Trial investigators hypothesized that neoadjuvant Pembrolizumab, could downstage miUBC and reduce recurrence. Patients with T2-T4a, N0 urothelial bladder carcinoma with residual disease after transurethral resection of the bladder (according to TURB, surgical opinion, cystoscopy or radiological presence) will receive 3 cycles of Pembrolizumab at 200mg every 3 weekly prior to radical cystectomy. Radical cystectomy will be performed within 3 weeks of the last dose (after a total of 9 weeks). CT scan and fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan will be done during screening and before radical cystectomy.
After radical cystectomy, patients with pT3-4 and/or pN+ disease will be managed according to local guidelines. Further anti PD-1 therapy will not be given post-operatively. PD-L1 status will be assessed on TURB specimen using the anti-PD-L1 Antibody clone 22C3 and a prototype IHC assay and centralized to Qualtek, Goleta, CA. PD-L1 positivity will be defined as any staining in the stroma or in ≥1% of tumor cells.
This trial will use an intention to treat analysis, including all patients who received at least 1 cycle of Pembrolizumab. The primary endpoint is pathologic complete response (pCR). The null hypothesis is that pCR≤10%, while the H1 is pCR> 20%. A 2-stage design will be used to estimate the number of patients required out of the total 90 patients. The first stage will include 49 pts, necessitating ≥6 pCR, and ≥13 pCR in the whole study population (80% power and a 2-sided test of significance at the 10% level).
Additional correlative research on pre- and post-therapy blood samples will be performed and include, multiparametric flow cytometry, Immunohistochemistry, cytokine assessment, and molecular profiling of tumor samples (ClinicalTrials.gov NCT02736266).
Presented by: Necchi A. Mariani L., Anichini A., Giannatempo P., Raggi D. Togliardi E., Calareso G., Nicolai N.6, Crippa F., Biasoni D., Torelli T., Catanzaro M., Stagni S., Piva L., Salvioni R
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto
at the #EAU17 -March 24-28, 2017- London, England