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비근육 침습성 방광암 환자에서 EGFR 발현에 대한 Apalutamide의 효과

2026년 9월 25일 업데이트: University of Wisconsin, Madison

비근육 침습성 방광암에서 Apalutamide의 무작위 시험

This phase I trial evaluates the effects of bicalutamide, compared to no study drug (NSD), on epidermal growth factor receptor (EGFR) protein expression in patients with non-muscle invasive bladder cancer. Bicalutamide is in a class of medications called androgen receptor inhibitors. It works by blocking the effects of androgen (a male reproductive hormone) to stop the growth and spread of tumor cells. Previous studies have suggested that expression of a protein called EGFR on tumor cells is related to bladder cancer disease progression. This trial may help doctors evaluate if bicalutamide has any effect on EGFR expression in patients with non-muscle invasive bladder cancer.

연구 개요

상태

모병

정황

개입 / 치료

상세 설명

PRIMARY OBJECTIVE:

1. To compare epidermal growth factor receptor (EGFR) messenger ribonucleic acid (mRNA) expression measured by reverse transcriptase polymerase chain reaction (rt-PCR) in normal appearing urothelium adjacent to tumor (measured as a ratio relative to urothelium and lamina-propria specific markers) in participants treated with anti-androgen therapy versus (vs.) participants given NSD.

SECONDARY OBJECTIVES:

  1. To determine effect of bicalutamide on EGFR expression (by rtPCR) in the subgroup of patients whose normal appearing urothelium adjacent to tumor expresses the androgen receptor (AR) (at least "1" by immunohistochemistry [IHC] score).
  2. To correlate AR expression in adjacent urothelium (by IHC score) with EGFR expression by rtPCR in participants randomized to bicalutamide versus NSD.
  3. Comparison of pre vs. post intervention urinary biomarkers (CxBladderTM) in both groups, examining the 5 RNAs (by RT-PCR) that make up the test, both as a group and each RNA separately.

EXPLORATORY OBJECTIVES:

  1. Comparison of AR and EGFR (and possibly phosphorylated EGFR [pEGFR]) staining levels (low, moderate, high; by immunocytology) in pre-treatment vs. post-treatment bladder wash immunocytology.
  2. To compare expression of direct androgen response gene (ADAR)-2 measured by rtPCR in normal appearing adjacent (to tumor) urothelium that does and does not express AR (by IHC), in participants randomized to bicalutamide versus NSD.
  3. Ki-67 expression (by IHC) in normal appearing urothelium adjacent to tumor in participants randomized to bicalutamide versus NSD.
  4. Subgroup analysis of Ki-67 expression in the AR+ subgroup.
  5. Differences in expression of AR, EGFR, pEGFR, and Ki-67 (by semi-quantitative IHC) in tumor in participants randomized to bicalutamide versus NSD.
  6. Change in EGFR expression by rt-PCR in tumor in participants randomized to bicalutamide versus NSD.
  7. Fibroblast growth factor receptor 3 (FGFR3) mutation analysis in deoxyribonucleic acid (DNA) extracted from formalin fixed paraffin embedded (FFPE) blocks from neighboring normal urothelium and tumor tissue in participants randomized to bicalutamide versus NSD.
  8. Define changes in the tumor immune microenvironment pre- and post-bicalutamide through liquid biopsies of blood and urine using high-dimensional flow cytometry.
  9. Analyze tumor (biopsy specimen) immune microenvironment via multiplex immunofluorescence and spatial transcriptomics.
  10. Other exploratory markers such as changes in the urinary microbiome in bladder cancer participants randomized to bicalutamide versus NSD.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM 1: Patients receive bicalutamide orally (PO) once daily (QD) on days 1-21. Patients undergo TURBT on day 21. Up to 28 days of bicalutamide prior to TURBT is permitted in the absence of unacceptable toxicity. Patients undergo blood and urine sample collection throughout the study. Patients may optionally undergo tumor biopsy at baseline.

ARM 2: Patients receive NSD PO QD on days 1-21. Patients undergo TURBT on day 21. Up to 28 days of NSD prior to TURBT is permitted in the absence of unacceptable toxicity. Patients undergo blood and urine sample collection throughout the study. Patients may optionally undergo tumor biopsy at baseline.

After completion of study treatment, patients are followed up 20-30 days after TURBT.

연구 유형

중재적

등록 (추정된)

80

단계

  • 1단계

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 장소

    • Arizona
      • Tucson, Arizona, 미국, 85719
        • 모병
        • University of Arizona Cancer Center - Prevention Research Clinic
        • 연락하다:
        • 수석 연구원:
          • Juan Chipollini
    • California
      • Los Angeles, California, 미국, 90048
        • 아직 모집하지 않음
        • Cedars Sinai Medical Center
        • 연락하다:
        • 수석 연구원:
          • Michael A. Ahdoot
    • Maryland
      • Bethesda, Maryland, 미국, 20892
        • 아직 모집하지 않음
        • National Cancer Institute Urologic Oncology Branch
        • 연락하다:
        • 수석 연구원:
          • Sandeep Gurram
    • New York
      • Rochester, New York, 미국, 14642
        • 아직 모집하지 않음
        • University of Rochester
        • 연락하다:
        • 수석 연구원:
          • Edward M. Messing
    • Ohio
      • Columbus, Ohio, 미국, 43210
        • 모병
        • Ohio State University Comprehensive Cancer Center
        • 연락하다:
        • 수석 연구원:
          • Debasish Sundi
    • Wisconsin
      • Madison, Wisconsin, 미국, 53792
        • 모병
        • University of Wisconsin Carbone Cancer Center - University Hospital
        • 연락하다:
        • 수석 연구원:
          • Kyle A. Richards

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

18년 이상 (성인, 고령자)

건강한 자원 봉사자를 받아들입니다

아니

연구 대상 성별

남성

설명

Inclusion Criteria:

  • Biologic male adults (>= 18 years old)

    • Note: Because no dosing or adverse event (AE) data are currently available on the use of bicalutamide in participants < 18 years of age, children are excluded from this study but will be eligible for future pediatric trials, if applicable
  • Have suspected new or occasionally recurrent NMIBC (i.e., </= 2 prior NMIBC episodes in the 18 months preceding the cystoscopy where the index tumor was identified) on clinic-based cystoscopy or imaging as viewed by an American Urological Association (AUA) board-certified urologist

  • Have had cross sectional imaging of the abdomen and pelvis (computed tomography [CT] or magnetic resonance imaging [MRI] with or without contrast) within 6 months prior to enrollment with no signs of upper tract urothelial cancer (UC), invasive, nor metastatic disease

    • Note: If adenopathy or upper tract abnormalities are identified, a negative biopsy and or ureteroscopy is required prior to enrollment
  • Participants with single and multiple tumor lesions

  • In the opinion of the treating urologist, the participant is suitable to undergo surgery.

  • Participants may have received intravesical chemotherapy at any time.

  • Total bilirubin =< 1.5 x institutional upper limit of normal (note: in participants with Gilbert's syndrome, if total bilirubin is > 1.5 x upper limit of normal, measure direct and indirect bilirubin and if direct bilirubin is =< 1.5 x upper limit of normal, participants may be eligible)

  • Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) =< 2 × institutional upper limit of normal

  • Alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 2 × institutional upper limit of normal

  • Serum Testosterone >= 250 ng/dL

  • Thyroid stimulating hormone (TSH) within institutional normal

  • The effects of bicalutamide on the developing human fetus at the recommended therapeutic dose are unknown. For this reason, men who are having sex must wear a condom when engaging in any activity that allows for passage of ejaculate to another person throughout the course of the study and 4 months after receiving last dose of study intervention. Male participants should also be advised of the benefit for a female partner to use a highly effective method of contraception as a condom may break or leak. Additionally, men must agree to not donate sperm for the purpose of reproduction during the study and for a minimum of 4 months after receiving the last dose of study intervention

  • Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

  • Participants who have had a previous exposure to sex hormone (e.g., exogenous androgens) or anti-androgenic therapies (e.g., luteinizing hormone-releasing hormone [LHRH] agonists, LHRH antagonists, 5 alpha reductase-inhibitors, abiraterone or other anti-androgens) within 6 months of accrual
  • Participants taking Coumarin derivative anticoagulation (e.g., warfarin). Other anticoagulation medications are allowed.
  • Participants receiving any other investigational agents.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to bicalutamide.
  • History of prior or concurrent muscle invading UC, or concurrent prostatic urethral, urethral, or upper tract UC or non-urothelial bladder cancer
  • History of radiation therapy to the pelvis, prostate or prostatic bed, or rectum
  • Any condition (uncontrolled intercurrent illness, psychiatric illness, or social situation) for which, in the opinion of the investigator, participation would not be in the best interest of the participant (e.g., compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments.
  • Allergy or hypersensitivity to bicalutamide, or excipients, unable or unwilling to take ADT.
  • Plans to father a child while enrolled in this study or within 4 months after the last dose of study intervention.
  • Participants with suspected Carcinoma in Situ (CIS) without suspected Ta or T1 disease are not eligible.
  • Participants with a history of documented CIS within 2 years are not eligible.
  • Participants who have received Gacillus Calmette-Guerin (BCG) within 2 years are not eligible.

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

  • 주 목적: 방지
  • 할당: 무작위
  • 중재 모델: 병렬 할당
  • 마스킹: 네 배로

무기와 개입

참가자 그룹 / 팔
개입 / 치료
실험적: Arm 1 (bicalutamide,TURBT)

Patients receive bicalutamide PO QD on days 1-21. Patients undergo TURBT on day 21. Up to 28 days of bicalutamide prior to TURBT is permitted in the absence of unacceptable toxicity. Patients undergo blood and urine sample collection throughout the study. Patients may optionally undergo tumor biopsy at baseline.

Ancillary studies

Undergo tumor biopsy

다른 이름들:
  • 비엑스
  • 생검_유형
  • 생검

Undergo blood and urine sample collection

다른 이름들:
  • 생물학적 샘플 수집
  • 생체 표본 수집
  • 표본 수집

Given PO

다른 이름들:
  • 카소덱스

Undergo TURBT

다른 이름들:
  • 경요도 절제술(TURBT)
  • TURBT
실험적: Arm 2 (TURBT)

Patients undergo TURBT on day 21. Patients undergo blood and urine sample collection throughout the study. Patients may optionally undergo tumor biopsy at baseline.

Ancillary studies

Undergo tumor biopsy

다른 이름들:
  • 비엑스
  • 생검_유형
  • 생검

Undergo blood and urine sample collection

다른 이름들:
  • 생물학적 샘플 수집
  • 생체 표본 수집
  • 표본 수집

Undergo TURBT

다른 이름들:
  • 경요도 절제술(TURBT)
  • TURBT

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정
측정값 설명
기간
Average Epidermal Growth Factor Receptor (EGFR) expression level
기간: Up to 28 days

Will be analyzed as a continuous variable. A two-sample t-test will be conducted to test whether there are significant differences of the log-transformed EGFR expression level (measured by reverse transcriptase polymerase chain reaction [rtPCR]) in normal appearing urothelium adjacent to tumor in participants treated with anti-androgen therapy versus (vs.) NSD participants. In case the normality assumption of the two-sample t-test does not hold, Wilcoxon rank-sum test will be performed as a sensitivity analysis. Considering androgen receptor (AR) status can be a treatment effect modifier, a regression analysis will also be performed with the log-transformed EGFR expression level as the outcome and treatment status (bicalutamide or NSD), AR status, and treatment-AR interaction as the predictors.

Up to 28 days

2차 결과 측정

결과 측정
측정값 설명
기간
Effect of bicalutamide on EGFR expression
기간: Up to 28 days

A two-sample Wilcoxon rank-sum test will be conducted to compare the difference of EGFR expression in AR positive participants treated with and without bicalutamide.

Up to 28 days
AR expression in adjacent urothelium
기간: Up to 28 days

Will evaluate the correlation between AR expression in adjacent urothelium with EGFR expression. Pearson correlation and Spearman's rank correlation will be calculated between the AR expression and EGFR expression.

Up to 28 days
Pre vs. post intervention urinary biomarkers
기간: Up to 28 days

Comparison of pre vs. post intervention urinary biomarkers (CxBladderTM) in both groups, examining the 5 ribonucleic acids (RNAs) (by rtPCR) that make up the test, both as a group and each RNA separately. Will be summarized by descriptive statistics such as rates and proportions and compared between NSD and bicalutamide using nonparametric tests such as the Kruskal-Wallis test.

Up to 28 days

기타 결과 측정

결과 측정
측정값 설명
기간
AR and EGFR (and possibly phosphorylated EGFR [pEGFR]) staining levels
기간: Up to 28 days

Will be summarized by descriptive statistics such as rates and proportions and compared between NSD and bicalutamide using nonparametric tests such as the Kruskal-Wallis test.

Up to 28 days
Expression of direct androgen response gene (ADAR)-2
기간: Up to 28 days

Will be summarized by descriptive statistics such as rates and proportions and compared between NSD and bicalutamide using nonparametric tests such as the Kruskal-Wallis test.

Up to 28 days
Ki-67 expression
기간: Up to 28 days

Will be summarized by descriptive statistics such as rates and proportions and compared between NSD and bicalutamide using nonparametric tests such as the Kruskal-Wallis test.

Up to 28 days
Ki-67 expression in the AR+ subgroup
기간: Up to 28 days

Will be summarized by descriptive statistics such as rates and proportions and compared between NSD and bicalutamide using nonparametric tests such as the Kruskal-Wallis test.

Up to 28 days
Differences in expression of AR, EGFR, pEGFR, and Ki-67
기간: Up to 28 days

Will be summarized by descriptive statistics such as rates and proportions and compared between NSD and bicalutamide using nonparametric tests such as the Kruskal-Wallis test.

Up to 28 days
Change in EGFR expression in tumor from participants randomized to bicalutamide versus NSD
기간: Up to 28 days

Will be summarized by descriptive statistics such as rates and proportions and compared between NSD and bicalutamide using nonparametric tests such as the Kruskal-Wallis test.

Up to 28 days
Analysis of fibroblast growth factor receptor 3 (FGFR3) in deoxyribonucleic acid (DNA)
기간: Up to 28 days

Extracted from fixed paraffin embedded (FFPE) blocks from neighboring normal urothelium and tumor tissue in participants treated with or without bicalutamide. Will be summarized by descriptive statistics such as rates and proportions and compared between NSD and bicalutamide using nonparametric tests such as the Kruskal-Wallis test.

Up to 28 days
Changes in the tumor immune microenvironment pre- and post-bicalutamide
기간: Up to 28 days

Will be summarized by descriptive statistics such as rates and proportions.

Up to 28 days
Analysis of tumor (biopsy specimen) infiltrating CD8+ T-cells
기간: Up to 28 days

The tumor immune microenvironment will be analyzed via multiplex immunofluorescence and spatial transcriptomics. Assessments will include CD8+ T-cell functional markers: TCF1/Tcf7 of CD44+, CD62L, PD-1, TIM3 and SLAMF6. Will be summarized by descriptive statistics such as rates and proportions and compared between NSD and bicalutamide using nonparametric tests such as the Kruskal-Wallis test.

Up to 28 days
AR, EGFR, and pEGFR in biopsies of tumors
기간: At index cystoscopy and TURBT

Optional biopsy tissue will be used to compare AR, EGFR, and pEGFR in biopsies of tumors done at index cystoscopy vs. transurethral resection of bladder tumor in participants randomized to bicalutamide versus NSD.

At index cystoscopy and TURBT
Exploratory markers
기간: Up to 28 days

Will be summarized by descriptive statistics such as rates and proportions and compared between NSD and bicalutamide using nonparametric tests such as the Kruskal-Wallis test.

Up to 28 days

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

스폰서

협력자

수사관

  • 수석 연구원: Edward M Messing, University of Wisconsin, Madison

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작 (실제)

2026년 6월 25일

기본 완료 (추정된)

2028년 6월 1일

연구 완료 (추정된)

2028년 12월 1일

연구 등록 날짜

최초 제출

2022년 8월 27일

QC 기준을 충족하는 최초 제출

2022년 8월 27일

처음 게시됨 (실제)

2022년 8월 30일

연구 기록 업데이트

마지막 업데이트 게시됨 (실제)

2026년 9월 30일

QC 기준을 충족하는 마지막 업데이트 제출

2026년 9월 25일

마지막으로 확인됨

2026년 9월 1일

추가 정보

이 연구와 관련된 용어

기타 연구 ID 번호

  • 2026-0131
  • P30CA014520 (미국 NIH 보조금/계약)
  • UG1CA242635 (미국 NIH 보조금/계약)
  • NCI-2022-06871 (레지스트리 식별자: CTRP (Clinical Trial Reporting Program))
  • INT22-09-01 (기타 식별자: DCP)
  • 2026-0131 (기타 식별자: UWCCC)
  • Protocol Version 8/26/26 (기타 식별자: DCP)

개별 참가자 데이터(IPD) 계획

개별 참가자 데이터(IPD)를 공유할 계획입니까?

예

IPD 계획 설명

NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page.

약물 및 장치 정보, 연구 문서

미국 FDA 규제 의약품 연구

예

미국 FDA 규제 기기 제품 연구

아니

이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .