KEYNOTE 676 (blaas, 2de lijn)
De KEYNOTE 676 studie is bestemd voor patiënten met een hooggradig niet-spierinvasief urotheelcarcinoom van de blaas die 1x inductie behandeling met BCG spoelingen hebben gehad. Het betreft een wereldwijde fase 3 studie naar de effectiviteit van de PD-1 remmer pembrolizumab. In totaal worden 550 patiënten geïncludeerd. De studie populatie wordt verdeeld in twee armen, waarbij in beide armen patiënten BCG spoelingen (inductie 1x per week, 6 weken – daarna maintenance volgens protocol schema) krijgen. Aan arm 1 wordt pembrolizumab toegevoegd, aan arm 2 niet. Patiënten in arm 1 zullen 3-wekelijkse infusies met Pembrolizumab 200 mg krijgen gedurende 2 jaar of tot het moment van eerste recidief, of onacceptabele toxiciteit.
PD-1 komt tot expressie in urotheelcarcinoom van de blaas en de effectiviteit van PD-1 en PD-L1 remming is reeds aangetoond voor gemetastaseerd urotheelcarcinoom van de blaas.
LET OP: recent is een amendement goedgekeurd en is een BCG naïef cohort aan deze studie toegevoegd. Dit houdt in dat er ook randomisatie plaatsvindt van dezelfde patiënten populatie die randomiseren tussen 6 inductiespoelingen met BCG versus 6x BCG + pembrolizumab elke 3 weken. In het licht van het huidige aanhoudende BCG tekort is deze studie extra interessant, omdat BCG voor deelnemende patiënten gegarandeerd is.
Verwijzers kunnen contact opnemen met dr. Joost Boormans, uroloog (j.boormans@erasmusmc.nl).
Voor meer informatie: Efficacy and Safety of Pembrolizumab (MK-3475) in Combination With Bacillus Calmette-Guerin (BCG) in High-Risk Non-Muscle Invasive Bladder Cancer (HR NMIBC) (MK-3475-676/KEYNOTE-676)
Deelnemende ziekenhuizen: ErasmusMC Kanker Instituut, MUMC en UMCU.
In- en exclusie criteria
Inclusion Criteria:
- Have locally and blinded independent central review (BICR)-confirmed histological diagnosis of high-risk non-muscle invasive (T1, high grade Ta and/or CIS) UC of the bladder
- Has undergone cystoscopy/ transurethral resection of bladder tumor (TURBT) to remove all resectable disease
- Has provided tissue for biomarker analysis
- Has Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2
- Has adequate organ function
- During the treatment period and for ≥7 days after the last dose of BCG, male participants are EITHER abstinent from heterosexual intercourse as their preferred and usual lifestyle and agree to remain abstinent, OR, must agree to use contraception unless confirmed to be azoospermic
- Female participants who are not pregnant, not breastfeeding, and either not a woman of child bearing potential (WOCBP); or are a WOCBP who agrees to use a contraception method that is highly effective or remains abstinent from heterosexual intercourse during the treatment period and for ≥7 days after the last dose of BCG or 120 days after the last dose of pembrolizumab, whichever comes last
BCG Post-induction Cohort (Cohort A) Only
- Has been treated with one adequate course of BCG induction therapy for the treatment of HR NMIBC
- Following adequate BCG induction therapy, must have persistent or recurrent HR NMIBC
Exclusion Criteria:
- Has a history of or concurrent locally advanced (i.e., T2, T3, T4) or metastatic UC
- Has concurrent extra-vesical (i.e, urethra, ureter, renal pelvis) non-muscle invasive urothelial carcinoma or a history of extra-vesical non-muscle invasive UC
- Has received prior therapy with anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor
- Has received prior systemic anti-cancer therapy including investigational agents within 4 weeks of start of study treatment
- Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks of start of study treatment
- Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days of start of study treatment
- Has a known additional malignancy that is progressing or requires active treatment within the past 3 years
- Has an active autoimmune disease that has required systemic treatment in past 2 years
- Has a history of (non-infectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease
- Has one or more of the following contraindications to BCG: prior BCG sepsis or systemic infection, total bladder incontinence, or an adverse experience to a previous BCG instillation that resulted in treatment discontinuation and precludes retreating with BCG
- Has an active infection or diagnosis requiring systemic antimicrobial therapy
- Has a known history of human immunodeficiency virus (HIV) infection
- Has a known history of Hepatitis B or known active Hepatitis C virus infection
- Has current active tuberculosis
- Has had an allogenic-tissue/solid organ transplant
- Has any contraindication(s) to IV contrast or is otherwise unable to have screening imaging with IV contrast performed
BCG Post-induction Cohort (Cohort A) Only – Has persistent T1 disease following an induction course of BCG
BCG Naïve Cohort (Cohort B) Only
– Has received any prior treatment with BCG for their NMIBC within the past 2 years prior to study entry