Neoadjuvant Zanidatamab + Tislelizumab + Chemotherapy for Selective Bladder Preservation in HER2-Positive MIBC

NCT ID: NCT07296705

Last Updated: 2025-12-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

25 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-10-25

Study Completion Date

2029-12-31

Brief Summary

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This is a multicenter, open-label, prospective, single-arm, phase II study designed to evaluate the efficacy and safety of neoadjuvant zanidatamab combined with tislelizumab and chemotherapy, followed by selective bladder preservation, in patients with HER2-positive muscle-invasive bladder cancer (MIBC) staged cT2-4aN0-1M0.

Detailed Description

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Eligible patients will receive neoadjuvant therapy with zanidatamab plus tislelizumab in combination with chemotherapy, followed by clinical reassessment. Patients who achieve a clinical complete response (cCR) will continue maintenance therapy with zanidatamab and tislelizumab. Patients who do not achieve cCR may, undergo radiotherapy or partial cystectomy and then continue maintenance zanidatamab plus tislelizumab; alternatively, they may proceed directly to radical cystectomy followed by adjuvant tislelizumab.

Conditions

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Muscle Invasive Bladder Cancer (MIBC)

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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Experimental group

Group Type EXPERIMENTAL

Zanidatamab

Intervention Type DRUG

Zanidatamab (1,800 mg for patients \<70 kg or 2,400 mg for patients ≥70 kg, administered intravenously every 3 weeks) for 4 cycles is given as part of the neoadjuvant regimen. After completion of neoadjuvant therapy, disease status is reassessed. Patients achieving a clinical complete response (cCR) may continue zanidatamab every 3 weeks for 2-4 cycles as part of bladder-preserving treatment; those without cCR may receive radiotherapy or partial cystectomy followed by zanidatamab every 3 weeks for 2-4 cycles, or undergo radical cystectomy without further zanidatamab treatment.

Tislelizumab

Intervention Type DRUG

Tislelizumab (200 mg administered intravenously every 3 weeks) is administered for 4 cycles as neoadjuvant therapy. After completion of 4 cycles, disease status is reassessed. Patients achieving a clinical complete response (cCR) may proceed with selective bladder preservation and continue tislelizumab every 3 weeks for 12 cycles; those without cCR may receive radiotherapy or partial cystectomy followed by tislelizumab every 3 weeks for 12 cycles, or undergo radical cystectomy with adjuvant tislelizumab every 3 weeks for 12 cycles.

Cisplatin

Intervention Type DRUG

Cisplatin (70 mg/m² administered intravenously every 3 weeks ) for 4 cycles is included in the neoadjuvant chemotherapy regimen for eligible cisplatin-based chemotherapy.

Gemcitabine

Intervention Type DRUG

Gemcitabine (1,000 mg/m² administered intravenously every 3 weeks) for 4 cycles is given as part of the neoadjuvant chemotherapy regimen for eligible cisplatin-based chemotherapy.

Nab-paclitaxel

Intervention Type DRUG

Nab-paclitaxel (125 mg/m² administered intravenously every 3 weeks) for 4 cycles is given as part of the neoadjuvant chemotherapy regimen for ineligible or refused cisplatin-based chemotherapy.

Interventions

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Zanidatamab

Zanidatamab (1,800 mg for patients \<70 kg or 2,400 mg for patients ≥70 kg, administered intravenously every 3 weeks) for 4 cycles is given as part of the neoadjuvant regimen. After completion of neoadjuvant therapy, disease status is reassessed. Patients achieving a clinical complete response (cCR) may continue zanidatamab every 3 weeks for 2-4 cycles as part of bladder-preserving treatment; those without cCR may receive radiotherapy or partial cystectomy followed by zanidatamab every 3 weeks for 2-4 cycles, or undergo radical cystectomy without further zanidatamab treatment.

Intervention Type DRUG

Tislelizumab

Tislelizumab (200 mg administered intravenously every 3 weeks) is administered for 4 cycles as neoadjuvant therapy. After completion of 4 cycles, disease status is reassessed. Patients achieving a clinical complete response (cCR) may proceed with selective bladder preservation and continue tislelizumab every 3 weeks for 12 cycles; those without cCR may receive radiotherapy or partial cystectomy followed by tislelizumab every 3 weeks for 12 cycles, or undergo radical cystectomy with adjuvant tislelizumab every 3 weeks for 12 cycles.

Intervention Type DRUG

Cisplatin

Cisplatin (70 mg/m² administered intravenously every 3 weeks ) for 4 cycles is included in the neoadjuvant chemotherapy regimen for eligible cisplatin-based chemotherapy.

Intervention Type DRUG

Gemcitabine

Gemcitabine (1,000 mg/m² administered intravenously every 3 weeks) for 4 cycles is given as part of the neoadjuvant chemotherapy regimen for eligible cisplatin-based chemotherapy.

Intervention Type DRUG

Nab-paclitaxel

Nab-paclitaxel (125 mg/m² administered intravenously every 3 weeks) for 4 cycles is given as part of the neoadjuvant chemotherapy regimen for ineligible or refused cisplatin-based chemotherapy.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Willing to participate, able to provide written informed consent, and able to understand and comply with study requirements and the assessment schedule.
2. Age 18 to 85 years on the date of informed consent.
3. Residual disease after TURBT; histologically confirmed urothelial carcinoma of the bladder staged cT2-T4aN0-1M0 per AJCC 8th edition by histology and imaging. For mixed histology, urothelial carcinoma must be predominant (≥50%).
4. Availability of TURBT tumor tissue and corresponding pathology report; either fresh surgical tissue or unstained slides may be submitted.
5. HER2-positive: IHC 2+ or 3+.
6. No prior anti-HER2-directed therapy (including but not limited to HER2 antibodies, HER2-targeting ADCs, or HER2-targeted TKIs) and no prior PD-(L)1 therapy.
7. ECOG performance status 0-2.
8. Adequate organ function based on screening labs obtained ≤14 days before enrollment:

a. For the following counts, no growth-factor support within 14 days prior to sample collection: i. Absolute neutrophil count ≥ 1.5 × 10\^9/L ii. Platelets ≥ 100 × 10\^9/L iii. Hemoglobin ≥ 90 g/L b. INR or aPTT ≤ 1.5 × upper limit of normal (ULN) c. Total bilirubin ≤ 1.5 × ULN (≤ 3 × ULN for Gilbert syndrome or isolated indirect hyperbilirubinemia) d. AST, ALT, and alkaline phosphatase ≤ 2.5 × ULN
9. Women of childbearing potential must have a negative urine or serum pregnancy test within ≤7 days before enrollment and agree to use highly effective contraception during the study and for ≥120 days after the last dose of zanidatamab, tislelizumab, or chemotherapy (whichever occurs later).
10. Non-sterilized men must agree to use highly effective contraception during the study and for ≥120 days after the last dose of zanidatamab, tislelizumab, or chemotherapy (whichever occurs later).

Exclusion Criteria

1. Pregnant or breastfeeding women.
2. Uncontrolled infection requiring systemic therapy.
3. Diagnosis of another malignancy within the past 5 years.
4. Major surgery or significant trauma within 28 days prior to enrollment (placement of a vascular access device and TURBT are not considered major surgery).
5. Prior radiotherapy to the bladder for bladder cancer.
6. Active autoimmune disease requiring systemic treatment that, in the investigator's judgment, would affect study therapy.
7. Any of the following cardiovascular criteria:

1. Cardiac chest pain within ≤28 days before first study dose, defined as moderate pain that limits activities of daily living.
2. Symptomatic pulmonary embolism within ≤28 days before first study dose.
3. Any acute myocardial infarction within ≤6 months before first study dose.
4. Any history of heart failure of New York Heart Association (NYHA) Class III or IV within ≤6 months before first study dose.
5. Any ventricular arrhythmia of severity ≥ Grade 2 within ≤6 months before first study dose.
6. Any cerebrovascular accident within ≤6 months before first study dose.
7. Corrected QT interval (QTc by Fridericia): ≥470 msec for women or ≥450 msec for men.

i. Note: If the initial ECG shows QTc \>450 msec (men) or \>470 msec (women), a follow-up ECG should be performed to confirm.

h) Left ventricular ejection fraction (LVEF) ≤50% by multigated acquisition (MUGA) scan or echocardiography (ECHO). The same modality used at baseline must be used for follow-up assessments.
8. History of acute myocardial infarction or ischemic stroke within 6 months.
9. Human immunodeficiency virus (HIV) infection (i.e., positive antibodies to HIV-1/2), active syphilis infection, or active tuberculosis infection.
10. Active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection.
11. History of interstitial lung disease, non-infectious pneumonitis, or uncontrolled pulmonary disease, including pulmonary fibrosis or acute lung disease.
12. Known hypersensitivity to any study drug.
13. Concurrent participation in another clinical study, unless observational (non-interventional) or in the follow-up phase of an interventional study.
14. Any other condition deemed by the investigator to render the patient ineligible.
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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BeiGene

INDUSTRY

Sponsor Role collaborator

Fujian Medical University Union Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Fujian Medical University Union Hospital

Fuzhou, Fujian, China

Site Status RECRUITING

Fujian Provincial Hospital Affiliated to Fuzhou University

Fuzhou, Fujian, China

Site Status RECRUITING

Affiliated Hospital of Putian University

Putian, Fujian, China

Site Status RECRUITING

Quanzhou First Hospital Affiliated to Fujian Medical University

Quanzhou, Fujian, China

Site Status RECRUITING

Sanming First Hospital

Sanming, Fujian, China

Site Status RECRUITING

The First Affi liated Hospital of Xiamen University

Xiamen, Fujian, China

Site Status RECRUITING

Zhangzhou Affiliated Hospital to Fujian Medical University

Zhangzhou, Fujian, China

Site Status RECRUITING

Jiangxi Cancer Hospital

Nanchang, Jiangxi, China

Site Status RECRUITING

Shandong Cancer Hospital

Jinan, Shandong, China

Site Status RECRUITING

Fudan University Shanghai Cancer Center

Shanghai, Shanghai Municipality, China

Site Status RECRUITING

Zhejiang Cancer Hospital

Hangzhou, Zhejiang, China

Site Status RECRUITING

The First Affiliated Hospital of Wenzhou Medical University

Wenzhou, Zhejiang, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Shaoxing Zhu, MD

Role: CONTACT

Phone: 86-18758872716

Email: [email protected]

Facility Contacts

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Shaoxing Zhu, MD

Role: primary

Qingguo Zhu

Role: primary

Guowei Lin

Role: primary

Changde Fu

Role: primary

Dongming Lu

Role: primary

Zhun Wu

Role: primary

Zhiming Zhuang

Role: primary

Xinhua Tu

Role: primary

Jiasheng Bian

Role: primary

Yijun Shen

Role: primary

Jinchao Chen

Role: primary

Hang Huang

Role: primary

Other Identifiers

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HARBOR-II-2025

Identifier Type: -

Identifier Source: org_study_id