Multi-parameter Magnetic Resonance Imaging Guides Precise Treatment of Urothelial Carcinoma

NCT04588168 | Recruiting

• 1 other identifier: 2020-SR-252
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Purpose：To evaluate whether immediate multiparametric MRI evaluate the sensitivity of modified neoadjuvant chemotherapy early in patient with muscle invasive bladder cancer（MIBC）. Rationale：Multiparametric MRI may help detect the early changes of bladder cancer receiving neoadjuvant chemotherapy.

Conditions

Bladder Cancer

Keywords

Multiparametric Magnetic Resonance Imaging; Bladder Cancer; Chemotherapy

Outcome Measures

Primary Outcomes (1)

• Changes from baseline tumor mp-MRI parameters at immediate mp-MRI evaluation.

  Using the built-in tools of the MRI imaging system to assess the changes of tumor size between immediate mp-MRI evaluation and baseline mp-MRI evaluation after the use of cisplatin during the first course of modified GC neoadjuvant chemotherapy.

  baseline, during the intervention (Within 24 hours after use of cisplatin of the first course of neoadjuvant chemotherapy(NAC), up to 2 weeks)

Secondary Outcomes (2)

• Changes from baseline tumor mp-MRI parameters after two course of modified GC neoadjuvant chemotherapy.

  baseline, during the intervention(From the end date of the second course of NAC until one day before the third course of NAC, up to 7 weeks)

• Changes from baseline tumor mp-MRI parameters after three course of modified GC neoadjuvant chemotherapy.

  baseline, during the intervention(From the end date of the third course of NAC until one day before surgery, up to 10 weeks)

Other Outcomes (1)

• Overall survival.

  through study completion，an average of 3 year

Study Arms (2)

Experimental: Chemotherapy + mpMRI + surgery

EXPERIMENTAL

Baseline mpMRI /Neoadjuvant chemotherapy /Immediate mpMRI /Cystectomy and Lymphadenectomy / Postoperative pathology Drug: Chemotherapy Procedure: Immediate Multiparametric MRI Procedure: Cystectomy and Lymphadenectomy

Drug: Chemotherapy; Diagnostic Test: Immediate Multiparametric MRI; Procedure: Cystectomy and Lymphadenectomy; Diagnostic Test: conventional Multiparametric MRI; Diagnostic Test: Baseline Multiparametric MRI

Experimental: Chemotherapy + surgery

EXPERIMENTAL

Baseline mpMRI /Neoadjuvant chemotherapy /Cystectomy and Lymphadenectomy / Postoperative pathology Drug: Chemotherapy Procedure: Cystectomy and Lymphadenectomy

Drug: Chemotherapy; Procedure: Cystectomy and Lymphadenectomy; Diagnostic Test: conventional Multiparametric MRI; Diagnostic Test: Baseline Multiparametric MRI

Interventions

Chemotherapy DRUG

Patients with muscle invasive bladder cancer will receive modified gemcitabine-cisplatin neoadjuvant chemotherapy prior to radical cystectomy for a period of two months (three 21 day cycles) as part of standard clinical routine.

Also known as: Neoadjuvant chemotherapy

Experimental: Chemotherapy + mpMRI + surgery; Experimental: Chemotherapy + surgery

Immediate Multiparametric MRI DIAGNOSTIC_TEST

Within 24 hours after the use of cisplatin during the first course of modified GC neoadjuvant chemotherapy, patient considered muscle invasive bladder cancer with baseline mpMRI will receive an immediate mpMRI scan.

Also known as: Multiparameter magnetic resonance imaging

Experimental: Chemotherapy + mpMRI + surgery

Cystectomy and Lymphadenectomy PROCEDURE

The patient with muscle invasive bladder cancer will undergo radical cystectomy and pelvic lymph node dissection followed by a urinary tract reconstruction.

Also known as: surgery

Experimental: Chemotherapy + mpMRI + surgery; Experimental: Chemotherapy + surgery

conventional Multiparametric MRI DIAGNOSTIC_TEST

After two and three course of neoadjuvant chemotherapy, patient considered muscle invasive bladder cancer with baseline mpMRI will receive a conventional mpMRI scan.

Also known as: Multiparameter magnetic resonance imaging

Experimental: Chemotherapy + mpMRI + surgery; Experimental: Chemotherapy + surgery

Baseline Multiparametric MRI DIAGNOSTIC_TEST

Patient considered muscle invasive bladder cancer will receive a baseline mpMRI scan within one week before neoadjuvant chemotherapy.

Also known as: Multiparameter magnetic resonance imaging

Experimental: Chemotherapy + mpMRI + surgery; Experimental: Chemotherapy + surgery

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Pathologically confirmed primary or recurrent bladder cancer.
• Planned to undergo transurethral resection of bladder tumor (TURBT) or modified GC regimen neoadjuvant chemotherapy plus radical total cystectomy.
• years old and older.
• Willing to give valid written informed consent.
• No contraindications to the MRI(magnetic resonance imaging) and MRI contrast agent.

You may not qualify if:

• Abnormal liver function (1.5 times higher than normal).
• Glomerular filtration rate \< 60ml /min·kg.
• Heart failure.
• Acute myocardial infarction.
• Severe heart and lung disease.
• Hypotension and hypoxia.
• Brain metastases, or other known central nervous system metastases.
• A history of severe central nervous system diseases, including unexplained loss of consciousness or transient ischemic attack.
• Known congenital or acquired immunodeficiency, active hepatitis, active tuberculosis and other active infections, etc.
• Pregnant or lactating women.
• Patients participating in other drug trials.
• Patients with poor general condition (eg malnutrition, dehydration). Behavioral status score (ZPS quintile) ≥ 2.
• Patients with previous autoimmune diseases or existing autoimmune diseases. (including controlled or uncontrolled drugs).
• Patients undergoing organ transplantation (transplantation of liver, kidney, heart, lung and other organs) or those who require long-term administration of immunosuppressive agents due to personal conditions.
• Those who are intolerant or allergic to cytotoxic chemotherapeutic drugs.

Sponsors & Collaborators

• The First Affiliated Hospital with Nanjing Medical University: lead

Study Sites (1)

The first affiliated hospital of Nanjing Medical University

Nanjing, Jiangsu, 210000, China

RECRUITING

Related Publications (14)

• Raghavan D. Chemotherapy and cystectomy for invasive transitional cell carcinoma of bladder. Urol Oncol. 2003 Nov-Dec;21(6):468-74. doi: 10.1016/s1078-1439(03)00145-5.

  PMID: 14693275 BACKGROUND

• Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, Raghavan D, Skinner DG. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001 Feb 1;19(3):666-75. doi: 10.1200/JCO.2001.19.3.666.

  PMID: 11157016 BACKGROUND

• Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, deVere White RW, Sarosdy MF, Wood DP Jr, Raghavan D, Crawford ED. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003 Aug 28;349(9):859-66. doi: 10.1056/NEJMoa022148.

  PMID: 12944571 BACKGROUND

• Galsky MD, Pal SK, Chowdhury S, Harshman LC, Crabb SJ, Wong YN, Yu EY, Powles T, Moshier EL, Ladoire S, Hussain SA, Agarwal N, Vaishampayan UN, Recine F, Berthold D, Necchi A, Theodore C, Milowsky MI, Bellmunt J, Rosenberg JE; Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators. Comparative effectiveness of gemcitabine plus cisplatin versus methotrexate, vinblastine, doxorubicin, plus cisplatin as neoadjuvant therapy for muscle-invasive bladder cancer. Cancer. 2015 Aug 1;121(15):2586-93. doi: 10.1002/cncr.29387. Epub 2015 Apr 14.

  PMID: 25872978 BACKGROUND

• International Collaboration of Trialists; Medical Research Council Advanced Bladder Cancer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group); European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group; Australian Bladder Cancer Study Group; National Cancer Institute of Canada Clinical Trials Group; Finnbladder; Norwegian Bladder Cancer Study Group; Club Urologico Espanol de Tratamiento Oncologico Group; Griffiths G, Hall R, Sylvester R, Raghavan D, Parmar MK. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol. 2011 Jun 1;29(16):2171-7. doi: 10.1200/JCO.2010.32.3139. Epub 2011 Apr 18.

  PMID: 21502557 BACKGROUND

• Kim TJ, Cho KS, Koo KC. Current Status and Future Perspectives of Immunotherapy for Locally Advanced or Metastatic Urothelial Carcinoma: A Comprehensive Review. Cancers (Basel). 2020 Jan 13;12(1):192. doi: 10.3390/cancers12010192.

  PMID: 31940998 BACKGROUND

• Yin M, Joshi M, Meijer RP, Glantz M, Holder S, Harvey HA, Kaag M, Fransen van de Putte EE, Horenblas S, Drabick JJ. Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: A Systematic Review and Two-Step Meta-Analysis. Oncologist. 2016 Jun;21(6):708-15. doi: 10.1634/theoncologist.2015-0440. Epub 2016 Apr 6.

  PMID: 27053504 BACKGROUND

• Bellmunt J, Mottet N, De Santis M. Urothelial carcinoma management in elderly or unfit patients. EJC Suppl. 2016 Mar;14(1):1-20. doi: 10.1016/j.ejcsup.2016.01.001. Epub 2016 Mar 22. No abstract available.

  PMID: 27358584 BACKGROUND

• Galsky MD, Hahn NM, Rosenberg J, Sonpavde G, Hutson T, Oh WK, Dreicer R, Vogelzang N, Sternberg C, Bajorin DF, Bellmunt J. A consensus definition of patients with metastatic urothelial carcinoma who are unfit for cisplatin-based chemotherapy. Lancet Oncol. 2011 Mar;12(3):211-4. doi: 10.1016/S1470-2045(10)70275-8. No abstract available.

  PMID: 21376284 BACKGROUND

• Dash A, Galsky MD, Vickers AJ, Serio AM, Koppie TM, Dalbagni G, Bochner BH. Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. Cancer. 2006 Aug 1;107(3):506-13. doi: 10.1002/cncr.22031.

  PMID: 16773629 BACKGROUND

• von der Maase H, Sengelov L, Roberts JT, Ricci S, Dogliotti L, Oliver T, Moore MJ, Zimmermann A, Arning M. Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol. 2005 Jul 20;23(21):4602-8. doi: 10.1200/JCO.2005.07.757.

  PMID: 16034041 BACKGROUND

• Hayashi N, Tochigi H, Shiraishi T, Takeda K, Kawamura J. A new staging criterion for bladder carcinoma using gadolinium-enhanced magnetic resonance imaging with an endorectal surface coil: a comparison with ultrasonography. BJU Int. 2000 Jan;85(1):32-6. doi: 10.1046/j.1464-410x.2000.00358.x.

  PMID: 10619941 BACKGROUND

• Panebianco V, Narumi Y, Altun E, Bochner BH, Efstathiou JA, Hafeez S, Huddart R, Kennish S, Lerner S, Montironi R, Muglia VF, Salomon G, Thomas S, Vargas HA, Witjes JA, Takeuchi M, Barentsz J, Catto JWF. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System). Eur Urol. 2018 Sep;74(3):294-306. doi: 10.1016/j.eururo.2018.04.029. Epub 2018 May 10.

  PMID: 29755006 BACKGROUND

• Zargar H, Espiritu PN, Fairey AS, Mertens LS, Dinney CP, Mir MC, Krabbe LM, Cookson MS, Jacobsen NE, Gandhi NM, Griffin J, Montgomery JS, Vasdev N, Yu EY, Youssef D, Xylinas E, Campain NJ, Kassouf W, Dall'Era MA, Seah JA, Ercole CE, Horenblas S, Sridhar SS, McGrath JS, Aning J, Shariat SF, Wright JL, Thorpe AC, Morgan TM, Holzbeierlein JM, Bivalacqua TJ, North S, Barocas DA, Lotan Y, Garcia JA, Stephenson AJ, Shah JB, van Rhijn BW, Daneshmand S, Spiess PE, Black PC. Multicenter assessment of neoadjuvant chemotherapy for muscle-invasive bladder cancer. Eur Urol. 2015 Feb;67(2):241-9. doi: 10.1016/j.eururo.2014.09.007. Epub 2014 Sep 23.

  PMID: 25257030 BACKGROUND

MeSH Terms

Conditions

Urinary Bladder Neoplasms

Interventions

Drug Therapy; Neoadjuvant Therapy; Cystectomy; Lymph Node Excision; Surgical Procedures, Operative

Condition Hierarchy (Ancestors)

Urologic Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Urinary Bladder Diseases; Urologic Diseases; Male Urogenital Diseases

Intervention Hierarchy (Ancestors)

Therapeutics; Combined Modality Therapy; Urologic Surgical Procedures; Urogenital Surgical Procedures

Study Officials

• Lv Qiang, MD，PHD

  The First Affiliated Hospital with Nanjing Medical University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Yuan Baorui

CONTACT

+86 18351998926; yuanbr960720@163.com

Lv Qiang

CONTACT

+86 13505196501; doctorlvqiang@sina.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: DIAGNOSTIC
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 13, 2020
• First Posted: October 19, 2020
• Study Start: January 1, 2018
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): June 1, 2026
• Last Updated: October 19, 2020

Record last verified: 2020-09

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)