Gemcitabine and Split-dose Cisplatin (GC) Plus Sorafenib in Chemotherapy-naïve Patients With Locally Advanced or Metastatic Urothelial Carcinoma
Condition: Bladder Cancer; URINARY BLADDER
MeSH terms: Carcinoma, Transitional Cell
Intervention: gemcitabine and cisplatin plus sorafenib
Intervention description: Gemcitabine 1000 mg/m 2 will be administered on days 1 and 8 and cisplatin 35 mg/m 2 will be administered on days 1 and 8. A total of six cycles of therapy will be administered at 21day intervals. Sorafenib 400 mg PO twice daily will be initiated on day 1 of cycle 1 and continued, as tolerated, until the time of disease progression or a maximum of 12 months. The total chemotherapy dose for gemcitabine and cisplatin (GC) may be modified for patients with severe obesity (e.g. body surface area (BSA) > 2.1), after consultation with the Principal Investigator.
Intervention MeSH terms: Gemcitabine; Sorafenib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 2.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Bladder; Urinary; SORAFENIB; CISPLATIN; GEMCITABINE

Summary:

      Standard chemotherapy drugs generally work by killing rapidly dividing cells in your body.
      Cancers cells are some of the most rapidly dividing cells and that is why chemotherapy can be
      effective in some patients. Gemcitabine and Cisplatin are an effective and standard drug
      combination used to treat locally advanced and metastatic urothelial cancer. However, these
      drugs do not shrink tumors in all patients and when they do, it is generally for a limited
      amount of time. This has led scientists to look for different ways to treat cancer.

      New drugs have been developed to treat cancer that work differently than standard
      chemotherapy drugs. These drugs attempt to decrease the blood supply to tumors. By doing so,
      this may limit the tumor's source of oxygen and nutrients and prevent the tumor from growing.
      Sorafenib is an example of a drug that works in this way.

      In some patients with advanced kidney cancer, sorafenib alone has been shown to slow the
      progression of their disease. The purpose of this study is to find out what effects, good
      and/or bad, the combination of gemcitabine, cisplatin, and sorafenib has on you and your
      cancer.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have measurable or evaluable urothelial cancer.

               -  Measurable disease includes unresectable or metastatic urothelial tract tumors
                  that are unidimensionally measurable by xray,CT/MRI scan or physical examination.

               -  Evaluable disease is restricted to patients with unresectable primary bladder
                  tumors which can be evaluated for response by cystoscopy.

          -  Pathologic confirmation by the Department of Pathology at MSKCC.

          -  Karnofsky Performance Status (KPS) ≥60%.

          -  Adequate marrow function defined as granulocytes ≥ 1500 cells/mm 3 , platelets ≥
             100,000 cells/mm 3 , and hemoglobin ≥ 8.0 g/dl.

          -  Serum creatinine < 2.0 mg/dl

          -  24-hour urine sample demonstrating creatinine clearance ≥ 60 ml/min/1.73m2 or
             calculated creatinine clearance ≥ 60 ml/min/1.73m 2 using the formula: Jeliffe
             Equation: estimated creatinine clearance = 98 x (0.8 [age(yrs) 20]/Serum Creatinine
             (mg/dL) x (0.9 if Female))

          -  Adequate hepatic function defined as:

               -  Total Bilirubin < or = to 1.5 x ULN

               -  AST and ALT < or = to 3.0 x ULN (< or = to 5.0 x ULN is acceptable if liver has
                  tumor involvement)

          -  Normal coagulation profile including PT/INR and PTT, unless patient is receiving
             anticoagulation therapy with agents such as warfarin or heparin.

          -  Age ≥ 18 years

          -  Informed consent

          -  Women of childbearing potential must have a negative pregnancy test.

          -  Men and women of childbearing potential must be willing to consent to using effective
             contraception while on treatment and for at least 3 months thereafter.

          -  Patients are encouraged to continue barrier method contraception for two years or
             longer after treatment.

        Exclusion Criteria:

          -  Prior treatment with systemic chemotherapy (prior intravesical therapy is permitted).

          -  Current, recent (within 4 weeks of the first infusion of this study), or planned
             participation in an experimental drug study.

          -  Blood Pressure of > 150/100 mm Hg.

          -  Irradiation within 4 weeks of start of protocol.

          -  Evidence of another active cancer, except for nonmelanoma skin carcinoma, insitu
             carcinoma of the cervix curatively treated, and adenocarcinoma of the prostate that
             has been surgically treated with a post-treatment PSA that is nondetectable.

          -  Significant cardiovascular disease including congestive heart failure (New York Heart
             Association Class II or higher) or active angina pectoris.

          -  History of a myocardial infarction within 6 months.

          -  History of a stroke or transient ischemic attack within 6 months.

          -  Clinically significant peripheral vascular disease.

          -  Evidence of bleeding diathesis or coagulopathy.

          -  Presence of central nervous system or brain metastases.

          -  Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
             prior to Day 0.

          -  Minor surgical procedures such as fine needle aspirations or core biopsies within 7
             days prior to Day 0.

          -  History of abdominal fistula, gastrointestinal perforation, or intraabdominal abscess
             within 6 months prior to Day 0.

          -  Serious nonhealing wound, ulcer, or bone fracture.

          -  History of persistent gross hematuria.

          -  Uncontrolled infection.

          -  Hypersensitivity to sorafenib, or any component of the formulation.

          -  Pregnant (positive pregnancy test) or lactating.

          -  Inability to comply with the study and/or followup procedures.