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A Window of Opportunity Trial: Avelumab in Non-metastatic Muscle Invasive Bladder Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03498196
Recruitment Status : Terminated (The sponsor of this study has terminated the study due to poor enrollment.)
First Posted : April 13, 2018
Last Update Posted : January 18, 2020
Sponsor:
Collaborator:
Pfizer
Information provided by (Responsible Party):
Jennifer Taylor, Baylor College of Medicine

Brief Summary:
This is a pilot study of avelumab in patients with non-metastatic, muscle invasive bladder cancer who are eligible for radical cystectomy (RC), but are ineligible for cisplatin based neoadjuvant therapy. The target recruitment is 10 evaluable patients for this window of opportunity study. Pre- and post-treatment tumor samples from transurethral resection of the bladder tumor and RC will be used for study endpoints.

Condition or disease Intervention/treatment Phase
Bladder Cancer Metastatic Bladder Cancer Invasive Bladder Cancer Drug: Avelumab Phase 1 Phase 2

Detailed Description:

Avelumab is a fully human monoclonal PD-L1 antibody of the immunoglobulin G1 (IgG1) subclass. It works by binding to PD-L1 on tumor cells, immune cells and/or stromal cells. This prevents PD-L1 from interacting with PD-1. Inhibition of this interaction increases activation/survival of antitumor lymphocytes. It also increases innate immunity by resulting in decreased PD-1 suppression of NK cell function and bolsters antibody production by B cells due to less PD-L1 binding of PD-1 on B-cells. Additionally, avelumab has been suggested to have another mechanism involving antibody dependent cellular cytotoxicity (ADCC). ADCC in these cases involves NK cell recognition and lysis of tumor cells that have antibody bound to PD-L1. By blocking PD-L1, avelumab leads to less CD80 binding by PD-L1 and more CD80-CD28 binding in response to antigen presentation to T-cells. This results in increased costimulatory signaling and is another mechanism by which avelumab may enhance T-cell activation.

Avelumab has been shown to be efficacious across multiple metastatic tumor types, including urothelial cancer. The phase Ib study has reported survival and safety outcomes with >12 months followup using pooled data on 249 patients with metastatic UC (Apolo et al, ESMO Sept 2017). Patients had been treated with a median of 2 prior therapies in the metastatic setting and 13 patients who were cisplatin-ineligible were evaluated for safety alone. PD-L1 expression was not a criterion for enrollment. The confirmed objective response rate (ORR) was 16.1%, with 5% complete responses and 11.2% partial responses. The 6-month progression-free survival was 27%. The ORR was better than or comparable to chemotherapy in historical controls. Among responders, 70.3% were maintained > 12 months. Treatment-related adverse events (AE) occurred in 70%, with 10.7% of the total with AE's of grade >3. Immune-mediated AE's occurred in 18.5%, of which 4% were grade >3. There is currently a phase III clinical trial ongoing comparing avelumab to standard of care chemotherapy in the second line setting or beyond for metastatic UC. Two other checkpoint inhibitors have been approved in the last 2 years for first line treatment of patients with metastatic UC who are ineligible for cisplatin-based therapy.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Window of Opportunity Trial: Avelumab in Non-metastatic Muscle Invasive Bladder Cancer (BL-AIR: Bladder Cancer-Avelumab for Invasive Resectable Disease)
Actual Study Start Date : December 14, 2018
Actual Primary Completion Date : December 9, 2019
Actual Study Completion Date : December 9, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Bladder Cancer
Drug Information available for: Avelumab

Arm Intervention/treatment
Experimental: Avelumab
Avelumab 10 mg/kg intravenously, over 60 minutes every 2 weeks for 3 cycles or 42 days.
Drug: Avelumab
avelumab 10 mg/kg intravenously every 2 weeks for 3 cycles or 42 days.
Other Name: MSB0010718C




Primary Outcome Measures :
  1. Change in T cell subpopulations [ Time Frame: pre-study time and 2-3 week post-operation ]
    The change in T cell subpopulations (CD8, CD4 and/or CD3) in tumor samples will be collected from FFPE tissue. FFPE tissue from the pre-study time point refers to tissue from the TURBT. FFPE tissue from the 2-3 week post-op time point refers to FFPE tissue from the RC


Secondary Outcome Measures :
  1. Pathological response rate [ Time Frame: pre-study time and 2-3 week post-operation ]
  2. 2 year disease free survival (DFS) [ Time Frame: 2 years after radical cystectomy ]
    A patient will be followed for recurrence and survival for up to 2 years after radical cystectomy.

  3. Rate of High grade(grade 3-4) adverse event [ Time Frame: 90 days post operation ]


Information from the National Library of Medicine

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.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Have undergone TURBT showing newly diagnosed muscle invasive UCB (mixed histology is allowed if the predominant histology is UCC) within 6 weeks prior to cycle 1, day 1 of treatment.
  • No prior systemic treatment for muscle invasive UCB
  • Clinical T2-T4a disease
  • No evidence of clinically positive lymph nodes or distant metastasis on computed tomography (CT) scans of chest and CT or magnetic resonance imaging (MRI) studies of the abdomen/pelvis. Imaging must be within 90 days of registration.
  • Male or female subjects aged ≥ 18 years old.
  • Must have adequate kidney, liver, and bone marrow function within 30 days of registration, as follows:
  • Absolute neutrophil count (ANC) ≥ 1.5 × 109/L
  • platelet count ≥ 100 × 109/L
  • hemoglobin ≥ 9 g/dL (may have been transfused)
  • Total bilirubin level ≤ 1.5 × ULN
  • AST and ALT levels ≤ 2.5 × ULN
  • Estimated creatinine clearance ≥ 30 mL/min according to the Cockcroft-Gault formula
  • Negative serum or urine pregnancy test at screening for women of childbearing potential (WOCBP), within 30 days of registration.
  • Both male and female subjects must agree to use highly effective contraception (see Section 6.1 Table 8) while receiving avelumab and for at least 60 days after last avelumab treatment if the risk of conception exists.

Female patients must agree to inform study coordinator or investigator immediately if they think they have become pregnant during the study.

  • Must have FFPE tissue available from the TURBT, and patient must consent to the use of tissue specimens from TURBT and RC for the study.
  • Patients must be ineligible for cisplatin-based NAC. Ineligibility criteria include: creatinine clearance < 60 ml/min by Cockcroft-Gault formula, CTCAE grade ≥ 2 hearing loss, CTCAE grade ≥ 2 neuropathy, and at discretion of medical oncologist.
  • Must be eligible for RC in the opinion of the treating investigator, and willing to undergo this procedure.
  • ECOG performance status (PS) score of 0-2
  • Signed informed consent form.

Exclusion Criteria:

Patients must not have any of the following:

  • IMMUNOSUPRESSANTS: Current use of immunosuppressive medication or within 4 weeks of C1D1, EXCEPT for the following: a. intranasal, inhaled, topical steroids, or local steroid injection (e.g., intra-articular injection); b. Systemic corticosteroids at physiologic doses ≤ 10 mg/day of prednisone or equivalent; c. Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication).
  • AUTOIMMUNE DISEASE: Active autoimmune disease that might deteriorate when receiving an immuno-stimulatory agent. Patients with diabetes type I, vitiligo, psoriasis, or hypo- or hyperthyroid diseases not requiring immunosuppressive treatment are eligible. Patients with type I diabetes or hypo- or hyperthyroidism should be on stable doses of medications for participation.
  • ORGAN TRANSPLANTATION: Prior organ transplantation including allogenic stem-cell transplantation.
  • INFECTIONS: Active infection requiring systemic therapy.
  • HIV/AIDS: Known history of testing positive for HIV or known acquired immunodeficiency syndrome.
  • HEPATITIS: Hepatitis B virus (HBV) or hepatitis C virus (HCV) infection at screening (positive HBV surface antigen or HCV RNA if anti-HCV antibody screening test positive)
  • VACCINATION: Vaccinate within 4 weeks of the first dose of avelumab and while on study drug is prohibited except for administration of inactivated vaccines
  • HYPERSENSITIIVTY TO STUDY DRUG: Known prior severe hypersensitivity to investigational product or any component in its formulations, including known severe hypersensitivity reactions to monoclonal antibodies (NCI CTCAE v4.03 Grade ≥ 3)
  • CARDIOVASCULAR DISEASE: Clinically significant (i.e., active) cardiovascular disease: cerebral vascular accident/stroke (< 6 months prior to enrollment), myocardial infarction (< 6 months prior to enrollment), unstable angina, congestive heart failure (≥ New York Heart Association Classification Class II), or serious cardiac arrhythmia requiring medication.
  • Other severe acute or chronic medical conditions including colitis, inflammatory bowel disease, pneumonitis, pulmonary fibrosis or psychiatric conditions including recent (within the past year) or active suicidal ideation or behavior; or laboratory abnormalities that may increase the risk associated with study participation or study treatment administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study.
  • Relapsed MIBC (all patients participating in the study should be newly diagnosed)
  • Concomitant UCC outside the bladder (e.g., ureter, urethra or renal pelvis)
  • Underlying immune disorder (e.g., combined variable immunodeficiency syndrome)
  • Erythropoietin receptor agonists within 30 days prior to enrollment.
  • G-CSF, GM-CSF or TPO mimetics during the study period or within 3 weeks prior to study enrollment
  • Malignancies other than UCB within 5 years prior to Cycle 1, Day 1, with the exception of those with low risk of metastasis or death treated with expected curative outcome (such as, but not limited to, adequately treated carcinoma in situ of the cervix, basal or squamous cell skin cancer, localized prostate cancer treated with curative intent and absence of PSA relapse, or ductal carcinoma in situ of the breast treated surgically with curative intent) or incidental prostate cancer (T1a, Gleason score ≤ 6 and PSA < 0.5 ng/ml)
  • Prior immunotherapy with T-cell co-stimulation or checkpoint targeted agents (e.g., CTLA-4 inhibitors, anti-PD1 antibodies or anti-PD-L1 antibodies)
  • Intravesical chemotherapy or biologic therapy within 6 weeks of Cycle 1, Day 1
  • Current participation in another clinical trial for MIBC
  • Nursing or pregnant woman
  • Uncontrolled cystitis, significant bladder pain or spasms, or gross hematuria that in the opinion of the principal investigator will preclude study participation
  • Major surgical procedures within 4 weeks of registration (other than for diagnosis) or anticipation that such a procedure will be needed during the study (other than RC)

Information from the National Library of Medicine

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): NCT03498196


Locations
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United States, Texas
Baylor College of Medicine Medical Center - McNair Campus
Houston, Texas, United States, 77030
Ben Taub General Hospital
Houston, Texas, United States, 77030
Michael E. DeBakey Veteran Affairs Medical Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
Baylor College of Medicine
Pfizer
Investigators
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Principal Investigator: Jennifer M. Taylor, MD Baylor College of Medicine
  Study Documents (Full-Text)

Documents provided by Jennifer Taylor, Baylor College of Medicine:
Study Protocol  [PDF] December 11, 2017


Additional Information:
Publications:
International Collaboration of Trialists; Medical Research Council Advanced Bladder Cancer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group); European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group; Australian Bladder Cancer Study Group; National Cancer Institute of Canada Clinical Trials Group; Finnbladder; Norwegian Bladder Cancer Study Group; Club Urologico Espanol de Tratamiento Oncologico Group, Griffiths G, Hall R, Sylvester R, Raghavan D, Parmar MK. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol. 2011 Jun 1;29(16):2171-7. doi: 10.1200/JCO.2010.32.3139. Epub 2011 Apr 18.

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Responsible Party: Jennifer Taylor, Assistant Professor of Urology, Baylor College of Medicine
ClinicalTrials.gov Identifier: NCT03498196    
Other Study ID Numbers: H-41207
First Posted: April 13, 2018    Key Record Dates
Last Update Posted: January 18, 2020
Last Verified: January 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Jennifer Taylor, Baylor College of Medicine:
muscle invasive bladder cancer
non-muscle invasive bladder cancer
radical cystectomy
monoclonal antibodies
Avelumab
Invasive Resectable disease
MIBC
NMIBC
neoadjuvant chemotherapy
Additional relevant MeSH terms:
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Urinary Bladder Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Urinary Bladder Diseases
Urologic Diseases
Antibodies, Monoclonal
Immunologic Factors
Physiological Effects of Drugs