Combining enfortumab vedotin with radiation for bladder cancer treatment

Stereotactic Treatment With neoAdjuvant Radiotherapy and Enfortumab Vedotin: a Phase I/II Study With Safety Lead-In for Localized, Cisplatin Ineligible, Muscle Invasive Bladder Cancer (STAR-EV)

This study is testing if combining a new drug called enfortumab vedotin with radiation can help patients with muscle invasive bladder cancer who can’t take standard chemotherapy before their surgery.

Quick facts

• Phase: Phase1; Phase2
• Study type: Interventional
• Enrollment: 19 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University of Texas Southwestern Medical Center (Academic / other)
• Drugs / interventions: enfortumab, chemotherapy, radiation
• Locations: 1 site (Dallas, Texas)
• Trial ID: NCT06394570 on ClinicalTrials.gov

What this trial studies

This trial evaluates the combination of enfortumab vedotin and stereotactic radiation as a neoadjuvant treatment for patients with muscle invasive bladder cancer who are ineligible for cisplatin-based chemotherapy. The study employs a dose escalation approach to determine the safety and efficacy of the treatment regimen, which includes administering enfortumab vedotin followed by radiation therapy. Participants will undergo three cycles of treatment before proceeding to radical cystectomy surgery. The primary endpoints focus on safety and the rate of pathologic complete response at the time of surgery.

Who should consider this trial

Good fit: Ideal candidates are adults with urothelial carcinoma of the bladder who are ineligible for cisplatin-based chemotherapy and are planned for radical cystectomy.

Not a fit: Patients with small cell/neuroendocrine or plasmacytoid/signet ring components in their bladder cancer may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could improve treatment outcomes for patients with muscle invasive bladder cancer who cannot receive standard cisplatin therapy.

How similar studies have performed: While this specific combination of enfortumab vedotin and stereotactic radiation is novel, similar approaches in cancer treatment have shown promising results in other studies.

Eligibility criteria

Inclusion Criteria:

1. Urothelial carcinoma of the urinary bladder stage cT2-4a (AJCC 8th edition) N0M0 planned for radical cystectomy. Mixed cell types with variant histologies (including squamous, plasmacytoid, adenocarcinoma, sarcomatoid, micropapillary, nested, and lipid cell variants) are allowed as long as any urothelial histology is present (i.e. -not 100% variant histology). Small cell/neuroendocrine component is excluded.
2. Ineligibility for cisplatin-based chemotherapy based on treating physician assessment and any of the following "Galsky criteria": renal insufficiency (Creatinine Clearance \<60ml/min by standard institutional calculation method), \>=grade 2 peripheral neuropathy, \>=grade 2 hearing loss, New York Heart Association (NYHA) class III heart failure; a combination of these; or patient refusal.
3. Age \>=18.
4. Performance status Eastern Cooperative Oncology Group (ECOG) 0-1
5. Adequate organ and marrow function as defined below:

   •Hematologic:

   -Absolute neutrophil count (ANC) \>=1500/mm3
   * Platelet count \>=100x109/L
   * Hemoglobin ≥ 9 g/dL

     •Hepatic:
   * Serum bilirubin ≤ 1.5 × upper limit of normal (ULN) or ≤ 3 × ULN for subjects with Gilbert's disease
   * Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 × ULN

     •Renal:
   * No end stage renal disease requiring dialysis allowed
6. All men, as well as women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 3 months following completion of study neoadjuvant therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.

6a. A female of child-bearing potential is any woman (regardless of sexual orientation, marital status, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:

* Has not undergone a hysterectomy or bilateral oophorectomy; or
* Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).

  7.Ability to understand and the willingness to sign a written informed consent.

Exclusion Criteria:

1. No prior systemic therapy (except prior therapy for non-muscle invasive bladder cancer \>12 prior to registration) for bladder cancer or prior pelvic radiotherapy. Prior intra-vesical therapies are allowed, including Bacillus Calmette-Guerin (BCG) for non-muscle invasive bladder cancer. Prior chemotherapy for other cancers is allowed if given \>=1 year prior to study registration.
2. Baseline \>= Grade 2 sensory or motor neuropathy
3. Subjects may not be receiving any other investigational agents for the treatment of the cancer under study.
4. History of allergic reactions attributed to compounds of similar chemical or biologic composition to enfortumab vedotin or other agents used in study.
5. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that, in the opinion of the investigator, would limit compliance with study requirements.
6. Subjects must not be pregnant or nursing due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants.

Where this trial is running

Dallas, Texas

• UT Southwestern Medical Center — Dallas, Texas, United States (Recruiting)

Study contacts

• Study coordinator: Tian Zhang, MD, MHS

Conditions Bladder Cancer