Propranolol With Tislelizumab Plus GC in Neoadjuvant Bladder UC

NCT07353294 | Enrolling By Invitation Phase 1 DMC

• 1 other identifier: SYSKY-2025-837-02
• Study Type: interventional
• Target: 12
• Locations: 1 country
• Sites: 1

Brief Summary

This is a prospective, multicenter, Phase Ib clinical study designed to evaluate the safety and preliminary efficacy of propranolol combined with tislelizumab plus gemcitabine/cisplatin (GC) as neoadjuvant therapy for patients with bladder urothelial carcinoma with clinical lymph node involvement (cT1-T4aN1-3M0). Current neoadjuvant immunochemotherapy regimens can improve clinical outcomes in cisplatin-eligible patients; however, patients with lymph node metastasis show a significantly poorer pathological complete response (pCR) rate compared with non-metastatic cases. Real-world clinical observations have shown that more than 20% of patients achieve complete response in the primary tumor after immunotherapy but have persistent or progressive positive lymph nodes, suggesting unique resistance mechanisms within lymph node metastatic lesions. Preclinical studies conducted by our team demonstrated that sympathetic innervation within lymph nodes releases norepinephrine, which activates β-adrenergic signaling in metastatic tumor cells and promotes lipid metabolic reprogramming, leading to CD8⁺ T-cell exhaustion and immune resistance. Propranolol, a non-selective β-adrenergic blocker, may reduce metabolic stress and restore antitumor immunity, potentially enhancing the efficacy of immune checkpoint blockade. In this study, enrolled patients will receive oral propranolol in combination with intravenous tislelizumab and standard GC chemotherapy prior to surgery. Participants will be closely monitored for treatment-related adverse events, including cardiovascular events, hematologic toxicity, and immune-related reactions. The primary endpoint is dose-limiting toxicity (DLT). Secondary endpoints include pathological complete response (pCR), pathological downstaging, safety, and survival outcomes. Exploratory analyses will evaluate changes in immune cell populations in tumor tissues, lymph nodes, and peripheral blood. The results of this study aim to provide evidence for new neoadjuvant strategies targeting lymph node metastatic bladder cancer and support the development of personalized therapeutic approaches.

Conditions

Bladder Urothelial Carcinoma; Lymph Node Metastasis

Keywords

Bladder urothelial carcinoma; Lymph Node Metastasis; Neoadjuvant therapy; Tislelizumab; Gemcitabine; Cisplatin; Propranolol

Outcome Measures

Primary Outcomes (1)

• Incidence of Dose-Limiting Toxicities (DLTs)

  Dose-limiting toxicities (DLTs) are defined as treatment-related adverse events occurring during the first treatment cycle that meet predefined severity criteria based on the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0. DLTs may include grade 3 or higher non-hematologic toxicity, grade 4 hematologic toxicity, or clinically significant events leading to treatment interruption or discontinuation, as determined by the investigators.

  At the end of Cycle 1 (each cycle is 28 days)

Secondary Outcomes (5)

• Pathological Complete Response (pCR) Rate

  At the time of surgery

• Pathological Downstaging Rate

  At the time of surgery

• Incidence of Treatment-Related Adverse Events

  From first dose through 30 days after the last administration of study treatment

• Progression-Free Survival (PFS)

  Up to 24 months after surgery

• Overall Survival (OS)

  Up to 36 months after surgery

Other Outcomes (1)

• Proportion of exhausted CD8+ T cells among CD8+ T cells

  At baseline and at time of surgery

Study Arms (1)

Propranolol + Tislelizumab + Gemcitabine/Cisplatin

EXPERIMENTAL

Patients will receive oral propranolol in combination with intravenous tislelizumab and gemcitabine/cisplatin as neoadjuvant therapy prior to radical surgery. Propranolol will be administered in escalating doses up to a maximum of 40 mg twice daily if tolerated. Tislelizumab is given intravenously every treatment cycle. Gemcitabine and cisplatin will be administered according to standard GC chemotherapy dosing. Participants will be monitored for treatment-related adverse events, including cardiovascular, hematologic, and immune-related toxicities. Dose adjustments, treatment interruptions, or discontinuation may be implemented according to predefined safety criteria.

Drug: propranolol; Drug: Tislelizumab; Drug: gemcitabine; Drug: Cisplatin

Interventions

propranolol DRUG

Propranolol will be administered orally as a non-selective β-adrenergic receptor blocker. Treatment will start at a low dose and may be escalated to a maximum of 40 mg twice daily if tolerated. Vital signs will be monitored regularly, and dose adjustment, interruption, or discontinuation may occur based on predefined cardiovascular safety criteria.

Also known as: β-blocker, Propranolol Hydrochloride

Propranolol + Tislelizumab + Gemcitabine/Cisplatin

Tislelizumab DRUG

Tislelizumab will be administered intravenously as an anti-PD-1 monoclonal antibody according to standard dosing schedules for neoadjuvant immunotherapy. Infusion monitoring will be conducted in a facility equipped for emergency management. Dose interruption or discontinuation may occur if immune-related adverse events develop.

Propranolol + Tislelizumab + Gemcitabine/Cisplatin

gemcitabine DRUG

Gemcitabine will be administered intravenously as part of the gemcitabine/cisplatin chemotherapy regimen during neoadjuvant treatment. Hematologic parameters and organ function will be regularly monitored, and chemotherapy dose may be modified based on toxicity and tolerability according to institutional standards.

Propranolol + Tislelizumab + Gemcitabine/Cisplatin

Cisplatin DRUG

Cisplatin will be administered intravenously as part of the gemcitabine/cisplatin regimen. Renal function, electrolyte balance, and hematologic tests will be routinely monitored. Dosing may be adjusted or withheld according to predefined safety criteria and institutional guidelines for cisplatin-based chemotherapy.

Propranolol + Tislelizumab + Gemcitabine/Cisplatin

Eligibility Criteria

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

You may qualify if:

• Voluntarily agrees to participate in the study, is able to provide written informed consent, and is willing to comply with study procedures and visit schedules.
• Age ≥ 18 years at the time of consent; sex unrestricted.
• Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1.
• Histologically confirmed bladder urothelial carcinoma with clinical lymph node involvement (cT1-T4a, N1-N3, M0) based on the AJCC 8th edition. Mixed histology is permitted if the urothelial carcinoma component is ≥ 50%.
• No antihypertensive medication used during screening, with resting systolic blood pressure between 110-140 mmHg measured under natural conditions.
• Adequate organ function as demonstrated by laboratory results obtained within 14 days prior to enrollment:
• a. No administration of hematopoietic growth factors within 14 days prior to sample collection.
• i. Absolute neutrophil count ≥ 1.5 × 10⁹/L ii. Platelet count ≥ 90 × 10⁹/L iii. Hemoglobin ≥ 90 g/L b. INR or aPTT ≤ 1.5 × ULN c. Total bilirubin ≤ 1.5 × ULN (≤ 3 × ULN in patients with Gilbert syndrome or indirect hyperbilirubinemia) d. AST, ALT, and alkaline phosphatase ≤ 2.5 × ULN e. Preoperative pulmonary function assessment indicating tolerance of major abdominal surgery.
• Cisplatin-eligible patients, or cisplatin-ineligible patients who meet at least one of the following:
• ECOG performance status \> 1 or Karnofsky 60-70%
• Creatinine clearance \< 60 mL/min
• Grade ≥ 2 hearing loss (NCI-CTCAE v5.0)
• Grade ≥ 2 peripheral neuropathy (NCI-CTCAE v5.0)
• New York Heart Association (NYHA) class III or above heart failure
• Women of childbearing potential must have a negative serum or urine pregnancy test within 7 days prior to enrollment and agree to use effective contraception during the study and for ≥ 120 days after the last dose. Male participants must agree to use effective contraception during the study and for ≥ 120 days after the last dose.

You may not qualify if:

• Prior treatment with PD-1, PD-L1, PD-L2, CTLA-4 inhibitors, or other T-cell co-stimulatory/checkpoint agents.
• Systemic antineoplastic therapy or immunomodulatory therapy within 28 days prior to enrollment, including interferon, interleukin-2, or TNF-based agents.
• Prior radiotherapy for bladder cancer.
• Prior systemic anticancer therapy except:
• Previous systemic chemotherapy completed ≥ 12 months before initiation of study treatment.
• Intravesical chemotherapy or immunotherapy completed ≥ 7 days prior to initiation of study treatment.
• Major surgery or significant trauma within 28 days prior to enrollment (vascular access placement and TURBT excluded).
• Receipt of live attenuated vaccines within 28 days prior to enrollment. Inactivated influenza vaccination is allowed; intranasal influenza vaccine is not permitted.
• Active autoimmune disease requiring systemic therapy, as judged by the investigator.
• Long-term systemic corticosteroid therapy or other immunosuppressive medications judged to interfere with study treatment.
• Uncontrolled systemic disease that may interfere with treatment, including:
• Clinically relevant electrolyte abnormalities
• Hypoalbuminemia
• Interstitial lung disease or non-infectious pneumonitis
• Uncontrolled diabetes, hypertension, or cardiovascular disease (including unstable angina, myocardial infarction, symptomatic heart failure, or medically managed ventricular arrhythmias within 6 months).

Sponsors & Collaborators

• Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University: lead
• Peking University People's Hospital: collaborator
• Fuzhou University Affiliated Provincial Hospital: collaborator

Study Sites (1)

Sun Yat-sen Memorial Hospital, Sun Yat-sen University

Guangzhou, Guangdong, 510000, China

Location

MeSH Terms

Conditions

Lymphatic Metastasis

Interventions

Propranolol; tislelizumab; Gemcitabine; Cisplatin

Condition Hierarchy (Ancestors)

Neoplasm Metastasis; Neoplastic Processes; Neoplasms; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Phenoxypropanolamines; Propanolamines; Amino Alcohols; Alcohols; Organic Chemicals; Propanols; Amines; Naphthalenes; Polycyclic Aromatic Hydrocarbons; Hydrocarbons, Aromatic; Hydrocarbons, Cyclic; Hydrocarbons; Polycyclic Compounds; Heterocyclic Compounds; Deoxycytidine; Cytidine; Pyrimidine Nucleosides; Pyrimidines; Heterocyclic Compounds, 1-Ring; Chlorine Compounds; Inorganic Chemicals; Nitrogen Compounds; Platinum Compounds

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Single-arm, open-label interventional study evaluating the combination of propranolol, tislelizumab and GC.

Study Record Dates

• First Submitted: December 11, 2025
• First Posted: January 20, 2026
• Study Start: January 1, 2026
• Primary Completion (Estimated): December 31, 2028
• Study Completion (Estimated): June 30, 2029
• Last Updated: April 22, 2026

Record last verified: 2026-04

Locations

CN (1)