Ascorbic Acid with Gemcitabine and Carboplatin for Treating Patients with Muscle Invasive Bladder Cancer

Inclusion Criteria

• Ability of participant to understand this study, and participant willingness to sign a written informed consent
• Consent to participate in biorepository protocol number GUB-BCR-001, University of Kansas (KU) Institutional Review Board (IRB) approved Human Subjects Committee (HSC) # STUDY00141546
• Males and females age ≥ 18 years
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2
• Women of childbearing potential must have a negative serum pregnancy test 72 hours prior to initiating treatment
• Diagnosis/disease status cisplatin-ineligible or declined muscle invasive bladder cancer * Cisplatin ineligibility will be defined based on Galsky criteria: ** Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 ** Common Terminology Criteria for Adverse Events (CTCAE) version (ver.) 5.0 grade 2 or greater peripheral neuropathy ** CTCAE ver. 5.0 grade 2 or greater hearing loss ** Creatinine clearance estimated or calculated < 60 ml/min ** New York Heart Association (NYHA) class II or greater congestive heart failure
• Absolute neutrophil count ≥ 1.5 K/UL * NOTE: Patients with established diagnosis of benign neutropenia are eligible to participate with absolute neutrophil count (ANC) between 1000-1500 based on discretion of the treating physician
• Platelets ≥ 100 K/UL
• Hemoglobin ≥ 9 g/dL
• Serum creatinine ≤ 1.5 x upper limit of normal (ULN) or calculated creatinine clearance ≥ 30 mL/min using the Cockcroft-Gault equation
• Total bilirubin ≤ 2.0 x ULN
• Aspartate aminotransferase (AST [serum glutamic oxaloacetic transaminase (SGOT)]) and alanine aminotransferase (ALT [serum glutamic pyruvic transaminase (SGPT)]) ≤ 2.5 x ULN unless liver metastases are present, in which case they must be ≤ 5 x ULN
• Normal glucose-6-phosphate dehydrogenase (G6PD) status will be defined as levels above the lower limit of normal (LLN) of the local testing lab reference range. A deficiency in G6PD levels will exclude patient from trial
• Women of child-bearing potential (WOCBP) and men with partners of child-bearing potential must agree not to donate sperm (men), to practice sexual abstinence or to use the forms of contraception for the duration of study participation and for WOMEN: 6 months after end of treatment (EOT), MEN: 3 months after EOT following completion of therapy

Exclusion Criteria

• Simultaneously enrolled in any therapeutic clinical trial
• Current or anticipating use of other anti-neoplastic or investigational agents while participating in this study
• Diagnosed with a psychiatric illness or is in a social situation that would limit compliance with study requirements
• Is pregnant or breastfeeding. There is a potential for congenital abnormalities and for this regimen to harm breast feeding infants
• Women of childbearing age expecting to conceive children while receiving study treatment and for 6 months after the last dose of study treatment. Men expecting to conceive children while receiving study treatment and for 3 months after the last dose of study treatment
• Has a severe known allergic reaction to any excipient contained in the study drug formulation
• Active grade 3 or 4 (per the National Cancer Institute [NCI] Common Terminology Criteria for Adverse Events [CTCAE], version 5.0) viral, bacterial, or fungal infection within 2 weeks prior to the first dose of study treatment
• Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhea, as determined per treating physician
• Histology of pure adenocarcinoma, pure squamous cell carcinoma, or pure small cell carcinoma in the transurethral resection of bladder tumor (TURBT) sample
• Current consumption of tobacco products, patients may be asked to quit for 2 weeks prior to enrollment
• If tobacco use is suspected at any point during the trial, cotinine level will be obtained
• History of G6PD deficiency
• History of oxalate renal calculi – per discretion of treating physician