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First-line Gemcitabine/Cisplatin +/- Avelumab in Locally Advanced or Metastatic Bladder Carcinoma (GCISAVE)

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: NCT03324282
Recruitment Status : Terminated (ANSM's refusal to validate ATU requests for avelumab in bladder cancer, Decrease in recruitment, Most investigators would like to offer avelumab for maintenance, Absence of benefit to the chemo-immuno combination (pembro+gem-platinum) in phase III)
First Posted : October 27, 2017
Last Update Posted : May 3, 2022
Sponsor:
Information provided by (Responsible Party):
University Hospital, Bordeaux

Brief Summary:
This study will assess efficacy (based on response rate) and safety (based on grade ≥ 3 severe adverse effects) of the combination Gemcitabine Cisplatin (GC) + anti-PD-L1 (avelumab) in first-line treatment for locally advanced or metastatic urothelial bladder cancer patients, after 6 cycles of treatment (or at 18 weeks if less than 6 cycles have been given, or earlier if a second line treatment is needed, before this new anticancer treatment has been started).

Condition or disease Intervention/treatment Phase
Bladder Carcinoma Drug: Avelumab Drug: GC Phase 2

Detailed Description:

Recent results in cancer research highlight the importance of immune checkpoints in the control of immune response and provide access to molecules interfering with the inhibited immune response during the development of cancer. Drugs targeted against CTLA-4, PD-1 or PD-L1 have shown efficacy in various tumor types. In locally advanced or metastatic urothelial bladder cancer (MBC), the standard first-line treatment is the association of Gemcitabine and Cisplatin (GC). Objective responses and prolonged objective responses have been reported with monoclonal antibodies against PD-1 or PD-L1 in MBC patients after failure of chemotherapy. Avelumab is an investigational fully human anti-PD-L1 IgG1 monoclonal antibody. Avelumab treatment did not show unexpected cross-toxicity with chemotherapy when studied in phase I / II in patients with different tumor types. So the combination at full doses of GC and avelumab seems appropriate.

The experimental treatment is a combination of GC and avelumab given for 6 cycles. The duration of each cycle is 3 weeks (Gemcitabine: dose of 1000 mg/m2 as an intravenous infusion over 30 minutes on Days 1 and 8 of each 21-day cycle; Cisplatin: dose of 70 mg/m2 as a slow intravenous infusion over 2 to 4 hours on Day 1 of each 21-day cycle; Avelumab: 10 mg/kg body weight administered Iv once every 3 weeks).

Patients who have received all scheduled treatments and whose disease has not progressed at the end of treatment will enter into disease follow-up. During this follow-up period, patients will have disease and safety assessments performed every 3 months. Patients will remain in follow-up for up to 1 year from last dose of treatment and will have survival follow-up.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 65 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Gemcitabine-cisplatin Plus Avelumab or Gemcitabine-cisplatin as First-line Treatment of Patients With Locally Advanced or Metastatic Urothelial Bladder Carcinoma (GCISAVE)
Actual Study Start Date : February 23, 2018
Actual Primary Completion Date : December 31, 2021
Actual Study Completion Date : January 14, 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Bladder Cancer

Arm Intervention/treatment
Experimental: Arm A: GC + avelumab group Drug: Avelumab
Combination of Gemcitabin-Cisplatin and avelumab given for 6 cycles (each cycle is 21 days)

Drug: GC
Combination of Gemcitabin-Cisplatin given for 6 cycles (each cycle is 21 days)

Active Comparator: Arm B: GC group Drug: GC
Combination of Gemcitabin-Cisplatin given for 6 cycles (each cycle is 21 days)




Primary Outcome Measures :
  1. Efficacy: objective response rate with RECIST 1.1 with GC + avelumab [ Time Frame: At the end of cycle 6 (each cycle is 21 days) ]
  2. Safety: proportion of severe toxicity with GC + avelumab [ Time Frame: At the end of cycle 6 (each cycle is 21 days) ]

Secondary Outcome Measures :
  1. Immunological capacities in peripheral blood of GC alone and GC+avelumab groups [ Time Frame: During treatment and after the 6 cycles of treatment (EOT + 3, 6, 9 and 12 months ]
  2. Specific immunological toxicity documented and recorded using NCI CTCAE version 4.0 [ Time Frame: At the end of cycle 6 (each cycle is 21 days) ]
  3. Duration of response [ Time Frame: Up to 18 months ]
  4. Progression-free survival [ Time Frame: At 18 months in GC+avelumab treated patients ]
  5. Overall survival [ Time Frame: At 18 months in GC+avelumab treated patients ]
  6. GC+avelumab efficacy according to the expression of PD-L1 at the tumor site [ Time Frame: At the end of cycle 6 (each cycle is 21 days) ]
  7. GC+avelumab efficacy according to the immune infiltrate populations at the tumor level and/or the tumor surroundings [ Time Frame: At the end of cycle 6 (each cycle is 21 days) ]


Information from the National Library of Medicine

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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:

  1. Signed and dated informed consent;
  2. Male or female, age ≥18 years at time of informed consent signature;
  3. Histological confirmed locally advanced (any T N2-3) or metastatic urothelial bladder carcinoma, eligible to first-line treatment (previous neo adjuvant or adjuvant treatment must have been given and stopped more than one year before);
  4. Evidence of progressive disease in the previous 6 months, documented by chest and/or abdominal CT-scan or MRI;
  5. Measurable disease according to RECIST 1.1;
  6. Karnofsky index ≥ 70%;
  7. Availability of a representative formalin-fixed, paraffin-embedded (FFPE) tumour specimen (infiltrative urothelial bladder carcinoma or metastasis) collected within 12 months before Cycle 1 Day 1;
  8. At least 3 weeks since the end of prior local intravesical treatment (BCG-therapy or ametycine) with resolution of all treatment-related toxicity to grade ≤1 (NCI CTCAE 4.0);
  9. Palliative local treatment is allowed if performed ≥ 2 weeks prior study entry for radiotherapy, cimentoplasty or minor surgery, and ≥4 weeks for major surgery;
  10. Adequate organ function as defined by the following criteria:

    1. Absolute White Blood Cells count (WBC) ≥ 2000 cells/mm3
    2. Absolute Neutrophils count (ANC) ≥ 1500 cells/mm3
    3. Platelets ≥100 000 cells/mm3
    4. Hemoglobin ≥ 9.0 g/dL
    5. Total bilirubin level ≤ 1.5 × the upper limit of normal (ULN) range and AST and ALT levels ≤ 2.5 × ULN or AST and ALT levels ≤ 5 x ULN (for subjects with documented metastatic disease to the liver).
    6. Calculated creatinine clearance ≥ 60 mL/min
  11. Women of childbearing potential must have a negative serum βHCG or urine pregnancy test within 7 days prior to initiation of treatment; both sexually active females and males (and their female partners) patients must agree to use two methods of effective contraception one of them being a barrier method, or to abstain from sexual activity during the study, for at least 3 months after the last administration of study treatment;
  12. Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures;
  13. Patient affiliated to a social security system or beneficiary of the same.

Exclusion Criteria:

  1. Other prior first-line therapy;
  2. Any concurrent chemotherapy, immunotherapy, biologic or hormonal therapy for cancer treatment; focal radiation therapy less than 14 days prior to the first day of the first cycle;
  3. Other invasive malignancy within 3 years (except for locally curable cancers that have been apparently cured, such as basal or squamous cell skin cancer, superficial bladder cancer, or carcinoma in situ of the prostate, cervix or breast); Patient with low risk prostate cancer (defined as Stage T1/T2a, Gleason score ≤ 7 and PSA ≤ 10ng/mL) who are treatment-naïve and undergoing active surveillance are eligible;
  4. Persisting toxicity related to prior therapy (NCI CTCAE v. 4.03 Grade > 1); however, alopecia, sensory neuropathy Grade ≤ 2, or other Grade ≤ 2 not constituting a safety risk based on investigator's judgment are acceptable;
  5. Symptomatic central nervous system (CNS) metastases or untreated CNS metastases requiring concurrent treatment;
  6. 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;
  7. Uncontrolled adrenal insufficiency;
  8. Active chronic liver disease;
  9. 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;
  10. Active infection requiring systemic antibiotic;
  11. Vaccination within 4 weeks of the first dose of avelumab and while on trials is prohibited except for administration of inactivated vaccines;
  12. Current use of immunosuppressive medication, 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);
  13. Major surgery less than 28 days prior to the first day of the first cycle. Minor surgery less than 14 days prior to the first day of the first cycle;
  14. 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;
  15. History of primary immunodeficiency;
  16. History of organ transplant including allogeneic stem-cell transplantation;
  17. 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);
  18. Women who are pregnant or lactating;
  19. Known history of testing positive for HIV or known acquired immunodeficiency syndrome;
  20. Positive test for hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus ribonucleic acid (HCV RNA) indicating acute or chronic infection.

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): NCT03324282


Locations
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France
CHU de Besançon
Besançon, France
CHU de Bordeaux
Bordeaux, France
Institut Bergonié
Bordeaux, France
Centre François Baclesse
Caen, France
Centre Léon Bérard
Lyon, France
Institut Paoli Calmettes
Marseille, France
Institut de cancérologie de l'Ouest - René Gauducheau
Nantes, France
Hôpital Européen Georges-Pompidou, AP-HP
Paris, France
Hôpital Saint-Louis, AP-HP
Paris, France
CHU de Poitiers
Poitiers, France
CHU de Strasbourg
Strasbourg, France
Institut Universitaire du Cancer de Toulouse - Oncopole
Toulouse, France
Institut Gustave Roussy
Villejuif, France
Sponsors and Collaborators
University Hospital, Bordeaux
Investigators
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Principal Investigator: Alain RAVAUD, MD. PhD University Hospital, Bordeaux
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: University Hospital, Bordeaux
ClinicalTrials.gov Identifier: NCT03324282    
Other Study ID Numbers: CHUBX 2016/33
First Posted: October 27, 2017    Key Record Dates
Last Update Posted: May 3, 2022
Last Verified: April 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by University Hospital, Bordeaux:
Anti PD1
Bladder carcinoma
Chemotherapy
Immunological monitoring
Additional relevant MeSH terms:
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Carcinoma
Urinary Bladder Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Urinary Bladder Diseases
Urologic Diseases
Avelumab
Antineoplastic Agents, Immunological
Antineoplastic Agents