- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04138628
Treatment Of Metastatic Bladder Cancer at the Time Of Biochemical reLApse Following Radical Cystectomy (TOMBOLA)
Immunotherapy (checkpoint inhibitors) is approved as first and second line treatment to patients with metastatic bladder cancer. However, response rates are low and no biomarkers have yet shown strong predictive value for patient selection. Moreover, the term 'metastatic' is based on metastases visible on conventional CT scans and, thus, require a certain size of tumour load. Clinical trials are currently being conducted that investigate the use of adjuvant immunotherapy for this group of patients (treatment to all), which will result in massive over-treatment and huge costs to the healthcare system.
This project has the primary objective to identify new indications for initiating immunotherapy in patients with metastatic bladder cancer. Sensitive molecular techniques for detection of tumor DNA in the blood will be used to identify patients with early signs of metastatic disease. In addition, comprehensive biomarker analysis will be performed to identify predictors of treatment response.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The study aim at investigate the response rate and oncological outcome of systemic immunotherapy (PDL-1 inhibitor; atezolizumab) administered early at the time of biochemical relapse (circulating tumor DNA (ctDNA) positive) in patients who have undergone radical cystectomy because of muscle invasive bladder cancer.
Biomarkers that predict response to systemic immunotherapy will be identified by comprehensive multi-omics analysis of primary tumors and metastatic lesions. Furthermore, we will determine if ctDNA levels during therapy can be used as a biomarker for early indication of therapy response.
The hypotheses is that 1) early initiation of immunotherapy in high-risk (ctDNA positive) patients will result in better response rates and improved survival compared to later treatment following conventional imaging diagnosis of metastasis, and 2) biomarkers for predicting response can be identified and used for tailoring treatment regimens in the future to patients at high risk and at high likelihood of response.
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Jørgen B Jensen, MD, DMSc
- Phone Number: +45 30915459
- Email: bjerggaard@skejby.rm.dk
Study Contact Backup
- Name: Lars Dyrskjøt, Professor
- Phone Number: +45 78455320
- Email: lars@clin.au.dk
Study Locations
-
-
-
Aalborg, Denmark, 9100
- Recruiting
- Aalborg Universitetshospital
-
Contact:
- Astrid Livbjerg, MD
- Phone Number: +45 97663008
-
Principal Investigator:
- Astrid Livbjerg, MD
-
Principal Investigator:
- Andreas Carus, MD
-
Aarhus, Denmark, 8200
- Recruiting
- Aarhus University Hospital
-
Contact:
- Jørgen B Jensen, MD
- Phone Number: +4530915682
- Email: bjerggaard@skejby.rm.dk
-
Principal Investigator:
- Mads Agerbæk, MD
-
Principal Investigator:
- Jørgen B Jensen, MD
-
Copenhagen, Denmark, 2100
- Recruiting
- Rigshospitalet
-
Contact:
- Ulla N Joensen, MD
- Phone Number: +45 35452111
-
Principal Investigator:
- Ulla N Joensen, MD
-
Principal Investigator:
- Helle Pappot, MD
-
Herlev, Denmark, 2730
- Recruiting
- Herlev Hospital
-
Contact:
- Gitte W Lam, MD
- Phone Number: +45 38680140
-
Principal Investigator:
- Line H Dohn, MD
-
Principal Investigator:
- Gitte W Lam, MD
-
Odense, Denmark, 5000
- Recruiting
- Odense Universitetshospital
-
Contact:
- Thor K Jensen, MD
- Phone Number: +45 65414400
-
Principal Investigator:
- Thor K Jensen, MD
-
Principal Investigator:
- Niels V Jensen, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- ≥18 years of age at the time of signing the Informed Consent Form
- For male study subjects: agreement to remain abstinent (refrain from heterosexual intercourse) or use a condom, and agreement to refrain from donating sperm.
- Signed Informed Consent Form
- ECOG PS 0, 1 or 2
- Is, according to the Investigator's judgement, able to comply with the trial protocol
- Ability to understand the Participant Information Sheet orally and in writing
- Preoperative PET/CT of thorax, abdomen, and pelvis with no suspicion of organ metastases or lymph node metastasis* above the aortic bifuraction
Study Subjects undergoing radical cystectomy due to histologically documented muscle invasive urothelial carcinoma (including subtypes) stage cT2-4a in the urinary bladder following NAC** in cisplatin-fit Study Subjects.
Study Subjects who have undergone down-staging chemotherapy because of lymph node metastasis with no organ metastases can be included if complete response regarding lymph nodes are identified on preoperative imaging.
- NAC includes Study Subjects who have stopped after one course of chemotherapy because of side effects or local non-metastatic progression
Exclusion Criteria:
- Subjects undergoing non-radical cystectomy for palliative reasons
- Non-radical surgery estimated intraoperative
- Other histology of BC than urothelial carcinoma - mixed tumours with urothelial features are allowed
- Concomitant invasive cancer within 5 years other than non-melanoma skin cancer and prostate cancer without metastasis
- Known contraindication to immunotherapy
- A history of autoimmune disease. Study Subjects with vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll. Subjects with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
Study Subjects who meet any of the following criteria will be excluded from study entry:
- History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography (CT) scan
- Treatment with systemic immunostimulatory agents (including, but not limited to, interferon and interleukin 2 [IL-2]) within 4 weeks or 5 drug elimination half-lives (whichever is longer) prior to initiation of study treatment
- HIV positive
- History of pneumonitis (History of radiation pneumonitis in the radiation field (fibrosis) is permitted.
- Hepatitis B or hepatitis C infection
- Subjects who have received a live, attenuated vaccine within 28 days prior to enrolment
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: ctDNA screening arm
Flat dose 1200 mg Atezolizumab every three weeks for up to 13 months
|
The study drug will be given according to current recommendations as systemic treatment every third week for 12 months or until progression.
Treatment will be initiated within 28 days of detection of ctDNA.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Complete response (CR) after treatment with investigational agent initiated by ctDNA positive status after radical cystectomy (with or without concomitant visible metastases on CT).
Time Frame: Time from treatment initiation with investigational agent until 12 months after initiation
|
CR in the current study is defined as ctDNA negative status combined with regular imaging (CT) after treatment. Thus, any metastasis visible on CT at the time of treatment initiation should undergo complete response. In Study Subjects without visible metastasis on CT at the time of treatment, initiation should result in unchanged status on CT. Data will be compared to available historical data on response to PD-1 / PD-L1 targeted agents. |
Time from treatment initiation with investigational agent until 12 months after initiation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Duration of freedom from clinical relapse in Study Subjects showing decrease or stabilization of ctDNA level after treatment with investigational agent
Time Frame: 12 months
|
Time from initiation of therapy until response
|
12 months
|
Overall survival after cystectomy in Study Subjects having biochemical relapse
Time Frame: 5 years
|
Percentage
|
5 years
|
Cancer specific survival after cystectomy in Study Subjects having biochemical relapse
Time Frame: 5 years
|
Percentage
|
5 years
|
Recurrence free survival after cystectomy in Study Subjects having biochemical relapse
Time Frame: 5 years
|
Percentage
|
5 years
|
Cancer specific survival after cystectomy in Study Subjects having biochemical relapse stratified for potential predictive biomarkers for response to treatment
Time Frame: 5 years
|
Percentage
|
5 years
|
Response rate to investigated agent stratified for PD-L1 expression and other predictive biomarkers like TMB, immune cell infiltration, tumor subtypes etc.
Time Frame: 12 months
|
Percentage
|
12 months
|
Time to recurrence seen on imaging (symptomatic or asymptomatic)
Time Frame: 5 years
|
Percentage
|
5 years
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Jørgen B Jensen, Professor, Dept. Of Urology, Aarhus University Hospital, Denmark
- Study Chair: Lars Dyrskjøt, Professor, Dept. Of Molecular Medicine (MOMA) Aarhus University Hospital, Denmark
- Principal Investigator: Mads Agerbæk, MD, Dept. Of Oncology, Aarhus University Hospital, Denmark
- Study Chair: Karin Birkenkamp-Demtröder, Ass. professor, Dept. Of Molecular Medicine (MOMA) Aarhus University Hospital, Denmark
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- DaBlaCa-14
- 2019-001679-36 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Bladder Cancer
-
University of Southern CaliforniaNational Cancer Institute (NCI)TerminatedStage III Bladder Cancer | No Evidence of Disease | Stage II Bladder Cancer | Stage IVA Bladder Cancer | Stage IVB Bladder CancerUnited States
-
H. Lee Moffitt Cancer Center and Research InstituteCompletedMuscle-Invasive Bladder Carcinoma | Bladder Cancer Stage II | Bladder Cancer Stage III | Bladder Cancer Stage IVUnited States
-
Case Comprehensive Cancer CenterNational Cancer Institute (NCI)WithdrawnRecurrent Bladder Cancer | Urinary Complications | Stage 0 Bladder Cancer | Stage I Bladder Cancer | Stage II Bladder Cancer
-
Fox Chase Cancer CenterTerminatedStage III Bladder Cancer | Distal Urethral Cancer | Proximal Urethral Cancer | Squamous Cell Carcinoma of the Bladder | Urethral Cancer Associated With Invasive Bladder Cancer | Stage II Bladder CancerUnited States
-
National Cancer Institute (NCI)CompletedStage III Bladder Cancer | Stage I Bladder Cancer | Stage II Bladder CancerUnited States
-
National Cancer Institute (NCI)TerminatedStage III Bladder Cancer | Stage IV Bladder Cancer | Recurrent Bladder Carcinoma | Bladder Adenocarcinoma | Bladder Squamous Cell Carcinoma | Bladder Urothelial Carcinoma | Stage I Bladder Cancer | Stage II Bladder CancerUnited States
-
University of WashingtonNational Cancer Institute (NCI)CompletedStage III Bladder Cancer | Stage IV Bladder Cancer | Recurrent Bladder Carcinoma | Stage II Bladder CancerUnited States
-
Academisch Medisch Centrum - Universiteit van Amsterdam...Bristol-Myers SquibbRecruitingUrinary Bladder Cancer | Invasive Bladder CancerNetherlands
-
National Cancer Institute (NCI)CompletedRecurrent Bladder Cancer | Stage III Bladder Cancer | Stage IV Bladder Cancer | Transitional Cell Carcinoma of the Bladder | Stage I Bladder Cancer | Stage II Bladder CancerUnited States
-
Taris Biomedical LLCBristol-Myers SquibbTerminatedBladder Cancer TNM Staging Primary Tumor (T) T2 | Bladder Cancer TNM Staging Primary Tumor (T) T2A | Bladder Cancer TNM Staging Primary Tumor (T) T2B | Bladder Cancer TNM Staging Primary Tumor (T) T3 | Bladder Cancer TNM Staging Primary Tumor (T) T3A | Bladder Cancer TNM Staging Primary Tumor... and other conditionsUnited States
Clinical Trials on Atezolizumab
-
University of Southern CaliforniaNational Cancer Institute (NCI); Genentech, Inc.RecruitingStage IVA Lung Cancer AJCC v8 | Stage IVB Lung Cancer AJCC v8 | Lung Non-Small Cell Carcinoma | Stage III Lung Cancer AJCC v8 | Stage IV Lung Cancer AJCC v8 | Stage II Lung Cancer AJCC v8 | Stage IIA Lung Cancer AJCC v8 | Stage IIB Lung Cancer AJCC v8 | Stage IIIA Lung Cancer AJCC v8 | Stage IIIB Lung... and other conditionsUnited States
-
Yonsei UniversityNot yet recruitingNon-small Cell Lung CancerKorea, Republic of
-
Intergroupe Francophone de Cancerologie ThoraciqueRoche Pharma AG; GFPCCompletedSmall Cell Lung CancerFrance
-
Incyte CorporationHoffmann-La Roche; Genentech, Inc.TerminatedUC (Urothelial Cancer) | NSCLC (Non-small Cell Lung Carcinoma)United States
-
First Affiliated Hospital of Zhejiang UniversityHoffmann-La Roche; Geneplus-Beijing Co. Ltd.UnknownNon-Small Cell Lung CancerChina
-
Corvus Pharmaceuticals, Inc.Genentech, Inc.CompletedRenal Cell Cancer | Metastatic Castration Resistant Prostate CancerUnited States, Canada, Australia
-
Astellas Pharma Global Development, Inc.CompletedAcute Myeloid Leukemia (AML) | Acute Myeloid Leukemia With FMS-like Tyrosine Kinase (FLT3) MutationUnited States
-
The Netherlands Cancer InstituteRoche Pharma AGCompletedBreast Cancer | Ovarian Cancer | Cervix Cancer | Endometrial CancerNetherlands
-
Yale UniversityTerminatedAsymptomatic MyelomaUnited States
-
Seoul National University HospitalUnknown