MVAC (Methotrexate, Vinblastine, Adriamycin, and Cisplatin) in Organ-Confined Bladder Cancer Based on p53 Status
OBJECTIVES:
- Compare the recurrence-free and overall survival in patients with transitional cell
carcinoma of the bladder with p53 gene alterations treated with methotrexate,
vinblastine, doxorubicin, and cisplatin vs observation alone.
- Compare the recurrence-free and overall survival in patients with or without p53 gene
alterations treated with observation alone.
- Examine the expression of p53 and other genes, particularly RB, p21, and p16, involved
in cell cycle regulation that may be involved in the response to chemotherapy in these
patients.
- Correlate p53 mutational gene status with p53 protein expression by
immunohistochemistry, outcome (recurrence-free and overall survival), response to
chemotherapy, and expression of key molecules in the p53-mediated apoptotic pathway in
patients treated with this regimen vs observation alone.
OUTLINE: This is a randomized, multicenter study. Patients are assigned to 1 of 2 treatment
groups based on the status of the p53 gene in the bladder tumor.
- Group A (p53 gene alteration, defined by greater than 10% nuclear reactivity): Patients
are stratified according to age (under 65 vs 65 and over), stage (P1 vs P2a vs P2b),
grade (1 or 2 vs 3 or 4), and p21 status. Patients are randomized to 1 of 2 treatment
arms within 10 weeks after radical cystectomy and bilateral pelvic lymphadenectomy and
within 2 weeks after registration.
- Arm I: Within 2 weeks after randomization, patients receive methotrexate IV on
days 1, 15, and 22; vinblastine IV on days 2, 15, and 22; and doxorubicin IV and
cisplatin IV on day 2. Treatment repeats every 4 weeks for 3 courses in the
absence of disease progression or unacceptable toxicity.
- Arm II: Patients undergo observation for recurrence but do not receive adjuvant
chemotherapy after surgery.
Patients who are eligible for randomization but decline to be randomized undergo observation
for recurrence.
- Group B (p53 gene normal, defined by less than 10% nuclear reactivity): Patients
undergo observation for recurrence but do not receive adjuvant chemotherapy after
surgery.
Patients are followed every 6 months for 5 years and then annually thereafter.
PROJECTED ACCRUAL: A total of 800 patients will be accrued for this study within 4.75 years.
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Time to recurrence at 3 years
No
Richard J. Cote, MD, FRCPath
Study Chair
USC/Norris Comprehensive Cancer Center
United States: Federal Government
CDR0000067639
NCT00005047
September 1998
Name | Location |
---|---|
Fred Hutchinson Cancer Research Center | Seattle, Washington 98109 |
University of Michigan Comprehensive Cancer Center | Ann Arbor, Michigan 48109-0752 |
Cardinal Bernardin Cancer Center at Loyola University Medical Center | Maywood, Illinois 60153-5500 |
CCOP - Wichita | Wichita, Kansas 67214-3882 |
University of Texas Health Science Center at San Antonio | San Antonio, Texas 78284-7811 |
Veterans Affairs Medical Center - Dayton | Dayton, Ohio 45428 |
CCOP - Dayton | Kettering, Ohio 45429 |
CCOP - Western Regional, Arizona | Phoenix, Arizona 85006-2726 |
Cleveland Clinic Taussig Cancer Center | Cleveland, Ohio 44195 |
USC/Norris Comprehensive Cancer Center and Hospital | Los Angeles, California 90033-0804 |
Veterans Affairs Medical Center - Shreveport | Shreveport, Louisiana 71130 |
CCOP - St. Louis-Cape Girardeau | Saint Louis, Missouri 63141 |
Brooke Army Medical Center | Fort Sam Houston, Texas 78234-6200 |
Veterans Affairs Medical Center - San Antonio (Murphy) | San Antonio, Texas 78284 |
CCOP - Virginia Mason Research Center | Seattle, Washington 98101 |
Herbert Irving Comprehensive Cancer Center at Columbia University | New York, New York 10032 |
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus | Seattle, Washington 98104 |
Wilford Hall Medical Center | Lackland Air Force Base, Texas 78236-5300 |
Via Christi Cancer Center at Via Christi Regional Medical Center | Wichita, Kansas 67214 |
James P. Wilmot Cancer Center at University of Rochester Medical Center | Rochester, New York 14642 |
Banner Good Samaritan Medical Center | Phoenix, Arizona 85006 |
Banner Thunderbird Medical Center | Phoenix, Arizona 85306 |
North Colorado Medical Center | Greeley, Colorado 80631 |
McKee Medical Center | Loveland, Colorado 80539 |
Saint Anthony's Hospital at Saint Anthony's Health Center | Alton, Illinois 62002 |
Good Samaritan Regional Health Center | Mt. Vernon, Illinois 62864 |
Cancer Center of Kansas, P.A. - El Dorado | El Dorado, Kansas 67042 |
Veterans Affairs Medical Center - Kansas City | Kansas City, Kansas 64128 |
Southwest Medical Center | Liberal, Kansas 67901 |
Cancer Center of Kansas, P.A. - Parsons | Parsons, Kansas 67357 |
Cancer Center of Kansas, P.A. - Wichita | Wichita, Kansas 67214 |
William Beaumont Hospital - Royal Oak Campus | Royal Oak, Michigan 48073 |
St. Francis Medical Center | Cape Girardeau, Missouri 63701 |
Southeast Missouri Regional Cancer Center at Southeast Missouri Hospital | Gape Girardeau, Missouri 63701 |
David C. Pratt Cancer Center at St. John's Mercy | St. Louis, Missouri 63141 |
Big Sky Oncology | Great Falls, Montana 59405 |
Sletten Regional Cancer Institute | Great Falls, Montana 59405 |
St. Joseph Hospital Community Cancer Center | Bellingham, Washington 98225 |
Olympic Hematology and Oncology | Bremerton, Washington 98310 |
Skagit Valley Hospital Cancer Care Center | Mt. Vernon, Washington 98273 |
University Cancer Center at University of Washington Medical Center | Seattle, Washington 98195 |
Harborview Medical Center | Seattle, Washington 98104 |
Group Health Central Hospital | Seattle, Washington 98104 |
North Puget Oncology at United General Hospital | Sedro-Wooley, Washington 98284 |
Cancer Care Northwest - Spokane South | Spokane, Washington 99202 |
Wenatchee Valley Clinic | Wenatchee, Washington 98801 |
St. Francis Hospital and Health Centers - Beech Grove Campus | Beech Grove, Indiana 46107 |
Cancer Center of Kansas, P.A. - Chanute | Chanute, Kansas 66720 |
Cancer Center of Kansas, P.A. - Kingman | Kingman, Kansas 67068 |
Cancer Center of Kansas, P.A. - Newton | Newton, Kansas 67114 |
Cancer Center of Kansas, P.A. - Pratt | Pratt, Kansas 67124 |
Cancer Center of Kansas, P.A. - Salina | Salina, Kansas 67042 |
Salina Regional Health Center | Salina, Kansas 67401 |
Cancer Center of Kansas, P.A. - Wellington | Wellington, Kansas 67152 |
Cancer Center of Kansas, P.A. - Medical Arts Tower | Wichita, Kansas 67208 |
Associates in Womens Health, P.A. - North Review | Wichita, Kansas 67203 |
Cancer Center of Kansas, P.A. - Winfield | Winfield, Kansas 67156 |
Feist-Weiller Cancer Center at Louisiana State University Health Sciences | Shreveport, Louisiana 71130-3932 |
Samaritan North Cancer Care Center | Dayton, Ohio 45415 |
Grandview Hospital | Dayton, Ohio 45405 |
David L. Rike Cancer Center at Miami Valley Hospital | Dayton, Ohio 45409 |
Good Samaritan Hospital | Dayton, Ohio 45406 |
Community Oncology Group at Cleveland Clinic Cancer Center | Independence, Ohio 44131 |
Charles F. Kettering Memorial Hospital | Kettering, Ohio 45429 |
Middletown Regional Hospital | Middletown, Ohio 45044 |
UVMC Cancer Care Center at Upper Valley Medical Center | Troy, Ohio 45373-1300 |
Cleveland Clinic - Wooster | Wooster, Ohio 44691 |
Ruth G. McMillan Cancer Center at Greene Memorial Hospital | Xenia, Ohio 45385 |
Cancer Therapy and Research Center | San Antonio, Texas 78229 |
University Hospital - San Antonio | San Antonio, Texas 78229 |
Community Comprehensive Cancer Center at Camden-Clark Memorial Hospital | Parkersburg, West Virginia 26102 |
Sentara Cancer Institute at Sentara Norfolk General Hospital | Norfolk, Virginia 23507 |
Cancer Center of Kansas, P.A. - Dodge City | Dodge City, Kansas 67801 |