ClinicalTrials.gg
Active, not recruitingNCT05241340RAD-VACCINEUpdated Oct 24, 2025

Neoadjuvant Sasanlimab With Radiation as an in Situ Vaccine for Cisplatin-ineligible Muscle Invasive Bladder Cancer

A Phase 2 interventional study of Sasanlimab and Stereotactic Body Radiation Therapy in Urothelial Carcinoma Bladder, sponsored by The Methodist Hospital Research Institute. Active, not recruiting at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-10-24.

Sponsored by The Methodist Hospital Research Institute · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
33
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

This is a prospective, single-institution, single-arm, phase II clinical trial that tests a novel strategy of neoadjuvant Sasanlimab, an immune checkpoint inhibitor (ICI), in combination with stereotactic body radiation therapy as an in-situ vaccination in patients, who are ineligible to receive cisplatin-based chemotherapy and undergoing radical cystectomy for muscle-invasive bladder cancer.

Read the detailed description

Patients with cT2-T4a, N0, M0 urothelial bladder carcinoma (UBC) after transurethral resection of the bladder will receive 2 doses of sasanlimab (PF-06801591) at the dose of 300mg subcutaneously, followed by 3 doses of radiation (8Gy x 3) prior to surgery (radical cystectomy). Cystectomy will be planned to be done within 6 weeks of the last dose of sasanlimab.

Pathologic complete response (pT0) is the primary endpoint, in addition to a safety lead-in endpoint consisting of a composite outcome of feasibility and safety.

Exploratory biomarker analysis on tissue/blood samples will include genomic and immune-system profiling in tumor and blood before and after sasanlimab/radiation therapy, and after radical cystectomy.

02

Conditions studied

  • Urothelial Carcinoma Bladder

Keywords

  • Bladder Cancer
  • Muscle Invasive Bladder Cancer
  • Immune Checkpoint Inhibitor
  • Immunotherapy
  • Urothelial Carcinoma of the Bladder
  • Urologic neoplasms
  • Neoadjuvant therapy
  • Radiation
  • Stereotactic Body Radiation Therapy
  • Urinary Bladder Diseases
  • Urologic Diseases
  • Sasanlimab
  • Antineoplastic agents
  • Antineoplastic agents, Immunological
03

In context

Urinary Bladder Neoplasms

1,798 studies on the registry are indexed under Urinary Bladder Neoplasms; 445 are open to participants now.

This study's planned enrollment of 33 is below the median of 60 across 1,296 interventional studies indexed under Urinary Bladder Neoplasms.

Browse Urinary Bladder Neoplasms studies →

Lead sponsor

The Methodist Hospital Research Institute is the lead sponsor of 160 studies on the registry; 59 are open to participants now.

Of its 28 completed or terminated interventional studies of FDA-regulated products, 18 (64%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. Capable of giving signed
  2. Age ≥ 18 years
  3. Eastern Cooperative Oncology Group performance status 0-2
  4. Predominant (>50%) urothelial carcinoma histology
  5. Muscle-invasive bladder cancer (cT2-4a, cN0, cM0)
  6. Decline/refuse OR Ineligible to receive cisplatin-based Chemotherapy due to at least one of the following criteria:

    a. less than 60 mL/min b. Eastern Cooperative Oncology Group performance status of ≥ 2 c. Grade ≥ 2 hearing loss d. Grade ≥ 2 neuropathy

  7. Adequate Bone Marrow Function (without hematopoietic growth factor support within 14 days prior to study screening), defined as:

    a. (ANC) ≥1,500/mm3 or ≥1.5 x 109/L b. ≥100,000/mm3 or 100 x 109/L c. ≥9 g/dL (≥5.6 mmol/L)

  8. Adequate renal function defined by an estimated creatinine clearance ≥30 mL/min according to the Cockcroft Gault formula or by 24-hour urine collection for creatinine clearance.
  9. Adequate liver function, including:

    a. Aspartate and (AST and ALT) ≤ 2.5 × the upper normal limit range () b. Total serum ≤ 1.5 x ULN

  10. Able to give informed consent and patient is willing and able to comply with scheduled study visits and treatment plan
  11. Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other procedures.
  12. Meeting the following criteria for sex specific considerations:

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  1. Males - for the duration of study and for at least 6 months after the last dose of study drug (Sasanlimab):

    1. Refrain from donating sperm and be abstinent from intercourse OR Agree to use male condom and also consider the benefit for a female partner to use a highly effective method of as a condom may break or leak when having sexual intercourse with a woman of (WOCBP) who is not currently pregnant
  2. Females:

    a) Eligible to participate if not pregnant or breast feeding AND Is not a woman of childbearing potential (WOCBP) OR Is a WOCBP and is using a contraceptive method that is highly effective (failure rate of \< 1% per year), with low user dependency during the during the study treatment and for at least 6 months after the last dose of study drug (Sasanlimab) b) A WOCBP must have a negative, highly sensitive (at least 25 IU/mL) pregnancy test by urine or serum testing within 24 hours before the first dose of study drug (Sasanlimab). In cases where the urine test cannot be confirmed to be negative, a serum pregnancy test will be used.

Exclusion criteria

Exclusion Criteria:

  1. Lymphadenopathy (>1cm short-axis measurement on CT/MRI Imaging or proven)
  2. disease
  3. Prior systemic chemotherapy for bladder cancer (however, may have had intra-vesical chemotherapy such as gemcitabine, docetaxel or mitomycin-C)
  4. Prior treatment with systemic anti-cancer agent
  5. Other within 2 years prior to study screening, or active malignancy except for adequately treated basal cell or squamous cell skin cancer, or carcinoma in situ of the breast or of the cervix, or low-grade (Gleason 6 or below) prostate cancer on surveillance without any plans for treatment intervention (e.g., surgery, radiation, or castration) or other concurrent malignancy felt by the investigator has a very low likelihood to become metastatic
  6. Previous radiation therapy to the bladder
  7. Active or history of disease which may deteriorate when receiving immune checkpoint blockade.

    1. These autoimmune conditions include but are not limited to limited to, myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, antiphospholipid antibody syndrome, Wegener granulomatosis, Sjögren syndrome, Guillain-Barré syndrome, or multiple sclerosis
    2. Participants with diabetes type I, vitiligo, psoriasis, or hypo or hyperthyroid disease not requiring treatment are eligible.
  8. Severe active infections (e.g., pulmonary tuberculosis) requiring systemic therapeutic oral or IV antibiotics within 2 weeks prior to study entry.
  9. , multiple or severe drug allergies, intolerance to topical
  10. Current unstable liver or biliary disease, defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminemia, esophageal or gastric varices, persistent jaundice, or cirrhosis.

    • NOTE: Stable chronic liver disease (including Gilbert's syndrome, asymptomatic gallstones, and chronic stable or C -e.g., presence of hepatitis B surface antigen [HBsAg] or positive antibody test result at screening) is acceptable.
  11. Active, uncontrolled /AIDS infection (well-controlled HIV patients may be allowed).
  12. Prior immunotherapy with anti , anti PD-L1, anti PD-L2, or anti cytotoxic T- lymphocyte-associated antigen-4 (CTLA-4) antibody. Note: prior intra-vesical BCG therapy is acceptable.
  13. Prior treatment with immune-stimulatory agents including interleukin (IL)-2, IL-15, interferon (INF)- γ.
  14. Vaccination within 4 weeks from study screening and while on study treatment unless administration of inactivated vaccines.
  15. Patients with a condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids, and adrenal replacement doses >10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
  16. Clinically significant (active) cardiovascular disease including the following: cerebral vascular accident/stroke \<6 months prior to screening; myocardial infarction \<6 months prior to screening; unstable angina; congestive heart failure (≥ Classification Class III); or serious cardiac arrhythmia (uncontrolled, clinically significant) requiring medication.
  17. Q-T interval corrected for heart rate () >450 msec for male participants or QTc >470 msec for female participants or QTc >480 msec in participants with right bundle branch block
  18. Prior organ transplantation or allogenic stem cell transplantation.
  19. Known history of: immune-mediated colitis, inflammatory bowel disease, pneumonitis, or pulmonary fibrosis.
  20. Patients with intolerance to or who have had a severe (Grade ≥3) allergic or anaphylactic reaction to antibodies or infused therapeutic proteins
  21. Pregnant female patients; breastfeeding female patients; male patients able to father children and female patients of who are unwilling or unable to use a highly effective method(s) of as outlined in this protocol for at least 6 months after the last dose of Sasanlimab (PF-06801591)
Terms in these criteria, in plain language(26)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Adjuvant and neoadjuvant

Neoadjuvant treatment is given before the main treatment (usually surgery), often to shrink a tumour. Adjuvant treatment is given after it, to lower the chance of the cancer coming back.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Autoimmune disease

A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.

Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

PD-1, PD-L1 and checkpoint inhibitors

PD-1, PD-L1 and CTLA-4 are proteins that act as brakes on the immune system. Checkpoint inhibitors, such as pembrolizumab or nivolumab, block them so the immune system can attack a cancer.

PD-L1 can also be measured in a tumour sample. Some scores count stained tumour cells only (TPS); others also count certain immune cells (CPS). The study names the score and the minimum it uses.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

QT and QTc

On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.

The study may name a correction formula and a limit in milliseconds, often around 450–480.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
33 participants (estimated)

Study arms

  • Experimental
    Open arm

    All patients will receive study interventions (sasanlimab and SBRT) and standard-of-care radical cystectomy.

    Drug: Sasanlimab · Radiation: Stereotactic Body Radiation Therapy · Procedure: Radical Cystectomy + pelvic lymph node dissection + urinary diversion

Interventions

  • Sasanlimab (PF-06801591) is a recombinant humanized monoclonal antibody (immunoglobulin gamma-4 with kappa light chains, IgG4 kappa) directed against programmed death 1 (PD-1). Manufactured by Pfizer, Inc.

    Also known as: PF-06801591, PD-1 Inhibitor

  • RadiationStereotactic Body Radiation Therapy

    This current study is designed to deliver a biologically equivalent dose of 43.2Gy using a strategy of HD hypo-fractionated radiation therapy 8Gy x 3 in combination with Sasanlimab

  • ProcedureRadical Cystectomy + pelvic lymph node dissection + urinary diversion

    This will include a cysto-prostatectomy in males or a radical cystectomy with anterior exenteration in females, bilateral pelvic lymph node dissection, and creation of a urinary diversion (ileal conduit, Indiana pouch or orthotopic neo-bladder). Robotic assisted or open surgery will be permitted. Because there is currently equipoise regarding standard or extended template pelvic lymph node dissection, the limits of node dissection will not be protocol mandated. In the standard template, nodal packets will include the common iliac, external iliac, internal iliac (or hypogastric) and obturator nodes. Patients receiving an extended template will have the standard nodes with the addition of the para-aortic, para-caval, pre-sacral, and pre-sciatic node packets. The decision for urinary diversion is multifactorial involving patient factors (e.g., adequate renal function) and preference; thus, it will be made on a case-by-case basis.

06

What researchers measure

Primary outcomes

  1. Composite outcome for Feasibility and Safety

    Combination of Sasanlimab and SBRT will be deemed both feasible and safe (composite outcome) if, after the treatment of 10 patients, ≥ 7 of 10 patients meet all of the following feasibility criteria: 1. Receive at least 1 dose of 2 of Sasanlimab 2. Receive at least 2 of 3 fractions SBRT 3. Undergo radical cystectomy RC within 4 weeks of completing therapy (after end of cycle 2) and meet all of the safety criteria, defined as not experiencing any following Common Terminology Criteria for Adverse Events (CTCAE) toxicities up to 4 weeks after the completion of radical cystectomy: 1. Hematologic toxicity ≥ Grade 4 2. Non-hematologic toxicity ≥ Grade 3 3. Non-hematologic toxicity ≥ Grade 2 lasting \>1 week (except alopecia, emesis, and laboratory abnormalities)

    Time frame: From date of registration to date of death due to any cause, assessed up to 4 weeks after radical cystectomy

  2. Clinical benefit rate defined as pathologic complete response (pT0)

    Proportion of patients experiencing pathologic complete response (pT0) after the study treatment followed by radical cystectomy.

    Time frame: At time of radical cystectomy

Secondary outcomes

  1. Incidence of adverse events graded by NCI CTCAE version 5.0

    Graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

    Time frame: From date of registration to date of death due to any cause, assessed up to 12 weeks after radical cystectomy

  2. Incidence of major surgical complications graded by Clavien-Dindo Scale

    Clavien-Dindo scale is widely utilized for grading adverse events (i.e. complications) that may occur as a result of surgical procedures. The severity of the complication increases from grade 1 to grade 5.

    Time frame: From date of radical cystectomy to date of death, assessed up to 30 days following surgery

  3. Health Related Quality of Life for Patients with T2-T4 muscle invasive bladder cancer

    Patient's health related quality of life survey on 30 items including urinary symptoms, sexual function, urostomy issues, catheter use, and body image will be assessed by The European Organization for Research and Treatment of Cancer (EORTC) QOL C30-BLM 30, in order to assess changes in patient-reported quality of life at baseline and changes. Each item is scored on a 4 point scale, with a higher score reflecting a better quality of life.

    Time frame: From date of registration to date of death due to any cause, assessed up to 24 months after radical cystectomy

  4. Overall survival (OS)

    Overall Survival is defined as the duration of time from the date of treatment initiation that a patient is still alive.

    Time frame: From date of registration to date of death due to any cause, assessed up to 24 months after radical cystectomy

  5. Recurrence free survival (RFS)

    RFS is defined as the time from surgery and study treatment to recurrence or death, whichever occurred first.

    Time frame: From date of registration to date of death due to any cause, assessed up to 24 months after radical cystectomy

07

Study locations

1 site
08

References and documents

Publications

  • Satkunasivam R, Lim K, Teh BS, Guzman J, Zhang J, Farach A, Chen SH, Wallis CJ, Efstathiou E, Esnaola NF, Sonpavde GP. A phase II clinical trial of neoadjuvant sasanlimab and stereotactic body radiation therapy as an in situ vaccine for cisplatin-ineligible MIBC: the RAD VACCINE MIBC trial. Future Oncol. 2022 Aug;18(25):2771-2781. doi: 10.2217/fon-2022-0380. Epub 2022 Jun 15. PubMed 35703113 ↗

Individual participant data

Plan to share: No

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Oct 24, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT05241340
Collaborators
Pfizer
Responsible party
Raj Satkunasivam (Associate Professor, The Methodist Hospital Research Institute) — Principal investigator
First posted
Feb 15, 2022
Start date
Feb 15, 2022
Primary completion
Aug 1, 2025
Completion
Apr 1, 2027 (estimated)
Last update
Oct 24, 2025

Study contacts

Raj Satkunasivam, MD
principal investigator · Houston Methodist Hospital, Houston Methodist Research Institute

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

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Studies of the drug tested here: Sasanlimab

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