A Phase III Randomised Control Clinical Trial of Radiotherapy With Radiosensitisation Versus Intravesical Bacillus Calmette-Guerin Therapy for High-risk Non-muscle Invasive Bladder Cancer.

NCT07268339 | Not Yet Recruiting Phase 3 DMC

• 1 other identifier: CFTsp223
• Study Type: interventional
• Target: 328
• Locations: 1 country
• Sites: 1

Brief Summary

In the UK 20,000 people develop urothelial bladder cancer each year with 75-80% having Non-Muscle Invasive Bladder Cancer (NMIBC). The current standard of care for patients with High Risk-NMIBC (HR-NMIBC) is either surgery to remove the tumour (transurethral resection of bladder tumour; TURBT) followed by BCG (Bacillus Calmette Guérin, an immunotherapy drug) given directly into the bladder, or surgery to remove the bladder (cystectomy). BCG is given weekly for six weeks followed by maintenance treatment up to 3 years. However, in up to 50% of patients their cancer returns (recurrence) or gets worse (progression) after BCG and 25% stop treatment due to side effects. Globally BCG supply has been restricted in recent years has increased HR-NMIBC recurrence rates and costs. Improved treatments are required, to prevent recurrence, progression and cystectomy, and mitigate the effects of unpredictable supply. Trimodality treatment (TMT) is maximal TURBT + radiotherapy + a radiosensitiser (gemcitabine, mitomycin C/fluorouracil or carbogen/nicotinamide) and is an equivalent alternative treatment to cystectomy for muscle-invasive bladder cancer (MIBC). TMT is not routinely used for HR-NMIBC. A study found that 54% of HR-NMIBC patients who received TMT did not have recurrence within 5 years. Modern radiotherapy is expected to further improve outcomes and minimise side-effects. Patients will be randomised 1:1 to BCG or radiotherapy with radiosensitisation. Patients randomised to the experimental arm will receive 55Gy in 20 fractions. Investigators can then choose from three different options for the radiosensitiser. TRAIN will test if radiotherapy with radiosensitisation improves outcomes for people with HR-NMIBC compared to BCG. TRAIN will recruit 328 patients with HR-NMIBC following maximal TURBT. All patients will be followed up for a minimum of two years to record their response to treatment.

Conditions

High-Risk Non-Muscle Invasive Bladder Cancer

Keywords

non-muscle invasive bladder cancer; radiotherapy with radiosensitisation drugs; Bacillus Calmette-Guerin therapy

Outcome Measures

Primary Outcomes (1)

• To compare event-free survival between BCG and radiotherapy with radiosensitisation.

  Event-free survival is defined as recurrence of CIS or high-risk non-muscle invasive papillary tumour, continued presence of HR NMIBC even after treatment completion, progression to muscle-invasive disease, distant metastatic bladder cancer, cystectomy (for any reason) or death from any cause.

  From baseline to at least 96 weeks after initial of treatment.

Secondary Outcomes (10)

• To determine the difference between BCG and radiotherapy in terms of patient-reported symptoms.

  From baseline to at least 96 weeks post treatment.

• To evaluate each component of the primary outcome comparing between BCG and radiotherapy with radiosensitisation.

  From baseline to at least 96 weeks post treatment.

• To establish the tolerability and safety of radiotherapy.

  From baseline to at least end of 4 week treatment.

• To determine the difference in cancer specific survival between groups.

  From baseline to at least 96 weeks post treatment.

• To determine the difference in treatment fidelity between the groups.

  From baseline to at least 96 weeks post treatment.

Study Arms (2)

Control Arm: BCG

ACTIVE COMPARATOR

This arm is standard of care for this patient group. A standard protocol of 6 weekly intravesical installations, followed by 3 weekly instillations at approximately 3, 6, 12, 18, 24, 30 months and 36 months (depending on toxicity). Stock is taken and given per local hospital guildlines.

Other: BCG

Experimental Arm: Radiotherapy with Radiosentiser drugs.

EXPERIMENTAL

Patients randomised to the radiotherapy arm will receive a hypofractionated schedule of external beam radiotherapy with a regimen of 55Gy in 20 fractions given once daily Monday to Friday over 4 weeks. Radiotherapy will be delivered with a conventional or 3D conformal technique with an empty bladder. It will be administered concurrently with a radiosensitiser (detailed below) selected by the treating physician according to local institutional practice. Radiosensitiser will be selected as one option from the following: * Gemcitabine 75-100mg/m2 administered once a week during a four-week radiotherapy course. Cycle 1 will be given on the first radiotherapy day, to a planned total of 4 cycles. 2-4 hours prior to radiotherapy * 5-FU and Mitomycin C - Fluorouracil 500mg/m2 Days 1-5 and 16-20 via continuous infusion. Mitomycin C 12mg/m2 Day 1 via intravenous infusion * Carbogen and nicotinamide (CON) - 2% CO2 and 98% O2 Carbogen will be delivered through a closed breathing system with

Radiation: radiotherapy

Interventions

radiotherapy RADIATION

Radiotherapy - 55Gy in 20 fractions treating once daily Monday to Friday over 4 weeks.

Experimental Arm: Radiotherapy with Radiosentiser drugs.

BCG OTHER

BCG protocol of 6 weekly intravesical instillations, followed by 3 weekly instillations at 3, 6, 12, 18, 24, 30, 36 months.

Control Arm: BCG

Eligibility Criteria

• Age: 16 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Diagnosed with histologically confirmed grade 3 T1 N0 M0 transitional cell carcinoma, OR carcinoma in situ of the bladder (and N0 M0), OR both, with detrusor muscle present in the biopsy specimen if T1 disease (or a repeat resection that does contain muscle that is clear)
• Suitable for BCG treatment
• Suitable for radiotherapy and radiosensitisation according to the schedule of administration outlined in the Radiotherapy Planning Guidance document.
• Life expectancy over 12 months
• ECOG performance status 0 - 2
• Age \>=16 years
• Provided written informed consent

You may not qualify if:

• MDT selected patients with HR-NMIBC who are deemed best suited for primary cystectomy (patients that have had this treatment recommendation but then decline cystectomy remain eligible for TRAIN)
• Previous radiotherapy to the pelvis
• Previous intravesical therapy
• Poor bladder function (IPSS \>16)
• A recent or current other cancer. Current non-melanoma skin cancer, cervical carcinoma in situ or localized prostate cancer not requiring current treatment are permissible, as is a history of a separate other malignancy having completed all active treatment ≥2 years previously and without evidence of relapse
• Pre-existing medical conditions that preclude treatment options in either trial arm
• Patient currently recruited to another interventional trial or participation within an interventional clinical trial within 3 months of the point of registration within TRAIN.
• Pregnant or breast-feeding
• Not able to use appropriate adequate effective contraception during and for 3 months after the study

Sponsors & Collaborators

• The Christie NHS Foundation Trust: lead

Study Sites (1)

The Christie

Manchester, M20 4BX, United Kingdom

Location

Related Links

• The TRAIN trial website.

MeSH Terms

Conditions

Non-Muscle Invasive Bladder Neoplasms

Interventions

Radiotherapy

Condition Hierarchy (Ancestors)

Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Urinary Bladder Neoplasms; Urologic Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Urinary Bladder Diseases; Urologic Diseases; Male Urogenital Diseases

Intervention Hierarchy (Ancestors)

Therapeutics

Central Study Contacts

Amber B Cole

CONTACT

023 8120 5154; train@soton.ac.uk

Daniel Griffiths

CONTACT

023 8120 5154; train@soton.ac.uk

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Masking Description
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Model Description

Study Record Dates

• First Submitted: September 24, 2025
• First Posted: December 5, 2025
• Study Start: December 1, 2025
• Primary Completion (Estimated): December 1, 2031
• Study Completion (Estimated): December 1, 2031
• Last Updated: December 5, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: Anonymous data will be available for request from three months after publication of the article, to researchers who provide a completed Data Sharing request form that describes a methodologically sound proposal, for the purpose of the approved proposal and if appropriate, signed a Data Sharing Agreement.
• Access Criteria: Data will be shared once all parties have signed relevant data-sharing documentation, covering SCTU conditions for sharing and if required, an additional Data Sharing Agreement from Sponsor. Proposals should be directed to ctu@soton.ac.uk.

Locations

GB (1)