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A Phase II Trial Evaluating an Organ-conserving Strategy by Radiochemotherapy for Muscle-infiltrative Bladder Cancer (GETUGV04)

Primary Purpose

Infiltrating Bladder Urothelial Carcinoma

Status
Active
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Radiation + cisplatin
Radiation + cisplatin + gemcitabine
Sponsored by
Institut du Cancer de Montpellier - Val d'Aurelle
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Infiltrating Bladder Urothelial Carcinoma focused on measuring Bladder cancer, Organ-conserving strategy, Radiochemotherapy, non metastatic

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Muscle invasive urothelial cancer (front line or following the progression of a superficial tumor), pT2-pT3 stage without lymphatic impairment (N0) and without detectable metastases (M0). An optimal macroscopic resection (TURB) have to be performed
  • The proof of invasive tumor to the muscle should be brought by a transurethral resection under anaesthesia less than 8 weeks before or, in the absence, by superficial biopsies and formal imaging. Multiples biopsies in the bladder must also be performed.
  • Age ≥ 18 years
  • Life expectancy ≥ 6 months
  • Kanorfsky index ≥ 70 % (WHO 0, 1, 2)
  • Biological criteria: neutrophils ≥ 1500/mm3, Platelets ≥ 100 000/mm3, haemoglobin ≥ 10 g/dl, creatinine clearance > 60 ml/mn
  • No distant metastases (Thorax, abdomen, and pelvic CT-scan, bone scan)
  • Efficient contraception for premenopausal women, maintained during the whole treatment and up to two months after the completion of radiotherapy.
  • No radiotherapy or chemotherapy history except for in situ bladder lesions.
  • No carcinological history except for non melanoma skin tumours, in situ uterine cervix cancer
  • No contraindication to gemcitabine or cisplatin.
  • No contraindication to radiotherapy
  • Information letter and informed consent signed
  • Patient covered by social security

Exclusion Criteria:

  • Bladder tumors without any muscle infiltration
  • Epidermoid carcinoma or adenocarcinoma
  • Distance metastases or extrapelvic node positivity
  • Severe digestive history (ulcerative colitis, complicated diverticulitis)
  • Pregnancy and breast feeding

Sites / Locations

  • Institut Bergonié
  • Centre Francois Baclesse
  • Hopital Henri Mondor
  • CRLC GF Leclerc
  • CRLC Val d'Aurelle-Paul Lamarque
  • Centre azuréen de Cancérologie
  • Centre Antoine Lacassagne
  • Hopital saint Louis
  • HEGP
  • Institut de Cancérologie Lucien Neuwirth
  • Clinique Patseur
  • Centre Alexis Vautrin

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Radiotherapy + cisplatin

Radiotherapy + cisplatin + gemcitabine

Arm Description

Outcomes

Primary Outcome Measures

Disease-free survival
The time to relapse is defined as the time from the date of randomisation to the date of the first event. Time to relapse for patients without any event (local, regional, distance, or death) will be censored at the date of latest information.

Secondary Outcome Measures

Overall survival
The time to death is defined as time from the randomization to the date of death from any cause, or to the date on which latest information is obtained.
Acute and late toxicities
Acute and late toxicities will be scored according to the NCI-CTC v4.0.
measurement of Quality of life
Questionnaires QLQ C30 + QLQ-BLM30 + QLQ-ELD15 + Oncodage
Correlation between lymphocyte apoptosis and severity of late toxicities.
Before starting radiotherapy, 5ml of blood will be sampled in a 5ml heparinised tube to prospectively measure the rate of CD8 radio-induced lymphocyte apoptosis before any radiotherapy treatment. A correlation between the low rate of lymphocyte apoptosis and the severity of late toxicities will be studied to confirm the predictive power of this biological test on radio-induced side-effects.

Full Information

First Posted
December 14, 2011
Last Updated
November 29, 2022
Sponsor
Institut du Cancer de Montpellier - Val d'Aurelle
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1. Study Identification

Unique Protocol Identification Number
NCT01495676
Brief Title
A Phase II Trial Evaluating an Organ-conserving Strategy by Radiochemotherapy for Muscle-infiltrative Bladder Cancer
Acronym
GETUGV04
Official Title
A Randomized Phase II Trial Evaluating an Organ-conserving Strategy With Radiotherapy + CDDP + Gemcitabine vs Radiotherapy + CDDP in Muscle-infiltrative Bladder Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
July 6, 2011 (Actual)
Primary Completion Date
July 25, 2022 (Actual)
Study Completion Date
September 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Institut du Cancer de Montpellier - Val d'Aurelle

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
If radical cystectomy remains the standard of care for muscle invasive bladder cancer, consequences of this surgical procedure are often harsh. Over the past years, concurrent chemo-radiotherapy has imposed itself as an alternative treatment. Published data on concomitant radiochemotherapy (radiotherapy/cisplatin or radiotherapy/cisplatin/5-fluorouracil combinations) showed local control rates with bladder preservation at 5 years ranging from 40% to 65% according to the disease stage, and overall survival probabilities ranging from 40% to 50% at 5 years. In order to improve local and systemic prognosis, evaluation of other chemotherapy agents with higher radiosensitizing effect, such as gemcitabine, is justified. Gemcitabine possesses its own anti-cancer activities on urothelial diseases and has a synergetic activity with cisplatin. The investigators completed a monocenter phase I study combining radiotherapy, cisplatin, and twice-weekly gemcitabine, and determined a recommended dose of gemcitabine 25 mg/m². The objective of the present study is to evaluate the combination of radiotherapy + cisplatin + gemcitabine in terms of disease-free survival in non metastatic muscle invasive urothelial cancer patients.
Detailed Description
The objective of the present study is to evaluate the combination of radiotherapy + cisplatin + gemcitabine in terms of disease-free survival in non metastatic muscle invasive urothelial cancer patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Infiltrating Bladder Urothelial Carcinoma
Keywords
Bladder cancer, Organ-conserving strategy, Radiochemotherapy, non metastatic

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
69 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Radiotherapy + cisplatin
Arm Type
Active Comparator
Arm Title
Radiotherapy + cisplatin + gemcitabine
Arm Type
Experimental
Intervention Type
Other
Intervention Name(s)
Radiation + cisplatin
Intervention Description
RT will encompass bilateral internal and external iliac lymph nodes at a dose of 45 Gy and the bladder up to 63 Gy. Fractionation will be 1.8 Gy per fraction. Cisplatin: 20 mg/m2/day through continuous iv perfusion for 4 consecutive days, from D2 to D5 and from D23 to D26 for the first part of the treatment, then from D2 to D5 if an additional treatment is decided. A cystoscopy with a transurethral resection will be performed 3 weeks after the last day of the first part of radio-chemotherapy. In the absence of tumor cells, the 2nd part will start on the 4th week or at latest on the 5th week after the last day of the 1st part of radio-chemotherapy. In case of a microscopic tumor residue or of a local tumor progression, operability will be re-evaluated in view of a radical cystectomy and the patient will exit the study.
Intervention Type
Other
Intervention Name(s)
Radiation + cisplatin + gemcitabine
Intervention Description
Radiotherapy will encompass bilateral internal and external iliac lymph nodes at a dose of 45 Gy and the bladder up to 63 Gy. Fractionation will be 1.8 Gy per fraction. Cisplatin: 20 mg/m2/day through continuous iv perfusion for 4 consecutive days, from D2 to D5 and from D23 to D26 for the first part of the treatment, then from D2 to D5 for the second part of the treatment if an additional treatment is decided. Gemcitabine: iv injection for 30 minutes, twice a week at a dose of 25 mg/m2 on days 2, 5, 9, 12, 16, 19, 23, 26, 30, and 33 for the 1st part of treatment, then on days 2, 5, 9, and 12 for the 2nd part of treatment if an additional treatment is decided (cystoscopy with a transurethral resection). RT will be delivered between 2 and 6 hours after completion of the gemcitabine injection.
Primary Outcome Measure Information:
Title
Disease-free survival
Description
The time to relapse is defined as the time from the date of randomisation to the date of the first event. Time to relapse for patients without any event (local, regional, distance, or death) will be censored at the date of latest information.
Time Frame
Two years after the end of the complete therapeutic sequence
Secondary Outcome Measure Information:
Title
Overall survival
Description
The time to death is defined as time from the randomization to the date of death from any cause, or to the date on which latest information is obtained.
Time Frame
Up to 5 years
Title
Acute and late toxicities
Description
Acute and late toxicities will be scored according to the NCI-CTC v4.0.
Time Frame
Up to 5 years
Title
measurement of Quality of life
Description
Questionnaires QLQ C30 + QLQ-BLM30 + QLQ-ELD15 + Oncodage
Time Frame
Up to 5 years
Title
Correlation between lymphocyte apoptosis and severity of late toxicities.
Description
Before starting radiotherapy, 5ml of blood will be sampled in a 5ml heparinised tube to prospectively measure the rate of CD8 radio-induced lymphocyte apoptosis before any radiotherapy treatment. A correlation between the low rate of lymphocyte apoptosis and the severity of late toxicities will be studied to confirm the predictive power of this biological test on radio-induced side-effects.
Time Frame
Up to 5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Muscle invasive urothelial cancer (front line or following the progression of a superficial tumor), pT2-pT3 stage without lymphatic impairment (N0) and without detectable metastases (M0). An optimal macroscopic resection (TURB) have to be performed The proof of invasive tumor to the muscle should be brought by a transurethral resection under anaesthesia less than 8 weeks before or, in the absence, by superficial biopsies and formal imaging. Multiples biopsies in the bladder must also be performed. Age ≥ 18 years Life expectancy ≥ 6 months Kanorfsky index ≥ 70 % (WHO 0, 1, 2) Biological criteria: neutrophils ≥ 1500/mm3, Platelets ≥ 100 000/mm3, haemoglobin ≥ 10 g/dl, creatinine clearance > 60 ml/mn No distant metastases (Thorax, abdomen, and pelvic CT-scan, bone scan) Efficient contraception for premenopausal women, maintained during the whole treatment and up to two months after the completion of radiotherapy. No radiotherapy or chemotherapy history except for in situ bladder lesions. No carcinological history except for non melanoma skin tumours, in situ uterine cervix cancer No contraindication to gemcitabine or cisplatin. No contraindication to radiotherapy Information letter and informed consent signed Patient covered by social security Exclusion Criteria: Bladder tumors without any muscle infiltration Epidermoid carcinoma or adenocarcinoma Distance metastases or extrapelvic node positivity Severe digestive history (ulcerative colitis, complicated diverticulitis) Pregnancy and breast feeding
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Azria David, MD
Organizational Affiliation
ICM Val d'Aurelle
Official's Role
Study Chair
Facility Information:
Facility Name
Institut Bergonié
City
Bordeaux
ZIP/Postal Code
33000
Country
France
Facility Name
Centre Francois Baclesse
City
Caen
ZIP/Postal Code
14000
Country
France
Facility Name
Hopital Henri Mondor
City
Créteil
ZIP/Postal Code
94010
Country
France
Facility Name
CRLC GF Leclerc
City
Dijon
ZIP/Postal Code
21000
Country
France
Facility Name
CRLC Val d'Aurelle-Paul Lamarque
City
Montpellier
ZIP/Postal Code
34000
Country
France
Facility Name
Centre azuréen de Cancérologie
City
Mougins
ZIP/Postal Code
06250
Country
France
Facility Name
Centre Antoine Lacassagne
City
Nice
ZIP/Postal Code
06189
Country
France
Facility Name
Hopital saint Louis
City
Paris
ZIP/Postal Code
75010
Country
France
Facility Name
HEGP
City
Paris
ZIP/Postal Code
75015
Country
France
Facility Name
Institut de Cancérologie Lucien Neuwirth
City
Saint-Priest-en-Jarez
ZIP/Postal Code
42705
Country
France
Facility Name
Clinique Patseur
City
Toulouse
ZIP/Postal Code
31300
Country
France
Facility Name
Centre Alexis Vautrin
City
Vandœuvre-lès-Nancy
ZIP/Postal Code
54511
Country
France

12. IPD Sharing Statement

Plan to Share IPD
No
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A Phase II Trial Evaluating an Organ-conserving Strategy by Radiochemotherapy for Muscle-infiltrative Bladder Cancer

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