Testing the addition of the immunotherapy drug, pembrolizumab, to radiation therapy compared to the usual chemotherapy treatment during radiation therapy for bladder cancer (The PARRC Study)

People who have bladder cancer and the option to keep their bladder.

This study is being done to answer the following question: Can we avoid having your bladder removed and increase the time without your bladder cancer getting worse by adding the immunotherapy drug, pembrolizumab, to the usual radiation therapy?

If you decide to take part in this study, you will not have bladder removal surgery and will receive treatment that keeps the bladder. You will either get chemotherapy and radiation therapy for up to 4-7 weeks, or you will get radiation therapy for 4-7 weeks plus the immunotherapy drug, pembrolizumab, given every 6 weeks for about one year (for a total of 9 doses).

The usual approach for patients who are not in a study is surgery to remove the bladder, or a surgical procedure to only remove the bladder tumor (called transurethral resection of bladder tumor (TURBT)) and treatment with intravesical therapy, or FDA approved chemotherapy or immunotherapy drugs. Sometimes, combinations of these treatments are used. Bladder removal surgery is not used when a patient is not able to undergo the surgery, refuses the surgery, or wishes to try a different treatment approach. Your doctor can explain which treatment may be best for you. These treatments can reduce symptoms and may stop the tumor from growing for a few months or longer. The usual approach is proven to help patients with your health condition live longer.

If you choose to take part in this study, there is a risk that the study drug may not be as good as the usual approach for your cancer at stabilizing your cancer. There is also a risk that you could have side effects from the study drug. These side effects may be worse and may be different than you would get with the usual approach for your cancer. Some of the most common side effects that the study doctors know about are: Fatigue, nausea, diarrhea, mild pain in the treated area, and rash. There may be some risks that the study doctors do not yet know about.

There is evidence that the addition of pembrolizumab to radiation therapy is effective in curingw your type of cancer. It is not possible to know now if the study drug will extend your time without disease compared to the usual approach. This study will help the study doctors learn things that will help people in the future.

After you finish your study treatment your doctor will continue to follow your condition for almost 10 years, either by telephone or clinic visit, and watch you for side effects. They will monitor you every 3 months for 2 years, then every 6 months for 3 years and then annually for 5 years.

No. Taking part in this study is voluntary. You are free to choose to participate or not to participate. If you choose to participate in this study, you are able to leave the study at any time. If you decide not to take part in this study, your doctor will discuss other treatment options with you.

You and/or your insurance plan will need to pay for the costs of medical care you get as part of the study, just as you would if you were getting the usual care for your cancer.

This includes:

• the costs of tests, exams, procedures, and drugs that you get during the study to monitor your safety and prevent and treat side effects.
• the costs the chemotherapy including getting it ready and giving it to you. 
• the costs of getting pembrolizumab ready and giving it to you. 
• the costs of the radiation therapy 
• your insurance co-pays and deductibles. 

Talk to your insurance provider and make sure that you understand what your insurance pays for and what it doesn’t pay for if you take part in this clinical trial. Also, find out if you need approval from your plan before you can take part in the study. 

You will not be paid for taking part in this study.

Your privacy is very important to us and the researchers will make every effort to protect it. Your information may be given out if required by law. For example, certain states require doctors to report to health boards if they find a disease like tuberculosis. However, the researchers will do their best to make sure that any information that is released will not identify you. Some of your health information and/or information about your specimens from this study will be kept in a central database for research. Your name or contact information will not be put in the database.

There are organizations that may inspect your records. These organizations are required to make sure your information is kept private, unless required by law to provide information. Some of these organizations are:

• NRG Oncology and any company supporting the study now or in the future. This would include any organization helping the company with the study 
• The Nation Cancer Institute (NCI) Central Investigational Review Board (IRB), which is a group of people who review the research with the goal of protecting the people who take part in the study. 
• The Food & Drug Administration and the groups it works with to review research. 
• The NCI and the groups it works with to review research, including the Cancer Trials Support Unit (CTSU). 
• The NCI’s National Clinical Trials Network and the groups it works with to conduct research including the Imaging and Radiation Oncology Core (IROC).

Doctors and researchers conduct a clinical study, also called a “clinical trial,” to find better ways to prevent, diagnose, or treat an illness. NRG Oncology is supported by the National Cancer Institute (NCI) and runs clinical studies specifically for patients with cancer or to prevent cancer. Most clinical studies test something we know against something we don’t know. In all situations, these studies are strictly evaluated before they are allowed to be offered to any patient. The study is designed to answer the question that we do not know the answer to, so that current and future patients may have better treatments or information than what we currently have. There are different types of clinical studies that might be available for patients. For more information see “Types of Clinical Trials” and “Phases of Clinical Trials”.

Patients who volunteer to take part in a clinical study are followed closely by their health care professionals and members of the research team. For more information see “Research Team Members”.

Yes. They are exactly the same thing.

The care cancer doctors provide to cancer patients today is the direct result of clinical studies (also known as clinical trials) that were done in the past. Clinical studies give doctors and the treatment team information about what types of treatments work and what treatments do not work, in a number of different situations. Some studies focus on treating the cancer, others on preventing the cancer, and others on helping patients feel better or healthier during or after treatments. When you take part in a clinical study, you add to our knowledge about cancer and it may help improve cancer care for future patients. Clinical studies are available to patients with many types of cancer and at all stages of treatment. In some situations, the only way to get these new treatments is by joining a clinical study.

A clinical study may take place in many locations, such as:

A study is typically led by a principal investigator who is a doctor or other advanced health care professional. A clinical study is carried out by following a very specific plan known as the “protocol”. The protocol is designed so all patients in the study are treated as well as possible and in the same way. The protocol also provides rules for the doctors and clinical study staff to follow to keep patients safe and make sure the study is run in an ethical manner.

No, not at all. Participation in a clinical study is completely voluntary. For more information see “Deciding to Take Part in a Clinical Trial”. You are free to choose to participate or not to participate. If you choose to participate in a study, you may still decide to leave the study at any time. If you decide not to participate in a study, your doctor will discuss other treatment options with you. For more information see “Questions to Ask Your Doctor about Treatment Clinical Trials“.

• You may choose to have the usual treatment approach (known as “standard of care”)
• You may choose to take part or learn more about a different study, if one is available
• You may choose not to be treated for cancer