Bladder CancerPhase 1/2NCT06470282
Enfortumab Vedotin and Pembrolizumab Combined With Radiotherapy in Muscle Invasive Bladder Cancer
A Phase 1/2 study testing Enfortumab Vedotin, Pembrolizumab and Intensity Modulated Radiation Therapy (IMRT) in people with Bladder Cancer and Muscle-Invasive Bladder Carcinoma, run by University of California, San Francisco at 1 site in United States.
Trial summary
This phase Ib/II trial studies the side effects, best dose, and effectiveness of enfortumab vedotin (EV) in combination with pembrolizumab and radiation therapy for treating patients with muscle invasive bladder cancer. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Bladder Cancer, Muscle-Invasive Bladder Carcinoma, Stage II Bladder Cancer AJCC v8
- What is being tested?
- Enfortumab Vedotin, Pembrolizumab and Intensity Modulated Radiation Therapy (IMRT)
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 47 participants
- Where
- 1 siteUnited States
- Study dates
- 31 Mar 2025to 31 Jan 2028
- Phase
- Phase 1/2
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Biopsy-confirmed muscle-invasive bladder cancer (cT2,T3,T4a). (Note: Tissue samples are required.) (Participants with cT3/T4a staged disease will be capped at 25% of patients treated at RP2D).
- Urothelial histology present. Mixed histologies other than small cell/neuroendocrine are allowed as long as some urothelial histology is present. Neuroendocrine histology of any component and pure variant (non-urothelial) histology tumors will be excluded. (Patients with < 50% urothelial histology will be capped at 25% of patients treated at RP2D).
- Must be judged by the investigator to be ineligible for radical cystectomy or electing not to undergo radical cystectomy.
- Must be eligible for and agree to receive bladder irradiation as determined by the treating investigator.
- Must have a TURBT within 8 weeks of combination treatment start with viable tumor content. If no viable tumor content is present on TURBT, archival TURBT sample confirming MIBC diagnosis can be used instead.
- Patients who have autoimmune disease will be evaluated on a case-by-case basis and can only enroll so long as participants are not on active immunosuppression with a corticoid steroid allowance exceeding 10mg of prednisone or equivalent per day.
Show all 30Show fewer
- Age >= 18 years.
- Eastern Cooperative Oncology Group (ECOG) performance status <= 1.
- Demonstrates adequate organ function as defined below:
- Absolute neutrophil count ≥ 1,500/microliter (mcL).
- Platelets >= 100,000/mcL.
- Hemoglobin >= 9.0 g/dL or ≥ 5.6 mmol/L. * Criteria must be met without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within last 2 weeks
- Adequate Hepatic function:
- Total bilirubin <= 1.5 × upper limit of normal, unless elevated due to Gilbert's syndrome and direct bilirubin is within normal limits.
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase (SGOT)) <= 2.5 X institutional upper limit of normal.
- Alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase (SGPT)) <= 2.5 X institutional upper limit of normal.
- Adequate renal function:
- Creatinine clearance glomerular filtration rate (GFR) >= 30 mL/min/1.73 m^2, calculated by Cockcroft-Gault or measured using 24-hour creatinine clearance.
- Adequate coagulatiohhn:
- International normalized ratio (INR) OR prothrombin time (PT) <= 1.5 × upper limit of normal (ULN).
- Activated partial thromboplastin time (aPTT) <= 1.5 × ULN.
- If participant is receiving anticoagulant therapy, as long as PT or aPTT is within therapeutic range of intended use of anticoagulants, participant is eligible.
- Ability to understand and the willingness to sign a written informed consent document.
- Human immunodeficiency virus (HIV)-infected individuals on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial.
- 12. Participants who are Hepatitis B surface antigen (HBsAg) positive are eligible if they have an undetectable hepatitis B Virus (HBV) viral load prior to randomization. Participants should remain on anti-viral therapy throughout study intervention and follow local guidelines for HBV anti-viral therapy post completion of study intervention.
- Note: Hepatitis B screening tests are not required unless patients have a known history of HBV infection.
- Participants with a history of hepatitis C virus (HCV) infection are eligible if HCV viral load is undetectable at screening.
- Note: Participants must have completed curative anti-viral therapy at least 4 weeks prior to cycle 1 day 1. Testing for Hepatitis C is not required unless clinically indicated or there is a known history of a hepatitis infection.
- Women of child-bearing potential and men with sexual partners of childbearing potential must agree to use adequate contraception for the duration of study participation. Enfortumab vedotin (EV) may cause fetal harm. Women of child-bearing potential must use contraception during treatment with EV and for 120 days after the last dose. Men with female partners who are women of child-bearing potential must use contraception during treatment with EV and for 120 days after the last dose. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Acceptable methods include barrier method, hormonal method, as well as intrauterine devices
- Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 8 weeks after last administration of study treatment.
Who cannot join
- Presence of distant metastases on imaging (M1 disease).
- Presence of ≥ N2 disease on imaging (N1 disease allowed, but participants with N1 disease will be capped at 25% of patients treated at RP2D).
- Presence of small cell / neuroendocrine histology in tumor sample (any content).
- Absence of urothelial histology in TURBT tumor sample (pure variant histology).
- Presence of untreated upper tract urothelial cancer.
- Presence of severe hydronephrosis precluding therapy in the judgement of the treating physician.
Show all 30Show fewer
- Presence of extensive carcinoma in situ (CIS) is exclusionary; moderate CIS that could still benefit from radiation treatment in the judgement of treating physician is allowed.
- Baseline neuropathy grade 2 (G2) or greater.
- Baseline uncontrolled diabetes mellitus. Uncontrolled diabetes is defined as hemoglobin A1c (HbA1c) ≥ 8% or HbA1c 7 to < 8% with associated diabetes symptoms (polyuria or polydipsia) that are not otherwise explained.
- Note: Patients with prior diagnosis but with disease under control are eligible
- Prior treatment with systemic immunotherapy or chemotherapy for urothelial cancer. (with the exception of prior systematic therapy treatment >12 months prior). Note: Prior bacillus calmette-guerin (BCG) and intravesical treatments are allowed
- Has received prior systemic anti-cancer therapy including investigational agents within 4 weeks prior to cycle 1 day 1.
- Has received prior radiotherapy within 2 weeks of cycle 1 day 1 or had radiation-related toxicities requiring corticosteroids.
- Has received a live vaccine or live-attenuated vaccine within 30 days before the first dose of study intervention.
- Note: Administration of killed vaccines is allowed. Any licensed coronavirus 2019 (COVID-19) vaccine (including for emergency use) is allowed in the study as long as they are messenger ribonucleic acid (mRNA) vaccines, replication-incompetent adenoviral vaccines, or inactivated vaccines.
- Major surgery within 2 weeks prior to first dose of EV.
- Note: Cataract surgery, standard tissue biopsies, and standard of care cardiac devices, such as a pacemaker or stent placed on an elective basis, are allowable procedures.
- Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug.
- Note: Inhaled or topical steroids are permitted.
- HIV-infected participants with a history of Kaposi's sarcoma and/or Multicentric Castleman's Disease.
- Has known active CNS metastases and/or carcinomatous meningitis.
- History of another significant life-limiting malignancy requiring systematic treatment within 2 years prior to the first dose of study drugs, or any evidence of residual disease from a previously diagnosed malignancy.
- Note: Patients with nonmelanoma skin cancer, curatively treated localized prostate cancer, curatively treated upper tract urothelial cancer, or carcinoma in situ of any type (if complete resection was performed) are allowed.
- Hypersensitivity to pembrolizumab or enfortumab vedotin, or any of their excipients.
- Prior allogeneic stem cell or solid organ transplant.
- Has a history of (non-infectious) pneumonitis/interstitial lung disease that required steroids or current pneumonitis/interstitial lung disease requiring active management.
- Has an active infection requiring systemic therapy that in the judgement of the treating team would preclude treatment with EV, pembrolizumab or RT.
- Has a history or current evidence of any condition, therapy, or laboratory abnormality or other circumstance that might confound the results of the study, interfere with the participant's participation for the full duration of the study, such that it is not in the best interest of the participant to participate, in the opinion of the treating investigator.
- Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
- Pregnant and breast feeding participants are excluded from this study because targeted chemotherapy and radiation have the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with EV+pembrolizumab, breastfeeding should be discontinued if the mother is treated with these investigational products.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
United States1 site, 1 recruiting
- Recruiting
University of California, San Francisco
San Francisco, California, 94143
UCSF Genitourinary Medical Oncology Recruitment, 877-827-3222, GUTrials@ucsf.edu
cancertrials@ucsf.edu
About this study
Official title: EV-PRIME: Phase Ib/II Study of Enfortumab Vedotin and Pembrolizumab Combined With Radiotherapy as a Bladder-Sparing Trimodality Therapy in Muscle Invasive Bladder Cancer
This phase Ib/II trial studies the side effects, best dose, and effectiveness of enfortumab vedotin (EV) in combination with pembrolizumab and radiation therapy for treating patients with muscle invasive bladder cancer. Standard of care treatment for muscle invasive bladder cancer is chemotherapy, to shrink the tumor before the main treatment is given (neoadjuvant), followed by surgery to remove all of the bladder as well as nearby tissues and organs (radical cystectomy). In cases where patients are not candidates for the standard of care approach or prefer a bladder sparing option, tri-modality therapy with transurethral resection of bladder tumor (TURBT) followed by combined chemotherapy and radiation therapy is used. Enfortumab vedotin is a monoclonal antibody, enfortumab, linked to an anticancer drug called vedotin. It works by helping the immune system to slow or stop the growth of tumor cells. Enfortumab attaches to a protein called nectin-4 on tumor cells in a targeted way and delivers vedotin to kill them. It is a type of antibody-drug conjugate. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Intensity-modulated radiation therapy is a type of 3-dimensional radiation therapy that uses computer-generated images to show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles. This type of radiation therapy reduces the damage to healthy tissue near the tumor. Giving enfortumab vedotin with pembrolizumab and radiation therapy may work better in treating patients with muscle invasive bladder cancer.
Read the detailed description
PRIMARY OBJECTIVES:
- To determine the recommended phase II dose (RP2D) of enfortumab vedotin given in combination with pembrolizumab and concurrent radiation therapy (RT). (Phase Ib).
II. To assess the toxicity and safety of enfortumab vedotin given in combination with pembrolizumab and concurrent radiation therapy (RT). (Phase Ib).
III. To evaluate the rate of clinical complete response to treatment (cCR) at the RP2D based on 6-month post-treatment cystoscopy, TURBT, cytology, and cross sectional imaging. (Phase II).
IV. To characterize the safety of enfortumab vedotin at the RP2D given in combination with pembrolizumab and concurrent radiation therapy (RT). (Phase II).
SECONDARY OBJECTIVES:
- To evaluate the rate of cCR 6 months post-treatment start based on cystoscopy, TURBT, and cross sectional imaging. (Phase Ib) II. To evaluate the preliminary efficacy of enfortumab vedotin given in combination with pembrolizumab and concurrent radiation therapy (RT) as measured by 1-year recurrence free survival rate, 2-year cystectomy-free survival rate, 2-year overall survival rate, the median recurrence free survival (RFS) rate, median overall survival, and median cystectomy-free survival. (Phase Ib and Phase II) III. To assess the downstaging to ≤ pT1N0 or less following completion of treatment, based on 6-month post-treatment cystoscopy, for participants treated at RP2D of enfortumab vedotin (EV). (Phase Ib and Phase II) IV. To assess the downstaging to ≤ pT1N0 or less following completion of treatment, based on 6-month post-treatment cystoscopy, for participants across all EV dose levels. (Phase Ib and Phase II).
EXPLORATORY OBJECTIVES:
- Assessment of change in tumor gene expression signatures using single-cell ribonucleic acid (RNA) sequencing (scRNA-Seq) following initiation of combination treatment.
II. Assessment of the change in the populations of tumor-infiltrating immune cells (TIICs) induced by initiation of the combination treatment.
III. Determination of the impact of EV/pembrolizumab combination treatment on programmed death-ligand 1 (PD-L1) expression in tumor cells and TIICs, as well as on other immunologic predictive markers.
IV. Assessment of modulation of tumor microenvironment pre- and post-initiation of combination treatment using multiplex immunohistochemistry (IHC).
- Assessment of the modulation of circulating immune cells following initiation of combination treatment using mass cytometry (cytometry by time of flight, or CyTOF).
VI. Assessment of the change in T-cell receptor repertoire by scRNA-Seq following initiation of combination treatment.
VII. Change in tumor expression of nectin cell adhesion molecule 4 (Nectin-4) following combination treatment relative to baseline.
VIII. Assessment in the change in CD3+ T cell density (T cell count/μm^2) from baseline biopsy to post-RT biopsy in participants with residual tumor, across all EV dose levels and at RP2D.
OUTLINE:
This is a phase Ib, dose escalation study of enfortumab vedotin followed by a phase II study.
Participants receive enfortumab vedotin and pembrolizumab for up to 5 cycle of enfortumab vedotin and up to 17 cycles of pembrolizumab in the absence of disease progression or unacceptable toxicity. Beginning on cycle 1 day 1, participants also undergo non-investigational, standard of care intensity modulated radiation therapy (IMRT) over 6.5-8 weeks.
After completion of study treatment, participants are followed up at 90 days and then every 12 weeks for up to 5 years.
- Conditions
- Bladder Cancer, Muscle-Invasive Bladder Carcinoma, Stage II Bladder Cancer AJCC v8, Stage IIIA Bladder Cancer AJCC v8
- Being tested
- Enfortumab Vedotin, Pembrolizumab, Intensity Modulated Radiation Therapy (IMRT), Transurethral Resection of Bladder Tumor, Cystoscopy (CS)
- Medical subject headings
- Urinary Bladder Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Enfortumab VedotinDrug
Also called Padcev
Given intravenously (IV)
PembrolizumabBiological
Also called Keytruda
Given IV
Intensity Modulated Radiation Therapy (IMRT)Radiation
Also called Standard of care IMRT
Undergo standard of care, IMRT
Transurethral Resection of Bladder TumorProcedure or surgery
Also called Transurethral resection (TURBT)
Undergo TURBT
Cystoscopy (CS)Procedure or surgery
Also called CS
Undergo cystoscopy
Computed Tomography (CT)Procedure or surgery
Also called CT Scan
Undergo CT imaging
Magnetic Resonance Imaging (MRI)Procedure or surgery
Also called MRI Scan
Undergo MRI imaging
Positron Emission Tomography (PET)Procedure or surgery
Also called PET Scan
Undergo PET Scan, may be combined with CT (PET/CT)
| Study group | Role | What they receive |
|---|---|---|
| Dose Level 1: 0.75 mg/kg Enfortumab Vedotin (Starting Dose) | Experimental | Participants receive 0.75 mg/kg enfortumab vedotin intravenously (IV) over 30 minutes on days 1 and 8 of cycles 1-5 and pembrolizumab IV on day 1 of each cycle. Cycles repeat every 21 days for up to 5 cycles of enfortumab vedotin and up to 17 cycles of pembrolizumab in the absence of disease progression or unacceptable toxicity. Beginning on cycle 1 day 1, participants also undergo standard of care intensity modulated radiation therapy (IMRT) once daily (QD) for 32 days over 6.5-8 weeks. Participants also undergo TURBT, cystoscopy, as well as imaging throughout the study. Receives: Drug: Enfortumab Vedotin; Biological: Pembrolizumab; Radiation: Intensity Modulated Radiation Therapy (IMRT); Procedure: Transurethral Resection of Bladder Tumor; Procedure: Cystoscopy (CS); Procedure: Computed Tomography (CT); Procedure: Magnetic Resonance Imaging (MRI); Procedure: Positron Emission Tomography (PET) |
| Dose Level 2: 1.0 mg/kg Enfortumab Vedotin | Experimental | Participants receive 1.05 mg/kg enfortumab vedotin intravenously (IV) over 30 minutes on days 1 and 8 of cycles 1-5 and pembrolizumab IV on day 1 of each cycle. Cycles repeat every 21 days for up to 5 cycles of enfortumab vedotin and up to 17 cycles of pembrolizumab in the absence of disease progression or unacceptable toxicity. Beginning on cycle 1 day 1, participants also undergo standard of care intensity modulated radiation therapy (IMRT) once daily (QD) for 32 days over 6.5-8 weeks. Participants also undergo TURBT, cystoscopy, as well as imaging throughout the study. Receives: Drug: Enfortumab Vedotin; Biological: Pembrolizumab; Radiation: Intensity Modulated Radiation Therapy (IMRT); Procedure: Transurethral Resection of Bladder Tumor; Procedure: Cystoscopy (CS); Procedure: Computed Tomography (CT); Procedure: Magnetic Resonance Imaging (MRI); Procedure: Positron Emission Tomography (PET) |
| Dose Level 3: 1.25 mg/kg Enfortumab Vedotin | Experimental | Participants receive 1.25 mg/kg enfortumab vedotin intravenously (IV) over 30 minutes on days 1 and 8 of cycles 1-5 and pembrolizumab IV on day 1 of each cycle. Cycles repeat every 21 days for up to 5 cycles of enfortumab vedotin and up to 17 cycles of pembrolizumab in the absence of disease progression or unacceptable toxicity. Beginning on cycle 1 day 1, participants also undergo standard of care intensity modulated radiation therapy (IMRT) once daily (QD) for 32 days over 6.5-8 weeks. Participants also undergo TURBT, cystoscopy, as well as imaging throughout the study. Receives: Drug: Enfortumab Vedotin; Biological: Pembrolizumab; Radiation: Intensity Modulated Radiation Therapy (IMRT); Procedure: Transurethral Resection of Bladder Tumor; Procedure: Cystoscopy (CS); Procedure: Computed Tomography (CT); Procedure: Magnetic Resonance Imaging (MRI); Procedure: Positron Emission Tomography (PET) |
| Dose Expansion; Recommended Phase 2 Dose (RP2D) | Experimental | Participants receive RP2D of enfortumab vedotin intravenously (IV) over 30 minutes on days 1 and 8 of cycles 1-5 and pembrolizumab IV on day 1 of each cycle. Cycles repeat every 21 days for up to 5 cycles of enfortumab vedotin and up to 17 cycles of pembrolizumab in the absence of disease progression or unacceptable toxicity. Beginning on cycle 1 day 1, participants also undergo standard of care intensity modulated radiation therapy (IMRT) once daily (QD) for 32 days over 6.5-8 weeks. Participants also undergo TURBT, cystoscopy, as well as imaging throughout the study. Receives: Drug: Enfortumab Vedotin; Biological: Pembrolizumab; Radiation: Intensity Modulated Radiation Therapy (IMRT); Procedure: Transurethral Resection of Bladder Tumor; Procedure: Cystoscopy (CS); Procedure: Computed Tomography (CT); Procedure: Magnetic Resonance Imaging (MRI); Procedure: Positron Emission Tomography (PET) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Recommended phase II dose (RP2D) (Phase Ib)
The RP2D is the last dose cohort at which no more than one instance of a dose limiting toxicity (DLT) is observed among 6 participants treated. If the maximum tolerated dose (MTD) cannot be determined due to lack of DLT during the DLT window, the maximum dose level of enfortumab vedotin administered during the study will be declared the RP2D. For the purposes of this study, the RP2D is the MTD.
Measured: Up to 72 days
Proportion of participants reporting dose limiting toxicities (DLTs) (Phase Ib)
The DLT evaluation period will be within the first three cycles (e.g., 56 days or eight weeks, and not to exceed 72 days) of treatment start with enfortumab-vedotin, pembrolizumab, and standard of care fractionation radiation therapy. Participants who receive > 75% of intended enfortumab vedotin, pembrolizumab, and standard of care radiation doses will be considered DLT evaluable (DE).
Measured: Up to 72 days
Frequency of treatment-emergent adverse events
The frequency of adverse events by highest grade and overall attribution to study drugs, according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Measured: Up to 14 months
Percentage of participants with Clinical complete response (cCR) (Phase II)
The rate of clinical complete response to treatment (cCR) will be measured as the percentage of participants with cCR based on cystoscopy and TURBT done at 6 months from treatment start. cCR is defined as no visual tumor AND no histological presence of tumor (i.e., ypT0).
Measured: Up to 6 months
Secondary outcomes (9)
Proportion of participants with Clinical Complete Response (cCR) (Phase Ib)
cCR is defined as no visual tumor AND no histological presence of tumor (i.e., ypT0). The point estimate of the clinical complete response (CR) rate will be obtained with 95% confidence interval by Wilson Score confidence interval method
Measured: Up to 6 months
Median Recurrence Free Survival Rate (RFS) at 1 year
The median 1-year RFS is defined as the time of treatment start until evidence of disease recurrence, time of death, or until the participants completes study follow up participation, or is documented as lost to follow up per institutional standard (whichever is sooner) at 1 year determined by Kaplan Meier method.
Measured: Up to 1 year
Median Cystectomy Free Survival rate (CFS) at 2 years
The median 2-year CFS is defined as the time of treatment start until time of cystectomy, time of death, or until the participant completes study follow up participation, or is documented as lost to follow up per institutional standard (whichever is sooner) at 2 years determined by Kaplan Meier method.
Measured: Up to 2 years
Median Overall Survival (OS) at 2 years
The median 2-year OS is defined as the time from start of treatment, across all EV dose levels and at RP2D until time of death, or until the participant is documented as lost to follow up per institutional standard at 2 years determined by Kaplan Meier method.
Measured: Up to 2 years
Median Overall OS
The median overall OS is defined as the time from treatment start until evidence of disease recurrence, time of death, or until the participant completes study follow up participation, or is documented as lost to follow up per institutional standard (whichever is sooner) will be reported.
Measured: Up to 5 years
Median Overall RFS
The median overall RFS is defined as the time from treatment start until evidence of disease recurrence, time of death, or until the participant completes study follow up participation, or is documented as lost to follow up per institutional standard (whichever is sooner) will be reported.
Measured: Up to 5 years
Median Overall CFS
The median overall CFS is defined as the time from treatment start until time of cystectomy, time of death, or until the participant completes study follow up participation, or is documented as lost to follow up per institutional standard (whichever is sooner) will be reported
Measured: Up to 5 years
Proportion of participants who have been downstaged to <= pT1N0, pT1 or less
The point estimate of the proportion of the participants with downstaging to <= pT1N0, pT1, or less at 6 months following the start of treatment will be obtained with 95% confidence interval by Wilson Score confidence interval method.
Measured: Up to 6 months
Proportion of participants who have been downstaged to <= pT1N0
The point estimate of the proportion of the participants with downstaging to <= pT1N0 at 6 months following the start of treatment will be obtained with 95% confidence interval by Wilson Score confidence interval method.
Measured: Up to 6 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Jun 2024
- Study start31 Mar 2025
- Primary completion31 Jan 2028 (estimated)
- Study completion31 Jan 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Bladder CancerStudies of the same condition, open and under way.
- More trials run by University of California, San FranciscoThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1/2
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Enrolment
- 47 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of California, San Francisco
- Sponsor type
- University, hospital or other
- Collaborators
- Astellas Pharma Inc, Merck Sharp & Dohme LLC
- Responsible party
- Principal investigator, Vadim S Koshkin, University of California, San Francisco
- Investigators
- Vadim Koshkin, MD, Principal investigator, University of California, San Francisco
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06470282
- Sponsor's protocol ID
- 24522
- Other IDs
- NCI-2024-04701
- Status last verified
- Sep 2026
- First submitted
- 17 Jun 2024
- Last updated
- 1 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 1 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- EV-PRIME: Phase Ib/II Study of Enfortumab Vedotin and Pembrolizumab Combined With Radiotherapy as a Bladder-Sparing Trimodality Therapy in Muscle Invasive Bladder Cancer
- ClinicalTrials.gov ID
- NCT06470282
- Acronym / sponsor ID
- 24522
- Conditions
- Bladder Cancer, Muscle-Invasive Bladder Carcinoma, Stage II Bladder Cancer AJCC v8, Stage IIIA Bladder Cancer AJCC v8
- Phase
- Phase 1/2
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 47 participants (estimated)
- Lead sponsor
- University of California, San FranciscoUniversity, hospital or other
- Collaborators
- Astellas Pharma Inc, Merck Sharp & Dohme LLC
- Study start
- 31 Mar 2025 (actual)
- Primary completion
- 31 Jan 2028 (estimated)
- Study completion
- 31 Jan 2028 (estimated)
- First posted
- 24 Jun 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This phase Ib/II trial studies the side effects, best dose, and effectiveness of enfortumab vedotin (EV) in combination with pembrolizumab and radiation therapy for treating patients with muscle invasive bladder cancer. Standard of care treatment for muscle invasive bladder cancer is chemotherapy, to shrink the tumor before the main treatment is given (neoadjuvant), followed by surgery to remove all of the bladder as well as nearby tissues and organs (radical cystectomy). In cases where patients are not candidates for the standard of care approach or prefer a bladder sparing option, tri-modality therapy with transurethral resection of bladder tumor (TURBT) followed by combined chemotherapy and radiation therapy is used. Enfortumab vedotin is a monoclonal antibody, enfortumab, linked to an anticancer drug called vedotin. It works by helping the immune system to slow or stop the growth of tumor cells. Enfortumab attaches to a protein called nectin-4 on tumor cells in a targeted way and delivers vedotin to kill them. It is a type of antibody-drug conjugate. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Intensity-modulated radiation therapy is a type of 3-dimensional radiation therapy that uses computer-generated images to show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles. This type of radiation therapy reduces the damage to healthy tissue near the tumor. Giving enfortumab vedotin with pembrolizumab and radiation therapy may work better in treating patients with muscle invasive bladder cancer.
Detailed description
PRIMARY OBJECTIVES:
- To determine the recommended phase II dose (RP2D) of enfortumab vedotin given in combination with pembrolizumab and concurrent radiation therapy (RT). (Phase Ib).
II. To assess the toxicity and safety of enfortumab vedotin given in combination with pembrolizumab and concurrent radiation therapy (RT). (Phase Ib).
III. To evaluate the rate of clinical complete response to treatment (cCR) at the RP2D based on 6-month post-treatment cystoscopy, TURBT, cytology, and cross sectional imaging. (Phase II).
IV. To characterize the safety of enfortumab vedotin at the RP2D given in combination with pembrolizumab and concurrent radiation therapy (RT). (Phase II).
SECONDARY OBJECTIVES:
- To evaluate the rate of cCR 6 months post-treatment start based on cystoscopy, TURBT, and cross sectional imaging. (Phase Ib) II. To evaluate the preliminary efficacy of enfortumab vedotin given in combination with pembrolizumab and concurrent radiation therapy (RT) as measured by 1-year recurrence free survival rate, 2-year cystectomy-free survival rate, 2-year overall survival rate, the median recurrence free survival (RFS) rate, median overall survival, and median cystectomy-free survival. (Phase Ib and Phase II) III. To assess the downstaging to ≤ pT1N0 or less following completion of treatment, based on 6-month post-treatment cystoscopy, for participants treated at RP2D of enfortumab vedotin (EV). (Phase Ib and Phase II) IV. To assess the downstaging to ≤ pT1N0 or less following completion of treatment, based on 6-month post-treatment cystoscopy, for participants across all EV dose levels. (Phase Ib and Phase II).
EXPLORATORY OBJECTIVES:
- Assessment of change in tumor gene expression signatures using single-cell ribonucleic acid (RNA) sequencing (scRNA-Seq) following initiation of combination treatment.
II. Assessment of the change in the populations of tumor-infiltrating immune cells (TIICs) induced by initiation of the combination treatment.
III. Determination of the impact of EV/pembrolizumab combination treatment on programmed death-ligand 1 (PD-L1) expression in tumor cells and TIICs, as well as on other immunologic predictive markers.
IV. Assessment of modulation of tumor microenvironment pre- and post-initiation of combination treatment using multiplex immunohistochemistry (IHC).
- Assessment of the modulation of circulating immune cells following initiation of combination treatment using mass cytometry (cytometry by time of flight, or CyTOF).
VI. Assessment of the change in T-cell receptor repertoire by scRNA-Seq following initiation of combination treatment.
VII. Change in tumor expression of nectin cell adhesion molecule 4 (Nectin-4) following combination treatment relative to baseline.
VIII. Assessment in the change in CD3+ T cell density (T cell count/μm^2) from baseline biopsy to post-RT biopsy in participants with residual tumor, across all EV dose levels and at RP2D.
OUTLINE:
This is a phase Ib, dose escalation study of enfortumab vedotin followed by a phase II study.
Participants receive enfortumab vedotin and pembrolizumab for up to 5 cycle of enfortumab vedotin and up to 17 cycles of pembrolizumab in the absence of disease progression or unacceptable toxicity. Beginning on cycle 1 day 1, participants also undergo non-investigational, standard of care intensity modulated radiation therapy (IMRT) over 6.5-8 weeks.
After completion of study treatment, participants are followed up at 90 days and then every 12 weeks for up to 5 years.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| Dose Level 1: 0.75 mg/kg Enfortumab Vedotin (Starting Dose) | Experimental | Drug: Enfortumab Vedotin, Biological: Pembrolizumab, Radiation: Intensity Modulated Radiation Therapy (IMRT), Procedure: Transurethral Resection of Bladder Tumor, Procedure: Cystoscopy (CS), Procedure: Computed Tomography (CT), Procedure: Magnetic Resonance Imaging (MRI), Procedure: Positron Emission Tomography (PET)Participants receive 0.75 mg/kg enfortumab vedotin intravenously (IV) over 30 minutes on days 1 and 8 of cycles 1-5 and pembrolizumab IV on day 1 of each cycle. Cycles repeat every 21 days for up to 5 cycles of enfortumab vedotin and up to 17 cycles of pembrolizumab in the absence of disease progression or unacceptable toxicity. Beginning on cycle 1 day 1, participants also undergo standard of care intensity modulated radiation therapy (IMRT) once daily (QD) for 32 days over 6.5-8 weeks. Participants also undergo TURBT, cystoscopy, as well as imaging throughout the study. |
| Dose Level 2: 1.0 mg/kg Enfortumab Vedotin | Experimental | Drug: Enfortumab Vedotin, Biological: Pembrolizumab, Radiation: Intensity Modulated Radiation Therapy (IMRT), Procedure: Transurethral Resection of Bladder Tumor, Procedure: Cystoscopy (CS), Procedure: Computed Tomography (CT), Procedure: Magnetic Resonance Imaging (MRI), Procedure: Positron Emission Tomography (PET)Participants receive 1.05 mg/kg enfortumab vedotin intravenously (IV) over 30 minutes on days 1 and 8 of cycles 1-5 and pembrolizumab IV on day 1 of each cycle. Cycles repeat every 21 days for up to 5 cycles of enfortumab vedotin and up to 17 cycles of pembrolizumab in the absence of disease progression or unacceptable toxicity. Beginning on cycle 1 day 1, participants also undergo standard of care intensity modulated radiation therapy (IMRT) once daily (QD) for 32 days over 6.5-8 weeks. Participants also undergo TURBT, cystoscopy, as well as imaging throughout the study. |
| Dose Level 3: 1.25 mg/kg Enfortumab Vedotin | Experimental | Drug: Enfortumab Vedotin, Biological: Pembrolizumab, Radiation: Intensity Modulated Radiation Therapy (IMRT), Procedure: Transurethral Resection of Bladder Tumor, Procedure: Cystoscopy (CS), Procedure: Computed Tomography (CT), Procedure: Magnetic Resonance Imaging (MRI), Procedure: Positron Emission Tomography (PET)Participants receive 1.25 mg/kg enfortumab vedotin intravenously (IV) over 30 minutes on days 1 and 8 of cycles 1-5 and pembrolizumab IV on day 1 of each cycle. Cycles repeat every 21 days for up to 5 cycles of enfortumab vedotin and up to 17 cycles of pembrolizumab in the absence of disease progression or unacceptable toxicity. Beginning on cycle 1 day 1, participants also undergo standard of care intensity modulated radiation therapy (IMRT) once daily (QD) for 32 days over 6.5-8 weeks. Participants also undergo TURBT, cystoscopy, as well as imaging throughout the study. |
| Dose Expansion; Recommended Phase 2 Dose (RP2D) | Experimental | Drug: Enfortumab Vedotin, Biological: Pembrolizumab, Radiation: Intensity Modulated Radiation Therapy (IMRT), Procedure: Transurethral Resection of Bladder Tumor, Procedure: Cystoscopy (CS), Procedure: Computed Tomography (CT), Procedure: Magnetic Resonance Imaging (MRI), Procedure: Positron Emission Tomography (PET)Participants receive RP2D of enfortumab vedotin intravenously (IV) over 30 minutes on days 1 and 8 of cycles 1-5 and pembrolizumab IV on day 1 of each cycle. Cycles repeat every 21 days for up to 5 cycles of enfortumab vedotin and up to 17 cycles of pembrolizumab in the absence of disease progression or unacceptable toxicity. Beginning on cycle 1 day 1, participants also undergo standard of care intensity modulated radiation therapy (IMRT) once daily (QD) for 32 days over 6.5-8 weeks. Participants also undergo TURBT, cystoscopy, as well as imaging throughout the study. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (30 listed)
- Biopsy-confirmed muscle-invasive bladder cancer (cT2,T3,T4a). (Note: Tissue samples are required.) (Participants with cT3/T4a staged disease will be capped at 25% of patients treated at RP2D).
- Urothelial histology present. Mixed histologies other than small cell/neuroendocrine are allowed as long as some urothelial histology is present. Neuroendocrine histology of any component and pure variant (non-urothelial) histology tumors will be excluded. (Patients with < 50% urothelial histology will be capped at 25% of patients treated at RP2D).
- Must be judged by the investigator to be ineligible for radical cystectomy or electing not to undergo radical cystectomy.
- Must be eligible for and agree to receive bladder irradiation as determined by the treating investigator.
- Must have a TURBT within 8 weeks of combination treatment start with viable tumor content. If no viable tumor content is present on TURBT, archival TURBT sample confirming MIBC diagnosis can be used instead.
Key exclusion criteria (30 listed)
- Presence of distant metastases on imaging (M1 disease).
- Presence of ≥ N2 disease on imaging (N1 disease allowed, but participants with N1 disease will be capped at 25% of patients treated at RP2D).
- Presence of small cell / neuroendocrine histology in tumor sample (any content).
- Absence of urothelial histology in TURBT tumor sample (pure variant histology).
- Presence of untreated upper tract urothelial cancer.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Enfortumab VedotinAlso: PadcevGiven intravenously (IV) | Drug | Dose Expansion; Recommended Phase 2 Dose (RP2D), Dose Level 1: 0.75 mg/kg Enfortumab Vedotin (Starting Dose), Dose Level 2: 1.0 mg/kg Enfortumab Vedotin, Dose Level 3: 1.25 mg/kg Enfortumab Vedotin |
| PembrolizumabAlso: KeytrudaGiven IV | Biological | Dose Expansion; Recommended Phase 2 Dose (RP2D), Dose Level 1: 0.75 mg/kg Enfortumab Vedotin (Starting Dose), Dose Level 2: 1.0 mg/kg Enfortumab Vedotin, Dose Level 3: 1.25 mg/kg Enfortumab Vedotin |
| Intensity Modulated Radiation Therapy (IMRT)Also: Standard of care IMRTUndergo standard of care, IMRT | Radiation | Dose Expansion; Recommended Phase 2 Dose (RP2D), Dose Level 1: 0.75 mg/kg Enfortumab Vedotin (Starting Dose), Dose Level 2: 1.0 mg/kg Enfortumab Vedotin, Dose Level 3: 1.25 mg/kg Enfortumab Vedotin |
| Transurethral Resection of Bladder TumorAlso: Transurethral resection (TURBT)Undergo TURBT | Procedure or surgery | Dose Expansion; Recommended Phase 2 Dose (RP2D), Dose Level 1: 0.75 mg/kg Enfortumab Vedotin (Starting Dose), Dose Level 2: 1.0 mg/kg Enfortumab Vedotin, Dose Level 3: 1.25 mg/kg Enfortumab Vedotin |
| Cystoscopy (CS)Also: CSUndergo cystoscopy | Procedure or surgery | Dose Expansion; Recommended Phase 2 Dose (RP2D), Dose Level 1: 0.75 mg/kg Enfortumab Vedotin (Starting Dose), Dose Level 2: 1.0 mg/kg Enfortumab Vedotin, Dose Level 3: 1.25 mg/kg Enfortumab Vedotin |
| Computed Tomography (CT)Also: CT ScanUndergo CT imaging | Procedure or surgery | Dose Expansion; Recommended Phase 2 Dose (RP2D), Dose Level 1: 0.75 mg/kg Enfortumab Vedotin (Starting Dose), Dose Level 2: 1.0 mg/kg Enfortumab Vedotin, Dose Level 3: 1.25 mg/kg Enfortumab Vedotin |
| Magnetic Resonance Imaging (MRI)Also: MRI ScanUndergo MRI imaging | Procedure or surgery | Dose Expansion; Recommended Phase 2 Dose (RP2D), Dose Level 1: 0.75 mg/kg Enfortumab Vedotin (Starting Dose), Dose Level 2: 1.0 mg/kg Enfortumab Vedotin, Dose Level 3: 1.25 mg/kg Enfortumab Vedotin |
| Positron Emission Tomography (PET)Also: PET ScanUndergo PET Scan, may be combined with CT (PET/CT) | Procedure or surgery | Dose Expansion; Recommended Phase 2 Dose (RP2D), Dose Level 1: 0.75 mg/kg Enfortumab Vedotin (Starting Dose), Dose Level 2: 1.0 mg/kg Enfortumab Vedotin, Dose Level 3: 1.25 mg/kg Enfortumab Vedotin |
Primary outcome
Recommended phase II dose (RP2D) (Phase Ib)
Time frame: Up to 72 days
The RP2D is the last dose cohort at which no more than one instance of a dose limiting toxicity (DLT) is observed among 6 participants treated. If the maximum tolerated dose (MTD) cannot be determined due to lack of DLT during the DLT window, the maximum dose level of enfortumab vedotin administered during the study will be declared the RP2D. For the purposes of this study, the RP2D is the MTD.
Proportion of participants reporting dose limiting toxicities (DLTs) (Phase Ib)
Time frame: Up to 72 days
The DLT evaluation period will be within the first three cycles (e.g., 56 days or eight weeks, and not to exceed 72 days) of treatment start with enfortumab-vedotin, pembrolizumab, and standard of care fractionation radiation therapy. Participants who receive > 75% of intended enfortumab vedotin, pembrolizumab, and standard of care radiation doses will be considered DLT evaluable (DE).
Frequency of treatment-emergent adverse events
Time frame: Up to 14 months
The frequency of adverse events by highest grade and overall attribution to study drugs, according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Percentage of participants with Clinical complete response (cCR) (Phase II)
Time frame: Up to 6 months
The rate of clinical complete response to treatment (cCR) will be measured as the percentage of participants with cCR based on cystoscopy and TURBT done at 6 months from treatment start. cCR is defined as no visual tumor AND no histological presence of tumor (i.e., ypT0).
9 secondary outcomes
Proportion of participants with Clinical Complete Response (cCR) (Phase Ib)
Time frame: Up to 6 months
Median Recurrence Free Survival Rate (RFS) at 1 year
Time frame: Up to 1 year
Median Cystectomy Free Survival rate (CFS) at 2 years
Time frame: Up to 2 years
Median Overall Survival (OS) at 2 years
Time frame: Up to 2 years
Median Overall OS
Time frame: Up to 5 years
Median Overall RFS
Time frame: Up to 5 years
Median Overall CFS
Time frame: Up to 5 years
Proportion of participants who have been downstaged to <= pT1N0, pT1 or less
Time frame: Up to 6 months
Proportion of participants who have been downstaged to <= pT1N0
Time frame: Up to 6 months
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 Oct 2026.
- Individual participant dataSharing planned: No
Related trials for Bladder Cancer
RecruitingPhase 2/3
Testing the Role of DNA Released From Tumor Cells Into the Blood in Guiding the Use of Immunotherapy After Surgical Removal of the Bladder, Kidney, Ureter, and Urethra for Urothelial Cancer Treatment, MODERN Study
Muscle Invasive Bladder Urothelial Carcinoma, Muscle Invasive Renal Pelvis Urothelial Carcinoma
RecruitingPhase 3
A Clinical Trial of Sacituzumab Tirumotecan (Sac-TMT, MK-2870) and Pembrolizumab (MK-3475A) in Participants With Bladder Cancer (MK-2870-055)
Bladder Cancer
Active, not recruitingPhase 2/3
A Study of CTX-009 in Combination With Paclitaxel in Adult Patients With Unresectable Advanced, Metastatic or Recurrent Biliary Tract Cancers (COMPANION-002)
Biliary Tract Cancer, Cholangiocarcinoma
Recruiting
Effect of Cyclic Sighing Breathing Exercise on CRBD, Pain, and Sleep Quality in Patients Undergoing TUR
Transurethral Resection of Bladder Tumor, Transurethral Resection of the Prostate (TURP)
Recruiting
The Vanguard Study: Testing a New Way to Screen for Cancer
Bladder Carcinoma, Breast Carcinoma
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Vadim Koshkin, MD principal investigator
University of California, San Francisco
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1/2 study testing Enfortumab Vedotin, Pembrolizumab and Intensity Modulated Radiation Therapy (IMRT) in people with Bladder Cancer and Muscle-Invasive Bladder Carcinoma, run by University of California, San Francisco at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 30 inclusion and 30 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 1 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this combined phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact UCSF Genitourinary Medical Oncology Recruitment (877-827-3222, GUTrials@ucsf.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Recommended phase II dose (RP2D) (Phase Ib) (time frame: Up to 72 days). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Oct 2026.