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AGEN1884 and AGEN2034 in Combination with Cisplatin and Gemcitabine for the Treatment of Muscle-invasive Bladder Cancer before Radical Cystectomy

Trial Status: Active

This phase II trial investigates how well AGEN1884 and AGEN2034 work in combination with cisplatin and gemcitabine in treating patients with muscle-invasive bladder cancer before surgery that removes all of the bladder as well as nearby tissues and organs (radical cystectomy). AGEN1884 (a CTLA-4 blocking agent) and AGEN2034 (a PD-1 blocking agent) are a class of drugs called immune checkpoint inhibitors that may help the body's immune system attack the cancer and interfere with the ability of tumor cells to grow and spread. Chemotherapy drugs, such as cisplatin and gemcitabine, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Standard of care treatment of muscle-invasive bladder cancer is chemotherapy followed by surgery and a cystectomy. Adding AGEN1884 and AGEN2034 to this standard treatment may improve the rate of the bladder cancer coming back.

Inclusion Criteria

  • Diagnosis of muscle-invasive, non-metastatic urothelial carcinoma of the bladder, cT2-4, N0-1, M0
  • Eligible to receive cisplatin-based chemotherapy, with eligibility defined as meeting all of the following criteria: * Eastern Cooperative Oncology Group performance status of 0-1 * Creatinine clearance (CrCl) of >= 50 mL/min, as measured by 24-hour urine collection or estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Patients with CrCl between 50-60 mL/min are eligible for the study but will receive split dose cisplatin * Grade =< 2 hearing loss * Grade =< 2 peripheral neuropathy * New York Heart Association Class < III heart failure
  • Eligible to receive gemcitabine as dosed here
  • Absolute neutrophil count >= 2,000/mcL
  • Hemoglobin >= 9.0 mg/mL
  • Platelets >= 100,000/mcL
  • Total bilirubin within normal limits or known to be elevated due to a benign conjugation defect such as Gilbert’s syndrome, as evidenced by normal conjugated bilirubin level
  • Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) < 3 x institutional normal limits
  • Creatinine clearance (CrCl) >= 50 mL/min/1.73 m^2, as measured with 24 hour (hr) urine collection or estimated by CKD-EPI, whichever is greater
  • Signed, written informed consents to allow transfer of tumor tissue and production of peptides and to receive experimental treatment and monitoring if agreeable, or monitoring without experimental treatment otherwise
  • Available fresh tissue from surgical excision. If fresh tissue is not available, archival tissue may be used
  • Female subjects of childbearing potential must have a negative serum pregnancy test at screening (within 72 hours of first dose of study medication). Non-childbearing potential (other than by medical reasons) is defined as 1 of the following: * >= 45 years of age and amenorrheic for > 1 year by self-report * Amenorrheic for > 2 years without a hysterectomy and oophorectomy, and follicle-stimulating hormone value in the postmenopausal range upon pretrial (screening) evaluation * Status post-hysterectomy, -oophorectomy, or -tubal ligation ** If of childbearing potential, female subjects must be willing to use adequate birth control during the study, starting with the screening visit through 120 days after the last dose of study therapy. ** Male subjects with a female partner(s) of childbearing potential must agree to use a condom throughout the trial, starting with the screening visit through 120 days after the last dose of study therapy. Males with pregnant partners must agree to use a condom; no additional method of contraception is required for the pregnant partner ** Note: Abstinence is acceptable for both female and male subjects if this is the subject’s established and preferred contraception method

Exclusion Criteria

  • Subjects must not have previously received a checkpoint inhibitor i.e., anti-PD-1, anti-PD L1, or anti CTLA-4 antibody
  • Subjects must not have previously received anticancer medications or investigational drugs for the disease under study within the following windows: * =< 28 days for prior monoclonal antibody used for anticancer therapy, with the exception of denosumab * =< 7 days for immunosuppressive treatment for any reason, with the following exceptions: ** Physiologic steroid replacement for adrenal insufficiency (e.g., < 10 mg prednisone per day) is permitted ** Use of inhaled or topical corticosteroid for radiographic procedures is permitted * Systemic corticosteroids =< 7 days are not allowed except as defined above * =< 28 days before first dose of study drug for all other investigational study drugs or devices
  • Has persisting toxicity related to prior therapy of National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 (NCI-CTCAE) grade > 1 severity * Note: Sensory neuropathy or alopecia of grade =< 2 is acceptable
  • Has known severe hypersensitivity reactions to fully human monoclonal antibodies (NCI-CTCAE version 5.0 grade >= 3), any history of anaphylaxis, or uncontrolled asthma
  • Active or history of any autoimmune disease (subjects with diabetes type 1, vitiligo, psoriasis, hypo- or hyperthyroid disease not requiring immunosuppressive treatment are eligible). Patients with a history of inflammatory bowel disease (including Crohn's disease and ulcerative colitis) and autoimmune disorders such as rheumatoid arthritis, systemic progressive sclerosis (scleroderma), systemic lupus erythematosus or autoimmune vasculitis (e.g., Wegener's granulomatosis) are excluded from this study
  • Any condition requiring systemic treatment with corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days prior to first dose of study drug. Inhaled steroids and adrenal replacement steroids doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease
  • Uncontrolled intercurrent illness, including but not limited to uncontrolled infection, interstitial lung disease or active, non-infectious pneumonitis, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac arrhythmia, or social situations that would limit compliance with study requirements in the opinion of the treating investigator or medical monitor
  • History of intolerance or allergic reactions attributed to compounds of similar chemical or biologic composition to AGEN1884 or AGEN2034
  • Women who are pregnant or breastfeeding
  • Receipt of a live vaccine within 30 days prior to the first dose of study drug
  • Inability to adhere to the protocol


San Antonio
Cancer Therapy and Research Center at The UT Health Science Center at San Antonio
Status: ACTIVE
Contact: Chethan Ramamurthy
Phone: 210-450-1132


I. To estimate the pathologic tumor downstaging of >= T2 to pT0 rate using neoadjuvant zalifrelimab (AGEN1884) plus balstilimab (AGEN2034) in combination with cisplatin-gemcitabine chemotherapy in the treatment of muscle-invasive bladder cancer in patients eligible for cisplatin-based chemotherapy.


I. To evaluate the safety and tolerability of using AGEN1884 plus AGEN2034 plus cisplatin and gemcitabine chemotherapy in the neoadjuvant treatment of muscle-invasive bladder cancer prior to radical cystectomy.

II. To estimate pathologic downstaging of >= T2 to < T2 rate.

III. To investigate biological outcomes that could predict treatment efficacy.


I. To correlate clinical outcomes with immune and biologic endpoints and identify patient and tumor characteristics that can predict treatment responses.


Patients receive balstilimab intravenously (IV) over 30 minutes on day 1, zalifrelimab IV over 30 minutes on day 1 of cycles 1 and 3, gemcitabine IV over 30 minutes on days 1 and 8, and cisplatin IV over 2 hours on day 1. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Within 10 weeks after completing treatment, patients undergo radical cystectomy.

After completion of study treatment, patients are followed up every 3 months for 1 year and then quarterly but not less than 1 year from initiation of treatment. Thereafter, patients are seen based on their clinical stability, but no less than every 6 months for a total of 2 years.

Trial Phase Phase II

Trial Type Treatment

Lead Organization
Cancer Therapy and Research Center at The UT Health Science Center at San Antonio

Principal Investigator
Chethan Ramamurthy

  • Primary ID CTMS 19-0193
  • Secondary IDs NCI-2020-05751
  • ID NCT04430036