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Trial record 10 of 26 for:    upper tract urothelial

Clinical Trial Of Neoadjuvant Chemotherapy (NAC)In Upper Tract Urothelial Carcinoma (UTUC)

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ClinicalTrials.gov Identifier: NCT01663285
Recruitment Status : Terminated (Low study participant enrollment.)
First Posted : August 13, 2012
Results First Posted : September 18, 2014
Last Update Posted : December 3, 2015
Sponsor:
Information provided by (Responsible Party):
University of Michigan Rogel Cancer Center

Tracking Information
First Submitted Date  ICMJE July 24, 2012
First Posted Date  ICMJE August 13, 2012
Results First Submitted Date  ICMJE September 11, 2014
Results First Posted Date  ICMJE September 18, 2014
Last Update Posted Date December 3, 2015
Study Start Date  ICMJE September 2012
Actual Primary Completion Date January 2014   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: September 11, 2014)
Recurrence-free Survival Time [ Time Frame: 2 years after participant surgery ]
The 2-year recurrence-free survival (RFS) time for patients treated with neoadjuvant cisplatin and gemcitabine chemotherapy followed by surgery in high risk upper tract urothelial carcinoma.
Original Primary Outcome Measures  ICMJE
 (submitted: August 8, 2012)
Recurrence-free survival [ Time Frame: 2 years after participant surgery ]
To assess the 2-year recurrence-free survival (RFS) rate of patients treated with neoadjuvant cisplatin and gemcitabine chemotherapy followed by surgery in high risk upper tract urothelial carcinoma.
Change History Complete list of historical versions of study NCT01663285 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures  ICMJE
 (submitted: November 4, 2015)
  • Number of Patients With Pathologic T0/Tis/Ta N0. [ Time Frame: 51 months ]
    The proportion of patients with pathologic T0/Tis/Ta N0.
  • Number of Participants With Adverse Events [ Time Frame: 9 years ]
    The safety of neoadjuvant chemotherapy.
Original Secondary Outcome Measures  ICMJE
 (submitted: August 8, 2012)
  • Rate of Bladder Cancer Stage. [ Time Frame: 51 months ]
    To evaluate the frequency and proportion of patients with pathologic T0/Tis/Ta N0.
  • Number of Participants With Adverse Events [ Time Frame: 9 years ]
    To evaluate the safety of neoadjuvant chemotherapy.
  • Tumor Sequencing [ Time Frame: 9 years ]
    Integrative tumor sequencing of surgically resected tumor specimens.
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Clinical Trial Of Neoadjuvant Chemotherapy (NAC)In Upper Tract Urothelial Carcinoma (UTUC)
Official Title  ICMJE Phase II Clinical Trial Of Neoadjuvant Chemotherapy (NAC)In Upper Tract Urothelial Carcinoma (UTUC)
Brief Summary

The main purpose of this study is to look at the cancer-free survival at two years of subjects with high risk upper tract urothelial cancer when treated with the combination of two chemotherapy drugs called Gemcitabine and Cisplatin followed by surgery to remove the kidney, all or part of the ureter (ureters are tubes made of smooth muscle fibers that propel urine from the kidneys to the urinary bladder), and a cuff of bladder where the ureter drains into the bladder. Other purposes of the study include looking at the safety of Gemcitabine and Cisplatin before surgery for this type of cancer, time to recurrence of cancer, and overall survival.

Exploratory integrative tumor sequencing:

The purpose of this part of the study is to test deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) in various types of samples (tissue and blood) to detect different types of cancer genetic changes in upper tract urothelial cancer (UTUC) to help develop future studies in UTUC. DNA and RNA contain key instructions for cell function and help determine the characteristics of each individual such as hair, eye, and skin color, height, susceptibility to diseases, and other characteristics.

Detailed Description

In recent years, the combination of gemcitabine and cisplatin given every 21 days (gemcitabine on days 1 and 8 only) has been used in trials and routine clinical practice. Additionally, surgery, primarily radical nephroureterectomy (RNU) with bladder cuff removal, is the current standard treatment for invasive upper tract urothelial carcinoma.

Upper tract urothelial cancer (UTUC) or urothelial cancer arising in the pelvicalyceal or ureteral locations is a lethal cancer accounting for 5% of all urothelial cancers. In urothelial cancer of the bladder, randomized clinical trials and meta-analyses have shown a survival advantage with neoadjuvant cisplatin-based chemotherapy. It is conceivable that a similar approach may benefit patients with UTUC.

Both Gemcitabine and Cisplatin are approved by the FDA. Cisplatin is approved for use in urothelial cancer. Gemcitabine is FDA approved to be used alone or with other drugs to treat breast, non-small lung, ovarian, and pancreatic cancers. Gemcitabine is not approved by the FDA for urothelial cancer, but it is typically used together with Cisplatin in trials and routine clinical practice for treating urothelial cancer.

Exploratory integrative tumor sequencing:

The biology of UTUC is poorly understood due to the relative rarity of the disease and the lack of comprehensive genomic and translational studies. This trial offers a rare opportunity to apply high-throughput sequencing techniques in UTUC to detect several classes of cancer mutations including structural rearrangements, copy number alterations, point mutations, and gene expression alterations. This research could help to develop future studies in UTUC to help researchers understand more about UTUC and how to treat it. Additionally, we may identify a potentially important result from DNA samples from subjects that could possibly help manage their cancer better by pursing a different cancer therapy rather than the study therapy.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 2
Study Design  ICMJE Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE
  • Urothelial Cancer
  • Bladder Cancer
Intervention  ICMJE Drug: Neoadjuvant Cisplatin and Gemcitabine
Cisplatin 70 mg/m2 through IV for 60 minutes on day 1 of each cycle. Gemcitabine 1,000 mg/m2 IV for 30 minutes on days 1 and 8 during each cycle. Treatment is expected to continue for up to 4 cycles. Chemotherapy will be followed by radical nephroureterectomy within 6 weeks (+/- 2 weeks) from the last date of chemotherapy.
Study Arms  ICMJE Experimental: Neoadjuvant Gemcitabine and Cisplatin
Cisplatin 70 mg/m2 through IV for 60 minutes on day 1 of each cycle. Gemcitabine 1,000 mg/m2 IV for 30 minutes on days 1 and 8 during each cycle. Treatment is expected to continue for up to 4 cycles. Chemotherapy will be followed by radical nephroureterectomy within 6 weeks (+/- 2 weeks) from the last date of chemotherapy.
Intervention: Drug: Neoadjuvant Cisplatin and Gemcitabine
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Terminated
Actual Enrollment  ICMJE
 (submitted: February 12, 2014)
1
Original Estimated Enrollment  ICMJE
 (submitted: August 8, 2012)
55
Actual Study Completion Date  ICMJE January 2014
Actual Primary Completion Date January 2014   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Patients must have HIGH GRADE upper tract urothelial carcinoma
  • Patients must be considered to be a candidate for surgery with curative intent (nephroureterectomy or distal ureterectomy) with lymph node dissection by the treating urologist at baseline within 42 days prior to registration.
  • Patients must be able to care for themselves and must be up and about more than 50% of waking hours
  • All patients must be evaluated by a medical oncologist at baseline within 42 days prior to registration. Patients must be considered to be a candidate for cisplatin-based neoadjuvant chemotherapy by a medical oncologist at baseline and must have adequate kidney function and any pre-existing peripheral neuropathy must be moderate to mild.
  • Prior uro-oncologic history:

    • History of or active non-invasive carcinoma or carcinoma in situ of the bladder or upper tract is allowed.
    • Patients may have received prior intravesical chemotherapy or immunotherapy such as BCG.
    • Prior neoadjuvant chemotherapy for bladder cancer or invasive contralateral upper tract cancer is allowed.
    • Prior adjuvant chemotherapy for bladder cancer or invasive contralateral upper tract cancer is allowed but must have been completed ≥2 years prior to study registration.
  • Patients must have adequate organ and bone marrow function as determined by screening tests
  • Patients must have recovered from any reversible toxicities of prior procedure or surgery
  • Patients must be 18 years or older on date of registration
  • All patients must be informed of the investigational nature of this study and must sign an informed consent document

Exclusion Criteria:

  • Patients must have no evidence of regional lymphadenopathy or distant metastasis on imaging.
  • No history of invasive or node positive or metastatic bladder cancer or invasive contralateral upper tract cancer within 2 years prior to registration.
  • Patients with one kidney are not eligible
  • Patients may not be enrolled in another interventional clinical trial at the time of registration.
  • No prior non-urothelial malignancy is allowed, except for cancer from which the patient has been disease free for at least 1 year at the discretion of the treating oncologist. History of adequately treated (at the discretion of the treating oncologist) basal cell or squamous cell skin cancer or in situ cervical cancers is allowed.
  • Pregnant or lactating women are not eligible. Women/men of reproductive potential must agree to use an effective contraceptive method. Women with reproductive potential must have a negative pregnancy test within 14 days prior to registration.
  • Patients must not have any other medical condition(s) that make(s) their participation in the study unadvisable in the opinion of the treating oncologist.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT01663285
Other Study ID Numbers  ICMJE UMCC 2012.038
HUM00062285 ( Other Identifier: University of Michigan IRBMED )
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Responsible Party University of Michigan Rogel Cancer Center
Study Sponsor  ICMJE University of Michigan Rogel Cancer Center
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Ajjai S. Alva, M.D. University of Michigan
PRS Account University of Michigan Rogel Cancer Center
Verification Date November 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP