Futibatinib in Combination With Durvalumab Prior to Cystectomy for the Treatment of Muscle-Invasive Bladder Cancer Patients Who Are Ineligible for Cisplatin-based Therapy

Inclusion Criteria:

Able to provide written informed consent
Female or male subjects >= 18 years old
FGFR1, 2, or 3 overexpression as defined by a score of 3+ or 4+ on ribonucleic acid (RNA) in-situ hybridization (RNAScope assay)
Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2

Histologically confirmed urothelial carcinoma of the bladder

Mixed histologies are permitted if urothelial carcinoma is the predominant histology ( >= 50%)
Clinical stage T2-T4a, N0, M0 disease by trans urethral removal of bladder tumour (TURBT) and imaging studies (stage II-IIIA per American Joint Committee on Cancer [AJCC] 2018)

Refuse or ineligible for cisplatin-based neoadjuvant chemotherapy as defined by any of the following:

ECOG performance status (PS) > 1
Creatinine clearance (calculated or measured) < 60 mL/min as measured by the Cockcroft-Gault formula
Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v 5.0) grade >= 2 hearing loss
CTCAE v 5.0 grade >= 2 neuropathy
New York Heart Association (NYHA) class > II cardiac dysfunction
Treatment with anti-PD-1/PD-L1 therapy for non-muscle invasive bladder cancer is permitted if it is completed > 3 months before registration

Eligible for radical cystectomy by the following:

Fit and planned for radical cystectomy according to local guidelines
Archival tissue submission must be 30 unstained slides. If archival tissue is unavailable, the patient must undergo cystoscopy and biopsy. The tumor sample must contain at least 20% viable tumor

Evidence of post-menopausal status or negative urinary or serum pregnancy test for female premenopausal patients. Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply:

Women < 50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy)
Women >= 50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses > 1 year ago, had chemotherapy-induced menopause with last menses > 1 year ago, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy, or hysterectomy)
Male subjects must agree to use an adequate method of contraception starting with the first dose of study therapy through 100 days after the last dose of study therapy. Female subjects, if sexually active, must agree to use dual methods of contraception during the study and for a minimum period of 100 days after the last dose of the study drug
Women participants without childbearing potential should refrain from donating oocytes from screening through 100 days after the last dose of the study drug
Hemoglobin >= 9.0 g/dL
Absolute neutrophil count (ANC) > 1500 per mm^3
Platelet count >= 100 x 10^9/L
International normalized ratio (INR) or activated partial thromboplastin time (aPTT) < 1.5 × upper limit of normal (ULN), unless the patient is receiving anticoagulation therapy provided INR or PTT is within the therapeutic range of the intended anticoagulant therapy
Serum bilirubin =< 1.5 x institutional upper limit of normal (ULN)
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional upper limit of normal
Measured creatinine clearance (CL) > 30 mL/min or calculated creatinine CL > 30 mL/min by the Cockcroft-Gault formula or by 24-hour urine collection for determination of creatinine clearance

Exclusion Criteria:

Women who are pregnant or breastfeeding
Is currently participating in or has participated in a study of an investigational agent or using an investigational device within 4 weeks before the first dose of trial treatment
Has upper tract urothelial carcinoma
Has small-cell carcinoma component on histology
Evidence of measurable nodal or metastatic disease
Concurrent anticancer therapy (e.g., chemotherapy, radiation therapy, surgery, immunotherapy, biologic therapy, hormonal therapy, investigational therapy, intravesical therapy, or tumor embolization)
Received prior systemic chemotherapy for muscle-invasive bladder cancer at any time in the patient's medical history
Participation in any other study in which receipt of an investigational study drug or device occurred within 28 days or 5 half-lives (whichever is longer) before the first dose. For investigational agents with long half-lives (e.g., 5 days or more), enrollment before the fifth half-life requires medical monitor approval
Has received anti-PD-1/PD-L1 therapy or FGFR inhibitor previously for MIBC, except if used in earlier stage urothelial carcinoma such as non-muscle invasive bladder cancer (NMIBC) and completed > 3 months prior to registration
Underwent major surgery and has not recovered adequately from the intervention's toxicity and/or complications before starting therapy
Has an active second malignancy except for low-risk localized prostate cancer on "watch and wait"
Subjects with a history of malignancy that has been completely treated, with no evidence of active cancer for 2 years before enrollment, or subjects with surgically cured tumors with a low risk of recurrence are allowed to enroll at principal investigator (PI's) discretion

Has active cardiac disease, defined as:

Myocardial infarction or unstable angina pectoris within 3 months of the first date of study therapy
Unstable arrhythmias
Decompensated heart failure
Average QT corrected by the Fridericia formula (QTcF) > 470 msec (males and females) (Note: If the QTcF is > 470 msec in the first electrocardiography [ECG], a total of 3 ECGs separated by >= 5 minutes should be performed. If the average of these 3 consecutive results for QTcF is =< 470 msec, the subject meets eligibility in this regard.)
Has any medical condition that may prevent the patient from undergoing radical cystectomy
Must be at least 2 weeks beyond high-dose systemic corticosteroids; chronic steroid use up to 10 mg daily prednisone (or equivalent) is permitted
Has active autoimmune disease requiring systemic treatment with steroids (> 10 mg daily doses of prednisone or equivalent) or other immunosuppressive agents or any condition that, in the investigator's judgment, precludes treatment with durvalumab
Has a history or evidence of interstitial lung disease (ILD) or non-infectious pneumonitis
Has a known history of HIV-1/2 with detectable viral load and/or CD4 count < 300/mL within the previous 3 months
Has detectable hepatitis B virus (HBV) or hepatitis C virus (HCV) viral load polymerase chain reaction (PCR) if there is a known history of active hepatitis B or hepatitis C
History and/or current evidence of significant ectopic mineralization/calcification including but not limited to the soft tissues, kidneys, intestines, myocardium, and lungs, except calcified lymph nodes and asymptomatic coronary calcification
Current evidence of corneal or retinal disorder/ keratopathy including but not limited to bullous/ band keratopathy, corneal abrasion, inflammation/ulceration, keratoconjunctivitis etc., confirmed by ophthalmologic examination
Have current evidence of endocrine alterations of calcium/phosphate homeostasis (e.g., parathyroid disorders, history of parathyroidectomy, tumor lysis, tumoral calcinosis) unless well controlled
Have used drugs that are dual p-glycoprotein and strong CYP3A inducers or inhibitors within 7 days prior to the first dose of the study drug
Has other concurrent medical or psychiatric conditions that, in the investigator's opinion, may be likely to confound study interpretation or prevent completion of the study procedure and follow-up examinations