Conditions: Bladder Cancer Transitional Cell Cancer of the Renal Pelvis and Ureter Urethral Cancer
Keywords: anterior urethral cancer localized transitional cell cancer of the renal pelvis and ureter posterior urethral cancer stage II bladder cancer stage III bladder cancer transitional cell carcinoma of the bladder urethral cancer associated with invasive bladder cancer regional transitional cell cancer of the renal pelvis and ureter
Allocation: NA | Intervention model: SINGLE_GROUP
Enrollment: 77
Healthy volunteers: no

Brief summary:
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells and decrease the need for surgery.

PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy followed by observation or surgery to remove the bladder (cystectomy) in treating patients who have stage II or stage III cancer of the urothelium.

Detailed description:
OBJECTIVES:

* Determine the pathologic complete response of patients with stage II or III transitional cell cancer of the urothelium treated with neoadjuvant gemcitabine, paclitaxel, and carboplatin followed by observation or immediate cystectomy.
* Determine, preliminarily, if molecular markers predict response, survival, and tumor recurrence in patients treated with these regimens.
* Determine recurrence rates and cystectomy-free survival of patients who choose observation after an initial response to neoadjuvant chemotherapy.
* Compare the survival of patients treated with neoadjuvant chemotherapy followed by cystectomy vs observation.
* Determine the feasibility, tolerability, and toxicity of these regimens in these patients.

OUTLINE: This is a multicenter study.

Patients receive gemcitabine IV over 30 minutes and paclitaxel IV over 30 minutes on days 1 and 8 and carboplatin IV over 30 minutes on day 1. Treatment repeats every 3 weeks for 3 courses in the absence of disease progression or unacceptable toxicity.

Within 4-8 weeks after completion of neoadjuvant chemotherapy, patients undergo a third transurethral resection of bladder tumor.

Patients with T0 disease after neoadjuvant chemotherapy may choose to undergo observation. These patients undergo cystoscopies with biopsies every 3 months for 1 year, every 4 months for 1 year, and then every 6 months until disease progression.

Patients with T1 disease or greater after neoadjuvant chemotherapy undergo immediate cystectomy. Patients with T0 disease may also choose this option. Patients undergoing immediate cystectomy are followed every 6 months for 2 years and then annually for 3 years.

PROJECTED ACCRUAL: A total of 95 patients will be accrued for this study within 2 years.

Arms:
arm 1: Gemcitabine, Paclitaxel, Carboplatin followed by surgery

Interventions: intervention 1: carboplatin intervention 2: gemcitabine intervention 3: paclitaxel intervention 4: surgery
Intervention descriptions: intervention 1: None intervention 2: None intervention 3: None intervention 4: None

Protocol document: