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Effekter av Apalutamid på EGFR-ekspresjon hos pasienter med ikke-muskelinvasiv blærekreft

25. september 2026 oppdatert av: University of Wisconsin, Madison

En randomisert utprøving av apalutamid i ikke-muskelinvasiv blærekreft

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.

Studieoversikt

Status

Rekruttering

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

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.

Studietype

Intervensjonell

Registrering (Antatt)

80

Fase

  • Fase 1

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

  • Forente stater
    • Arizona
      • Tucson, Arizona, Forente stater, 85719
        • Rekruttering
        • University of Arizona Cancer Center - Prevention Research Clinic
        • Ta kontakt med:
        • Hovedetterforsker:
          • Juan Chipollini
    • California
      • Los Angeles, California, Forente stater, 90048
        • Har ikke rekruttert ennå
        • Cedars Sinai Medical Center
        • Ta kontakt med:
        • Hovedetterforsker:
          • Michael A. Ahdoot
    • Maryland
      • Bethesda, Maryland, Forente stater, 20892
        • Har ikke rekruttert ennå
        • National Cancer Institute Urologic Oncology Branch
        • Ta kontakt med:
        • Hovedetterforsker:
          • Sandeep Gurram
    • New York
      • Rochester, New York, Forente stater, 14642
        • Har ikke rekruttert ennå
        • University of Rochester
        • Ta kontakt med:
        • Hovedetterforsker:
          • Edward M. Messing
    • Ohio
      • Columbus, Ohio, Forente stater, 43210
        • Rekruttering
        • Ohio State University Comprehensive Cancer Center
        • Ta kontakt med:
        • Hovedetterforsker:
          • Debasish Sundi
    • Wisconsin
      • Madison, Wisconsin, Forente stater, 53792
        • Rekruttering
        • University of Wisconsin Carbone Cancer Center - University Hospital
        • Ta kontakt med:
        • Hovedetterforsker:
          • Kyle A. Richards

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Mann

Beskrivelse

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.

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Forebygging
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Firemannsrom

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Eksperimentell: 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.
Annen: Questionnaire Administration

Ancillary studies

Fremgangsmåte: Biopsy Procedure

Undergo tumor biopsy

Andre navn:
  • Bx
  • BIOPSY_TYPE
  • Biopsi
Fremgangsmåte: Biospecimen Collection

Undergo blood and urine sample collection

Andre navn:
  • Biologisk prøvesamling
  • Bioprøve samlet
  • Prøvesamling
Legemiddel: Bicalutamide

Given PO

Andre navn:
  • Casodex
Fremgangsmåte: Transurethral Resection of Bladder Tumor

Undergo TURBT

Andre navn:
  • Transuretral reseksjon (TURBT)
  • TURBT
Eksperimentell: 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.
Annen: Questionnaire Administration

Ancillary studies

Fremgangsmåte: Biopsy Procedure

Undergo tumor biopsy

Andre navn:
  • Bx
  • BIOPSY_TYPE
  • Biopsi
Fremgangsmåte: Biospecimen Collection

Undergo blood and urine sample collection

Andre navn:
  • Biologisk prøvesamling
  • Bioprøve samlet
  • Prøvesamling
Fremgangsmåte: Transurethral Resection of Bladder Tumor

Undergo TURBT

Andre navn:
  • Transuretral reseksjon (TURBT)
  • TURBT

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Average Epidermal Growth Factor Receptor (EGFR) expression level
Tidsramme: 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

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Effect of bicalutamide on EGFR expression
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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

Andre resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
AR and EGFR (and possibly phosphorylated EGFR [pEGFR]) staining levels
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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)
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

University of Wisconsin, Madison

Samarbeidspartnere

National Cancer Institute (NCI)

Etterforskere

  • Hovedetterforsker: Edward M Messing, University of Wisconsin, Madison

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

25. juni 2026

Primær fullføring (Antatt)

1. juni 2028

Studiet fullført (Antatt)

1. desember 2028

Datoer for studieregistrering

Først innsendt

27. august 2022

Først innsendt som oppfylte QC-kriteriene

27. august 2022

Først lagt ut (Faktiske)

30. august 2022

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

30. september 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

25. september 2026

Sist bekreftet

1. september 2026

Mer informasjon

Begreper knyttet til denne studien

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • 2026-0131
  • P30CA014520 (U.S. NIH-stipend/kontrakt)
  • UG1CA242635 (U.S. NIH-stipend/kontrakt)
  • NCI-2022-06871 (Registeridentifikator: CTRP (Clinical Trial Reporting Program))
  • INT22-09-01 (Annen identifikator: DCP)
  • 2026-0131 (Annen identifikator: UWCCC)
  • Protocol Version 8/26/26 (Annen identifikator: DCP)

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

JA

IPD-planbeskrivelse

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.

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Ja

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .

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