Patologia: Carcinoma della vescica
Osservazionale-Sperimentale: Sperimentale
Monocentrico-Multicentrico: Multicentrico
Randomizzato: Sì
Fase di studio: III
Linee di trattamento: Prima linea
Criteri di inclusione:
- Has a histologically confirmed diagnosis of MIBC with predominant urothelial histology
- Has clinically non-metastatic bladder cancer (N0M0)
- Has planned and is eligible to receive chemoradiotherapy (CRT) and one of the protocol-specified radiosensitizing chemotherapy regimens
- Has Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
- Demonstrates adequate organ function
- Male participants are eligible to participate if they agree to the following during the intervention period and for at least 180 days after the last dose of study intervention:
- Refrain from donating sperm
- Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent; or must agree to use contraception unless confirmed to be azoospermic
- A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
- Is not a woman of childbearing potential (WOCBP)
- Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), with low user dependency or be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis), during the intervention period and for at least 180 days after the last dose of study intervention; and agrees not to donate eggs (ova, oocytes) to others or freeze/store for her own use for the purpose of reproduction during this period.
Criteri di esclusione:
- Has the presence of diffuse carcinoma in situ (CIS) (multiple foci of CIS) throughout the bladder
- Has the presence of urothelial carcinoma (UC) at any site outside of the urinary bladder in the previous 2 years except for Ta stage/T1 stage/CIS of the upper tract if the participant has undergone a complete nephroureterectomy
- Has a known additional malignancy that is progressing or has required active therapy within the past 3 years, except basal cell carcinoma of the skin, squamous cell carcinoma of the skin, superficial bladder cancer or other carcinoma in situ that has undergone potentially curative therapy
- Has the presence of bilateral hydronephrosis
- Has limited bladder function with frequency of small amounts of urine (< 30 mL), urinary incontinence, or requires self-catheterization or a permanent indwelling catheter
- Has received prior pelvic/local radiation therapy or any antineoplastic treatment for muscle-invasive bladder cancer (MIBC). Treatment for non-muscle invasive bladder cancer (NMIBC) with intravesical instillation therapy that was completed ≥28 days prior to randomization is allowed. Prior systemic treatment of NMIBC is not permitted.
- Received prior therapy with an anti-PD-1 (programmed cell death protein 1), anti-PD-L1 (programmed death-ligand 1), or anti-PD-L2 (programmed cell death 1 ligand 2), or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (e.g., CTLA-4 [cytotoxic T-lymphocyte-associated protein 4], OX 40, or CD137 [cluster of differentiation 137])
- Has received a live vaccine within 30 days prior to the first dose of study drug
- Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study intervention
- Has severe hypersensitivity (≥Grade 3) to pembrolizumab and/or the selected chemotherapy regimen, and/or any of their excipients
- Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug
- Has an active autoimmune disease that has required systemic treatment in the past 2 years (ie, with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed
- Has a history of non-infectious pneumonitis that required steroids or has current pneumonitis
- Has an active infection requiring systemic therapy
- Has a known history of human immunodeficiency virus (HIV) infection
- Has a known history of Hepatitis B or known active Hepatitis C virus infection
- Has a known history of active tuberculosis (TB; Bacillus tuberculosis)
- Has a known psychiatric or substance abuse disorder that would interfere with the participant's ability to cooperate with the requirements of the study
- Has had an allogenic tissue/solid organ transplant.
Trattamento sperimentale:
Pembrolizumab + Chemotherapy + Radiotherapy
Trattamento di controllo:
Placebo + Chemotherapy + Radiotherapy
Obiettivi primari dello studio:
Bladder Intact Event-Free Survival (BI-EFS) [ Time Frame: Up to approximately 71 months ]
BI-EFS is defined as the time from randomization to any of the following events: residual/recurrent MIBC post-chemoradiotherapy (CRT), nodal or distant metastases post-CRT, radical cystectomy, or death due to any cause. The BI-EFS for all participants will be presented.
IRCCS Istituto Nazionale dei Tumori
Via Venezian 1 - 20133 Milano - MI
Ospedale San Raffaele di Milano
Via Olgettina 60 - 20132 Milano - MI
Riferimento: Prof. Andrea Necchi
Telefono: 0226435789
Email: necchi.andrea@unisr.it
A.O.U. Policlinico di Modena
Via del Pozzo 71 - 41100 Modena - MO
NB: Completed
AOU Careggi
Largo Brambilla 3 - 50134 Firenze - FI
Riferimento: Prof. Lorenzo Livi
Telefono: 055794111
Email: rt.datamanager@sbsc.unifi.it
Ospedale di Macerata
Via Santa Lucia 2 - 62100 Macerata - MC
Riferimento: Dr. Nicola Battelli
Telefono: 07332572881
Email: nicola.battelli@sanita.marche.it
Università Campus Bio-medico
Via Álvaro del Portillo 200 - 00128 Roma - RM
Istituto Tumori “Giovanni Paolo II” IRCCS
Viale Orazio Flacco 65 - 70124 Bari - BA
Riferimento: Dr. Emanuele Naglieri
Telefono: 0805555352
Email: e.naglieri@oncologico.bari.it
Istituto Nazionale Tumori IRCCS Fondazione Pascale
Via Mariano Semmola - 80131 Napoli - NA
Riferimento: Dr.ssa Rosa Tambaro
Telefono: 0815903358
Email: r.tambaro@istitutotumori.na.it
Numero di iscrizione a registro: 2019-004023-20
Data di inserimento: 22.04.2021
Data di aggiornamento: 27.03.2023
Merck Sharp & Dohme Corp.
na
Istituto Nazionale Tumori - IRCCS Fondazione Pascale, Napoli
Riferimento: Dr.ssa Rosa Tambaro
Telefono: 0815903358
Email: r.tambaro@istitutotumori.na.it
Localita: Napoli