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Bladder Urothelial Carcinoma In SituPhase 2NCT04496219

Acupuncture for the Treatment of Intravesical BCG-Related Adverse Events in High-Risk Non-muscle Invasive Bladder Cancer

A Phase 2 study testing Acupuncture Therapy, BCG Solution and Best Practice in people with Bladder Urothelial Carcinoma In Situ and Recurrent Bladder Urothelial Carcinoma, run by Fred Hutchinson Cancer Center at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This phase II trial studies the safety and feasibility of utilizing acupuncture in patients with high-risk bladder cancer that has not spread to the surrounding muscle (non-muscle invasive) undergoing treatment with Intravesical BCG. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Acupuncture Therapy, BCG Solution and Best Practice
Could I receive a placebo?
No, everyone receives an active treatment
How many people
45 participants
Where
1 siteUnited States
Study dates
22 Jan 2021to 23 Aug 2022
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • English-speaking
  • Diagnosis of American Urological Association (AUA) high-risk non-muscle invasive bladder cancer (NMIBC), including high grade (HG) pT1 (invading only the lamina propria of the bladder), recurrent HG pTa (superficial tumors), HG pTa > 3 cm in size or multifocal, any carcinoma in situ, any variant histology, any lymphovascular invasion, and HG prostatic urethral involvement
  • Diagnosis with urothelial carcinoma (primary histologic subtype), localized to the bladder, in the absence of nodal or other visceral metastases
  • Patients who have been indicated for induction intravesical BCG in shared-decision-making with their primary urologist
  • Have not received acupuncture in the previous 3 months
  • Access to phone for study contacts
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  • Willing and able to participate in trial activities
  • Platelets: 20,000/ uL or greater
  • Absolute neutrophil count (ANC): 500 cells/uL or greater
  • Able to understand and willing to sign written informed consent in English

Who cannot join

  • Subjects who have had intravesical or systemic chemotherapy or radiation therapy for bladder cancer or for other malignancies prior to entering the study
  • Subjects who are indicated to receive other intravesical agents or therapies concurrently with BCG will be excluded
  • Subjects who have muscle-invasive bladder cancer, radiographic evidence of lymph node metastases or metastatic disease involving other organs including brain metastases
  • Patients with predominant histology other than urothelial carcinoma of the bladder who would not otherwise be considered candidates for BCG
  • BCG is contraindicated in:
  • Patients who are pregnant or lactating
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  • Patients with active tuberculosis
  • Immunosuppressed patients with congenital or acquired immune deficiency, whether due to concurrent disease (e.g. acquired immunodeficiency syndrome [AIDS], lymphoma, leukemia), concomitant cancer therapy (cytotoxic drugs, radiation), or immunosuppressive therapy (e.g. corticosteroids, disease-modifying anti-rheumatic drugs [DMARDs])
  • Symptomatic urinary tract infection
  • Febrile illness
  • Patients requiring chronic treatment with certain antibiotics that may interfere with the effectiveness of BCG
  • Any previous allergies or severe reactions to BCG
  • Not pregnant or trying to become pregnant. Acupuncture points included in the protocol are contraindicated with pregnancy
  • Does not have a pacemaker. There is potential of electrostimulation interfering with the operation and function of pacemakers
  • Patients requiring chronic treatment with certain antibiotics that may interfere with the effectiveness of BCG. Fluoroquinolone therapy may decrease the efficacy of intravesical BCG. Antibiotic therapy for ongoing treatment of active tuberculosis will decrease the efficacy of intravesical BCG
  • Uncontrolled or concurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Pregnant women are excluded. Acupuncture points included in the protocol are contraindicated with pregnancy and BCG is contraindicated in pregnancy
  • Pacemaker. Patients with pacemakers are restricted due to the potential of electrostimulation interfering with a pacemakers operation
  • Platelets: < 20,000/ uL. Risk of bleeding with acupuncture
  • ANC: < 500 cells/uL. Risk of infection with acupuncture
  • Received acupuncture in the previous 3 months. Acupuncture treatment effects persist after a course of treatment, previous exposure to the intervention has the potential to affect the baseline data for treatment and control arms

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Fred Hutch/University of Washington Cancer Consortium

    Seattle, Washington, 98109

Other trials in United States

About this study

Official title: Acupuncture vs. Standard of Care for Induction Intravesical BCG-Related Adverse Events in High-Risk Non-Muscle Invasive Bladder Cancer

This phase II trial studies the safety and feasibility of utilizing acupuncture in patients with high-risk bladder cancer that has not spread to the surrounding muscle (non-muscle invasive) undergoing treatment with Intravesical BCG. BCG is a weakened form of the bacterium Mycobacterium bovis that does not cause disease. It is used in a solution to stimulate the immune system in the treatment of bladder cancer. Unfortunately, many patients experience side effects such as pelvic pain, painful urination, severe urgency, frequency, urge incontinence, need to urinate at night, and/or infectious complications. These side effects may cause patients to delay or stop BCG treatment. Acupuncture is a medical intervention in which fine metallic needles are inserted into anatomical locations of the body to stimulate the peripheral and the central nervous system. Giving acupuncture before each intravesical BCG treatment may help to reduce the side effects of intravesical BCG, and help patients complete treatment. Specific outcomes of interest include acceptability to patients, effect of acupuncture on intravesical BCG-related side effects, and adverse events associated with acupuncture.

Read the detailed description

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients undergo acupuncture therapy and receive BCG via intravesical injection on days 1, 8, 15, 22, 29, and 36 in the absence of unacceptable toxicity. Patients also receive standard of care symptom management.

ARM II: Patients receive BCG via intravesical injection on days 1, 8, 15, 22, 29, and 36 in the absence of unacceptable toxicity. Patients also receive standard of care symptom management. Patients may undergo acupuncture therapy after completion of intravesical BCG therapy.

After completion of study, patients are followed up at 1 week.

Being tested
Acupuncture Therapy, BCG Solution, Best Practice, Quality-of-Life Assessment, Questionnaire Administration
Keywords
Urinary Bladder
Medical subject headings
Urinary Bladder Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Acupuncture TherapyDevice

    Also called Acupuncture

    Undergo acupuncture therapy

  • BCG SolutionBiological

    Also called Bacillus Calmette Guerin Solution, Bacillus Calmette-Guerin Solution, TICE BCG Solution

    Given by intravesical injection

  • Best PracticeOther

    Also called standard of care, standard therapy

    Receive standard of care symptom management

  • Quality-of-Life AssessmentOther

    Also called Quality of Life Assessment

    Ancillary studies

  • Questionnaire AdministrationOther

    Ancillary studies

Study groups in NCT04496219
Study groupRoleWhat they receive
Arm I (acupuncture, BCG)ExperimentalPatients undergo acupuncture therapy and receive BCG via intravesical injection on days 1, 8, 15, 22, 29, and 36 in the absence of unacceptable toxicity. Patients also receive standard of care symptom management.
Receives: Device: Acupuncture Therapy; Biological: BCG Solution; Other: Best Practice; Other: Quality-of-Life Assessment; Other: Questionnaire Administration
Arm II (BCG, standard of care)Active comparatorPatients receive BCG via intravesical injection on days 1, 8, 15, 22, 29, and 36 in the absence of unacceptable toxicity. Patients also receive standard of care symptom management. Patients may undergo acupuncture therapy after completion of intravesical BCG therapy.
Receives: Device: Acupuncture Therapy; Biological: BCG Solution; Other: Best Practice; Other: Quality-of-Life Assessment; Other: Questionnaire Administration

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Trial Recruitment: Number of Participants Eligible, Enrolled, and Not Enrolled

    Will be described via qualitative report.

    Measured: Up to 1 week after completion of treatment, an average of 7 weeks

  2. Trial Retention (Proportion Retained Versus All Enrolled, Reason for Not Completing)

    Will be described via qualitative report. Successful retention is defined as continued participation within the trial until 1 week following completion of induction.

    Measured: Baseline, up to 1 week after completion of treatment, an average of 7 weeks

  3. Protocol Adherence (Proportion Adhered Versus All Enrolled, Specifics for How Protocol Was Not Followed and Why)

    Will be described via qualitative report. Protocol adherence is defined as completion of the acupuncture interventions and follow-up surveys if randomized to the acupuncture arm or completion of the follow-up surveys if randomized to the control arm.

    Measured: Up to 1 week after completion of treatment, an average of 7 weeks

  4. Patient Satisfaction

    Patients' responses to the Cancer Care Satisfaction survey at 3 weeks and at the conclusion of induction Bacillus Calmette-Guerin (BCG) between two arms will be compared using t-test.

    Measured: At 3 weeks and after completion of treatment, an average of 7 weeks

  5. Clinic Staff's Responses to Surveys

    Clinic staff's responses to surveys assessing the healthcare burden of this protocol and time spent undergoing the acupuncture therapy for the experimental arm will be described via qualitative report

    Measured: Up to 1 week after completion of treatment, an average of 7 weeks

  6. Number of Adverse Events

    BCG related adverse events compared between patients receiving acupuncture and patients receiving standard of care.

    Measured: Up to 1 week after completion of treatment, an average of 7 weeks

Secondary outcomes (4)
  1. BCG Instillation Adherence (Out of a Possible Planned Six Treatments)

    BCG instillation adherence (successful adherence defined as the number of successfully administered BCG instillations of a possible 6 total) and weeks missed (measured as total weeks that BCG was not administered of the planned 6 weekly induction doses of intravesical BCG). Results between the acupuncture and control arms will be compared via t-test.

    Measured: Up to 1 week after completion of treatment, an average of 7 weeks

  2. Bladder and Bowel Symptoms as Self Reported by Patients

    Assessed using the EORTC - Non-Muscle Invasive Bladder Cancer 24 (EORTC-NMIBC24) symptom index, which was specifically designed to assess bladder and bowel symptoms for patients with NMIBC including assessments of impact of intravesical therapy. All of the subscales and single-item measures range in score from 0 to 100 and a high scale score represents a higher response level (ranging from 0 = low to 100 = high/healthy level of function; from 0 = low to 100 = high quality-of-life; from 0 = low to 100 = high level of symptomatology/problems). Subscale scores are each calculated by transforming individual item scores into a 0 to 1 scale, taking the mean, and multiplying by 100.

    Measured: From week 1 to week 6 of treatment

  3. Quality of Life: EORTC-QLQ-C30

    Assessed using the EORTC Health and Quality of Life Rating Scale (EORTC-QLQ-C30). All of the subscales and single-item measures range in score from 0 to 100 and a high scale score represents a higher response level (ranging from 0 = low to 100 = high/healthy level of function; from 0 = low to 100 = high quality-of-life; from 0 = low to 100 = high level of symptomatology/problems). Subscale and global health status scores are each calculated by transforming individual item scores into a 0 to 1 scale, taking the mean, and multiplying by 100.

    Measured: From week 1 to week 6 of treatment

  4. Median Weekly Pill Counts of Medications Prescribed for the Management of BCG-related Side Effects, Standardized by Dosage Across Medication Types

    Will be compared via Wilcoxon rank sum test.

    Measured: Up to 1 week after completion of treatment, an average of 7 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Aug 2020
  2. Study start22 Jan 2021
  3. Primary completion16 Aug 2022
  4. Study completion23 Aug 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
45 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04496219
Sponsor's protocol ID
RG1007421
Other IDs
P30CA015704, NCI-2020-05021, 10544
Status last verified
Dec 2023
First submitted
29 Jul 2020
Last updated
2 Jan 2024
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Acupuncture Therapy, BCG Solution and Best Practice in people with Bladder Urothelial Carcinoma In Situ and Recurrent Bladder Urothelial Carcinoma, run by Fred Hutchinson Cancer Center at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 21 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 2 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 2 Jan 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Trial Recruitment: Number of Participants Eligible, Enrolled, and Not Enrolled (time frame: Up to 1 week after completion of treatment, an average of 7 weeks). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Jan 2024.

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