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| ID | Type | Description | Link |
|---|---|---|---|
| 2024-516450-21 | EudraCT Number |
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This study aims to prospectively observe whether certain alterations in some genes related to the DNA repair mechanism are related to better response to platinum-based chemotherapy used to treat metastatic bladder or urothelial cancers.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| DDR alterations positive | Active Comparator | This arm included all patients with DDR alteration in urothelial cancer |
|
| DDR alterations negative | Active Comparator | This arm included all patients without DDR alteration in urothelial cancer |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Platinum + Gemcitabine | Drug | Eligible patients will be treated with platinum-based chemotherapy (i.e. cisplatin + gemcitabine or carboplatin + gemcitabine). |
|
| Measure | Description | Time Frame |
|---|---|---|
| Overall Response Rate (ORR) by DDR group. | The difference in ORR defined as the percentage of patients who achieve PR or CR as measured by RECIST 1.1, to the platinum-based chemotherapy between patients with metastatic or locally advanced urothelial cancer with or without DDR genes alterations. | Six months |
| Measure | Description | Time Frame |
|---|---|---|
| Progression Free Survival (PFS) by DDR group. | The PFS defined as the time elapsed from start of investigational treatment to the documentation of investigator-assessed disease progression, according to RECIST 1.1 [22], or death due to any cause, whichever occurs first in patients with or without DDR genes alterations. | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Expression of PDL1 | This is the description of the rate of patients with positive expression of the marker over the study population. | six months |
| Expression of Nectin-4 | This is the description of the rate of patients with positive expression of the marker over the study population. |
Inclusion Criteria:
a Creatinine value <2.5 mg/dl and creatinine clearance > 30 ml/min evaluated by the Cockcroft-Gault Formula.
b Total bilirubin ≤1∙5 × the upper limit of normal (ULN); c Alanine aminotransferase and aspartate aminotransferase ≤2 × ULN (≤5 × ULN for patients with liver involvement of their cancer); d International normalized ratio (INR) and partial thromboplastin time (PTT) ≤1∙5 × ULN. Subjects who are therapeutically treated with an agent such as warfarin or heparin will be allowed to participate if no prior evidence of an underlying abnormality in coagulation parameters exists. Close monitoring of at least weekly evaluations will be performed until INR and PTT are stable based on a pre-dose measurement as defined by the local standard of care; e Platelet count ≥100 000/mm3, hemoglobin >9 g/dl, absolute neutrophil count >1,500/mm3; f Alkaline phosphatase limit ≤2∙5 × ULN (≤5 × ULN for patients with liver involvement of their cancer).
Exclusion Criteria:
Previous treatment for metastatic or locally advanced disease.
Previous adjuvant therapy within 1 year from the diagnosis of metastatic disease.
Prior treatment with immunotherapy.
Previous or concurrent cancer that is distinct in primary site or histology from urothelial cancer within 3 years before enrollment EXCEPT for curatively treated cervical cancer in situ, non-melanoma skin cancer and superficial bladder tumors (Ta [non-invasive tumor], Tis [carcinoma in situ], and T1 [tumor invades lamina propria]), pT2 prostate cancer with PSA<0.01.
Major surgical procedure, open biopsy, or significant traumatic injury within 28 days before start of study medication
Pregnancy or breast-feeding. Women of childbearing potential must have a pregnancy test performed a maximum of 7 days before start of treatment, and a negative result must be documented before start of treatment.
Any cardiological condition among:
Ongoing infection higher than National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0 grade 2.
Known history of human immunodeficiency (HIV) virus infection or known history of chronic hepatitis B or C.
Any autoimmune disease that contraindicates the use of maintenance immunotherapy in case of stable or responsive disease to chemotherapy.
Seizure disorder requiring medication.
Symptomatic metastatic brain or meningeal tumors unless the patient is >2 months from definitive therapy, has a negative imaging study within 4 weeks of study entry and is clinically stable with respect to the tumor at the time of study entry. Also, the patient must not be undergoing acute steroid therapy or tapering (chronic steroid therapy is acceptable provided that the dose is stable for 1 month before and after screening radiographic studies).
History of organ allograft.
Evidence or history of bleeding diathesis. Any hemorrhage or bleeding event of CTCAE grade 3 or higher within 4 weeks of start of study medication.
Non-healing wound, ulcer, or bone fracture.
Renal failure requiring hemodialysis or peritoneal dialysis.
Any illness or medical conditions that are unstable or could jeopardize the safety of the patient and his or her compliance in the study.
Has received a live vaccine or live-attenuated vaccine within 30 days prior to the first dose of study drug. Administration of killed vaccines is allowed.
Participation to another clinical trial at the time of the enrollment.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Roberto Iacovelli, Prof | Contact | +390630157373 | roberto.iacovelli@policlinicogemelli.it |
| Name | Affiliation | Role |
|---|---|---|
| Roberto Iacovelli, Prof | Fondazione Policlinico Universitario Agostino Gemelli IRCCS | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fondazione Policlinico Universitario A. Gemelli IRCCS | Recruiting | Rome | 00168 | Italy |
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Patients will be screened for DDR alteration on tumor tissue and treated with platinum-based chemotherapy followed by avelumab maintenance.
Outcome to therapy will be evaluated based on presence or not of DDR alterations.
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Both patients and clinicians are blinded for results of DDR test during platinum-based chemotherapy.
| Avelumab first-line maintenance | Drug | Patients with stable disease or tumor response after treatment with platinum-based chemotherapy will start treatment with avelumab 800 mg fat dose Q2 weeks until progression of disease or unacceptable toxicity |
|
| NGS test for DDR alterations | Diagnostic Test | All patients will be tested for DDR alterations on tumor tissue. |
|
| Overall Survival (OS) by DDR group. |
The OS is defined as time elapsed from start of treatment to the date of death due to any cause in patients with or without DDR genes alterations. |
| 12 months |
| Overall Response Rate (ORR) by treatment group. | The ORR is defined as the percentage of patients who achieve PR or CR as measured by RECIST 1.1 criteria in patients with or without DDR genes alterations between those treated with carboplatin o cisplatin. | six months |
| Disease Control Rate (DCR) by treatment group. | The disease control rate (DCR) is defined as the percentage of patients who achieve stable disease (SD), or PR or CR as measured by RECIST 1.1 criteria in patients treated with carboplatin o cisplatin. | six months |
| Disease Control Rate (DCR) by DDR group. | The disease control rate (DCR) is defined as the percentage of patients who achieve stable disease (SD), or PR or CR as measured by RECIST 1.1 criteria in patients with or without DDR genes alterations. | six months |
| Treatment-related toxicity | The treatment-related toxicity will be evaluated by the incidence of chemo-related adverse events in patients with or without DDR genes alterations graded according to NCI CTCAE version 5.0. | 12 months. |
| six months |
| Expression of Trop-2 | This is the description of the rate of patients with positive expression of the marker over the study population. | six months |
| Expression of Her-2 | This is the description of the rate of patients with positive expression of the marker over the study population. | six months |
| ID | Term |
|---|---|
| D009362 | Neoplasm Metastasis |
| ID | Term |
|---|---|
| D009385 | Neoplastic Processes |
| D009369 | Neoplasms |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D010984 | Platinum |
| D000093542 | Gemcitabine |
| ID | Term |
|---|---|
| D019216 | Metals, Heavy |
| D004602 | Elements |
| D007287 | Inorganic Chemicals |
| D028561 | Transition Elements |
| D008670 | Metals |
| D006571 | Heterocyclic Compounds |
| D003841 | Deoxycytidine |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
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