The purpose of this clinical trial is to evaluate the effectiveness of pembrolizumab monotherapy following 24 weeks of frontline pembrolizumab \& Enfortumab Vedotin (PEV) in patients with metastatic urothelial cancer (mUC).
This study aims to evaluate the de-escalation of therapy in patients with metastatic urothelial carcinoma (mUC). Patients will begin treatment with first-line (1L) (PEV) per standard of care. After 24 weeks, patients will be assessed for disease progression. Those who demonstrate stable disease or ongoing disease radiographic response and a ≥50% reduction in circulating tumor DNA (ctDNA) levels will enter the de-escalation phase. This phase consists of transitioning from PEV to pembrolizumab monotherapy. If, during the de-escalation period, patients exhibit disease progression or increased toxicity, they will be rechallenged with PEV.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Patients in the study will receive 1L PEV with 1.25 mg/kg of EV on day 1 and day 8 every 21 days, and 200 mg of pembrolizumab every 21 days.
Patients will receive 400 mg of pembrolizumab every 42 days. During the de-escalation period from PEV.
If patients experience radiographic progression on pembrolizumab monotherapy, they will undergo rechallenge with PEV.
OU Health Stephenson Cancer Center
Oklahoma City, Oklahoma, United States
RECRUITING3 months of progression-free survival (PFS) while on Pembrolizumab Monotherapy.
Number of patients who achieve PFS at the 3-month mark on pembrolizumab monotherapy. These patients will undergo radiographic assessments to evaluate progression-free survival (PFS).
Time frame: 3 months
6 months of PFS while on Pembrolizumab Monotherapy
Number of patients in the de-escalation phase who have reached 6-month PFS while on pembrolizumab monotherapy.
Time frame: 6 months
Treatment Related Adverse Events (TRAEs) while on Pembrolizumab Monotherapy.
Number of patients who experience treatment-related adverse events (TRAEs) while in the de-escalation phase treated with pembrolizumab monotherapy following 1L PEV. Any adverse events (AEs) or TRAEs that do occur will be assessed and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Time frame: 1 year
Pain Assessment In Patients While On Pembrolizumab Monotherapy.
The Brief Pain Inventory (BPI) questionnaire will be administered to assess participants' perceived pain levels. Pain intensity will be rated on a Likert scale ranging from 0, indicating no pain, to 10, representing the most severe and unimaginable pain.
Time frame: 1 year
Changes In Peripheral Neuropathy While on Pembrolizumab Monotherapy
The Functional Assessment of Cancer Therapy-Neurotoxicity 12 (FACT-NTX-12) will be administered every 12 weeks to evaluate peripheral neuropathy. This tool measures quality of life in relation to neuropathy symptoms, vibration perception threshold, and extension strength testing. Responses are rated on a 5-point Likert scale, ranging from 0 ("not at all") to 4 ("very much").
Time frame: 1 year
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Health Assessment In Patients While On Pembrolizumab Monotherapy
The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) will be administered to assess participants' quality of life, including physical, emotional, and social functioning, as well as cancer-related symptoms. Responses are measured on a Likert scale from 1 ("not at all") to 4 ("very much").
Time frame: 1 year