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O Impacto da Administração de EV/P em Diferentes Horários do Dia na Taxa de Resposta Objetiva em Adultos com Cancro da Bexiga Avançado (Chrono-EVP)

29 de setembro de 2026 atualizado por: Guliz Ozgun

CHRONO-EVP: Administração Dependente da Hora do Dia de Enfortumab Vedotin e Pembrolizumab (EV/P) no Cancro da Bexiga Avançado

The goal of this clinical trial is to learn if the timing of treatments plays a role in how effective the standard-of-care drugs enfortumab vedotin and pembrolizumab (EV/P) works to treat adults with advanced bladder cancer. The trial will also learn if time-of-day reduces EV/P side-effects.

Researchers will compare EV/P given in the morning (before 11:30am) vs in the afternoon (after 1:30pm), to see if circadian rhythm effects how EV/P works to treat advanced bladder cancer.

Participants will be randomized in Arm A or Arm B to receive drugs EV/P either in the morning (Arm A) or afternoon (Arm B) as part of their standard-of-care treatment for advanced bladder cancer. Participants will:

  • Visit the clinic either in the morning (Arm A) or afternoon (Arm B) to receive EV/P treatment as part of their regular medical care for advanced bladder cancer
  • Frequency of visits will follow standard-of-care guidelines
  • Participants will be followed-up by the study team for up to 24 months.

Visão geral do estudo

Status

Ainda não está recrutando

Condições

Intervenção / Tratamento

Tipo de estudo

Intervencional

Inscrição (Estimado)

224

Estágio

  • Fase 3

Contactos e Locais

Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.

Contato de estudo

Locais de estudo

  • Canadá
    • British Columbia
      • Abbotsford British Columbia, British Columbia, Canadá, V2S 0C2
        • BC Cancer - Abbotsford
        • Contato:
      • Kelowna, British Columbia, Canadá, V1Y 5L3
        • BC Cancer - Kelowna (Sindi Ahluwalia Hawkins Centre)
        • Contato:
      • Surrey, British Columbia, Canadá, V3V 1Z2
        • BC Cancer - Surrey
        • Contato:
      • Vancouver, British Columbia, Canadá, V5Z 4E6
        • BC Cancer - Vancouver Cancer Centre
        • Contato:
      • Victoria, British Columbia, Canadá, V8R 6V5

Critérios de participação

Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.

Critérios de elegibilidade

Idades elegíveis para estudo

18 anos e mais velhos (Adulto, Adulto mais velho)

Aceita Voluntários Saudáveis

Não

Gêneros Elegíveis para o Estudo

Tudo

Descrição

Inclusion Criteria:

  • Participants must meet all of the following inclusion criteria to be eligible for participation in this trial:

    1. Age 18 or older
    2. Able to provide informed consent
    3. Histologically confirmed advanced urothelial cancer
    4. Eligible for standard-of-care EV/P regimen
    5. Measurable disease per RECIST 1.1
    6. ECOG performance status 0-2
    7. Ability to adhere to scheduled infusion times (Before 11:30 a.m. or after 1:30 pm) Waivers to the inclusion criteria will NOT be allowed.

Exclusion Criteria:

  • Participants who meet any of following exclusion criteria will not be eligible for participation in this trial:

    1. Non-urothelial histology or mixed histology with predominant non-urothelial components
    2. Concurrent malignancy requiring active systemic therapy, unless disease-free for at least 2 years
    3. Inability to comply with protocol-specified infusion timing for at least the first 3 months
    4. Night shift workers
    5. Clinical evidence of new or enlarging brain metastasis or carcinomatous meningitis
    6. Known psychiatric or substance abuse disorder that would interfere with cooperation with the requirements of the trial
    7. Patients who have traveled across ≥2 time zones within the past 14 days prior to randomization will be excluded, due to potential disruption of circadian rhythms (jet lag), which may affect chronotherapy-related endpoints.
    8. Patients with a clinically diagnosed sleep disorder, including but not limited to insomnia, obstructive sleep apnea, restless leg syndrome, or circadian rhythm sleep-wake disorders, that is moderate to severe, untreated, or poorly controlled, will be excluded.

Waivers to the exclusion criteria will NOT be allowed.

Plano de estudo

Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.

Como o estudo é projetado?

Detalhes do projeto

  • Finalidade Principal: Tratamento
  • Alocação: Randomizado
  • Modelo Intervencional: Atribuição Paralela
  • Mascaramento: Nenhum (rótulo aberto)

Armas e Intervenções

Grupo de Participantes / Braço
Intervenção / Tratamento
Comparador Ativo: Arm A: Morning EV/P Treatment

Participants will receive standard-of-care therapy (Ev/P) administered in the morning (before 11:30am).
Medicamento: enfortumab vedotin and pembrolizumab (EV/P)

Participants will receive EV/P as part of their standard-of-care therapy administered either in the morning (Arm A) or afternoon (Arm B), as determined by randomization.
Comparador Ativo: Arm B: Afternoon EV/P Treatment

Participants will receive standard-of-care therapy (EV/P) administered in the afternoon (after 1:30pm).
Medicamento: enfortumab vedotin and pembrolizumab (EV/P)

Participants will receive EV/P as part of their standard-of-care therapy administered either in the morning (Arm A) or afternoon (Arm B), as determined by randomization.

O que o estudo está medindo?

Medidas de resultados primários

Medida de resultado
Descrição da medida
Prazo
Objective response rate in in time-of-day administration of EV/P treatment
Prazo: From enrollment to end of follow-up at 24-months.

Objective response rate (ORR) will be determined by proportion of patients achieving a complete or partial response as assessed by RECIST v1.1 criteria, confirmed by central review or investigator assessment. Tumor assessments will be performed as standard of care (typically every 12 weeks), and best overall response prior to disease progression will be used for ORR determination.
From enrollment to end of follow-up at 24-months.

Medidas de resultados secundários

Medida de resultado
Descrição da medida
Prazo
Assess treatment-related tolerability and toxicity differences
Prazo: From enrollment to the end of follow-up at 24-months.

Differences in steroid use (yes/no) for the management of treatment-related toxicity, treatment interruptions (yes/no) due to treatment-related toxicity, and treatment discontinuations (yes/no) due to treatment-related toxicity will be used as surrogate safety outcomes, as comprehensive adverse event documentation is beyond the scope of this pragmatic clinical trial. The study seeks to determine whether treatment administration at a predefined time of day is associated with differences in the need for toxicity-related clinical interventions. Given that the relevant adverse events are well characterized in the existing literature, the focus of this study is on comparative safety between groups using these surrogate measures rather than on detailed characterization of individual adverse events.
From enrollment to the end of follow-up at 24-months.
Immune Profiling
Prazo: At 4 time points: Baseline, 1-day post first cycle of treatment, 3 weeks into treatment and 12 weeks into treatment

Immune cell populations will be characterized from the blood samples at baseline (prior to treatment initiation) and at three predefined time points during therapy: 1 day after treatment initiation, 3 weeks into treatment, and 12 weeks into treatment. Cytometry by time-of-flight (CyTOF) will be used to comprehensively profile immune cell populations allowing for high-dimensional assessment of immune cell composition and activation states across treatment timing groups.
At 4 time points: Baseline, 1-day post first cycle of treatment, 3 weeks into treatment and 12 weeks into treatment
Bulk RNA sequencing (RNA-seq)
Prazo: At 4 time points: Baseline, 1-day post first cycle of treatment, 3 weeks into treatment and 12 weeks into treatment

Bulk RNA sequencing (RNA-seq) will be performed to comprehensively characterize global gene expression profiles and to evaluate time-of-day-associated differences in immune-related transcriptional signatures. This approach will enable the identification of circadian variation in gene expression and provide insight into temporal regulation of immune pathways in response to treatment.
At 4 time points: Baseline, 1-day post first cycle of treatment, 3 weeks into treatment and 12 weeks into treatment
Cytokine and chemokine analyses
Prazo: At 4 time points: Baseline, 1-day post first cycle of treatment, 3 weeks into treatment and 12 weeks into treatment

Plasma will be isolated for cytokine and chemokine analyses to assess systemic immune signaling and inflammatory profiles. Quantitative evaluation of circulating cytokines and chemokines will provide insight into treatment- and time-dependent changes in immune activation, inflammation, and immune regulation, complementing cellular and transcriptional immune profiling.
At 4 time points: Baseline, 1-day post first cycle of treatment, 3 weeks into treatment and 12 weeks into treatment
Evaluate Progression-Free Survival in time-of-day administration of EV/P
Prazo: From enrollment to end of follow-up at 24-months.

Progression-free Survival (PFS) will be determined by time of randomization to radiographic progression or death from any cause, whichever occurs first.
From enrollment to end of follow-up at 24-months.
Assess Overall-Survival in time-of-day administration of EV/P
Prazo: From enrollment to the end of follow-up at 24-months.

Overall-survival (OS) is defined as the time from randomization to death from any cause. The analysis will compare OS curves between study arms and estimate 2-year OS rates for each group.
From enrollment to the end of follow-up at 24-months.
Evaluate the Time-to-Treatment Failure in time-of-day administration of EV/P
Prazo: From enrollment to the end of follow-up at 24-months.

Time to treatment failure (TTF) is determined by assessing time from treatment initiation to treatment discontinuation for any reason, including disease progression, unacceptable toxicity, patient withdrawal, or death, capturing both treatment efficacy and tolerability.
From enrollment to the end of follow-up at 24-months.
Assess quantitative changes in ctDNA Kinetics of time-of-day administration of EV/P
Prazo: Baseline, 3 weeks, and 12-weeks.

Quantitative changes in circulating tumour DNA (ctDNA) levels will be collected and measured at baseline, post-cycle 1 (~3 weeks), and at post-cycle 4 (~12 weeks) at first radiographic assessment, with correlation to response and survival outcomes.
Baseline, 3 weeks, and 12-weeks.
Circulating Tumor DNA (ctDNA) Analyses
Prazo: At 3 time points: Baseline, 3 weeks into treatment and 12 weeks into treatment

Circulating tumor DNA (ctDNA) analyses will be performed on plasma samples collected at baseline (prior to treatment initiation), 3 weeks into treatment, and 12 weeks into treatment. ctDNA dynamics will be evaluated to assess molecular response to therapy, including changes in ctDNA levels and ctDNA clearance rates over time. Comparisons will be made between treatment administration at different times of day to determine whether timing of therapy is associated with differences in ctDNA kinetics, clearance rates, and early molecular response.
At 3 time points: Baseline, 3 weeks into treatment and 12 weeks into treatment

Colaboradores e Investigadores

É aqui que você encontrará pessoas e organizações envolvidas com este estudo.

Patrocinador

Guliz Ozgun

Colaboradores

British Columbia Cancer Agency

Publicações e links úteis

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Publicações Gerais

Datas de registro do estudo

Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados ​​pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.

Datas Principais do Estudo

Início do estudo (Estimado)

1 de novembro de 2026

Conclusão Primária (Estimado)

1 de dezembro de 2030

Conclusão do estudo (Estimado)

1 de dezembro de 2032

Datas de inscrição no estudo

Enviado pela primeira vez

8 de dezembro de 2025

Enviado pela primeira vez que atendeu aos critérios de CQ

7 de janeiro de 2026

Primeira postagem (Real)

16 de janeiro de 2026

Atualizações de registro de estudo

Última Atualização Postada (Real)

1 de outubro de 2026

Última atualização enviada que atendeu aos critérios de controle de qualidade

29 de setembro de 2026

Última verificação

1 de setembro de 2026

Mais Informações

Termos relacionados a este estudo

Palavras-chave

Termos MeSH relevantes adicionais

Outros números de identificação do estudo

  • Chrono-EVP

Plano para dados de participantes individuais (IPD)

Planeja compartilhar dados de participantes individuais (IPD)?

INDECISO

Informações sobre medicamentos e dispositivos, documentos de estudo

Estuda um medicamento regulamentado pela FDA dos EUA

Não

Estuda um produto de dispositivo regulamentado pela FDA dos EUA

Não

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