Chimiorésection néoadjuvante précise de NMIBC de bas grade (POLO)
Chimiorésection néoadjuvante précise de NMIBC de bas grade guidée par des dépistages de médicaments chez des organoïdes dérivés de patients : un essai ouvert à centre unique de phase II
Based on the unmet clinical need to reduce invasiveness of treatment of low grade NMIBC, the investigators conduct this prospective, open label, single arm and single center phase II trial. The investigators aim to use drug screens in PDOs to guide neoadjuvant intravesical instillation therapy with either Epirubicin, Mitomycin C, Gemcitabine or Docetaxel to achieve chemoresection NMIBC.
Aperçu de l'étude
Statut
Intervention / Traitement
Description détaillée
Bladder cancer is a disease of the elderly patient and related to several interventions and operations. Patients with a low risk non-muscle invasive bladder cancer (NMIBC) are treated by transurethral resection of the bladder tumor (TURBT). Due to the high recurrence rate of approximately 50% within 2 years of diagnosis, patients are followed in outpatient clinic by cystoscopy for at least 5 years.
Beside recurrence of low grade NMIBC to low grade disease, progression to higher grade or stage is infrequent to rare. Therefore, expectant management and actives surveillance seems to be an option for selected patients that are unfit for surgery. Moreover, intravesical chemoresection has been attempted in order to avoid surgery. However, all patients were treated with the same chemotherapeutic agent and anticipated response rates were missed.
At least four different drugs have been used in daily routine and/or clinical trials for instillation therapies in NMIBC. Namely, Epirubicin, Mitomycin C, Gemcitabine and Docetaxel have been investigated and administered.
The molecular landscape of NMIBC is heterogeneous. Not only the mutational pattern but also the transcriptomic characteristics vary between different NMIBC. Although different agents are used on a routine daily bases and in clinical trials, they have not been administered based on the molecular landscape or biological likelihood of response.
The investigators recently developed a pipeline for the generation of patient derived organoids (PDO) in NMIBC. In brief: The bladder cancer is sampled during TURBT. Generation of organoids has been carefully optimized in order to yield high viability from each sample. Beside confirmation of similarities of the molecular landscape between parental NMIBC and subsequent PDO (in approx. 30 samples), the investigators established a standardized protocol to perform drug screens on these PDOs.
In this trial (POLO Trial) the investigators aim to generate PDOs from bladder cancer biopsies that are harvested in the outpatient clinic. Subsequent drug screen in PDOs for Epirubicin, Mitomycin C, Gemcitabine and Docetaxel will identify the most effective agent in this given patient. Prior TURBT, patient will receive 6 intravesical instillations with the identified agent as neoadjuvant treatment in order to perform chemoresection of the tumor. Three months after initial diagnosis, TURBT will be performed as the standard treatment and to confirm response rate of precise chemoresection.
Type d'étude
Inscription (Estimé)
Phase
- Phase 2
Contacts et emplacements
Coordonnées de l'étude
- Nom: Roland Seiler, Prof.
- Numéro de téléphone: +41 32 324 32 06
- E-mail: urologie@szb-chb.ch
Sauvegarde des contacts de l'étude
- Nom: Martina Schneider
- Numéro de téléphone: +41 323243217
- E-mail: martina.schneider@szb-chb.ch
Lieux d'étude
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-
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Bern, Suisse, 3001
- Lindenhofspital, Klinik für Urologie
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Contact:
- Bernard Kiss
- Numéro de téléphone: +41 31 300 38 88
- E-mail: bernhard.kiss@hin.ch
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Chercheur principal:
- Bernard Kiss
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Biel, Suisse, 2501
- Spitalzentrum Biel, Klinik für Urologie
-
Contact:
- Martina Schneider
- Numéro de téléphone: +41 323243217
- E-mail: martina.schneider@szb-chb.ch
-
Contact:
- Roland Seiler, Prof.
- Numéro de téléphone: +41 32 324 32 06
- E-mail: Roland.Seiler-Blarer@szb-chb.ch
-
-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Signed Informed Consent Form
- Age ≥ 18 years
- Primary or recurrent NMIBC suspected to be low-grade or maximum G2 with a negative urine cytology
Exclusion Criteria:
- Anticoagulation other than acetylsalicylic acid
- Evidence of significant uncontrolled concomitant disease that could affect compliance with the protocol as judged by the investigator
- Severe infection within 4 weeks prior to the date of the patient's informed consent signature
- Contraindication for frequent catheterization
- Pregnancy or nursing. Female subject of childbearing potential (defined as premenopausal women who have not undergone surgical sterilization and are sexually active with a male part-ner) must have a negative urine pregnancy test at screening
- Female subject of childbearing potential who is unwilling to use effective contraception method(s) from the start of the intravesical instillation with the IMP until six months after the last instillation
- Male subject who is unwilling to use an effective contraception method from the start of the intravesical instillation with the IMP until four months after the last instillation
- Vulnerable individual, e.g., individual incapable of judgement or currently incarcerated or oth-erwise institutionalized (prisoner), or refugee
- Concomitant participation in another interventional clinical trial with an active treatment within 4 weeks prior to the date of the patient's informed consent signature and during the current trial.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Non randomisé
- Modèle interventionnel: Affectation à un seul groupe
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: Epirubicin
Patients in that PDOs show highest response to this drug in-vitro will be treated with Epirubicin. |
In PDOs from patients that show highest response to Epirubicin, this drug will be instilled intravesically once weekly for 6 times. Epirubicin will be used as a concentrate for injection/instillation 2 mg/ml in total 50mg per vial. Prior to use, the concentrate for injection is diluted with 25ml of 0.9% saline solution to obtain the final Solution with 1mg/ml of Epirubicin. |
|
Expérimental: Mitomycin
Patients in that PDOs show highest response to this drug in-vitro will be treated with Mitomycin. |
In PDOs from patients that show highest response to Mitomycin, this drug will be instilled intravesically once weekly for 6 times. Mitomycin C will be used as 20mg dry powder. Prior to use, the powder will be dissolved in 50ml of 0.9% saline solution according to the manufacturer instructions |
|
Expérimental: Gemcitabine
Patients in that PDOs show highest response to this drug in-vitro will be treated with Gemcitabine. |
In PDOs from patients that show highest response to Gemcitabine, this drug will be instilled intravesically once weekly for 6 times. Gemcitabine will be used as 2000 mg/50ml. For intravesical application, 1000mg of gemcitabine (corresponding to 25ml) will be diluted in 25ml 0.9% saline solution, to obtain the gemcitabine concentration of 1000mg/50ml used for instillation. |
|
Expérimental: Docetaxel
Patients in that PDOs show highest response to this drug in-vitro will be treated with Docetaxel. |
In PDOs from patients that show highest response to Docetaxel, this drug will be instilled intravesically once weekly for 6 times. Docetaxel will be used as 140mg/7ml solution. For intravesical application, 48.825ml of saline will be added to 1.875ml Docetaxel solution (according 37.5mg of Docetaxel). The concentration of this solution is 0.74mg/ml by a total volume of the instillation solution of 50,7. |
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Pathological response
Délai: 15 weeks
|
Rate of patients that show complete pathological response to neoadjuvant chemoresection |
15 weeks
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Feasibility of drug screen
Délai: 4 weeks
|
Rate of patients in which drug screen in patient derived organoids was successful |
4 weeks
|
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Safety of the study intervention
Délai: 12 weeks
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Incidence, severity and type of Adverse Events of Special Interest (AESIs) which are defined as adverse events related to chemotherapeutic intravesical instillation. AESIs include dysuria, urinary tract infections, and complications due to catheterism for intravesical instillation such as urethral irritation and haematuria |
12 weeks
|
|
Number of patients with recurrence free survival
Délai: 1 Year
|
Recurrence after neoadjuvant chemoresection and transurethral resection of the bladder tumor |
1 Year
|
|
Tolerability of instillation
Délai: 24 weeks
|
Quality of life measured with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). It corresponds to a functional Scales & Global Health Status; a higher score indicates a better outcome (a higher level of functioning or a better quality of life). The score minimum is 0 and maximum 100. |
24 weeks
|
|
Tolerability of instillation
Délai: 24 weeks
|
The quality of life is completed with a Symptom & Concern Scale specific for NMIBC called European Organisation for Research and Treatment of Cancer 24-Item Non-Muscle-Invasive Bladder Cancer Module (EORTC QLQ-NMIBC24). This Symptom & Concern Scale has also a minimum score of 0 and a maximum of 100. A higher score indicates a worse outcome (a greater burden of symptoms or high symptomatology). |
24 weeks
|
Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chaise d'étude: Roland Seiler, Prof., Spitalzentrum Biel
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Estimé)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
- Maladies urogénitales
- Tumeurs urogénitales
- Tumeurs par site
- Tumeurs
- Maladies urogénitales masculines
- Maladies urologiques
- Maladies urogénitales féminines
- Maladies urogénitales féminines et complications de la grossesse
- Tumeurs par type histologique
- Tumeurs, glandulaires et épithéliales
- Tumeurs urologiques
- Carcinome
- Maladies de la vessie urinaire
- Tumeurs de la vessie non envahissantes sur le plan musculaire
- Tumeurs de la vessie urinaire
- Produits chimiques organiques
- Composés hétérocycliques, 1 anneau
- Composés hétérocycliques
- Composés hétérocycliques, 2 anneaux
- Composés hétérocycliques, anneau fusionné
- Hydrocarbures
- Cycloparaffines
- Hydrocarbures, alicyclique
- Hydrocarbures, cyclique
- Terpènes
- Glucides
- Hydrocarbures aromatiques polycycliques
- Hydrocarbures, aromatique
- Composés polycycliques
- Glycosides
- Indoles
- Taxes
- Cyclodécanes
- Diterpènes
- Désoxycytidine
- Cytidine
- Nucléosides pyrimidine
- Pyrimidines
- Anthracyclines
- Naphtacènes
- Aminoglycosides
- Daunorubicine
- Quinones
- Azirines
- Mitomycines
- Indoléquinones
- Doxorubicine
- Docétaxel
- Gemcitabine
- Mitomycine
- Épirubicine
Autres numéros d'identification d'étude
- SZB-URO-26-001
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
Description du régime IPD
After completion of the trial for the primary endpoint, deidentified data will be shared to other researches upon request.
Délai de partage IPD
After completion of the trial to the primary endpoint.
Type d'informations de prise en charge du partage d'IPD
- PROTOCOLE D'ÉTUDE
Informations sur les médicaments et les dispositifs, documents d'étude
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