NCT06571708

Gemcitabine/Cisplatin Plus Cemiplimab With or Without Fianlimab in Localized Muscle-invasive Bladder Cancer (NeoSTOP-IT)

A Phase 2, Randomized, Open-label Study of Gemcitabine/Cisplatin Plus Cemiplimab (REGN2810, Anti-PD-1) With or Without Fianlimab (REGN3767, Anti-LAG-3) for Organ Preservation in Patients With Localized Muscle-invasive Bladder Cancer (NeoSTOP-IT)

• Status: Recruiting
• Phase: Phase 2
• Study type: Interventional
• Enrollment: 36 (estimated)
• Sponsor: Columbia University · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

The goal of this clinical trial is to learn if gemcitabine/cisplatin plus cemiplimab with or without fianlimab works to treat bladder cancer in adults. The main question it aims to answer is: Can gemcitabine, cisplatin, and cemiplimab with or without fianlimab treat bladder cancer? Participants will be randomly selected (like the loss of a coin) to treatment with gemcitabine, cisplatin, cemiplimab, and fianlimab or gemcitabine, cisplatin, and cemiplimab. Participants will: * Undergo transurethral resection of bladder tumor (TURBT) followed by the start of treatment, receive 4 cycles of treatment (21 day cycles) * After 4 cycles of treatment, patients will undergo repeat maximal TURBT with imaging * Participants with a complete response will continue maintenance cemiplimab or cemiplimab/fianlimab for 13 more cycles with imaging every 3 months * Participants without a complete clinical response will undergo cystectomy (bladder surgery).

Detailed description

This is a phase 2, open-label, randomized trial with continuous toxicity monitoring to ensure safety using Bayesian toxicity monitoring, which will evaluate treatment with doublet platinum-based chemotherapy (gemcitabine and cisplatin) plus cemiplimab (REGN2810) with or without fianlimab (REGN3767) for localized muscle-invasive bladder cancer (MIBC). Participants will be randomized to 4 cycles of 3 weeks each (12 weeks total) with gemcitabine, cisplatin, and cemiplimab with or without fianlimab. Participants achieving a clinical complete response will continue 13 more cycles of immunotherapy (39 weeks total). The total duration of systemic treatment, including neoadjuvant therapy, will be 52 weeks. In addition to the actual time on treatment, there will be time off treatment for recovery after neoadjuvant treatment and before adjuvant treatment. First, between the neoadjuvant phase and cystoscopy (with TURBT for residual disease), there will be up to 4 weeks off treatment. In between the cystoscopy/TURBT and start of adjuvant immunotherapy, there will be an additional up to 4 week interval for recovery. Participants will have regularly scheduled study visits at the clinical site on Day 1 and Day 8 of every three-week cycle in the neoadjuvant setting, where continuous assessment, including treatment response and safety assessments, will be performed. These will include laboratory tests, taking of vital signs, and physical examinations. In the adjuvant setting for participants who continue to maintenance immunotherapy, participants will have regularly scheduled study visits at the clinical site on Day 1 of every three-week cycle. Response to treatment will be determined by three modalities. First, CT scans (chest, abdomen, and pelvis with and without contrast) to ensure no metastatic disease. For participants who are unable to get a CT scan w/ contrast due to renal function (or any other reason), an MRI with and without contrast may be used instead. Scans are required at baseline and every 3 months in the adjuvant setting for participants who continue on with maintenance immunotherapy. Second, all participants will undergo post-treatment cystoscopy every 3 months while on treatment. Third, all participants will undergo post-treatment urine cytology every 3 months while on treatment.

Conditions

• Bladder Cancer
• Muscle-Invasive Bladder Carcinoma

Interventions

Type	Name	Description
DRUG	Gemcitabine	Gemcitabine 1000 mg/m\^2 IV
DRUG	Cisplatin	Cisplatin 70 mg/m\^2 IV or renally-dosed split-dose cisplatin 35 m/m\^2 IV
DRUG	Cemiplimab	Cemiplimab 350mg IV
DRUG	Fianlimab	Fianlimab 1600mg IV

Timeline

• Start date: 2025-08-14
• Primary completion: 2028-12-01
• Completion: 2028-12-01
• First posted: 2024-08-26
• Last updated: 2025-09-02

Locations

1 site across 1 country: United States

Regulatory

• FDA-regulated drug study