been developed in two stages with the aim of preserving patient's safety as a priority. This study includes a preliminary assessment about the safety of the combinations. Thus, there will be a safety run-in period in which 8 patients will receive the SG+ZIM combination to confirm the tolerability of this doublet in patients with MIBC. Once the safety of this doublet has been confirmed by an external safety committee then the study will proceed to an additional safety-run in cohort with the triplet.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
70
Sacituzumab govitecan is administered at 10 mg/kg as an intravenous (IV) infusion on Days 1 and 8 of a 21-day cycle.
ZIM is administered at 360 mg every 3 weeks as an intravenous (IV) infusion on Day 1 of a 21-day cycle.
DOM is administered at 1200 mg every 3 weeks as an intravenous (IV) infusion on Day 1 of a 21-day cycle.
Hospital Duran i Reynals (ICO L´Hospitalet)
L'Hospitalet de Llobregat, Barcelona, Spain
Hospital Universitario Marqués de Valdecilla
Santander, Cantabria, Spain
Hospital Clínico San Carlos
Madrid, Madrid, Spain
Hospital Universitario de Navarra
Pamplona, Navarre, Spain
To evaluate the efficacy measured as pathologic complete response rates of the combo SG+ZIM+DOM in the perioperative setting in patients with MIBC who are either unfit for platinum-based chemotherapy or unwilling to receive that therapy.
Efficacy of the combination of sacituzumab govitecan, zimberelimab and domvanalimab measured as pathologic complete response (pCR) rates. pCR is defined as absence of residual viable tumor (ypT0) in the radical cystectomy specimen and in the resected lymph nodes (ypN0) (post-treatment).
Time frame: 42 months
To evaluate the downstaging rate induced by the combo
Downstaging is defined as any non-muscle invasive residual disease after treatment in the cystectomy specimen (i.e ypTis, ypTa,ypT1).
Time frame: 42 months
To measure overall survival (OS) and disease-free survival (DFS) in the study population
OS is defined as the time from informed consent signature to death from any cause.
Time frame: 42 months
To evaluate the safety of the combo
Safety and tolerability of the combination of sacituzumab govitecan, zimberelimab and domvanalimab measured as the incidence, nature and severity of adverse events (AEs).
Time frame: 42 months
To identify predictive biomarkers associated with response to SG + ZIM + DOM.
Cancer associated fibroblast (CAFs) as predictors of response. Immune sub-populations as predictors of response
Time frame: 42 months
To gain knowledge about the role of ctDNA in the perioperative setting
This parameter will be measured by ctDNA clearance, defined as the proportion of patients who are ctDNA positive at baseline and ctDNA negative after concluding the neoadjuvant component of the treatment, at the time of concluding neoadjuvant treatment and at the time post cystectomy.
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Hospital Virgen de la Salud
Toledo, Toledo, Spain
Hospital Clinico Universitario de Valladolid
Valladolid, Valladolid, Spain
Time frame: 42 months
To explore the role of adjuvant ZIM+DOM in selected patients after definitive surgical treatment
DFS event is defined as any of the following: development of distant metastasis of urothelial carcinoma or presence of pelvic recurrence of urothelial carcinoma (including soft tissue and regional lymph nodes) or death from any cause. OS is defined as the time from informed consent signature to death from any cause.
Time frame: 42 months