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Crabb S, Wickens R, Jane-Bibby S, Dunkley D, Lawrence M, Knight A, Jones R, Birtle A, Huddart R, Linch M, Martin J, Coleman A, Boukas K, Markham H, Griffiths G. Evaluating atezolizumab in patients with urinary tract squamous cell carcinoma (AURORA): study protocol for a single arm, open-label, multicentre, phase II clinical trial. BMC Cancer 2023; 23:885. [PMID: 37726695 PMCID: PMC10510135 DOI: 10.1186/s12885-023-11397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Bladder and urinary tract cancers account for approximately 21,000 new diagnoses and 5,000 deaths annually in the UK. Approximately 90% are transitional cell carcinomas where advanced disease is treated with platinum based chemotherapy and PD-1/PD-L1 directed immunotherapy. Urinary tract squamous cell carcinoma (UTSCC) accounts for about 5% of urinary tract cancers overall making this a rare disease. We have yet to establish definitive systemic treatment options for advanced UTSCC. Preliminary translational data, from UTSCC patient tumour samples, indicate high PD-L1 expression and tumour infiltrating lymphocytes in a proportion of cases. Both of these features are associated with differential gene expression consistent with a tumour/immune microenvironment predicted to be susceptible to immune checkpoint directed immunotherapy which we will evaluate in the AURORA trial. METHODS AURORA is a single arm, open-label, multicentre,UK phase II clinical trial. 33 patients will be recruited from UK secondary care sites. Patients with UTSCC, suitable for treatment with palliative intent, will receive atezolizumab PD-L1 directed immunotherapy (IV infusion, 1680 mg, every 28 days) for one year if tolerated. Response assessment, by cross sectional imaging will occur every 12 weeks. AURORA uses a Simon's 2-stage optimal design with best overall objective response rate (ORR, by RECIST v1.1) at a minimum of 12 weeks from commencing treatment as the primary endpoint. Secondary endpoints will include overall survival, progression-free survival, duration of response, magnitude of response using waterfall plots of target lesion measurements, quality of life using the EORTC QLQ-C30 tool, safety and tolerability (CTCAE v5) and evaluation of potential biomarkers of treatment response including PD-L1 expression. Archival tumour samples and blood samples will be collected for translational analyses. DISCUSSION If this trial shows atezolizumab to be safe and effective it may lead to a future late phase randomised controlled trial in UTSCC. Ultimately, we hope to provide a new option for treatment for such patients. TRIAL REGISTRATIONS EudraCT Number: 2021-001995-32 (issued 8th September 2021); ISRCTN83474167 (registered 11 May 2022); NCT05038657 (issued 9th September 2021).
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Affiliation(s)
- Simon Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Robin Wickens
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sarah Jane-Bibby
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Denise Dunkley
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Megan Lawrence
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Allen Knight
- Action Bladder Cancer UK (Registered Charity No: 1164374), Tetbury, UK
| | - Robert Jones
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Alison Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Mark Linch
- University College London Hospital, London, UK
| | - Jonathan Martin
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Adam Coleman
- Experimental Cancer Medicine Centre (ECMC), University of Southampton, Southampton, UK
| | - Konstantinos Boukas
- Wessex Investigational Sciences Hub Laboratory (WISH Lab), University of Southampton, Southampton, UK
| | - Hannah Markham
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
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