S0219, Combination Chemotherapy Followed By Observation or Surgery in Patients With Stage II or Stage III Cancer of the Urothelium

NCT ID: NCT00045630

Last Updated: 2013-05-27

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

77 participants

Study Classification

INTERVENTIONAL

Study Start Date

2003-01-31

Study Completion Date

2011-12-31

Brief Summary

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RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells and decrease the need for surgery.

PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy followed by observation or surgery to remove the bladder (cystectomy) in treating patients who have stage II or stage III cancer of the urothelium.

Detailed Description

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OBJECTIVES:

* Determine the pathologic complete response of patients with stage II or III transitional cell cancer of the urothelium treated with neoadjuvant gemcitabine, paclitaxel, and carboplatin followed by observation or immediate cystectomy.
* Determine, preliminarily, if molecular markers predict response, survival, and tumor recurrence in patients treated with these regimens.
* Determine recurrence rates and cystectomy-free survival of patients who choose observation after an initial response to neoadjuvant chemotherapy.
* Compare the survival of patients treated with neoadjuvant chemotherapy followed by cystectomy vs observation.
* Determine the feasibility, tolerability, and toxicity of these regimens in these patients.

OUTLINE: This is a multicenter study.

Patients receive gemcitabine IV over 30 minutes and paclitaxel IV over 30 minutes on days 1 and 8 and carboplatin IV over 30 minutes on day 1. Treatment repeats every 3 weeks for 3 courses in the absence of disease progression or unacceptable toxicity.

Within 4-8 weeks after completion of neoadjuvant chemotherapy, patients undergo a third transurethral resection of bladder tumor.

Patients with T0 disease after neoadjuvant chemotherapy may choose to undergo observation. These patients undergo cystoscopies with biopsies every 3 months for 1 year, every 4 months for 1 year, and then every 6 months until disease progression.

Patients with T1 disease or greater after neoadjuvant chemotherapy undergo immediate cystectomy. Patients with T0 disease may also choose this option. Patients undergoing immediate cystectomy are followed every 6 months for 2 years and then annually for 3 years.

PROJECTED ACCRUAL: A total of 95 patients will be accrued for this study within 2 years.

Conditions

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Bladder Cancer Transitional Cell Cancer of the Renal Pelvis and Ureter Urethral Cancer

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Gemcitabine, Paclitaxel, Carboplatin

Gemcitabine, Paclitaxel, Carboplatin followed by surgery

Group Type EXPERIMENTAL

carboplatin

Intervention Type DRUG

gemcitabine

Intervention Type DRUG

paclitaxel

Intervention Type DRUG

surgery

Intervention Type PROCEDURE

Interventions

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carboplatin

Intervention Type DRUG

gemcitabine

Intervention Type DRUG

paclitaxel

Intervention Type DRUG

surgery

Intervention Type PROCEDURE

Other Intervention Names

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gemcitabine hydrochloride Taxol

Eligibility Criteria

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Inclusion Criteria

DISEASE CHARACTERISTICS:

* Histologically confirmed muscle-invasive (T2-T4a), node-negative (N0) urothelial transitional cell cancer (TCC) of the bladder
* Focal squamous and/or adenocarcinoma differentiation, defined as ≤ 10% of tumor volume allowed
* The following diagnoses are not allowed:

* Small cell carcinoma
* Sarcomatoid components
* Disease diagnosed with an initial transurethral resection of bladder tumor (TURBT) and a second TURBT performed within 8 weeks of first with attempt to remove all tumor present

* Residual disease after second TURBT allowed
* No more than 14-56 days after second TURBT
* No metastatic disease by chest x-ray and CT scan or MRI of the abdomen and pelvis
* Fresh tumor tissue, paraffin tumor tissue, unstained slides, or cell block specimen from one or both TURBTs available

PATIENT CHARACTERISTICS:

Age

* 18 and over

Performance status

* Zubrod 0-2

Life expectancy

* Not specified

Hematopoietic

* White blood cell count (WBC) at least 3,500/mm\^3
* Absolute granulocyte count at least 1,500/mm\^3
* Platelet count at least lower limit of normal

Hepatic

* Bilirubin no greater than 1.5 mg/dL
* Aspartate aminotransferase (SGOT) no greater than 2 times upper limit of normal

Renal

* Creatinine no greater than 2.0 mg/dL AND/OR
* Creatinine clearance at least 60 mL/min

Other

* No prohibitive medical risk that would preclude radical cystectomy
* No other serious concurrent systemic disorder that would preclude study compliance
* No other malignancy except adequately treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, adequately treated stage I or II cancer in complete remission, or any other cancer for which patient has been disease-free for 5 years
* Not pregnant or nursing
* Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

* Prior intravesical immunotherapy allowed

Chemotherapy

* No prior systemic chemotherapy for TCC of the urothelium
* Prior intravesical chemotherapy allowed

Endocrine therapy

* Not specified

Radiotherapy

* No prior radiotherapy for TCC of the urothelium
* No concurrent radiotherapy

Surgery

* See Disease Characteristics
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

SWOG Cancer Research Network

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Primo N. Lara, MD

Role: STUDY_CHAIR

University of California, Davis

Locations

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Cancer Center at Providence Alaska Medical Center

Anchorage, Alaska, United States

Site Status

Banner Thunderbird Medical Center

Glendale, Arizona, United States

Site Status

Banner Desert Medical Center

Mesa, Arizona, United States

Site Status

Banner Baywood Medical Center

Mesa, Arizona, United States

Site Status

Banner Good Samaritan Medical Center

Phoenix, Arizona, United States

Site Status

CCOP - Western Regional, Arizona

Phoenix, Arizona, United States

Site Status

Providence Saint Joseph Medical Center - Burbank

Burbank, California, United States

Site Status

USC/Norris Comprehensive Cancer Center and Hospital

Los Angeles, California, United States

Site Status

University of California Davis Cancer Center

Sacramento, California, United States

Site Status

University of Colorado Cancer Center at University of Colorado Health Sciences Center

Aurora, Colorado, United States

Site Status

Veterans Affairs Medical Center - Denver

Denver, Colorado, United States

Site Status

Shaw Cancer Center at Vail Valley Medical Center

Edwards, Colorado, United States

Site Status

North Colorado Medical Center

Greeley, Colorado, United States

Site Status

McKee Medical Center

Loveland, Colorado, United States

Site Status

Montrose Memorial Hospital Cancer Center

Montrose, Colorado, United States

Site Status

Saint Anthony's Hospital at Saint Anthony's Health Center

Alton, Illinois, United States

Site Status

Decatur Memorial Hospital Cancer Care Institute

Decatur, Illinois, United States

Site Status

Good Samaritan Regional Health Center

Mount Vernon, Illinois, United States

Site Status

Regional Cancer Center at Memorial Medical Center

Springfield, Illinois, United States

Site Status

Cancer Center of Kansas, PA - Chanute

Chanute, Kansas, United States

Site Status

Cancer Center of Kansas, PA - Dodge City

Dodge City, Kansas, United States

Site Status

Cancer Center of Kansas, PA - El Dorado

El Dorado, Kansas, United States

Site Status

Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center

Kansas City, Kansas, United States

Site Status

Cancer Center of Kansas, PA - Kingman

Kingman, Kansas, United States

Site Status

Southwest Medical Center

Liberal, Kansas, United States

Site Status

Cancer Center of Kansas, PA - Newton

Newton, Kansas, United States

Site Status

Cancer Center of Kansas, PA - Parsons

Parsons, Kansas, United States

Site Status

Cancer Center of Kansas, PA - Pratt

Pratt, Kansas, United States

Site Status

Cancer Center of Kansas, PA - Salina

Salina, Kansas, United States

Site Status

Tammy Walker Cancer Center at Salina Regional Health Center

Salina, Kansas, United States

Site Status

Cancer Center of Kansas, PA - Wellington

Wellington, Kansas, United States

Site Status

Associates in Womens Health, PA - North Review

Wichita, Kansas, United States

Site Status

Cancer Center of Kansas, PA - Medical Arts Tower

Wichita, Kansas, United States

Site Status

Cancer Center of Kansas, PA - Wichita

Wichita, Kansas, United States

Site Status

CCOP - Wichita

Wichita, Kansas, United States

Site Status

Via Christi Cancer Center at Via Christi Regional Medical Center

Wichita, Kansas, United States

Site Status

Cancer Center of Kansas, PA - Winfield

Winfield, Kansas, United States

Site Status

Markey Cancer Center at University of Kentucky Chandler Medical Center

Lexington, Kentucky, United States

Site Status

Christus Schumpert Cancer Treatment Center

Shreveport, Louisiana, United States

Site Status

Cancer Research Center at Boston Medical Center

Boston, Massachusetts, United States

Site Status

Saint Joseph Mercy Cancer Center

Ann Arbor, Michigan, United States

Site Status

CCOP - Michigan Cancer Research Consortium

Ann Arbor, Michigan, United States

Site Status

University of Michigan Comprehensive Cancer Center

Ann Arbor, Michigan, United States

Site Status

Battle Creek Health System Cancer Care Center

Battle Creek, Michigan, United States

Site Status

Bay Regional Medical Center

Bay City, Michigan, United States

Site Status

Mecosta County Medical Center

Big Rapids, Michigan, United States

Site Status

Oakwood Cancer Center at Oakwood Hospital and Medical Center

Dearborn, Michigan, United States

Site Status

Barbara Ann Karmanos Cancer Institute

Detroit, Michigan, United States

Site Status

Genesys Hurley Cancer Institute

Flint, Michigan, United States

Site Status

Hurley Medical Center

Flint, Michigan, United States

Site Status

CCOP - Grand Rapids

Grand Rapids, Michigan, United States

Site Status

Lacks Cancer Center at Saint Mary's Health Care

Grand Rapids, Michigan, United States

Site Status

Spectrum Health Hospital - Butterworth Campus

Grand Rapids, Michigan, United States

Site Status

Metropolitan Hospital

Grand Rapids, Michigan, United States

Site Status

Van Elslander Cancer Center at St. John Hospital and Medical Center

Grosse Pointe Woods, Michigan, United States

Site Status

Holland Community Hospital

Holland, Michigan, United States

Site Status

Foote Hospital

Jackson, Michigan, United States

Site Status

Sparrow Regional Cancer Center

Lansing, Michigan, United States

Site Status

Hackley Hospital

Muskegon, Michigan, United States

Site Status

Seton Cancer Institute - Saginaw

Saginaw, Michigan, United States

Site Status

Providence Cancer Institute at Providence Hospital - Southfield Campus

Southfield, Michigan, United States

Site Status

Munson Medical Center

Traverse City, Michigan, United States

Site Status

St. John Macomb Hospital

Warren, Michigan, United States

Site Status

Regional Cancer Center at Singing River Hospital

Pascagoula, Mississippi, United States

Site Status

Saint Francis Medical Center

Cape Girardeau, Missouri, United States

Site Status

Southeast Missouri Regional Cancer Center at Southeast Missouri Hospital

Gape Girardeau, Missouri, United States

Site Status

CCOP - St. Louis-Cape Girardeau

St Louis, Missouri, United States

Site Status

David C. Pratt Cancer Center at St. John's Mercy

St Louis, Missouri, United States

Site Status

CCOP - Montana Cancer Consortium

Billings, Montana, United States

Site Status

Hematology-Oncology Centers of the Northern Rockies - Billings

Billings, Montana, United States

Site Status

Northern Rockies Radiation Oncology Center

Billings, Montana, United States

Site Status

St. Vincent Healthcare

Billings, Montana, United States

Site Status

Deaconess Billings Clinic - Downtown

Billings, Montana, United States

Site Status

Bozeman Deaconess Hospital

Bozeman, Montana, United States

Site Status

St. James Community Hospital

Butte, Montana, United States

Site Status

Big Sky Oncology

Great Falls, Montana, United States

Site Status

Sletten Regional Cancer Institute at Benefis Healthcare

Great Falls, Montana, United States

Site Status

Great Falls, Montana, United States

Site Status

St. Peter's Hospital

Helena, Montana, United States

Site Status

Glacier Oncology, PLLC

Kalispell, Montana, United States

Site Status

Kalispell Medical Oncology

Kalispell, Montana, United States

Site Status

Kalispell Regional Medical Center

Kalispell, Montana, United States

Site Status

Community Medical Center

Missoula, Montana, United States

Site Status

Montana Cancer Specialists at Montana Cancer Center

Missoula, Montana, United States

Site Status

Montana Cancer Center at St. Patrick Hospital and Health Sciences Center

Missoula, Montana, United States

Site Status

Good Samaritan Cancer Center at Good Samaritan Hospital

Kearney, Nebraska, United States

Site Status

Adirondack Cancer Care - Glens Falls

Glens Falls, New York, United States

Site Status

Wayne Memorial Hospital, Incorporated

Goldsboro, North Carolina, United States

Site Status

Wayne Radiation Oncology

Goldsboro, North Carolina, United States

Site Status

Rutherford Hospital

Rutherfordton, North Carolina, United States

Site Status

Wilson Medical Center

Wilson, North Carolina, United States

Site Status

Forsyth Regional Cancer Center at Forsyth Medical Center

Winston-Salem, North Carolina, United States

Site Status

Legacy Mount Hood Medical Center

Gresham, Oregon, United States

Site Status

Providence Milwaukie Hospital

Milwaukie, Oregon, United States

Site Status

Legacy Good Samaritan Hospital & Medical Center Comprehensive Cancer Center

Portland, Oregon, United States

Site Status

Providence Cancer Center at Providence Portland Medical Center

Portland, Oregon, United States

Site Status

CCOP - Columbia River Oncology Program

Portland, Oregon, United States

Site Status

Providence St. Vincent Medical Center

Portland, Oregon, United States

Site Status

Legacy Emanuel Hospital and Health Center & Children's Hospital

Portland, Oregon, United States

Site Status

Legacy Meridian Park Hospital

Tualatin, Oregon, United States

Site Status

AnMed Health Cancer Center

Anderson, South Carolina, United States

Site Status

CCOP - Upstate Carolina

Spartanburg, South Carolina, United States

Site Status

Gibbs Regional Cancer Center at Spartanburg Regional Medical Center

Spartanburg, South Carolina, United States

Site Status

University of Tennessee Cancer Institute - Medical Center

Memphis, Tennessee, United States

Site Status

CCOP - Scott and White Hospital

Temple, Texas, United States

Site Status

American Fork Hospital

American Fork, Utah, United States

Site Status

Logan Regional Hospital

Logan, Utah, United States

Site Status

Cottonwood Hospital Medical Center

Murray, Utah, United States

Site Status

McKay-Dee Hospital Center

Ogden, Utah, United States

Site Status

Utah Valley Regional Medical Center - Provo

Provo, Utah, United States

Site Status

Utah Cancer Specialists at UCS Cancer Center

Salt Lake City, Utah, United States

Site Status

Latter Day Saints Hospital

Salt Lake City, Utah, United States

Site Status

Dixie Regional Medical Center - East Campus

St. George, Utah, United States

Site Status

Danville Regional Medical Center

Danville, Virginia, United States

Site Status

St. Joseph Cancer Center

Bellingham, Washington, United States

Site Status

Olympic Hematology and Oncology

Bremerton, Washington, United States

Site Status

Skagit Valley Hospital Cancer Care Center

Mount Vernon, Washington, United States

Site Status

Fred Hutchinson Cancer Research Center

Seattle, Washington, United States

Site Status

Harborview Medical Center

Seattle, Washington, United States

Site Status

Minor and James Medical, PLLC

Seattle, Washington, United States

Site Status

Swedish Cancer Institute at Swedish Medical Center - First Hill Campus

Seattle, Washington, United States

Site Status

Polyclinic First Hill

Seattle, Washington, United States

Site Status

University Cancer Center at University of Washington Medical Center

Seattle, Washington, United States

Site Status

North Puget Oncology at United General Hospital

Sedro-Woolley, Washington, United States

Site Status

Cancer Care Northwest - Spokane South

Spokane, Washington, United States

Site Status

Southwest Washington Medical Center Cancer Center

Vancouver, Washington, United States

Site Status

Wenatchee Valley Medical Center

Wenatchee, Washington, United States

Site Status

Welch Cancer Center at Sheridan Memorial Hospital

Sheridan, Wyoming, United States

Site Status

Countries

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United States

References

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deVere White RW, Lara PN Jr, Goldman B, Tangen CM, Smith DC, Wood DP Jr, Hussain MH, Crawford ED. A sequential treatment approach to myoinvasive urothelial cancer: a phase II Southwest Oncology Group trial (S0219). J Urol. 2009 Jun;181(6):2476-80; discussion 2480-1. doi: 10.1016/j.juro.2009.01.115. Epub 2009 Apr 16.

Reference Type RESULT
PMID: 19371909 (View on PubMed)

Lara PN, Goldman B, De Vere White R, et al.: A sequential treatment approach to muscle-invasive urothelial cancer: A phase II Southwest Oncology Group trial (S0219) of neoadjuvant paclitaxel, carboplatin, and gemcitabine (PCG). [Abstract] J Clin Oncol 26 (Suppl 15): A-5022, 2008.

Reference Type RESULT

Other Identifiers

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S0219

Identifier Type: OTHER

Identifier Source: secondary_id

U10CA032102

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CDR0000256921

Identifier Type: -

Identifier Source: org_study_id

NCT00191217

Identifier Type: -

Identifier Source: nct_alias

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