AURORAX-0093A: Glycosaminoglycan Profiling for Prognostication of Muscle-invasive Bladder Cancer - a Pilot Study (AUR93A)

Glycosaminoglycan Profiling for Prognostication of Muscle-invasive Bladder Cancer - a Pilot Study

AURORAX-0093A (AUR93A) is a pilot cohort observational study that will explore the use of urine and plasma glycosaminoglycans (GAGs) to prognosticate muscle-invasive bladder cancer (MIBC) patients elected for neo-adjuvant chemotherapy (NAC).

Study Overview

• Status: Completed
• Conditions: Muscle-Invasive Bladder Carcinoma
• Intervention / Treatment: Diagnostic test: GAG score

Detailed Description

There are around 200 000 cases of bladder cancer (BCa) in the EU every year. Of these, about 25% are diagnosed at a late stage wherein cancer has invaded the muscular wall. The survival of patients with muscle-invasive bladder cancer (MIBC) largely depends on the response to disease management, which in turn is likely dependent on the biology underlying different subtypes of MIBC.

The standard treatment is radical cystectomy (RC) and eligible patients are offered neo-adjuvant chemotherapy (NAC). However, only 30% of these patients report a complete response. Even though the response to NAC is likely correlated to the underlying tumor biology (for example, the TP53-like MIBC subtype is associated with a higher frequency of resistance to NAC), there are today no approved biomarkers to select patients likely to benefit from NAC. This information could in turn translate into more precise and personalized treatment for the patient.

In a proof-of-concept prospective study, we discovered that the profiling of urine and plasma glycosaminoglycans (GAGs) could be useful for the diagnosis and prognosis of BCa. AUR93A is a prospective single-arm cohort exploratory study. A sample size of approx. 47 patients with MIBC and elected for NAC will be included in this study and it is assumed that 30% will experience complete response at the post-operative visit. The goal is to correlate baseline (pre-NAC) GAGs to complete response rate (CRR) after RC and recurrence-free survival (RFS).

• Study Type: Observational
• Enrollment (Actual): 43

Contacts and Locations

Study Locations

• Denmark
  • Roskilde, Denmark
    • Zealand University Hospital
• Italy
  • Florence, Italy
    • AOU Careggi
  • Milano, Italy
    • IRCCS Ospedale San Raffaele, San Raffaele Hospital
  • Rome, Italy
    • IRCCS Regina Elena
• Sweden
  • Gothenburg, Sweden
    • Sahlgrenska University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

The study will enroll patients with MIBC elected for NAC, defined as:

• MIBC: pathologically confirmed transitional cell carcinoma of the bladder with the invasion of the bladder muscular wall and no evidence of regional or distal metastases (T2-T4a cN0-N2 M0)
• NAC: any choice of cisplatin-containing chemotherapeutic regimen.

Description

Inclusion Criteria:

• Histologically confirmed diagnosis of transitional cell carcinoma of the bladder (mixed histology tumors allowed if transitional cell histology is predominant [50%+] histology)
• Clinical stage T2-T4a N0-N2 M0 by CT (or MRI) + PET/CT
• Elected and fit according to institutional guidelines for cisplatin-based NAC followed by RC
• ECOG score 0-1

Exclusion Criteria:

• Previously intravenous chemotherapy for bladder cancer. (Patients who have had previous radiotherapy or concurrent chemo-radiation for bladder cancer are still eligible.)
• Currently participating or has participated in a study of an investigational agent and received study therapy or received investigational device within 4 weeks before the first dose NAC
• Known additional malignancy that is progressing or requires active treatment except for basal cell carcinoma of the skin, or squamous cell carcinoma of the skin that has undergone potentially curative therapy, or in situ cervical cancer.

(A history of prostate cancer that was treated with definitive intent (surgically or through radiation therapy) is acceptable provided that the following criteria are met: Stage T2N0M0 or lower, Gleason score less/equal to 7 and prostatic-specific antigen (PSA) undetectable for at least 1 year while off androgen deprivation therapy that was either treated with definitive intent or untreated in active surveillance that has been stable for the past year before study allocation. Pathological evidence of concurrent T1a/b prostate cancer after radical cystecto-prostatectomy are still eligible.)

- Evidence of measurable nodal or metastatic disease.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Cohort 1; Sample size of approximately 47 patients with MIBC and elected for NAC	Diagnostic test: GAG score; blood and urine samples to determine GAG scores

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of patients with complete response at the post-operative visit after RC.	Percentage point difference in complete response rates between GAG favorable and GAG poor patients	15 to 90 days after radical cystectomy surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of patients with recurrence at any time after treatment	Percentage point difference in recurrence rates between GAG favorable and GAG poor patients	15 to 90 days after radical cystectomy surgery
Proportion of complete responses after NAC according to CT-based RECIST v1.1	Percentage point difference in complete response rates after NAC between GAG favorable and GAG poor patients	15 to 90 days after radical cystectomy surgery

Collaborators and Investigators

• Sponsor: Elypta
• Collaborators: Lund University
• Investigators: Study Director: Francesco Gatto, Elypta, Solna, Sweden

Study record dates

Study Major Dates

• Study Start (Actual): July 21, 2021
• Primary Completion (Actual): April 30, 2025
• Study Completion (Actual): April 30, 2025

Study Registration Dates

• First Submitted: August 25, 2021
• First Submitted That Met QC Criteria: August 25, 2021
• First Posted (Actual): August 31, 2021

Study Record Updates

• Last Update Posted (Actual): May 9, 2025
• Last Update Submitted That Met QC Criteria: May 6, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urologic Neoplasms; Urinary Bladder Diseases; Urinary Bladder Neoplasms
• Other Study ID Numbers: ECD-AUR93A001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Unidentified clinical and biochemical data will become available to the research community along with the publication of a scientific article related to the present investigation.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No