RECRUITING

Therapeutic Plasma Exchange With Enfortumab Vedotin and Pembrolizumab for Treatment of Bladder Cancers

Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

This phase II trial compares therapeutic plasma exchange followed by enfortumab vedotin and pembrolizumab to standard of care next-line therapy for the treatment of patients with bladder or upper urinary tract cancers that have spread from where they first started (primary site) to other places in the body (metastatic) and that have not responded to previous treatment (refractory). TPE is a process that slowly removes a patient's blood through an intravenous or central line. The blood is sent through a machine that separates the plasma (the liquid part of blood) from other blood components (red cells, white cells, platelets). The plasma is then removed. The remaining blood components are combined with replacement fluid and returned to the patient's bloodstream through the intravenous or central line. 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 cancer cells. Enfortumab attaches to a protein called nectin-4 on cancer 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. Treatment with enfortumab vedotin and pembrolizumab is already approved by the Food and Drug Administration for the treatment of bladder cancer, but TPE is not. Combining TPE with enfortumab vedotin and pembrolizumab may work better than standard of care options for treating metastatic and refractory bladder and urinary tract cancers.

Official Title

Randomized Phase II Rescuing Cancer Immunotherapy With Plasma Exchange in Bladder Cancer 1 (ReCIPE-B1)

Quick Facts

Study Start:2025-08-01
Study Completion:2028-08-07
Study Type:Not specified
Phase:Not Applicable
Enrollment:Not specified
Status:RECRUITING

Study ID

NCT07087860

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:18 Years
Sexes Eligible for Study:ALL
Accepts Healthy Volunteers:No
Standard Ages:ADULT, OLDER_ADULT
Inclusion CriteriaExclusion Criteria
  1. * Age ≥ 18 years
  2. * Histologically proven urothelial carcinoma \[American Joint Committee on Cancer (AJCC) 2017\] of the bladder (BCa) or upper urothelial tract (UTUC), that has progressed despite enfortumab vedotin and pembrolizumab treatment
  3. * NOTE: Primary or secondary progression are allowed, therapies are not required to be concurrent or immediately antecedent to enrollment)
  4. * Measurable disease per RECIST version (v)1.1
  5. * Eastern Cooperative Oncology Group (ECOG) performance status grade 0, 1, or 2
  6. * Hemoglobin \> 7.0 g/dL (obtained ≤ 30 days prior to registration)
  7. * Platelet count ≥ 75,000/mm\^3 (obtained ≤ 30 days prior to registration)
  8. * Alanine aminotransferase (ALT) OR aspartate transaminase (AST) ≤ 3.5 x upper limit of normal (ULN) OR total bilirubin ≤ 3 x ULN OR direct bilirubin ≤ 3 x ULN (obtained ≤ 30 days prior to registration)
  9. * Estimated glomerular filtration rate (GFR) ≥ 15 ml/min (obtained ≤ 30 days prior to registration)
  10. * Negative pregnancy test ≤ 8 days prior to registration, for persons of childbearing potential only
  11. * Provide written informed consent
  12. * Ability to complete questionnaire(s) by themselves or with assistance
  13. * Willingness to undergo treatment on either treatment arm (group A: TPE + EV/pembro; OR group B: next line standard of care)
  14. * Willingness to provide mandatory blood and fluid specimens for correlative research
  15. * Willingness to provide tissue specimens for correlative research
  16. * Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)
  1. * Any of the following because this study involves an investigational agent, the genotoxic, mutagenic, and teratogenic effects of which on the developing fetus and newborn are unknown
  2. * Pregnant persons
  3. * Nursing persons
  4. * Persons of childbearing potential or able to father a child who are unwilling to employ adequate contraception
  5. * Any of the following histologic variants/divergent differentiation: Any amount of neuroendocrine, micropapillary, or signet ring cell features
  6. * Active malignancies (i.e., progressing or requiring treatment change ≤ 24 months before registration) other than the disease being treated under study
  7. * EXCEPTIONS:
  8. * Skin cancer (melanoma or non-melanoma) that is considered completely cured
  9. * Non-invasive cervical cancer that is considered completely cured
  10. * Breast cancer: adequately treated lobular carcinoma in situ or ductal carcinoma in situ considered to have a very low risk of recurrence
  11. * Localized prostate cancer (T1c/T2N0M0):
  12. * Gleason score 6, treated by either surgery or ablation ≤ 24 months prior to registration or untreated and under active surveillance
  13. * Gleason score 3+4 that has been treated (may include surgery or ablation) ≤ 24 months prior to registration and considered to have a very low risk of recurrence (i.e., cT1c or pT2 on prostatectomy specimen)
  14. * History of uncontrolled cardiovascular disease including any of the following ≤ 6 months prior to registration:
  15. * Significant cardiovascular disease \[New York Heart Association (NYHA) class ≥ III\], symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, myocardial infarction, ventricular fibrillation, Torsades de Pointes, cerebrovascular accident, or transient ischemic attack
  16. * Psychiatric illness/social situations (e.g., substance abuse) that would limit compliance with study requirements
  17. * Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the participants (e.g., compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments

Contacts and Locations

Study Contact

Clinical Trials Referral Office
CONTACT
855-776-0015
mayocliniccancerstudies@mayo.edu

Principal Investigator

Jacob J. Orme, MD, PhD
PRINCIPAL_INVESTIGATOR
Mayo Clinic

Study Locations (Sites)

Mayo Clinic in Rochester
Rochester, Minnesota, 55905
United States

Collaborators and Investigators

Sponsor: Mayo Clinic

  • Jacob J. Orme, MD, PhD, PRINCIPAL_INVESTIGATOR, Mayo Clinic

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2025-08-01
Study Completion Date2028-08-07

Study Record Updates

Study Start Date2025-08-01
Study Completion Date2028-08-07

Terms related to this study

Additional Relevant MeSH Terms

  • Metastatic Bladder Urothelial Carcinoma
  • Metastatic Renal Pelvis and Ureter Urothelial Carcinoma
  • Refractory Bladder Urothelial Carcinoma
  • Refractory Renal Pelvis and Ureter Urothelial Carcinoma
  • Stage IV Bladder Cancer AJCC v7
  • Stage IV Renal Pelvis and Ureter Cancer AJCC v7