Gemcitabine + Carboplatin + Nivolumab Versus Gemcitabine + Oxaliplatin + Nivolumab in Cisplatin-ineligible Patients With Metastatic Urothelial Cancer
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ClinicalTrials.gov Identifier: NCT03451331 |
Recruitment Status :
Recruiting
First Posted : March 1, 2018
Last Update Posted : March 8, 2021
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Condition or disease | Intervention/treatment | Phase |
---|---|---|
Metastatic Urothelial Cancer | Drug: Nivolumab Drug: Gemcitabine Drug: Carboplatin Drug: Oxaliplatin | Phase 2 |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 48 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Masking Description: | Open-label |
Primary Purpose: | Treatment |
Official Title: | Randomized Phase 2 Trial of Gemcitabine + Carboplatin + Nivolumab Versus Gemcitabine + Oxaliplatin + Nivolumab in Cisplatin-ineligible Patients With Metastatic Urothelial Cancer |
Actual Study Start Date : | May 10, 2018 |
Estimated Primary Completion Date : | May 1, 2021 |
Estimated Study Completion Date : | December 1, 2022 |

Arm | Intervention/treatment |
---|---|
Experimental: Arm A
Gemcitabine plus carboplatin plus nivolumab
|
Drug: Nivolumab
Nivolumab 360mg (and/or) Maintenance Single Agent Nivolumab 480mg (starting ~ 2-4 weeks after completing combination chemotherapy plus nivolumab)
Other Name: OPDIVO® Drug: Gemcitabine 1000 mg/m^2
Other Name: Gemzar Drug: Carboplatin AUC 4.5 (based on the Calvert formula)
Other Name: Paraplatin® |
Experimental: Arm B
Gemcitabine plus oxaliplatin plus nivolumab
|
Drug: Nivolumab
Nivolumab 360mg (and/or) Maintenance Single Agent Nivolumab 480mg (starting ~ 2-4 weeks after completing combination chemotherapy plus nivolumab)
Other Name: OPDIVO® Drug: Gemcitabine 1000 mg/m^2
Other Name: Gemzar Drug: Oxaliplatin 130 mg/m^2
Other Name: Eloxatin |
- Objective Response Rate (ORR) [ Time Frame: 1.5 years ](RECIST 1.1) to treatment with gemcitabine + carboplatin + nivolumab and gemcitabine + oxaliplatin + nivolumab in cisplatin-ineligible patients with metastatic urothelial cancer
- Assess Safety [ Time Frame: 1.5 years ]Assess all adverse events according to the NCI Common Terminology Criteria for (NCI CTCAE) v4
- Duration of Response [ Time Frame: 1.5 years ]Time from the first documentation of RECIST 1.1 response to the time of progression as per RECIST 1.1
- Progression-Free Survival (PFS) [ Time Frame: 3 years ]Time from randomization to death or progression, depending on which occurs first
- Overall Survival (OS) [ Time Frame: 3 years ]Time from randomization to death

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Subject must meet all the following applicable inclusion criteria to participate in this study:
- Written informed consent and HIPAA authorization for release of personal health information prior to registration. NOTE: HIPAA authorization may be included in the informed consent or obtained separately.
- Age ≥ 18 years at the time of consent.
- Eastern Cooperative Oncology Group (ECOG) performance status of = 2
- Able to comply with the study protocol, in the investigator's judgment.
- Histologically documented, locally advanced (T4b, any N; or any T, N 2-3) or metastatic urothelial carcinoma (mUC) (M1, Stage IV) (also termed TCC or UCC of the urinary tract; including renal pelvis, ureters, urinary bladder, and urethra) Patients with mixed histologies are required to have a dominant transitional cell pattern. Locally advanced bladder cancer must be inoperable on the basis of involvement of pelvic sidewall or adjacent viscera (clinical Stage T4b) or bulky nodal metastasis (N2-N3).
- Measurable disease, as defined by RECIST v1.1
- Representative formalin-fixed paraffin-embedded (FFPE) tumor specimens (metastatic specimens preferable but if not available primary tumor specimens that are at least muscle-invasive are acceptable) in paraffin blocks (blocks preferred) or at least 15 unstained slides. Subjects without adequate archival tumor tissue or for whom a biopsy is not considered possible may be considered for enrollment on a case by case basis after discussion with the sponsor-investigator.
- No prior chemotherapy for inoperable locally advanced or mUC. For patients who received prior adjuvant/neoadjuvant chemotherapy or chemo-radiation for urothelial carcinoma, a treatment-free interval > 12 months between the last treatment administration and the date of recurrence is required in order to be considered treatment naive in the metastatic setting.
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Cisplatin-ineligible as defined by at least one of the following:
- Calculated creatinine clearance ≥ 30 (Cockroft-Gault)
- ECOG performance status of 2 or greater
- CTCAE v4 Grade ≥ 2 audiometric hearing loss
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Demonstrate adequate organ function. All screening labs to be obtained within 28 days prior to registration:
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Hematological:
- Absolute Neutrophil Count (ANC) ≥ 1.5 x 10^9/L
- Hemoglobin (Hgb) ≥ 9 g/dL
- Platelets ≥ 100 x 10^9/L
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Renal:
• Calculated creatinine clearance ≥ 30 mL/min (Cockroft-Gault)
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Hepatic:
- Bilirubin ≤ 1.5 × upper limit of normal (ULN) (except subjects with Gilbert Syndrome, who can have total bilirubin < 3.0 mg/dL)
- Aspartate aminotransferase (AST) ≤ 3 × ULN
- Alanine aminotransferase (ALT) ≤ 3 × ULN
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- Women of childbearing potential must have a negative serum or urine pregnancy.
- Women of childbearing potential (WOCBP) must use appropriate method(s) of contraception as stated for the timeline below. Male subjects are not required to use contraception.
NOTE: Women of childbearing potential is defined as any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal. Menopause is defined clinically as 12 months of amenorrhea in a woman over 45 in the absence of other biological or physiological causes. In addition, women under the age of 62 must have a documented serum follicle stimulating hormone (FSH) level less than 40 mIU/mL.
NOTE: Women of childbearing potential (WOCBP) receiving nivolumab will be instructed to adhere to contraception for a period of 5 months after the last dose of investigational product.
Exclusion Criteria:
Subjects meeting any of the criteria below may not participate in the study:
- Active infection requiring systemic therapy.
- Pregnant or breastfeeding
- Any serious or uncontrolled medical disorder that, in the opinion of the site investigator, may increase the risk associated with study participation or study drug administration, impair the ability of the subject to receive protocol therapy, or interfere with the interpretation of study results.
- Prior malignancy active within the previous 3 years except for locally curable cancers that have been apparently cured.
- Subjects with active, known or suspected autoimmune disease. Subjects with vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.
- Subjects with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
- Prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint pathways.
- Grade ≥ 2 neuropathy (NCI CTCAE version 4).
- Positive test for hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus ribonucleic acid (RNA) or hepatitis C antibody (HCV antibody) indicating acute or chronic infection.
- Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS).
- Evidence of interstitial lung disease or active, non-infectious pneumonitis.
- Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class III or greater), myocardial infarction within 3 months prior to randomization, unstable arrhythmias, or unstable angina.
- Known left ventricular ejection fraction (LVEF) < 40% Patients with known coronary artery disease, congestive heart failure not meeting the above criteria, or LVEF 40%-50% must be on a stable medical regimen that is optimized in the opinion of the treating physician, in consultation with a cardiologist if appropriate.
- Solid organ or tissue transplant including stem cell transplant

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03451331
Contact: Matthew Galsky, M.D. | 212-824-5452 | matthew.galsky@mssm.edu | |
Contact: Ahran Lee | 317.634.5842 ext 14 | alee@hoosiercancer.org |
United States, Maryland | |
Johns Hopkins Sidney Kimmel Comprehensive Cancer Center | Recruiting |
Baltimore, Maryland, United States, 21287 | |
Contact: Victoria Sinibaldi 410-614-3209 sinibvi@jhmi.edu | |
Principal Investigator: Jean Hoffman-Censits, MD | |
United States, New Jersey | |
John Theuer Cancer Center | Recruiting |
Hackensack, New Jersey, United States, 07601 | |
Contact: Peter O'Rourke 551-996-5954 PORourke@Hackensackumc.org | |
Principal Investigator: Robert Alter, MD | |
Rutgers Cancer Institute of New Jersey | Recruiting |
New Brunswick, New Jersey, United States, 08903 | |
Contact: Tracie Saunders 732-235-8861 ks13@cinj.rutgers.edu | |
Principal Investigator: Tina Mayer, MD | |
United States, New York | |
Icahn School of Medicine: Tisch Cancer Institute at Mount Sinai Medical Center | Recruiting |
New York, New York, United States, 10029 | |
Contact: Matthew Galsky, M.D. 212-241-8214 matthew.galsky@mssm.edu | |
United States, Tennessee | |
Vanderbilt-Ingram Cancer Center | Recruiting |
Nashville, Tennessee, United States, 37232 | |
Contact: Matthew Fister 615-875-9979 matthew.c.fister@vumc.org | |
Principal Investigator: David Chism, MD | |
United States, Utah | |
Huntsman Cancer Institute University of Utah | Recruiting |
Salt Lake City, Utah, United States, 84112 | |
Contact: Jamie White 801-213-6106 Jamie.White@hci.utah.edu | |
Principal Investigator: Benjamin Maughan, MD |
Principal Investigator: | Matthew Galsky, M.D. | Icahn School of Medicine at Mount Sinai; Tisch Cancer Institute |
Responsible Party: | Matthew Galsky, Sponsor-Investigator, Hoosier Cancer Research Network |
ClinicalTrials.gov Identifier: | NCT03451331 |
Other Study ID Numbers: |
HCRN GU16-287 |
First Posted: | March 1, 2018 Key Record Dates |
Last Update Posted: | March 8, 2021 |
Last Verified: | March 2021 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Undecided |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Product Manufactured in and Exported from the U.S.: | Yes |
cisplatin-ineligible gemcitabine carboplatin nivolumab oxaliplatin |
Gemcitabine Carboplatin Oxaliplatin Nivolumab Antineoplastic Agents Antimetabolites, Antineoplastic Antimetabolites Molecular Mechanisms of Pharmacological Action |
Antiviral Agents Anti-Infective Agents Enzyme Inhibitors Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs Antineoplastic Agents, Immunological |