Multicenter Randomized Phase 2 Trial of Gemcitabine - Platinum With or Without Trastuzumab in Advanced or Metastatic Urothelial Carcinoma With HER2 Overexpression
Inclusion Criteria:
- Transitional cell carcinoma of the urothelium or bladder histologically proven stage
IV AJCC [locally advanced (T4b and / or N + M0) unresectable or metastatic (M1)]
- Tumor and / or metastasis overexpressing HER2 immunohistochemistry (IHC 3 +) or IHC 2
+ and FISH +. Centralized analysis.
- Measurable disease with at least one lesion with a diameter> 2 cm for conventional
methods (clinical examination, CT or MRI) or> 1 cm for the helical scanner. In case
of single metastasis, metastatic disease should be histologically proven
- Age ≥ 18 years and ≤80 years
- Life expectancy> 3 months,
- Index performance status <2 according to ECOG PS,
- No prior chemotherapy other than adjuvant and / or neoadjuvant chemotherapy, without
Herceptin ® and complete for more than 6 months (naive to any previous chemotherapy
in the metastatic setting)
- No radiotherapy within 4 weeks prior to inclusion,
- Normal cardiac function as measured by ejection fraction (LVEF> 50%),
- Blood and liver satisfactory constants:
Hematological criteria: - Neutrophils> 1.5 x 109 / L, - Chips> 100 x 109 / L - Hemoglobin>
10 g / dL, Liver function: - Alkaline phosphatase (unless bone metastases) <2 x N - Total
bilirubin <1.5 x N - transaminases (AST, ALT) <1.5 x N, renal Constants: - Creatinine
clearance > 30 ml / min (Cockcroft and Gault, cf. Annex XV protocol)
- Patient's written consent after full information.
Exclusion Criteria:
- Concurrent treatment with an experimental drug, participation in another clinical
trial within <30 days
- Patients previously treated with Herceptin ®, or another treatment targeting growth
factors EGF (eg Iressa ®, Tarceva ®)
- Existence of a severe pulmonary disease, liver or kidney is likely to be exacerbated
by the treatment,
- Other medical conditions: congestive heart failure or angina pectoris even if
medically controlled failure, history of myocardial infarction before entering the
trial, hypertension or uncontrolled arrhythmias, significant valvular disease,
- Patient with dyspnoea at rest or requiring oxygen therapy or with respiratory
failure,
- Presence of a severe infection requiring antibiotics,
- Presence of CNS metastases or meningeal
- History of another malignancy uncured or cured for less than 5 years (except basal
cell carcinoma, papillary thyroid carcinoma in situ of the cervix treated)
- Pregnant or lactating or not using effective contraception Women,
- For Cisplatin only: carrying a serious neurological disease, current events devices>
NCI grade 2 neuropathy, hearing loss, creatinine clearance <60 ml / min, the patient
can not support a patient hydration.