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Phase Ib Feasibility Trial of Neoadjuvant Nivolumab/Lirilumab in Cisplatin-Ineligible Muscle-Invasive Bladder Cancer (PrE0807)

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ClinicalTrials.gov Identifier: NCT03532451
Recruitment Status : Recruiting
First Posted : May 22, 2018
Last Update Posted : December 7, 2018
Sponsor:
Collaborator:
Bristol-Myers Squibb
Information provided by (Responsible Party):
PrECOG, LLC.

Brief Summary:

Patients with muscle-invasive bladder cancer (MIBC) who can not receive cisplatin therapy will receive nivolumab or nivolumab/lirilumab before a planned surgical procedure called a radical cystectomy (RC) to remove the bladder.

Nivolumab works by attaching to and blocking a molecule called Programmed Death-1 (PD-1). Lirilumab attaches to and blocks a group of molecules called Killer Cell Immunoglobulin-Like Receptor (KIR). PD-1 and KIR are proteins present mainly on immune system cells, and each controls part of the immune system by shutting it down. It is hoped that by binding to and inactivating these proteins, these drugs can enhance the body's ability to detect, attack and destroy cancer cells.

The purpose of this research study is to see whether nivolumab alone or combination of nivolumab and lirilumab given before surgery is effective in treating people who have bladder cancer, and to examine the side effects, good and bad, associated with nivolumab and lirilumab.


Condition or disease Intervention/treatment Phase
Bladder Cancer Drug: Nivolumab Drug: Nivolumab/Lirilumab Phase 1

Detailed Description:

Bladder cancer (BC) is the 6th most common malignancy in the United States with an estimated 79,030 new cases and 16,870 deaths in 2017. It is the 4th most common cancer in men and there are presently >500,000 BC patients alive in the US. It accounts for about 5% of all new cancers in the US. It is also the most expensive cancer to treat from diagnosis to death. Almost a third of BC patients present with MIBC.

This is a Phase Ib open-label clinical trial for patients with cisplatin-ineligible MIBC (Stage T2-T4a, N0-N1, M0). Neoadjuvant treatment must start within 8 weeks of transurethral resection of the first transurethral resection of bladder tumor (TURBT) that showed muscularis propria invasion.

Patients must have sufficient baseline tumor tissue. Tumor tissue content for CD8+ T-cell density assessment must be qualified as sufficient (≥ 20% tumor content in the specimen) for analysis and must be documented by the local pathologist prior to registration.

The first 12 patients will be enrolled into Cohort 1 and treated with nivolumab before a planned RC.

In the absence of the occurrence of high rate of treatment related Adverse Events (AEs) with nivolumab, the study will proceed with enrollment into Cohort 2 with the combination of nivolumab/lirilumab before a planned RC.

Each group will receive a total of 2 doses (week 0 and 4) of nivolumab (Cohort 1) or nivolumab/lirilumab (Cohort 2) therapy followed by RC with bilateral (standard or extended) pelvic lymph node dissection (PLND).

Mandatory tumor tissue at Screening (archived tumor tissue from Transurethral Resection of Bladder Tumor [TURBT] may be used) and at time of RC. Peripheral blood and urine samples are also required.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 43 participants
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Intervention Model Description: Cohort 1: Nivolumab alone. In the absence of the occurrence of high rate of treatment related adverse events, the study will proceed with enrollment into Cohort 2: Nivolumab/Lirilumab.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase Ib Feasibility Trial of Neoadjuvant Nivolumab/Lirilumab in Cisplatin-Ineligible Muscle-Invasive Bladder Cancer
Estimated Study Start Date : December 2018
Estimated Primary Completion Date : December 2020
Estimated Study Completion Date : September 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Bladder Cancer

Arm Intervention/treatment
Experimental: Cohort 1: Nivolumab
Nivolumab 480 mg IV on week 0 and week 4
Drug: Nivolumab
Nivolumab 480 mg intravenously (IV) over approximately 30 minutes every 4 weeks for 2 neo-adjuvant doses (week 0 and 4) followed by RC with bilateral (standard or extended) PLND as soon as possible but within 6 weeks after the last neoadjuvant infusion.
Other Name: Opdivo

Experimental: Cohort 2: Nivolumab/Lirilumab
Nivolumab 480 mg IV and Lirilumab 240 mg on week 0 and week 4
Drug: Nivolumab/Lirilumab
Nivolumab 480 mg IV over approximately 30 minutes every 4 weeks for 2 neo-adjuvant doses (week 0 and 4) with at least a 30 minute rest between infusions followed by lirilumab 240 mg IV over approximately 60 minutes every 4 weeks for 2 neo-adjuvant doses (week 0 and 4) followed by RC with bilateral (standard or extended) PLND as soon as possible but within 6 weeks after the last neoadjuvant infusion.
Other Names:
  • Opdivo
  • BMS-986015




Primary Outcome Measures :
  1. Number of Participants with Treatment-Related Adverse Events as Assessed by CTCAE V5.0 [ Time Frame: 30 months ]
    Number of patients with Grade 3 or higher adverse events (AEs) related to nivolumab and nivolumab/lirilumab


Secondary Outcome Measures :
  1. Change in CD8+ Tumor-Infiltrating Lymphocytes (TIL) Density [ Time Frame: 54 months ]
    Change (#) in CD8+ TIL density from pre-treatment TURBT to post-treatment RC tissues in patients treated with nivolumab and nivolumab/lirilumab

  2. Percent Change in CD8+ TIL Density [ Time Frame: 54 months ]
    Percent change in CD8+ TIL density from pre-treatment TURBT to post-treatment RC tissues in patients treated with nivolumab and nivolumab/lirilumab

  3. Number of Patients unable to undergo RC [ Time Frame: 30 months ]
    Number of patients in each cohort who do not get RC within 6 weeks after completion of neoadjuvant treatment related to treatment-related AEs

  4. Complete Response Rate [ Time Frame: 30 months ]
    Measured by pathologic complete (pT0N0) and partial (<pT2N0) response rate at time of RC in the two cohorts

  5. Recurrence-Free Survival (RFS) [ Time Frame: 54 months ]
    Rate of RFS at the two-year time point from the time of registration in patients treated with nivolumab and nivolumab/lirilumab

  6. Immunohistochemistry (IHC) Change [ Time Frame: 54 months ]
    Change in expression for pathologic partial and complete tumor response (defined by cystectomy pathologic staging <pT2N0 and pT0N0, respectively), in patients treated with nivolumab and nivolumab/lirilumab

  7. Peripheral Blood Mononuclear Cell (PBMC) T-Cell Subset Change [ Time Frame: 54 months ]
    %CD4+ T-cells will be assessed via flow cytometry and the change will be measured



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
  • Patients must have histologically confirmed MIBC (T2-T4a, N0-N1, M0 per American Joint Commission on Cancer [AJCC]) pure or mixed histology urothelial carcinoma. Clinical node-positive (N1) patients are eligible provided the lymph nodes (LNs) are confined to the true pelvis and are within the planned surgical LN dissection template.
  • The initial TURBT that showed muscularis propria invasion should be within 8 weeks prior to beginning study therapy. Patients must have sufficient baseline tumor tissue from either initial or repeat TURBTs. The local site pathologist will be asked to estimate and record the rough approximate percentage of viable tumor in the TURBT sample (initial or repeat TURBT with highest tumor content) to document at least 20% viable tumor content prior to registration.
  • Patients must be ineligible for cisplatin-based chemotherapy due to any of the following:

    • Creatinine clearance(CrCl) <60 mL/min with Easter Cooperative Oncology Group (ECOG) Performance Status (PS) 0-1
    • Hearing impaired ≥ Grade 2 by CTCAE criteria
    • Neuropathy ≥ Grade 2 by CTCAE criteria
    • Heart failure New York Heart Association (NYHA) ≥ III
  • Patients must be medically fit for TURBT and RC.
  • Age ≥ 18 years.
  • Ability to understand and willingness to sign Institutional Review Board (IRB)-approved informed consent.
  • Willing to provide tumor tissue, blood, and urine samples for research.
  • Adequate organ function as measured by the following criteria, obtained ≤ 4 weeks prior to registration:

    • Absolute Neutrophil Count (ANC) ≥ 1000/mm³ (stable off growth factor within 4 weeks of first study drug administration)
    • Platelets ≥ 100,000/mm³
    • Hemoglobin ≥ 8 g/dL
    • Serum Creatinine Clearance ≥ 30 mL/min using the Cockcroft-Gault formula
    • Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) ≤ 3x Upper Limit of Normal (ULN)
    • Total Bilirubin ≤ 1.5x ULN (in the absence of previously diagnosed Gilbert's disease)
  • Women must not be pregnant or breastfeeding since we do not know the effects of nivolumab and lirilumab on the fetus or breastfeeding child.
  • Sexually active women of child-bearing potential with a non-sterilized male partner and sexually active men must agree to use 2 methods of adequate contraception (hormonal plus barrier or 2 barrier forms) OR abstinence prior to study entry, for the duration of study participation, and for 5 months for women and 7 months for men following last dose of study drugs.
  • Active or prior documented autoimmune disease within the past 2 years prior to Screening or other immunosuppressive agent within 14 days of study treatment.
  • Patients may not have locally advanced unresectable or metastatic urothelial carcinoma as assessed on baseline radiographic imaging obtained within 28 days prior to study registration.
  • Patients may not have concurrent upper urinary tract (i.e. ureter, renal pelvis) invasive urothelial carcinoma. Patients with history of non-invasive (Ta, Tis) upper tract urothelial carcinoma that has been definitively treated with at least one post-treatment disease assessment (i.e. cytology, biopsy, imaging) that demonstrates no evidence of residual disease are eligible.
  • Patients may not have another malignancy that could interfere with the evaluation of safety or efficacy of the study drugs. Patients with a prior malignancy will be allowed without study chair approval in the following circumstances:

    • Not currently active and diagnosed at least 3 years prior to the date of registration.
    • Non-invasive diseases such as low risk cervical cancer or any cancer in situ.
    • Localized (early stage) cancer treated with curative intent (without evidence of recurrence and intent for further therapy), and in which no chemotherapy was indicated.(e.g. low/intermediate risk prostate cancer, etc.).
  • Patients may not have received any prior immune checkpoint inhibitor (i.e. anti-KIR, anti-PD-1, anti-PD-L1, or other).
  • Patients may not have undergone major surgery (e.g. intra-thoracic, intra-abdominal or intra-pelvic), open biopsy or significant traumatic injury or specific anti-cancer treatment ≤ 4 weeks prior to starting study drug, or patients who have had percutaneous biopsies or placement of vascular access device ≤ 1 week prior to starting study drug, or who have not recovered from side effects of such procedure or injury.
  • Patients must not have clinically significant cardiac disease.
  • Patients may not have chronic active liver disease or evidence of acute or chronic Hepatitis B Virus (HBV) or Hepatitis C (HCV).
  • Patients may not have known diagnosis of human immunodeficiency virus (HIV) infection. Testing is not required in absence of clinical suspicion.
  • Patients may not have known diagnosis of any condition (e.g. post-hematopoietic or solid organ transplant, pneumonitis, inflammatory bowel disease, etc.) that requires chronic immunosuppressive therapy. Usage of non-steroidal anti-inflammatory medications (NSAIDS) for the treatment of osteoarthritis and uric acid synthesis inhibitors for the treatment of gout are permitted.
  • Patients with any serious and/or uncontrolled concurrent medical conditions (e.g. active or uncontrolled infection, uncontrolled diabetes) or psychiatric illness that could, in the investigator's opinion, cause unacceptable safety risks or potentially interfere with the completion of the treatment according to the protocol are not eligible.
  • Patients may not have any live viral vaccine used for prevention of infectious diseases within 4 weeks prior to study drug(s).
  • Patients unwilling or unable to comply with the protocol.

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): NCT03532451


Contacts
Contact: Carolyn Andrews, RN 267-207-4070 candrews@precogllc.org

Locations
United States, Texas
University of TX Southwestern Recruiting
Dallas, Texas, United States, 75390
Contact: Allison Beaver Beaver    214-645-8788    allison.beaver@utsouthwestern.edu   
Contact: Darren Fleming    214-648-8310    darren.fleming@utsouthwestern.edu   
Principal Investigator: Kevin Courtney, MD         
United States, Virginia
University of Virginia Recruiting
Charlottesville, Virginia, United States, 22903
Contact: Jennifer Drake, RN    434-297-7782    jd4cx@virginia.edu   
Contact: Stacey Williams    434-243-8588    scw6n@virginia.edu   
Principal Investigator: Robert Dreicer, MD         
Sponsors and Collaborators
PrECOG, LLC.
Bristol-Myers Squibb
Investigators
Study Chair: Petros Grivas, MD, PhD University of Washington

Responsible Party: PrECOG, LLC.
ClinicalTrials.gov Identifier: NCT03532451     History of Changes
Other Study ID Numbers: PrE0807
CA209-9DF ( Other Identifier: BMS )
First Posted: May 22, 2018    Key Record Dates
Last Update Posted: December 7, 2018
Last Verified: December 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: Data is proprietary.

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by PrECOG, LLC.:
Muscle-Invasive
Cisplatin-Ineligible
Nivolumab
Lirilumab

Additional relevant MeSH terms:
Urinary Bladder Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Urinary Bladder Diseases
Urologic Diseases
Nivolumab
Cisplatin
Antibodies, Monoclonal
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs