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Genomic Based Assignment of Therapy in Advanced Urothelial Carcinoma

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ClinicalTrials.gov Identifier: NCT02788201
Recruitment Status : Recruiting
First Posted : June 2, 2016
Last Update Posted : September 10, 2019
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) )

Tracking Information
First Submitted Date  ICMJE May 28, 2016
First Posted Date  ICMJE June 2, 2016
Last Update Posted Date September 10, 2019
Actual Study Start Date  ICMJE March 27, 2017
Estimated Primary Completion Date July 1, 2020   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: June 12, 2019)
Percentage of patients success assigned a treatment within 3 weeks [ Time Frame: time to treatment assignment (approximately 3-5 weeks) ]
Treatment combination assigned by the COXEN algorithm.
Original Primary Outcome Measures  ICMJE
 (submitted: May 28, 2016)
Percentage of patients success assigned a treatment within 3 weeks [ Time Frame: time to treatment assignment (~3-5 weeks) ]
Change History Complete list of historical versions of study NCT02788201 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures  ICMJE
 (submitted: March 10, 2018)
  • Time to disease progression [ Time Frame: Progression ]
    Radiological assessment every 2 cycles to measure change intumor size until tumors increase.
  • Objective Response Rate [ Time Frame: end of treatment ]
    Proportion of patients whose tumors shrunk after therapy.
  • Average time that patients survive after COXEN intervention [ Time Frame: Death ]
    Median amount of time subject survives without disease progression after treatment.
  • Summary of Adverse events [ Time Frame: 30 days after the last dose ]
    List of adverse event frequency
Original Secondary Outcome Measures  ICMJE
 (submitted: May 28, 2016)
  • Time to disease progression [ Time Frame: Progression ]
  • Objective Response Rate [ Time Frame: end of treatment ]
  • Average time that patients survive after COXEN intervention [ Time Frame: Death ]
  • Summary of Adverse events [ Time Frame: 30 days after the last dose ]
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Genomic Based Assignment of Therapy in Advanced Urothelial Carcinoma
Official Title  ICMJE A Pilot Clinical Trial of Genomic Based Assignment of Therapy in Advanced Urothelial Carcinoma
Brief Summary

Background:

Advanced urothelial cancer has no cure. But only a few chemotherapy drugs have been tested for it. The Co-eXpression ExtrapolatioN (COXEN) model predicts if cells respond to treatment. It may also help determine which drugs fight urothelial cancer based on the characteristics of a tumor. Researchers want to test if this model can choose the best therapy for advanced urothelial cancer within 3 weeks and how tumors respond to the next best therapy.

Objective:

To test if the COXEN model can choose the best therapy for advanced urothelial cancer within 3 weeks.

Eligibility:

People ages 18 and older whose urothelial cancer has spread after at least 1 line of chemotherapy

Design:

Participants will be screened with medical history, physical exam, blood and urine tests, and tumor scans.

Participants will provide a tumor sample from a previous surgery and a new biopsy. A needle will remove a small piece of tumor.

Participants will repeat screening tests, plus have an EKG and scan. For the scan, they will get an injection of radioactive drug. They will lie in a machine that takes pictures.

Participants will take the drugs assigned by the COXEN model. They will have visits every 2 3 weeks. These will include blood and urine tests.

Participants will have tumor scans every 8 9 weeks.

Participants may have another biopsy.

Participants will take the drugs until they can t tolerate the side effects or their cancer worsens. They may be assigned to a second COXEN therapy.

Participants will have a follow-up visit 4 5 weeks after their last drug dose.

Participants will be contacted by phone every few months until death.

Detailed Description

Background:

  • Patients presenting de novo with metastatic bladder cancer, or developing visceral metastatic disease after local treatment, are incurable with currently available therapeutic modalities.
  • Only a small number of chemotherapeutic agents have been tested and very few have some single agent activity in the treatment of metastatic urothelial carcinoma. However most (>100) FDA approved anticancer agents have yet to be tested in this disease.
  • Novel approaches to the development of genomic predictors of chemosensitivity that do not require clinical trials for their identification are urgently needed in order to identify agents that are clinically effective when either repurposed or discovered de novo specifically for urothelial carcinoma. Such repurposing of an FDA approved anticancer agent in order to advance therapy from one cancer to another would require only minimal clinical development, saving billions of dollars and reducing the time required to reach routine clinical practice.
  • Our established extramural-intramural NCI collaboration pulls together significant expertise in biomarker development and clinical trial design in bladder cancer. The innovation of this group lies not only in the novel scientific approaches i.e. CoeXpression ExtrapolatioN (COXEN) under investigation, but also in the successful creation of a cohesive multi-institutional research collaboration dedicated to improved clinical outcomes in bladder cancer patients.
  • COXEN uses molecular profiles as a Rosetta Stone for translating drug sensitivities of one set of cancers into predictions for another completely independent set of cell lines or human tumors. The COXEN methodology has been scrutinized and deemed methodologically sound by peer review. The ability of COXEN to predict drug effectiveness in patients a priori, from purely in vitro assays, is unique as no other tool currently either in practice or in development provides similar results.

Objectives:

- To determine the feasibility of using the Co-eXpression ExtrapolatioN (COXEN) model in making a real-time treatment decision (within 3 weeks) in patients with advanced urothelial carcinoma.

Eligibility:

  • Patients must have a histologically confirmed diagnosis of metastatic, progressive urothelial carcinoma of the bladder, urethra, ureter, or renal pelvis.
  • Patients must have progressive metastatic disease defined as new or progressive lesions on cross-sectional imaging.
  • Patients must have at least:

    • One measurable site of disease (according to RECIST criteria)
    • Or, appearance of one new bone lesion
  • Patients must have been previously treated, as defined by treatment with at least one prior cytotoxic chemotherapy regimen or agent. Patients may have received any number of prior cytotoxic agents.
  • Archival tumor tissue must be available for enrollment.
  • Tumor amenable to biopsy will be mandatory for this study.
  • 18 years of age or older
  • ECOG performance status <2 (Karnofsky >60%)

Design:

  • This will be a pilot single-arm, open-label study using the COXEN score to select the best next therapy from a list of 75 FDA approved anti-neoplastic drugs, in patients with metastatic bladder cancer who have progressed despite treatment with cytotoxic chemotherapy. Combinations of the listed agents may also be utilized provided that phase 1 data are available.
  • The COXEN algorithm requires a multi-step process (pathology, tissue processing, mRNA profiling, bioinformatics, etc.) and is potentially labor intensive and time intensive.
  • Given the disease state of patients eligible for this protocol, using this algorithm to select a treatment would only be a worthwhile process to undertake if it can be demonstrated that a very high fraction of patients are likely to obtain the benefit from the procedure.
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 Carcinoma
  • Bladder Cancer
  • Urinary Bladder Neoplasms
Intervention  ICMJE
  • Drug: 75 approved agents
    One or combination of agents: Abiraterone, Arsenic Trioxide, Asparaginase Escherichia coli source, Axitinib, Azacitidine, Bendamustine, Bleomycin, Bortezomib, Busulfan, Carboplatin, Carfilzomib, Carmustine, Chlorambucil, Cisplatin, Cladribine, Clofarabine, Crizotinib, Cytarabine, Dacarbazine, Dactinomycin, Dasatinib, Daunorubicin, Decitabine, Docetaxel, Doxorubicin, Epirubicin, Eribulin, Erlotinib, Estramustine, Etoposide, Exemestane, Floxuridine, Fludarabine, Fluorouracil, Gefitinib, Gemcitabine, Hydroxyurea, Idarubicin, Ifosfamide, Imatinib, Irinotecan, Ixabepilone, Lapatinib, Lomustine, Mechlor, Melphalan, Mercapto, Methotrexate, Mitomycin, Mitotane, Mitoxantrone, Nilotinib, Oxaliplatin, Paclitaxel, Pazopanib, Pentostatin, Romidepsin, Ruxolitinib, Sorafenib, Streptozocinm, Sunitinib, Tamoxifen, Temsirolimus, Teniposide, Thioguanine, Thiotepa, Topotecan, Toremifene, Tretinoin, Vandetanib, Vemurafenib, Vinblastine, Vincristine, Vismodegib, and/or Vorinostat
  • Other: COXEN
    The COXEN algorithm will be used to determine the next best therapy from among 75 FDA approved agents (single agent or combination) in patients that have progressed on at least one chemotherapy regimen.
Study Arms  ICMJE Experimental: Arm 1
Treatment regimen selected by COXEN model
Interventions:
  • Drug: 75 approved agents
  • Other: COXEN
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 Recruiting
Estimated Enrollment  ICMJE
 (submitted: May 28, 2016)
20
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE July 1, 2021
Estimated Primary Completion Date July 1, 2020   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE
  • INCLUSION CRITERIA:
  • Patients must have a histologically confirmed diagnosis of metastatic, progressive urothelial carcinoma of the bladder, urethra, ureter, or renal pelvis.
  • Patients must have progressive metastatic disease defined as new or progressive lesions on cross-sectional imaging.
  • Patients must have at least:

    • One measurable site of disease (according to RECIST criteria), defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as more than or equal to 20 mm with conventional techniques or as less than or equal to 10 mm with spiral CT scan.
    • Or, appearance of one new bone lesion
  • Patients must have been previously treated with at least one prior cytotoxic chemotherapy regimen or agent. Patients may have received any number of prior cytotoxic agents.
  • Archival tumor tissue must be available for enrollment.
  • Tumor amenable to biopsy will be mandatory for this study.
  • Age more than or equal to 18 years. ECOG performance status less than or equal to 2 (Karnofsky more than or equal to 60%,).
  • Patients must have normal organ and marrow function as defined below:

    • hemoglobin more than or equal to 9 g/dL
    • leukocytes more than or equal to 3,000/mcL
    • absolute neutrophil count more than or equal to 1,200/mcL
    • platelets more than or equal to 75,000/mcL
    • total bilirubin within normal institutional limits
    • AST(SGOT)/ALT(SGPT) less than or equal to 2.5 X institutional upper limit of normal
    • creatinine 1.5 x the normal institutional limits

OR

--creatinine clearance more than or equal to 40 mL/min/1.73 m2

  • Because many of the therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.
  • HIV-positive patients on combination antiretroviral therapy may be eligible if there are no pharmacokinetic interactions with the agents used on the study, stable on CART therapy and CD4 is >200 and viral load is undetectable.
  • Ability of subject to understand and the willingness to sign a written informed consent document.

EXCLUSION CRITERIA:

  • The patient has received cytotoxic chemotherapy (including investigational cytotoxic chemotherapy) within 3 weeks or biologic agents (e.g., cytokines or antibodies) within 4 weeks prior to study enrolllment.
  • Patients who are receiving any investigational agents.
  • Patients with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events. Patients with brain metastases that are stable after more than or equal to 1 year after primary surgery or radiation will not be excluded.
  • The subject has not recovered to baseline or CTCAE less than or equalto Grade 1 from toxicity due to all prior therapies except alopecia and other non-clinically significant AEs.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Patients who are Hepatitis B or C positive.
  • Pregnant women are excluded from this study because the agents used in the study have the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with these agents, breastfeeding should be discontinued if the mother is treated with these agents. These potential risks may also apply to other agents used in this study.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 100 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Marissa B Mallek, R.N. (240) 760-7498 marissa.mallek@nih.gov
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT02788201
Other Study ID Numbers  ICMJE 160121
16-C-0121
Has Data Monitoring Committee Not Provided
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE Not Provided
Responsible Party National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) )
Study Sponsor  ICMJE National Cancer Institute (NCI)
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Andrea B Apolo, M.D. National Cancer Institute (NCI)
PRS Account National Institutes of Health Clinical Center (CC)
Verification Date June 11, 2019

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