Bladder CancerNCT06735287
A Bladder-Sparing Treatment Strategies of Large-Volume Non-Muscle-Invasive Bladder Cancer
A study testing bladder sparing set and RC in people with Bladder Cancer and NMIBC, run by The First Affiliated Hospital with Nanjing Medical University at 1 site in China.
Trial summary
Bladder cancer is a common malignancy in the urinary system, ranking 11th in cancer incidence in China (3.48/100,000), with male incidence ranking 8th (5.70/100,000). It is classified as non-muscle-invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) based on muscle involvement. Read more about this study
- Who is it for?
- Ages 18 to 80 years
- Conditions the study is for
- Bladder Cancer, NMIBC
- What is being tested?
- bladder sparing set and RC
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteChina
- Study dates
- 1 Dec 2024to 31 Dec 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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 to 80 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Diagnosis of large non-muscle-invasive bladder cancer: Tumor size ≥5 cm, ≤3 tumors, pre-TURBT VI-RADS score <3, or biopsy confirms non-muscle-invasive urothelial carcinoma.
- Ability to tolerate neoadjuvant chemotherapy and immunotherapy: Sufficient heart, bone marrow, liver, and kidney function (according to clinical trial center normal values), no severe hematologic abnormalities or organ dysfunction (heart function 0-2, WBC ≥3.5×10⁹/L, neutrophil count ≥1.5×10⁹/L, PLT ≥75.0×10⁹/L, HGb ≥80 g/L; liver function: total bilirubin ≤1.5×ULN, AST and ALT ≤2.5×ULN; kidney function: creatinine ≤1.5×ULN, or GFR ≥60 ml/min if creatinine >1.5×ULN).
- ECOG performance status: 0 or 1. No history of other malignancies. Able to receive regular mitomycin C bladder instillation therapy after TURBT. Male or female, aged ≥18 and <80 years. Voluntary participation with written informed consent, and ability to understand and comply with study requirements, including regular follow-up.
Who cannot join
- Preoperative imaging assessment with VI-RADS ≥3. Postoperative pathology showing non-urothelial carcinoma (e.g., adenocarcinoma, squamous cell carcinoma, small cell carcinoma, or mixed tumors), or urothelial carcinoma ≥T2.
- Presence of lymph node and/or distant metastases. Allergy or hypersensitivity to treatment drugs, or patients with autoimmune diseases.
- Any condition deemed by the investigator to potentially harm the participant or prevent them from meeting or fulfilling study requirements.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
China1 site, 1 recruiting
- Recruiting
The first affiliated hospital of Nanjing Medical University
Nanjing, Jiangsu, 210000
Qiang Lu, PhD, 13505196501, doctorlvqiang@njmu.edu.cn
Xiao Yang, PhD
About this study
Bladder cancer is a common malignancy in the urinary system, ranking 11th in cancer incidence in China (3.48/100,000), with male incidence ranking 8th (5.70/100,000). It is classified as non-muscle-invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) based on muscle involvement. About 75% of patients are initially diagnosed with NMIBC, with Ta, T1, and Tis stages comprising 70%, 20%, and 10%, respectively.
With the advancement of magnetic resonance imaging (MRI), its role in bladder cancer diagnosis and staging has expanded. Multiparametric MRI (MpMRI) enhances staging accuracy with better anatomical visualization. In 2018, Valeria et al. introduced the VI-RADS scoring system, which uses MpMRI to predict tumor stage. Retrospective studies by Wang et al. found that all tumors with a VI-RADS score of 1 were NMIBC, and 95.1% of tumors with a score of 2 were also NMIBC. A VI-RADS score of ≤2 can be used to identify NMIBC with high sensitivity.
Read more
NMIBC shows varied risks for recurrence and progression based on tumor characteristics like size, stage, grade, and multiplicity. The European Association of Urology (EAU) risk stratification system, established in 2021, classifies NMIBC into low-, intermediate-, high-, and very-high-risk groups. Transurethral resection of bladder tumor (TURBT) is the primary diagnostic and therapeutic approach for most NMIBC cases. However, residual tumors can remain after the first TURBT. For Ta and T1 tumors, 17%-72% and 33%-78% of cases show residual disease during second resection, respectively. Re-staging TURBT for T1 tumors improves prognosis. Studies show that second TURBT offers longer recurrence-free survival (47 months) compared to a single TURBT (12 months). The 5-year progression rate was 6.5% with second TURBT, compared to 23.5% with a single procedure.
Following TURBT, floating and residual tumor cells may lead to recurrence. Immediate postoperative bladder instillation of chemotherapy (e.g., pirarubicin, epirubicin, doxorubicin, mitomycin C, gemcitabine) significantly reduces recurrence in low-risk NMIBC but is less effective for intermediate- and high-risk NMIBC. For intermediate-risk NMIBC, maintenance chemotherapy is recommended, and for high-risk NMIBC, BCG immunotherapy is preferred. Both maintenance chemotherapy and BCG instillation reduce recurrence in these groups. Mitomycin C offers comparable efficacy to BCG with fewer side effects.
For patients in the very-high-risk group, immediate radical cystectomy is recommended because delayed cystectomy leads to poorer cancer-specific survival. High-risk NMIBC patients may undergo 1-3 years of BCG therapy or immediate cystectomy if necessary.
Large-volume NMIBC (≥5 cm) presents significant challenges in treatment. TURBT for large tumors often leads to difficulties in resection due to excessive bleeding, unclear vision, and increased risk of bladder wall injury. Larger tumors also increase the risk of tumor cell seeding and metastasis. Tumor size (≥3 cm) is an independent risk factor for early recurrence and progression, leading some experts to recommend immediate radical cystectomy for large-volume NMIBC.
Radical cystectomy is a high-risk procedure with complication rates of 28%-64% and mortality rates of 2.5%-2.7%. It also requires urinary diversion, which can significantly impact a patient's physical, psychological, and social well-being. Patients often face lifelong use of urinary collection devices, reducing their quality of life. Given the impact of radical cystectomy, bladder-sparing strategies have gained attention. These approaches aim to preserve the bladder while controlling tumor growth, maintaining the patient's quality of life.
Currently, no formal guidelines exist for bladder-sparing treatment of large-volume NMIBC. However, a 2022 Chinese consensus emphasizes maximal TURBT followed by adjuvant therapy to reduce recurrence and progression. Intravesical chemotherapy, particularly BCG and mitomycin C, is a key part of postoperative management. In the era of immunotherapy, PD-1/PD-L1 inhibitors are emerging as essential components of bladder-sparing strategies. Pembrolizumab, for example, has shown a 41% complete response rate in BCG-unresponsive NMIBC, leading to its FDA approval for carcinoma in situ patients who are ineligible or unwilling to undergo radical cystectomy.
Although neoadjuvant chemotherapy is not yet included in NMIBC guidelines, its success in MIBC suggests potential benefit for NMIBC. Neoadjuvant chemotherapy improves survival by 5%-10% and reduces mortality by 16%-33%. After achieving a pathological complete response (pT0), patients can avoid radical cystectomy, with a 5-year survival rate of 90%.
This study aims to explore the feasibility of bladder-sparing treatment for large-volume NMIBC, balancing quality of life with oncological outcomes.
- Conditions
- Bladder Cancer, NMIBC
- Being tested
- bladder sparing set, RC
- Medical subject headings
- Urinary Bladder Neoplasms, Non-Muscle Invasive Bladder Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
bladder sparing setProcedure or surgery
after neoadjuvant chemotherapy combined with immunotherapy, maximal TURBT and a re-TURBT shall be performed then mitomycin C bladder instillation therapy will be administered
RCProcedure or surgery
Radical cystectomy performed immediately after three cycles of neoadjuvant therapy.
| Study group | Role | What they receive |
|---|---|---|
| bladder sparing set | Experimental | Not described Receives: Procedure: bladder sparing set |
| radical cystectomy set | Active comparator | Not described Receives: Procedure: RC |
What is being measured
The primary outcome is the main question the study is designed to answer.
recurrence free survival
Measured: From enrollment to 3 years post-treatment completion
Secondary outcomes (1)
progress free survival
Measured: From enrollment to 3 years post-treatment completion
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted16 Dec 2024
- Study start1 Dec 2024
- Primary completion1 Dec 2027 (estimated)
- Study completion31 Dec 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Bladder CancerStudies of the same condition, open and under way.
- More trials run by The First Affiliated Hospital with Nanjing Medical UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 N/A
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Model description
- this study is a prospective, single-center, historical control trial, with a planned enrollment of 30 participants.
- Masking
- None (open label)
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06735287
- Sponsor's protocol ID
- 2024-SR-954
- Status last verified
- Mar 2025
- First submitted
- 11 Dec 2024
- Last updated
- 18 Mar 2025
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 18 Mar 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Bladder-Sparing Treatment Strategies of Large-Volume Non-Muscle-Invasive Bladder Cancer
- ClinicalTrials.gov ID
- NCT06735287
- Acronym / sponsor ID
- 2024-SR-954
- Conditions
- Bladder Cancer, NMIBC
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- The First Affiliated Hospital with Nanjing Medical UniversityUniversity, hospital or other
- Study start
- 1 Dec 2024 (actual)
- Primary completion
- 1 Dec 2027 (estimated)
- Study completion
- 31 Dec 2027 (estimated)
- First posted
- 16 Dec 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Bladder cancer is a common malignancy in the urinary system, ranking 11th in cancer incidence in China (3.48/100,000), with male incidence ranking 8th (5.70/100,000). It is classified as non-muscle-invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) based on muscle involvement. About 75% of patients are initially diagnosed with NMIBC, with Ta, T1, and Tis stages comprising 70%, 20%, and 10%, respectively.
With the advancement of magnetic resonance imaging (MRI), its role in bladder cancer diagnosis and staging has expanded. Multiparametric MRI (MpMRI) enhances staging accuracy with better anatomical visualization. In 2018, Valeria et al. introduced the VI-RADS scoring system, which uses MpMRI to predict tumor stage. Retrospective studies by Wang et al. found that all tumors with a VI-RADS score of 1 were NMIBC, and 95.1% of tumors with a score of 2 were also NMIBC. A VI-RADS score of ≤2 can be used to identify NMIBC with high sensitivity.
NMIBC shows varied risks for recurrence and progression based on tumor characteristics like size, stage, grade, and multiplicity. The European Association of Urology (EAU) risk stratification system, established in 2021, classifies NMIBC into low-, intermediate-, high-, and very-high-risk groups. Transurethral resection of bladder tumor (TURBT) is the primary diagnostic and therapeutic approach for most NMIBC cases. However, residual tumors can remain after the first TURBT. For Ta and T1 tumors, 17%-72% and 33%-78% of cases show residual disease during second resection, respectively. Re-staging TURBT for T1 tumors improves prognosis. Studies show that second TURBT offers longer recurrence-free survival (47 months) compared to a single TURBT (12 months). The 5-year progression rate was 6.5% with second TURBT, compared to 23.5% with a single procedure.
Following TURBT, floating and residual tumor cells may lead to recurrence. Immediate postoperative bladder instillation of chemotherapy (e.g., pirarubicin, epirubicin, doxorubicin, mitomycin C, gemcitabine) significantly reduces recurrence in low-risk NMIBC but is less effective for intermediate- and high-risk NMIBC. For intermediate-risk NMIBC, maintenance chemotherapy is recommended, and for high-risk NMIBC, BCG immunotherapy is preferred. Both maintenance chemotherapy and BCG instillation reduce recurrence in these groups. Mitomycin C offers comparable efficacy to BCG with fewer side effects.
For patients in the very-high-risk group, immediate radical cystectomy is recommended because delayed cystectomy leads to poorer cancer-specific survival. High-risk NMIBC patients may undergo 1-3 years of BCG therapy or immediate cystectomy if necessary.
Large-volume NMIBC (≥5 cm) presents significant challenges in treatment. TURBT for large tumors often leads to difficulties in resection due to excessive bleeding, unclear vision, and increased risk of bladder wall injury. Larger tumors also increase the risk of tumor cell seeding and metastasis. Tumor size (≥3 cm) is an independent risk factor for early recurrence and progression, leading some experts to recommend immediate radical cystectomy for large-volume NMIBC.
Radical cystectomy is a high-risk procedure with complication rates of 28%-64% and mortality rates of 2.5%-2.7%. It also requires urinary diversion, which can significantly impact a patient's physical, psychological, and social well-being. Patients often face lifelong use of urinary collection devices, reducing their quality of life. Given the impact of radical cystectomy, bladder-sparing strategies have gained attention. These approaches aim to preserve the bladder while controlling tumor growth, maintaining the patient's quality of life.
Currently, no formal guidelines exist for bladder-sparing treatment of large-volume NMIBC. However, a 2022 Chinese consensus emphasizes maximal TURBT followed by adjuvant therapy to reduce recurrence and progression. Intravesical chemotherapy, particularly BCG and mitomycin C, is a key part of postoperative management. In the era of immunotherapy, PD-1/PD-L1 inhibitors are emerging as essential components of bladder-sparing strategies. Pembrolizumab, for example, has shown a 41% complete response rate in BCG-unresponsive NMIBC, leading to its FDA approval for carcinoma in situ patients who are ineligible or unwilling to undergo radical cystectomy.
Although neoadjuvant chemotherapy is not yet included in NMIBC guidelines, its success in MIBC suggests potential benefit for NMIBC. Neoadjuvant chemotherapy improves survival by 5%-10% and reduces mortality by 16%-33%. After achieving a pathological complete response (pT0), patients can avoid radical cystectomy, with a 5-year survival rate of 90%.
This study aims to explore the feasibility of bladder-sparing treatment for large-volume NMIBC, balancing quality of life with oncological outcomes.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- this study is a prospective, single-center, historical control trial, with a planned enrollment of 30 participants.
| Arm | Type | Receives |
|---|---|---|
| bladder sparing set | Experimental | Procedure: bladder sparing set |
| radical cystectomy set | Active comparator | Procedure: RC |
Who may qualify
- Ages
- 18 to 80 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Diagnosis of large non-muscle-invasive bladder cancer: Tumor size ≥5 cm, ≤3 tumors, pre-TURBT VI-RADS score <3, or biopsy confirms non-muscle-invasive urothelial carcinoma.
- Ability to tolerate neoadjuvant chemotherapy and immunotherapy: Sufficient heart, bone marrow, liver, and kidney function (according to clinical trial center normal values), no severe hematologic abnormalities or organ dysfunction (heart function 0-2, WBC ≥3.5×10⁹/L, neutrophil count ≥1.5×10⁹/L, PLT ≥75.0×10⁹/L, HGb ≥80 g/L; liver function: total bilirubin ≤1.5×ULN, AST and ALT ≤2.5×ULN; kidney function: creatinine ≤1.5×ULN, or GFR ≥60 ml/min if creatinine >1.5×ULN).
- ECOG performance status: 0 or 1. No history of other malignancies. Able to receive regular mitomycin C bladder instillation therapy after TURBT. Male or female, aged ≥18 and <80 years. Voluntary participation with written informed consent, and ability to understand and comply with study requirements, including regular follow-up.
Key exclusion criteria (3 listed)
- Preoperative imaging assessment with VI-RADS ≥3. Postoperative pathology showing non-urothelial carcinoma (e.g., adenocarcinoma, squamous cell carcinoma, small cell carcinoma, or mixed tumors), or urothelial carcinoma ≥T2.
- Presence of lymph node and/or distant metastases. Allergy or hypersensitivity to treatment drugs, or patients with autoimmune diseases.
- Any condition deemed by the investigator to potentially harm the participant or prevent them from meeting or fulfilling study requirements.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| bladder sparing setafter neoadjuvant chemotherapy combined with immunotherapy, maximal TURBT and a re-TURBT shall be performed then mitomycin C bladder instillation therapy will be administered | Procedure or surgery | bladder sparing set |
| RCRadical cystectomy performed immediately after three cycles of neoadjuvant therapy. | Procedure or surgery | radical cystectomy set |
Primary outcome
recurrence free survival
Time frame: From enrollment to 3 years post-treatment completion
1 secondary outcome
progress free survival
Time frame: From enrollment to 3 years post-treatment completion
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 Mar 2025.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing bladder sparing set and RC in people with Bladder Cancer and NMIBC, run by The First Affiliated Hospital with Nanjing Medical University at 1 site in China.
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 3 inclusion and 3 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: looking for participants now, as of the sponsor's last update on 18 Mar 2025. 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 China. 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.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Qiang Cao, PhD (+8615151211913, qiang_cao@126.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
recurrence free survival (time frame: From enrollment to 3 years post-treatment completion). 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 18 Mar 2025.