Eligibility Details:
Inclusion Criteria:
- Histologically confirmed diagnosis of muscle invasive bladder cancer (T2-T4aN0M0) with
predominant (≥50%) urothelial histology. Participants with mixed histology are
eligible provided the urothelial component is ≥50%. Urothelial carcinomas not
originating from the bladder are not eligible. Participants whose tumors contain any
neuroendocrine component are not eligible.
- Clinically non-metastatic bladder cancer determined by imaging
- Eligible for radical cystectomy (RC) + pelvic lymph node dissection (PLND ), and
agreement to undergo curative intent standard RC + PLND (including prostatectomy if
applicable)
- Ineligible for treatment with cisplatin, as defined by meeting at least one of the
following criteria:
- Impaired renal function with measured or calculated CrCl 30 to 59 mL/min
- Eastern Cooperative Oncology Group (ECOG) Performance Status 2
- Common Terminology Criteria for Adverse Events (CTCAE) v.4 Grade ≥2 audiometric
hearing loss
- CTCAE v.4 Grade ≥2 peripheral neuropathy
- New York Heart Association (NYHA) Class III heart failure
- Transurethral resection (TUR) of a bladder tumor that is submitted and adequate for
evaluation of histology, muscle invasion and PD-L1 status
- ECOG performance status of 0, 1, or 2
- Adequate organ function
Exclusion Criteria:
- Known additional non-urothelial malignancy that is progressing or has required active
treatment ≤3 years of study randomization, with certain exceptions
- Received any prior systemic anti-neoplastic treatment for muscle-invasive bladder
cancer (MIBC)
- Received prior therapy with a anti-programmed cell death protein 1 (PD-1),
anti-programmed death-ligand 1 (PD-L1), or anti-programmed cell death 1 ligand 2
(PD-L2), or with an agent directed to another stimulatory or co-inhibitory T-cell
receptor
- Received prior systemic anti-cancer therapy including investigational agents within 3
years prior to randomization
- Received any prior radiotherapy to the bladder
- Received a live vaccine within 30 days prior to the first dose of study drug
- Current participation in or participation in a study of an investigational agent or
use of an investigational device within 4 weeks prior to the first dose of study
intervention
- Diagnosis of immunodeficiency or receipt of chronic systemic steroid therapy or any
other form of immunosuppressive therapy within 7 days prior the first dose of study
drug
- Hypersensitivity to monoclonal antibodies (including pembrolizumab) and/or any of
their excipients
- Active autoimmune disease that has required systemic therapy in past 2 years (i.e.,
with use of disease modifying agents, corticosteroids or immunosuppressive drugs).
Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid
replacement therapy for adrenal or pituitary insufficiency) is not considered a form
of systemic therapy and is allowed.
- History of (non-infectious) pneumonitis that required steroids, or current
pneumonitis.
- Active infection requiring systemic therapy