SWOG clinical trial number

A Randomized Phase II Study of CO-eXpression ExtrapolatioN (COXEN)-Directed Neoadjuvant Chemotherapy for Localized, Muscle-Invasive Bladder Cancer

Abbreviated Title
Phase II COXEN Trial for Localized Bladder Cancer

Research committees

Genitourinary Cancer


Cisplatin Doxorubicin Filgrastim Gemcitabine hydrochloride Methotrexate Vinblastine Sulfate Pegfilgrastim MVAC

Other Study Materials

Eligibility Criteria Expand/Collapse

Histologically proven urothelial Ca of the bladder (mixed histology ok); Stage cT2-T4aN0M0; no prior systemic chemotherapy or previous systemic anthracyclines (intravesical anthracycline is allowed); abdominal/pelvic CT or MRI scan and chest CT scan (or x-ray) w/in 56 days prior to registration; if alk phos is above IULN or presence of suspicious bone pain (or if other clinical suspicion) then a whole body bone scan w/in 56 days prior to registration; PS = 0 or 1; 18 yrs of age or older; must not have peripheral neuropathy >/= Gr2; must not have NYHA Class III or IV heart failure or a known LVEF < 50%; must not have clinically relevant hearing impairment > Gr2; must not have hypersensitivity to cisplatin, gemcitabine, doxorubicin, vinblastine, methotrexate, or filgrastim/pegfilgrastim; must not have incidence of or uncontrolled medical illness that would limit the patient's ability to participate in the protocol; must not be pregnant or nursing; pts of reproductive potential must agree to use an effective contraceptive method during and for 6 months after completing protocol txt (a neg pregnancy test is required w/in 7 days prior to registration); no other prior malignancy is allowed expect for the following: adequately treated basal cell or squamous cell skin Ca, in situ cervical Ca, adequately treated Stage I or II Ca from which the patient is currently in complete remission, or any other Ca from which the patient has been disease free for 5 years. Pts with localized prostate Ca who are being followed by an active surveillance program are also eligible; pts must have tumor tissue from transurethral resection of the bladder tumor (TURBT) available for submission for COXEN testing and must agree to submit 22 FFPE slides; pt must consent (if residual tumor is present) to the submission of FFPE slides; pt must agree to submit voided urine and whole blood; pts must agree to participate in the translational medicine studies outlined in Section 18.3 of the protocol; pts must be offered participation in the ultra pure Circulating Tumor Cells (upCTCs) study.

Adequate renal, hepatic, and hematologic function w/in 28 days prior to registration:
CrCl >/= 60 mL/min; total bilirubin </= 1.5 IULN (or 2.5 x IULN w/ Gilbert's disese); SGOT(AST)/SGPT(ALT) </= 2 X IULN; ANC >/= 1500/mcL; hemoglobin >/= 9 g/dL; platelets = 100,000/mcL

Publication Information Expand/Collapse


Association of DNA damage response (DDR) gene alterations (alts) and response to neoadjuvant cisplatin-based chemotherapy (chemo) in muscle-invasive bladder cancer (MIBC) patients (pts) enrolled onto SWOG S1314

G Iyer;C Tangen;M Sarfaty;A Regazzi;IM Thompson;D McConkey;T Flaig;J Rosenberg J Clin Oncol 40, 2022 (suppl 16; abstr 4522), poster 14; ASCO Annual Meeting (June 3-7, 2022, Chicago, IL)

Cell-free DNA methylation as a predictive biomarker of response to neoadjuvant chemotherapy for patients with muscle invasive bladder cancer in SWOG S1314

Y-T Lu;M Plets;G Morrison;A Cunha;S Cen;S Rhie;K Siegmund;S Daneshmand;D Quinn;S Lerner;D Petrylak;D McConkey;T Flaig;I Thompson;A Goldkorn J Clin Oncol 40, 2022 (suppl 16; abstr 4506), abst 4506; ASCO Annual Meeting (June 3-7, 2022, Chicago, IL)

S1314 Correlative analysis of ATM, RB1, ERCC2 and FANCC mutations and pathologic complete response (pT0) at cystectomy after neoadjuvant chemotherapy (NAC) in patients with muscle invasive bladder cancer (MIBC): implications for bladder preservation

E Plimack;C Tangen;M Plets;R Kokate;J Xiu;C Nabhan;E Ross;E Grundy;W Choi;C Dinney;I-L Lee;MS Lucia;T Flaig;D McConkey J Clin Oncol 40, 2022 (suppl 16; abstr 4581), poster 72; ASCO Annual Meeting (June 3-7, 2022, Chicago, IL)


A randomized phase II study of coexpression extrapolation (COXEN) with neoadjuvant chemotherapy for bladder cancer (SWOG S1314; NCT02177695)

T Flaig;C Tangen;S Daneshmand;A Alva;S Lerner;M Lucia;D McConkey;D Theodorescu;A Goldkorn;M Milowsky;R Bangs;G MacVicor;B Bastos;J Fowles;D Gustafson;M Plets;I Thompson Clinical Cancer Research May 1;27(9):2435-2441; Feb 10;clincanres.2409.2020. doi: 10.1158/1078-0432.CCR-20-2409. Online ahead of print

PMid: PMID33568346 | PMC number: PMC8219246


Association of Molecular Expression Based Subtypes with Pathologic Response in a Randomized Phase II Study of Co-Expression Extrapolation (COXEN) with Neoadjuvant Chemotherapy for Localized, Muscle-Invasive Bladder Cancer (SWOG S1314; NCT02177695)

S Lerner;D McConkey;C Tangen;J Meeks;T Flaig;X Hua;W Choi;S Daneshmand;A Alva;MS Lucia;D Theodorescu;A Goldkorn;M Milowsky;R Bangs;J Fowles;D Gustafson;I Thompson J Clin Oncol 38: 2020 (suppl; abstr 5028); American Society of Clinical Oncology 2020 Annual Meeting, poster


From the other side:The patient perspective on cancer clinical trials [Review]

R Bangs;A Crispino Urologic Oncology: Seminars and Original Investigations May;37(5):331-335; Feb 7 [Epub ahead of print]

PMid: PMID29428573

SWOG S1314: A Randomized Phase II Study of Co-Expression Extrapolation (COXEN) with Neoadjuvant Chemotherapy for Localized, Muscle-Invasive Bladder Cancer

T Flaig;C Tangen;S Daneshmand;A Alva;MS Lucia;D McConkey;D Theodorescu;A Goldkorn;M Milowsky;R Bangs;G MacVicar;BR Bastos;D Gustafson;M Plets;IM Thompson J Clin Oncol 37(suppl; abstr 4506); ASCO Annual Meeting (May 31-June 4, 2019, Chicago, IL), oral


Summary and recommendations from the National Cancer Institute's Clinical Trials planning meeting on novel therapeutics for non-muscle invasive bladder cancer

SP Lerner;DF Bajorin;CP Dinney;JA Efstathiou;S Groshen;NM Hahn;D Hansel;D Kwiatkowski;M O'Donnell;J Rosenberg;R Svatek;JS Abrams;H Al-Ahmadie;AB Apolo;J Bellmunt;M Callahan;EK Cha;C Drake;J Jarow;A Kamat;W Kim;M Knowles;B Mann;L Marchionni;D McConkey;L McShane;N Ramirez;A Sharabi;AH Sharpe;D Solit;CM Tangen;AT Amiri;E Van Allen;PJ West;JA Witjes;D Quale Bladder Cancer Apr 27;2(2):165-202

PMid: PMID27376138 | PMC number: PMC4927845


Novel neoadjuvant therapy paradigms for bladder cancer: results from the National Cancer Center Institute Forum

C Dinney;D Hansel;D McConkey;W Shipley;M Hagan;R Dreicer;S Lerner;B Czerniak;F Waldman;S Groshen;LD True;E Petricoin;D Theodorescu;A Hruszkewycz;D Bajorin Urologic Oncology 32(8):1108-15;

PMid: PMID25443274 | PMC number: PMC4262150

Other Clinical Trials

SWOG Clinical Trial Number
SWOG Clinical Trial Number