Phase 2
N=237
S1314, Co-expression Extrapolation (COXEN) Program to Predict Chemotherapy Response in Patients With Bladder Cancer
Bladder Cancer
Bottom Line
View on ClinicalTrials.gov: NCT02177695 ↗Enrolled (actual)
237
Serious AEs
2.2%
Results posted
Jan 2022
Primary outcome: Primary: Assessment of Whether the Treatment-specific COXEN Score is Prognostic of pT0 Rate — 8; 10; 20; 17 Participants — p=0.1
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 2
- Interventions
- Gemcitabine (Drug); Cisplatin (Drug); Methotrexate (Drug); Vinblastine (Drug); Doxorubicin (Drug); Filgrastim (Drug)
- Age
- Adult, Older Adult · 18+ yrs
- Sex
- All
- Sponsor
- SWOG Cancer Research Network
- Primary completion
- Feb 2020
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Assessment of Whether the Treatment-specific COXEN Score is Prognostic of pT0 Rate |
8; 10; 20; 17 | 0.1 |
| PRIMARY Assessment of Whether the Treatment-specific COXEN Score is Prognostic of ≤ pT1 Rate |
10; 16; 30; 31 | 0.02 sig |
| PRIMARY Assessment of COXEN Score as a Predictive Factor Distinguishing Between GC and ddMVAC |
0.88; 0.43; 0.66; 0.85 | — |
| PRIMARY Correlation Between GC-and ddMVAC-COXEN Score |
0.385; 0.386 | — |
| SECONDARY Predictability of the CO-eXpression ExtrapolatioN (COXEN) Score to Direct Which of the Two Regimens the Patient Should Receive: Gemcitabine+Cisplatin (GC) Versus Dose-dense Methotrexate, Vinblastin, Doxorubicin, and Cisplatin (DDMVAC) |
0.88; 0.43; 0.66; 0.85 | — |
| SECONDARY Value of Gene Expression Profiling in Predicting Overall Survival (OS) |
76; 71 | — |
| SECONDARY Pathologic T0 Rate Evaluation: Gemcitabine+Cisplatin (GC) Versus Dose-dense Methotrexate, Vinblastin, Doxorubicin, and Cisplatin (DDMVAC) |
36; 42 | — |
| SECONDARY Number of Participants With Gr 3 Through 5 Adverse Events That Are Related to Study Drugs |
0; 1; 1; 0; 10; 9 | — |
Summary
The primary focus of this study is to see if looking at tumor biomarkers using a program called coexpression extrapolation or "COXEN" may predict a patient's response to chemotherapy before surgery.
Eligibility Criteria
Inclusion Criteria
- Histologically proven bladder cancer (pure small cell carcinoma, pure adenocarcinoma, and pure squamous cell carcinoma histologies are excluded).
- Stage cT2-T4a N0 M0 disease.
- Documented muscle invasive disease with at least one of the following: disease measuring at least 10 mm on cross-sectional imaging OR the presence of tumor-associated hydronephrosis.
- Staging scans with abdominal/pelvic CT or MRI scan and CT scan or x-ray of the chest within 56 days prior to registration. If alkaline phosphatase is above the treating institution's upper limit of normal (ULN), presence of suspicious bone pain, or if other clinical suspicion, a whole body bone scan is required within 56 days prior to registration.
- Performance status = 0 or 1
- 18 years of age or older
- Must have tumor tissue from transurethral resection of the bladder tumor (TURBT) available for submission that is sufficient for COXEN testing and must agree to submission of 20 (10 micron) slides plus 2 (5 micron) slides from the start and end of the 20 slides for a total of 22 unstained slides.
- Must agree to collection of tissue (if residual disease is present), urine, and whole blood.
- Must agree to participate in the translational medicine studies outlined in the protocol
Exclusion Criteria
- Prior systemic cytotoxic chemotherapy or systemic anthracycline
- Peripheral neuropathy >/= Grade 2
- Class III/IV heart failure or known left ventricular ejection fraction (LVEF) Grade 2
- Renal function, calculated creatinine clearance 1.5 x institutional upper limit of normal (IULN) (or > 2.5 x IULN with Gilbert's disease); AST & ALT > 2 X IULN
- Hematologic function, absolute neutrophil count (ANC) < 1,500/mcL, hemoglobin < 9 g/dL, and platelets < 100,000/mcL
- Hypersensitivity to cisplatin, gemcitabine, doxorubicin, vinblastine, methotrexate, or filgrastim/pegfilgrastim
- Incidence of or uncontrolled medical illness (e.g. active cardiac symptoms, active systemic infection, etc.)
- Pregnant or nursing females
- No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated Stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for five years. However, patients with localized prostate cancer who are being followed by an active surveillance program are eligible.
Data sourced from ClinicalTrials.gov (NCT02177695). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.