Treatments and/or Procedures

Study Criteria

Inclusion Criteria:

  1. Patients must have a diagnosis of transitional cell carcinoma (TCC) of the urinary
     bladder confirmed at the study institution. The patient must have demonstrated
     nonmuscle-invasive bladder cancer refractory or recurrent to standard intravesical
     therapy. Refractory disease is defined as failure to achieve tumor-free status by 6
     months of initiation of adequate BCG therapy. Recurrent disease is defined as
     reappearance of disease after achieving a tumor-free status by 6 months of initiation
     of adequate BCG therapy. Adequate BCG therapy includes at least 6 weeks induction plus
     3 additional doses of either induction or maintenance. Patients with a history of
     other intravesical agents (except nab-rapamycin or gemcitabine) in addition to
     standard BCG will also be allowed to enroll. All grossly visible disease must be fully
     resected and pathologic stage will be confirmed at the institution where the patient
     is enrolled. This will include stage Ta, T1, Tis and exclude all patients with muscle
     invasion (T2).

       1. For phase 1, patients with multifocal low-grade Ta histology will be eligible for
          participation

       2. For phase 2, individuals with Ta disease only must have documentation of
          high-grade histology

       3. For phase 2, prior intravesical treatment with nab-rapamycin or gemcitabine is
          not allowed

  2. Age >18 and must be able to read, understand, and sign informed consent

  3. Performance Status: ECOG 0, 1, and 2 (See Appendix III)

  4. Hematologic inclusion within 2 weeks of start of treatment

       1. Absolute neutrophil count >1,500/mm3

       2. Hemoglobin >9.0 g/dl

       3. Platelet count >100,000/mm3

  5. Hepatic inclusion within 2 weeks of entry

       1. Total bilirubin must be within normal limits.

       2. Adequate renal function with serum creatinine ≤2.5 mg/dL

       3. Aspartate transaminase (AST) and alanine transaminase (ALT) ≤2.5 x ULN for the
          institution, alkaline phosphatase ≤ 2.5 x ULN for the institution, unless bone
          metastasis is present in the absence of liver metastasis

  6. Women of childbearing potential must have a negative pregnancy test.

  7. All patients of childbearing potential must be willing to consent to using effective
     contraception, ie, intrauterine device, birth control pills, depo-provera, and condoms
     while on treatment and for 3 months after their participation in the study ends.

Exclusion Criteria:

  1. Any other malignancy diagnosed within 1 year of study entry (except basal or squamous
     cell skin cancers or noninvasive cancer of the cervix) is excluded

  2. Concurrent treatment with any chemotherapeutic agent

  3. Women who are pregnant or lactating

  4. History of vesicoureteral reflux or an indwelling urinary stent

  5. Participation in any other research protocol involving administration of an
     investigational agent within 1 month prior to study entry

  6. History of radiation to the pelvis

  7. History of interstitial lung disease and/or pneumonitis

  8. Evidence of metastatic disease