A Phase 4, Multi-center, Open Label Trial to Evaluate Efficacy of Retreatment With Nadofaragene Firadenovec in Subjects With CIS ± High-grade Ta/T1 and no Complete Response to First Nadofaragene Firadenovec Dose

Bladder Cancer Clinical Trial

— ABLE-42  

Official title:

A Phase 4, Multi-center, Open Label Trial to Evaluate Efficacy of Retreatment With Nadofaragene Firadenovec in Subjects With CIS ± High-grade Ta/T1 and no Complete Response to First Nadofaragene Firadenovec Dose

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06390111
• Other study ID #: 000439
• Status: Not yet recruiting
• Phase: Phase 4
• Start date: April 30, 2024
• Est. completion date: July 31, 2026

Study information

• Verified date: April 2024
• Source: Ferring Pharmaceuticals
• Contact: Global Clinical Compliance
• Phone: 1-888-FERRING (1-888-337-7464)
• Email: DK0-Disclosure[@]ferring.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

In this phase 4 trial (000439), subjects with NMIBC CIS (± high-grade Ta/T1) who have not responded to their first dose of nadofaragene firadenovec (commercial ADSTILADRIN received before trial entry) will be offered retreatment when entering the trial. Retreatment is justified at 3 months after first dose of nadofaragene firadenovec, since 3-months' follow-up scheme is the standard of care in high-risk NMIBC. Retreatment at month 3 is used in a trial investigating intravesical instillation of a IL 15 superagonist (nogapendekin alfa inbakicept [NAI], also known as N 803), and lead to a CR in 46% (11 of 24) of the subjects at month 6. Moreover, retreatment is a widely accepted concept in immuno-oncology and has been used in IFN α treatment of kidney cancer in the past. It is currently also used in an ongoing phase 3 trial investigating the efficacy of oncolytic virus (CG0070) in BCG-unresponsive NMIBC. In this trial, around one third of the subjects who did not respond to the first treatment of CG0070 achieved CR after retreatment at 3 months. Therefore, it is also expected that a retreatment with nadofaragene firadenovec would show a comparable response rate.

Description:

Intravesical nadofaragene firadenovec was approved by the US Food and Drug Administration (FDA) in December 2022 for the treatment of high-risk BCG-unresponsive NMIBC with CIS with or without papillary tumors under the tradename ADSTILADRIN (hereafter nadofaragene firadenovec). It has only been approved in the US. Nadofaragene firadenovec is being developed as a vector-based gene therapy for NMIBC treatment to potentiate durable therapeutic responses by interferon alfa-2b (IFN-α2b) amplification. It is a non-replicating recombinant adenovirus serotype 5 vector containing a transgene encoding the human IFN-α2b gene. In addition, a single use vial of ADSTILADRIN contains the excipient [N-(3-cholamidopropyl)-N-(3-lactobionamidopropyl)]-cholamide (referred to as Syn3NODA) that enhances gene transfer across the urothelium.

Nadofaragene firadenovec is an efficacious and well tolerated intravesical bladder-sparing therapy, which has been investigated in clinical trials from phase 1 to 3 as part of the clinical development program. These trials established the safety and clinical efficacy of nadofaragene firadenovec in the treatment of CIS and high-grade Ta/T1 disease in subjects who are unresponsive to BCG treatment, as measured by complete response (CR) for CIS and high-grade recurrence-free survival for high-grade Ta/T1.

In this phase 4 trial (000439), subjects with NMIBC CIS (± high-grade Ta/T1) who have not responded to their first dose of nadofaragene firadenovec (commercial ADSTILADRIN received before trial entry) will be offered retreatment when entering the trial. Retreatment is justified at 3 months after first dose of nadofaragene firadenovec, since 3-months' follow-up scheme is the standard of care in high-risk NMIBC. Retreatment at month 3 is used in a trial investigating intravesical instillation of a IL 15 superagonist (nogapendekin alfa inbakicept [NAI], also known as N 803), and lead to a CR in 46% (11 of 24) of the subjects at month 6. Moreover, retreatment is a widely accepted concept in immuno-oncology and has been used in IFN α treatment of kidney cancer in the past. It is currently also used in an ongoing phase 3 trial investigating the efficacy of oncolytic virus (CG0070) in BCG-unresponsive NMIBC. In this trial, around one third of the subjects who did not respond to the first treatment of CG0070 achieved CR after retreatment at 3 months. Therefore, it is also expected that a retreatment with nadofaragene firadenovec would show a comparable response rate.

In BCG treatment of NMIBC, studies show that 40-60% of those who did not respond to initial treatment at 3 months, responded at month 6 to a second cycle at month 3. Retreatment has been shown to reduce the frequency of tumor recurrences over standard 6 weeks BCG treatment alone. Tumors recurred in 11% of subjects receiving 2 BCG courses vs. 29% of subjects treated with initial 6 weeks BCG treatment (p=0.03). Further, those subjects that received retreatment of BCG had higher CR rates after 6 months and longer disease-free intervals. The hypothesis is that first exposure to BCG primes the immune system to enhance anti-tumor effects of subsequent therapy. The same principle may apply for nadofaragene firadenovec retreatment. The first nadofaragene firadenovec instillation is likely to activate an initial immune response that enhances the antiinflammatory and anti-tumor effects of the second administration. As a result, subjects with no CR after 3 months may benefit from retreatment, with the first dose acting as the stimulator which enhances the anti-tumor effects of the second dose

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 25
• Est. completion date: July 31, 2026
• Est. primary completion date: July 31, 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 99 Years

Eligibility

Inclusion Criteria:

• Diagnosed, as documented, with CIS ± high-grade disease Ta/T1 and absence of progression after first dose of nadofaragene firadenovec within the last 5 months from instillation.

• Diagnosed, as documented, with:

• Low risk of disease progression as assessed at the discretion of the investigator

• Previous Bacillus Calmette Guerin (BCG) therapy (BCG exposed) with no maximum limit to the amount of BCG administered

Exclusion Criteria:

• Current or previous evidence of muscle-invasive (muscularis propria) or metastatic disease presented at the screening visit. Examples of increased risk of muscle-invasive include but are not limited to:

• Presence of lymphovascular invasion and / or micropapillary disease as shown in the histology of the biopsy sample

• Subjects with T1 disease accompanied by the presence of hydronephrosis secondary to the primary tumor

• Current and prior systemic or local therapy for bladder cancer since first dose of nadofaragene firadenovec

• Current or prior investigational treatment for BCG-unresponsive NMIBC or any other investigational drug (drug used in a clinical trial, i.e drug used in a Ferring sponsored non-interventional study does not apply) since first dose of nadofaragene firadenovec

• Clinically significant and unexplained elevated liver or renal function tests

• History of malignancy of other organ system within past 5 years, except treated basal cell carcinoma or squamous cell carcinoma of the skin and =pT2 upper tract urothelial carcinoma at least 24 months after nephroureterectomy. Also subjects with genitourinary cancers other than urothelial cancer or prostate cancer that are under active surveillance are excluded

Related Conditions & MeSH terms

• Bladder Cancer
• CIS
• Urinary Bladder Neoplasms

Intervention

Drug:
• nadofaragene firadenovec
The investigational medicinal product dose, concentration, and assessments are aligned with nadofaragene firadenovec US prescribing information.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Ferring Pharmaceuticals

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Complete response (CR) achieved at month 3 after nadofaragene firadenovec retreatment		at month 3
Secondary	Maintenance of CR at months 6 after nadofaragene firadenovec retreatment		at 6 months after nadofaragene firadenovec retreatment
Secondary	Maintenance of CR at months 9 after nadofaragene firadenovec retreatment		at 9 months after nadofaragene firadenovec retreatment
Secondary	Maintenance of CR at months 12 after nadofaragene firadenovec retreatment		at 12 months after nadofaragene firadenovec retreatment
Secondary	Durability of CR at months 6 after nadofaragene firadenovec retreatment	No evidence of CIS and/or high-grade Ta/T1	at 6 months after nadofaragene firadenovec retreatment
Secondary	Durability of CR at months 9 after nadofaragene firadenovec retreatment	No evidence of CIS and/or high-grade Ta/T1	at 9 months after nadofaragene firadenovec retreatment
Secondary	Durability of CR at months 12 after nadofaragene firadenovec retreatment	No evidence of CIS and/or high-grade Ta/T1	at 12 months after nadofaragene firadenovec retreatment
Secondary	Muscle-invasive progression of disease up to month 12 after nadofaragene firadenovec retreatment		Up to12 months after nadofaragene firadenovec retreatment
Secondary	Incidence of cystectomy		Up to 12 months after nadofaragene firadenovec retreatment
Secondary	Time to cystectomy		Up to 12 months after nadofaragene firadenovec retreatment
Secondary	Pathological staging at cystectomy		Up to 12 months after nadofaragene firadenovec retreatment