A Phase Ib Prospective Clinical Study Evaluating the Safety and Efficacy of Propranolol Combined With Tislelizumab Plus Gemcitabine/Cisplatin as Neoadjuvant Therapy for cT1-4aN1-3M0 Bladder Urothelial Carcinoma
Overview
- Phase
- Phase 1
- Status
- Enrolling By Invitation
- Enrollment
- 12
- Locations
- 1
- Primary Endpoint
- Incidence of Dose-Limiting Toxicities (DLTs)
Overview
Brief Summary
This is a prospective, multicenter, Phase Ib clinical study designed to evaluate the safety and preliminary efficacy of propranolol combined with tislelizumab plus gemcitabine/cisplatin (GC) as neoadjuvant therapy for patients with bladder urothelial carcinoma with clinical lymph node involvement (cT1-T4aN1-3M0). Current neoadjuvant immunochemotherapy regimens can improve clinical outcomes in cisplatin-eligible patients; however, patients with lymph node metastasis show a significantly poorer pathological complete response (pCR) rate compared with non-metastatic cases. Real-world clinical observations have shown that more than 20% of patients achieve complete response in the primary tumor after immunotherapy but have persistent or progressive positive lymph nodes, suggesting unique resistance mechanisms within lymph node metastatic lesions.
Preclinical studies conducted by our team demonstrated that sympathetic innervation within lymph nodes releases norepinephrine, which activates β-adrenergic signaling in metastatic tumor cells and promotes lipid metabolic reprogramming, leading to CD8⁺ T-cell exhaustion and immune resistance. Propranolol, a non-selective β-adrenergic blocker, may reduce metabolic stress and restore antitumor immunity, potentially enhancing the efficacy of immune checkpoint blockade.
In this study, enrolled patients will receive oral propranolol in combination with intravenous tislelizumab and standard GC chemotherapy prior to surgery. Participants will be closely monitored for treatment-related adverse events, including cardiovascular events, hematologic toxicity, and immune-related reactions. The primary endpoint is dose-limiting toxicity (DLT). Secondary endpoints include pathological complete response (pCR), pathological downstaging, safety, and survival outcomes. Exploratory analyses will evaluate changes in immune cell populations in tumor tissues, lymph nodes, and peripheral blood.
The results of this study aim to provide evidence for new neoadjuvant strategies targeting lymph node metastatic bladder cancer and support the development of personalized therapeutic approaches.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Voluntarily agrees to participate in the study, is able to provide written informed consent, and is willing to comply with study procedures and visit schedules.
- •Age ≥ 18 years at the time of consent; sex unrestricted.
- •Eastern Cooperative Oncology Group (ECOG) performance status 0 or
- •Histologically confirmed bladder urothelial carcinoma with clinical lymph node involvement (cT1-T4a, N1-N3, M0) based on the AJCC 8th edition. Mixed histology is permitted if the urothelial carcinoma component is ≥ 50%.
- •No antihypertensive medication used during screening, with resting systolic blood pressure between 110-140 mmHg measured under natural conditions.
- •Adequate organ function as demonstrated by laboratory results obtained within 14 days prior to enrollment:
- •a. No administration of hematopoietic growth factors within 14 days prior to sample collection.
- •i. Absolute neutrophil count ≥ 1.5 × 10⁹/L ii. Platelet count ≥ 90 × 10⁹/L iii. Hemoglobin ≥ 90 g/L b. INR or aPTT ≤ 1.5 × ULN c. Total bilirubin ≤ 1.5 × ULN (≤ 3 × ULN in patients with Gilbert syndrome or indirect hyperbilirubinemia) d. AST, ALT, and alkaline phosphatase ≤ 2.5 × ULN e. Preoperative pulmonary function assessment indicating tolerance of major abdominal surgery.
- •Cisplatin-eligible patients, or cisplatin-ineligible patients who meet at least one of the following:
- •ECOG performance status \> 1 or Karnofsky 60-70%
Exclusion Criteria
- •Prior treatment with PD-1, PD-L1, PD-L2, CTLA-4 inhibitors, or other T-cell co-stimulatory/checkpoint agents.
- •Systemic antineoplastic therapy or immunomodulatory therapy within 28 days prior to enrollment, including interferon, interleukin-2, or TNF-based agents.
- •Prior radiotherapy for bladder cancer.
- •Prior systemic anticancer therapy except:
- •Previous systemic chemotherapy completed ≥ 12 months before initiation of study treatment.
- •Intravesical chemotherapy or immunotherapy completed ≥ 7 days prior to initiation of study treatment.
- •Major surgery or significant trauma within 28 days prior to enrollment (vascular access placement and TURBT excluded).
- •Receipt of live attenuated vaccines within 28 days prior to enrollment. Inactivated influenza vaccination is allowed; intranasal influenza vaccine is not permitted.
- •Active autoimmune disease requiring systemic therapy, as judged by the investigator.
- •Long-term systemic corticosteroid therapy or other immunosuppressive medications judged to interfere with study treatment.
Arms & Interventions
Propranolol + Tislelizumab + Gemcitabine/Cisplatin
Patients will receive oral propranolol in combination with intravenous tislelizumab and gemcitabine/cisplatin as neoadjuvant therapy prior to radical surgery. Propranolol will be administered in escalating doses up to a maximum of 40 mg twice daily if tolerated. Tislelizumab is given intravenously every treatment cycle. Gemcitabine and cisplatin will be administered according to standard GC chemotherapy dosing. Participants will be monitored for treatment-related adverse events, including cardiovascular, hematologic, and immune-related toxicities. Dose adjustments, treatment interruptions, or discontinuation may be implemented according to predefined safety criteria.
Intervention: gemcitabine (Drug)
Propranolol + Tislelizumab + Gemcitabine/Cisplatin
Patients will receive oral propranolol in combination with intravenous tislelizumab and gemcitabine/cisplatin as neoadjuvant therapy prior to radical surgery. Propranolol will be administered in escalating doses up to a maximum of 40 mg twice daily if tolerated. Tislelizumab is given intravenously every treatment cycle. Gemcitabine and cisplatin will be administered according to standard GC chemotherapy dosing. Participants will be monitored for treatment-related adverse events, including cardiovascular, hematologic, and immune-related toxicities. Dose adjustments, treatment interruptions, or discontinuation may be implemented according to predefined safety criteria.
Intervention: propranolol (Drug)
Propranolol + Tislelizumab + Gemcitabine/Cisplatin
Patients will receive oral propranolol in combination with intravenous tislelizumab and gemcitabine/cisplatin as neoadjuvant therapy prior to radical surgery. Propranolol will be administered in escalating doses up to a maximum of 40 mg twice daily if tolerated. Tislelizumab is given intravenously every treatment cycle. Gemcitabine and cisplatin will be administered according to standard GC chemotherapy dosing. Participants will be monitored for treatment-related adverse events, including cardiovascular, hematologic, and immune-related toxicities. Dose adjustments, treatment interruptions, or discontinuation may be implemented according to predefined safety criteria.
Intervention: Tislelizumab (Drug)
Propranolol + Tislelizumab + Gemcitabine/Cisplatin
Patients will receive oral propranolol in combination with intravenous tislelizumab and gemcitabine/cisplatin as neoadjuvant therapy prior to radical surgery. Propranolol will be administered in escalating doses up to a maximum of 40 mg twice daily if tolerated. Tislelizumab is given intravenously every treatment cycle. Gemcitabine and cisplatin will be administered according to standard GC chemotherapy dosing. Participants will be monitored for treatment-related adverse events, including cardiovascular, hematologic, and immune-related toxicities. Dose adjustments, treatment interruptions, or discontinuation may be implemented according to predefined safety criteria.
Intervention: Cisplatin (Drug)
Outcomes
Primary Outcomes
Incidence of Dose-Limiting Toxicities (DLTs)
Time Frame: At the end of Cycle 1 (each cycle is 28 days)
Dose-limiting toxicities (DLTs) are defined as treatment-related adverse events occurring during the first treatment cycle that meet predefined severity criteria based on the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0. DLTs may include grade 3 or higher non-hematologic toxicity, grade 4 hematologic toxicity, or clinically significant events leading to treatment interruption or discontinuation, as determined by the investigators.
Secondary Outcomes
- Pathological Complete Response (pCR) Rate(At the time of surgery)
- Pathological Downstaging Rate(At the time of surgery)
- Incidence of Treatment-Related Adverse Events(From first dose through 30 days after the last administration of study treatment)
- Progression-Free Survival (PFS)(Up to 24 months after surgery)
- Overall Survival (OS)(Up to 36 months after surgery)