Single Arm Phase II Study of Bladder Preservation With Immunoradiotherapy After a Clinically Meaningful Response to Neoadjuvant Therapy in Patients With Muscle Invasive Bladder Cancer (BRIGHT)
Summary
This phase II trial tests the effect of giving pembrolizumab in combination with radiation therapy after chemotherapy in preventing surgery to remove the bladder in patients with muscle invasive bladder cancer. Standard of care therapy includes chemotherapy before surgery (neoadjuvant) to shrink or get rid of the tumor. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the tumor, and may interfere with the ability of tumor cells to grow and spread. Radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill cancer cells and shrink tumors. Photon beam radiation therapy is a type of radiation therapy that uses x-rays or gamma rays that come from a special machine called a linear accelerator. The radiation dose is delivered at the surface of the body and goes into the tumor and through the body. Giving pembrolizumab in combination with radiation therapy after neoadjuvant chemotherapy may help prevent surgical removal of the bladder in patients with muscle invasive bladder cancer.
Detailed description
PRIMARY OBJECTIVE: I. To evaluate whether 3-year bladder intact event-free survival (BI-EFS) is at least 70% in participants with clinically T0-clinically T1 without multifocal carcinoma in situ (CIS) following neoadjuvant therapy (NAT) for muscle-invasive bladder cancer (MIBC) who receive radiotherapy (RT) + pembrolizumab (MK-3475). SECONDARY OBJECTIVES: I. To estimate BI-EFS in participants who receive RT + pembrolizumab (MK-3475). II. To estimate local muscle invasive recurrence-free survival in participants who receive RT+ pembrolizumab (MK-3475). III. To estimate the metastasis-free survival (MFS) in participants who receive RT+ pembrolizumab (MK-3475). IV. To estimate the overall survival (OS) in participants who receive RT + pembrolizumab (MK-3475). V. To estimate the rate of salvage cystectomy in participants who receive RT+ pembrolizumab (MK-3475). VI. To evaluate the frequency and severity of toxicities in participants who receive RT + pembrolizumab (MK-3475). PATIENT REPORTED OUTCOMES (PRO)-COMMON TERMINOLOGY CRITERIA FOR ADVERSE EVENTS (CTCAE) OBJECTIVE: I. To evaluate participant-reported symptoms using selected items from Gastrointestinal, Genitourinary and sexual function domains of the PRO-CTCAE, with the goal of characterizing the frequency, severity, and interference of treatment-related symptoms. BANKING OBJECTIVE: I. To bank specimens for future correlative studies. OUTLINE: Patients undergo photon beam RT once daily (QD) on Monday-Friday for up to 20 treatments and receive pembrolizumab intravenously (IV) over 30 minutes on day 1 of each cycle. Cycles repeat every 21 days for up to 18 cycles (for a total of 12 months, including NAT) in the absence of disease progression or unacceptable toxicity. Patients also undergo transurethral resection of bladder tumor (TURBT) with tissue sample collection at pre-registration and computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET), cystoscopy, and urine and blood sample collection throughout the study. After completion of study treatment, patients are followed every 26 weeks until year 2 and then every 52 weeks up to year 5.
Arms & interventions
- ProcedureBiospecimen Collection
Undergo tissue, urine, and blood sample collection
- ProcedureComputed Tomography
Undergo CT
- ProcedureCystoscopy
Undergo cystoscopy
- ProcedureMagnetic Resonance Imaging
Undergo MRI
- BiologicalPembrolizumab
Given IV
- RadiationPhoton Beam Radiation Therapy
Undergo photon beam RT
- ProcedurePositron Emission Tomography
Undergo PET
- OtherQuestionnaire Administration
Ancillary studies
- ProcedureTransurethral Resection of Bladder Tumor
Undergo TURBT
Outcome measures
Primary
Bladder intact event-free survival (BI-EFS)
Will be evaluated as the percentage of participants who do not experience a BI-EFS event using a Kaplan-Meier estimate. A single-arm test of proportions will be used to test against the null hypothesis (true BI-EFS = 55%). Standard errors will be calculated using Greenwood's formula. If the upper bound of the one-sided 90% confidence interval includes 70%, then the radiation therapy + pembrolizumab regimen will be concluded to be active in this population.
Time frame: Within 3 years after registration
Secondary
BI-EFS
Time frame: From registration to the first documentation of a BI-EFS event, assessed up to 5 years
Local muscle invasive recurrence-free survival
Time frame: From date of registration to first radiologic or histologic evidence of local muscle invasive bladder carcinoma recurrence, assessed up to 5 years
Metastasis-free survival
Time frame: From date of registration to first radiologic or histologic evidence of metastatic disease or death due to any cause, assessed up to 5 years
Overall survival
Time frame: From date of registration to date of death due to any cause, assessed up to 5 years
Salvage cystectomy
Time frame: Up to 5 years
Incidence of adverse events
Time frame: Up to 30 days after last dose of study treatment
Eligibility criteria
Study locations (143)
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama, 35233
Banner MD Anderson Cancer Center
Gilbert, Arizona, 85234
Mayo Clinic Hospital in Arizona
Phoenix, Arizona, 85054
Highlands Oncology Group - Fayetteville
Fayetteville, Arkansas, 72703
Highlands Oncology Group - Rogers
Rogers, Arkansas, 72758
Highlands Oncology Group
Springdale, Arkansas, 72762
Tower Cancer Research Foundation
Beverly Hills, California, 90211
City of Hope Corona
Corona, California, 92882
City of Hope Comprehensive Cancer Center
Duarte, California, 91010
City of Hope at Irvine Lennar
Irvine, California, 92618
City of Hope Antelope Valley
Lancaster, California, 93534
Los Angeles General Medical Center
Los Angeles, California, 90033
USC / Norris Comprehensive Cancer Center
Los Angeles, California, 90033
Cedars-Sinai Medical Center
Los Angeles, California, 90048
University of California Davis Comprehensive Cancer Center
Sacramento, California, 95817
City of Hope South Pasadena
South Pasadena, California, 91030
Cedars-Sinai Cancer - Tarzana
Tarzana, California, 91356
City of Hope Upland
Upland, California, 91786
UCHealth University of Colorado Hospital
Aurora, Colorado, 80045
UCHealth - Cherry Creek
Denver, Colorado, 80206
Shaw Cancer Center
Edwards, Colorado, 81632
Poudre Valley Hospital
Fort Collins, Colorado, 80524
Cancer Care and Hematology-Fort Collins
Fort Collins, Colorado, 80528
UCHealth Greeley Hospital
Greeley, Colorado, 80631
UCHealth Highlands Ranch Hospital
Highlands Ranch, Colorado, 80129
UCHealth Lone Tree Health Center
Lone Tree, Colorado, 80124
Medical Center of the Rockies
Loveland, Colorado, 80538
Mayo Clinic in Florida
Jacksonville, Florida, 32224-9980
Moffitt Cancer Center at SouthShore
Ruskin, Florida, 33570
Moffitt Cancer Center-International Plaza
Tampa, Florida, 33607
Moffitt Cancer Center - McKinley Campus
Tampa, Florida, 33612
Moffitt Cancer Center
Tampa, Florida, 33612
Moffitt Cancer Center at Wesley Chapel
Wesley Chapel, Florida, 33544
CTCA at Southeastern Regional Medical Center
Newnan, Georgia, 30265
Kootenai Health - Coeur d'Alene
Coeur d'Alene, Idaho, 83814
Kootenai Clinic Cancer Services - Post Falls
Post Falls, Idaho, 83854
Kootenai Clinic Cancer Services - Sandpoint
Sandpoint, Idaho, 83864
Rush-Copley Medical Center
Aurora, Illinois, 60504
OSF Saint Joseph Medical Center
Bloomington, Illinois, 61701
Illinois CancerCare-Bloomington
Bloomington, Illinois, 61704
Illinois CancerCare-Canton
Canton, Illinois, 61520
Illinois CancerCare-Carthage
Carthage, Illinois, 62321
Northwestern University
Chicago, Illinois, 60611
Carle at The Riverfront
Danville, Illinois, 61832
Cancer Care Specialists of Illinois - Decatur
Decatur, Illinois, 62526
Decatur Memorial Hospital
Decatur, Illinois, 62526
Northwestern Medicine Cancer Center Kishwaukee
DeKalb, Illinois, 60115
Illinois CancerCare-Dixon
Dixon, Illinois, 61021
Carle Physician Group-Effingham
Effingham, Illinois, 62401
Crossroads Cancer Center
Effingham, Illinois, 62401
Illinois CancerCare-Eureka
Eureka, Illinois, 61530
NorthShore University HealthSystem-Evanston Hospital
Evanston, Illinois, 60201
Illinois CancerCare-Galesburg
Galesburg, Illinois, 61401
Northwestern Medicine Cancer Center Delnor
Geneva, Illinois, 60134
NorthShore University HealthSystem-Glenbrook Hospital
Glenview, Illinois, 60026
Northwestern Medicine Glenview Outpatient Center
Glenview, Illinois, 60026
Northwestern Medicine Grayslake Outpatient Center
Grayslake, Illinois, 60030
NorthShore University HealthSystem-Highland Park Hospital
Highland Park, Illinois, 60035
Illinois CancerCare-Kewanee Clinic
Kewanee, Illinois, 61443
Northwestern Medicine Lake Forest Hospital
Lake Forest, Illinois, 60045
Illinois CancerCare-Macomb
Macomb, Illinois, 61455
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois, 61938
Cancer Care Center of O'Fallon
O'Fallon, Illinois, 62269
HSHS Saint Elizabeth's Hospital
O'Fallon, Illinois, 62269
Northwestern Medicine Oak Brook
Oak Brook, Illinois, 60523
Northwestern Medicine Orland Park
Orland Park, Illinois, 60462
Illinois CancerCare-Ottawa Clinic
Ottawa, Illinois, 61350
Illinois CancerCare-Pekin
Pekin, Illinois, 61554
Illinois CancerCare-Peoria
Peoria, Illinois, 61615
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
Peoria, Illinois, 61615
OSF Saint Francis Medical Center
Peoria, Illinois, 61637
Illinois CancerCare-Peru
Peru, Illinois, 61354
Illinois CancerCare-Princeton
Princeton, Illinois, 61356
Southern Illinois University School of Medicine
Springfield, Illinois, 62702
Springfield Clinic
Springfield, Illinois, 62702
Springfield Memorial Hospital
Springfield, Illinois, 62781
Carle Cancer Center
Urbana, Illinois, 61801
Northwestern Medicine Cancer Center Warrenville
Warrenville, Illinois, 60555
Illinois CancerCare - Washington
Washington, Illinois, 61571
Mary Greeley Medical Center
Ames, Iowa, 50010
McFarland Clinic - Ames
Ames, Iowa, 50010
UI Health Care Mission Cancer and Blood - Ankeny Clinic
Ankeny, Iowa, 50023
McFarland Clinic - Boone
Boone, Iowa, 50036
Mercy Cancer Center-West Lakes
Clive, Iowa, 50325
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
Clive, Iowa, 50325
Iowa Methodist Medical Center
Des Moines, Iowa, 50309
UI Health Care Mission Cancer and Blood - Des Moines Clinic
Des Moines, Iowa, 50309
Mercy Medical Center - Des Moines
Des Moines, Iowa, 50314
UI Health Care Mission Cancer and Blood - Laurel Clinic
Des Moines, Iowa, 50314
McFarland Clinic - Trinity Cancer Center
Fort Dodge, Iowa, 50501
McFarland Clinic - Jefferson
Jefferson, Iowa, 50129
McFarland Clinic - Marshalltown
Marshalltown, Iowa, 50158
UI Health Care Mission Cancer and Blood - Waukee Clinic
Waukee, Iowa, 50263
The Iowa Clinic PC
West Des Moines, Iowa, 50266
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, 40536
The James Graham Brown Cancer Center at University of Louisville
Louisville, Kentucky, 40202
UofL Health Medical Center Northeast
Louisville, Kentucky, 40245
University Medical Center New Orleans
New Orleans, Louisiana, 70112
Tufts Medical Center
Boston, Massachusetts, 02111
UMass Memorial Medical Center - University Campus
Worcester, Massachusetts, 01655
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota, 56601
Fairview Southdale Hospital
Edina, Minnesota, 55435
Park Nicollet Clinic - Saint Louis Park
Saint Louis Park, Minnesota, 55416
University of Mississippi Medical Center
Jackson, Mississippi, 39216
Saint Francis Medical Center
Cape Girardeau, Missouri, 63703
Billings Clinic Cancer Center
Billings, Montana, 59101
Community Medical Center
Missoula, Montana, 59804
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire, 03756
Hunterdon Medical Center
Flemington, New Jersey, 08822
Jersey City Medical Center
Jersey City, New Jersey, 07302
Saint Barnabas Medical Center
Livingston, New Jersey, 07039
Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, 08903
The New York Hospital Medical Center of Queens
Flushing, New York, 11355
NYP/Weill Cornell Medical Center
New York, New York, 10065
Stony Brook University Medical Center
Stony Brook, New York, 11794
Sanford Broadway Medical Center
Fargo, North Dakota, 58122
Sanford Roger Maris Cancer Center
Fargo, North Dakota, 58122
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati, Ohio, 45219
University of Cincinnati Cancer Center-West Chester
West Chester, Ohio, 45069
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, 19107
Asplundh Cancer Pavilion
Willow Grove, Pennsylvania, 19090
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota, 57104
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
The West Clinic - Wolf River
Germantown, Tennessee, 38138
Parkland Memorial Hospital
Dallas, Texas, 75235
UT Southwestern Simmons Cancer Center - RedBird
Dallas, Texas, 75237
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
UT Southwestern/Simmons Cancer Center-Fort Worth
Fort Worth, Texas, 76104
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Houston, Texas, 77030
UT Southwestern Clinical Center at Richardson/Plano
Richardson, Texas, 75080
University of Texas Health Science Center at San Antonio
San Antonio, Texas, 78229
Dartmouth Cancer Center - North
Saint Johnsbury, Vermont, 05819
VCU Massey Cancer Center at Stony Point
Richmond, Virginia, 23235
VCU Massey Comprehensive Cancer Center
Richmond, Virginia, 23298
Swedish Medical Center-First Hill
Seattle, Washington, 98122
West Virginia University Healthcare
Morgantown, West Virginia, 26506
Camden Clark Medical Center
Parkersburg, West Virginia, 26101
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin, 54301
Saint Vincent Hospital Cancer Center at Saint Mary's
Green Bay, Wisconsin, 54303
Saint Vincent Hospital Cancer Center at Oconto Falls
Oconto Falls, Wisconsin, 54154
Saint Vincent Hospital Cancer Center at Sheboygan
Sheboygan, Wisconsin, 53081
Saint Vincent Hospital Cancer Center at Sturgeon Bay
Sturgeon Bay, Wisconsin, 54235-1495