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Weickhardt AJ, Foroudi F, Lawrentschuk N, Galleta L, Seegum A, Herschtal A, Link E, McJannett MM, Liow ECH, Grimison PS, Zhang AY, Patanjali NI, Ng S, Goodwin R, Tang C, Chen C, Hovey EJ, Hruby G, Guminski AD, Davis ID. Pembrolizumab with chemoradiotherapy as treatment for muscle invasive bladder cancer: A planned interim analysis of safety and efficacy of the PCR-MIB phase II clinical trial (ANZUP 1502). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
485 Background: In patients (pts) with muscle invasive bladder (MIBC) suitable for curative definitive chemoradiotherapy (CRT), we hypothesise that the addition of pembrolizumab may be safe and improve efficacy. A pre-planned safety analysis was performed after the first 10 of planned 30 pts were enrolled and completed treatment. Methods: Patients with maximally resected non-metastatic MIBC and ECOG 0-1, who desire bladder preservation or are ineligible for cystectomy were treated with 64Gy in 32 daily radiation fractions to the whole bladder alone over 6.5 weeks in combination with 6 concurrent doses of weekly cisplatin at 35mg/m2 IV. Pembrolizumab was commenced concurrently with radiation and given flat-dose 200mg IV q21 days for 7 doses. Surveillance cystoscopy, urine cytology and CT chest-abdomen-pelvis were performed 12 & 24 weeks post CRT. The primary endpoint is feasibility, defined by a satisfactory low rate of unacceptable toxicity of a) G3-4 non-urinary adverse events (AE) or b) failure of completion of planned CRT according to defined parameters. Secondary endpoints include complete cystoscopic response without metastatic disease at 12 & 24 weeks, loco-regional PFS, metastatic DFS, and overall survival. A 2-stage design was planned, with accrual to be halted if >5 of the first 10 pts experienced unacceptable toxicity up to 12 weeks post treatment. Results: All 10 pts completed the course of CRT and pembrolizumab without alteration in radiation dose or schedule. 1 patient had a dose of cisplatin withheld. 4/10 pts experienced G3-4 non-urinary adverse events within 12 weeks of completing treatment. One immune related AE interrupted pembrolizumab delivery (G2 nephritis). By week 24, 9/10 pts achieved a complete cystoscopic response to treatment post CRT and were free of distant metastatic disease. Conclusions: Interim results indicate that pembrolizumab and CRT shows satisfactory safety, and promising efficacy. There were no unexpected safety signals. Follow up of these and additional pts will better define the efficacy and safety of the combination. Enrolment is ongoing with 20 pts recruited out of a planned total of 30. Clinical trial information: NCT02662062.
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Affiliation(s)
| | - Farshad Foroudi
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
| | - Nathan Lawrentschuk
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
| | - Laura Galleta
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Amanda Seegum
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Emma Link
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Margaret Mary McJannett
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Camperdown, NSW, Australia
| | | | | | | | | | - Siobhan Ng
- Sir Charles Gairdner Hospital, Perth, Australia
| | | | - Colin Tang
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Colin Chen
- Prince of Wales Hospital, Sydney, Australia
| | | | - George Hruby
- Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Ian D. Davis
- Monash University Eastern Health Clinical School, Melbourne, Australia
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