Non-Muscle Invasive Bladder Cancer (NMIBC) Refractory to BCG Clinical Trial
Official title:
A Phase Ib Trial of Intravesical Photodynamic Therapy in Patients With Non-muscle Invasive Bladder Cancer at High Risk of Progression Who Are Refractory to Bacillus Calmette-Guerin Therapy and Who Are Medically Unfit for/Refuse Cystectomy
This is a phase Ib, open-label, single-arm, single-center study conducted in Canada. Subjects with NMIBC (Ta, T1, and/or Tis) who are not candidates for or have refused radical cystectomy will be eligible for participation in the study. Bacillus Calmette-Guerin (BCG) intolerance or refractory disease are defined as inability to tolerate or failure to achieve a tumour-free state after at least one induction (a minimum of 5 instillations) followed by either a second induction (a minimum of 5 instillations) or at least 2 maintenance instillations. Subjects experiencing disease relapse within 12 months or less after finishing the second course of BCG therapy are also considered refractory. The study will consist of 2 phases. In the first phase, 3 subjects will receive PDT (TLC-3200 System) employing 0.35 mg/cm^2 (maximum recommended starting dose) TLD1433. If treatment with the maximum recommended starting dose does not raise significant safety concerns as determined by the safety monitoring committee, an additional 6 subjects will receive PDT with 0.70 mg/cm^2 (therapeutic dose) TLD1433.
10.1 Overall Study Design and Plan: Description
This is a phase Ib, open-label, single-arm, single-center study conducted in Canada. Subjects
with NMIBC (Non-muscle Invasive Bladder Cancer, Ta, T1, and/or Tis) who are not candidates
for or have refused radical cystectomy will be eligible for participation in this study. BCG
intolerance or refractory disease are defined as inability to tolerate or failure to achieve
a tumour-free state after at least one induction (a minimum of 5 instillations) followed by
either a second induction (a minimum of 5 instillations) or at least 2 maintenance
instillations. Subjects experiencing disease relapse within 12 months or less after finishing
the second course of BCG therapy are also considered refractory.
The study will consist of 2 phases. In the first phase, 3 subjects will receive PDT employing
0.35 mg/cm^2 (maximum recommended starting dose) TLD1433 and 90 J/cm^2 of green light
delivered by TLC-3200. If treatment with the maximum recommended starting dose does not raise
significant safety concerns as determined by the safety monitoring committee, an additional 6
subjects will receive PDT with 0.70 mg/cm^2 (therapeutic dose) TLD1433 and 90 J/cm^2 of green
light delivered by TLC-3200.
10.2 Screening Period
Subjects will be qualified for study entry by review of inclusion and exclusion criteria
during the Screening Period, which will last up to 2 weeks.
10.3 Maximum Recommended Starting Dose Treatment Phase
Three subjects will receive a single instillation of 0.35 mg/cm^2 TLD1433 followed by PDT
(TLC-3200 System). If treatment with the maximum recommended starting dose doesn't raise
safety concerns after 1 month of patient follow-up based on the judgment of the safety
monitoring committee, the study will enroll an additional 3 subjects who will receive PDT at
the maximum recommended starting dose.
10.4 Follow-Up Phase
All subjects enrolled, regardless of TLD1433 dose received, will be followed until the End of
Study defined as completion of all required assessments after 6 months of follow-up or
earlier due to early discontinuation or withdrawal of informed consent.
During the Follow-Up Phase, information on safety and efficacy will be collected. Assessments
will be conducted at Day 7, Day 30 and monthly thereafter through Month 3, and every 3 months
until End of Study.
10.6 Study Drug and PDT Administration
TLD1433 for intravesical administration is supplied as a lyophilisate for suspension in
Sterile Water for Injection into the bladder and is packaged in the dark in amber
borosilicate glass vials which can be stored at room temperature. Just before administration,
it is reconstituted with Sterile Water for Injection to obtain the final clinical dilution.
TLD1433 will be supplied by Theralase Inc. Instillations cannot be done immediately following
biopsy taken by TURBT. Investigators must wait a minimum of 7 days before dosing subjects
after a TURBT/biopsy and/or until any bladder wall integrity issues have resolved.
Dose/volume reductions are not allowed during this study.
Upon determination of the bladder volume (during the screening period) through a voiding
diary or measuring instilled water volume, TLD1433 will be diluted to the proper
concentration. On day 0 (treatment day), subjects will be asked to restrict fluid intake 12
hours before study drug instillation. Study drug must be instilled into the subject's empty
bladder. Before instillation, a regular transurethral catheter should be inserted and the
bladder drained. A single instillation of TLD1433 will be infused intravesically for 60 min
(further TLD1433 will be instilled in case of leakage), followed by 3 washes with sterile
water. Bladder will be distended using a fourth instillation of sterile water to prevent
folds that prevent uniform light illumination. The laser technician worksheet must be
completed during the procedure and data must be promptly transferred to the corresponding
eCRF page. The optical fiber (with spherical diffuser) will be positioned in the center of
the bladder with the aid of TLC-3200 and will be locked in place using an endoscope holder
for continuous irradiation for the total exposure time. Exposure time will be calculated
based on power (measured at the end of the optic fiber before inserting though a liquid-tight
lock via catheter into the urethra) and bladder surface area to match the desired light dose
at the bladder wall. Green laser light (wavelength = 532 nm, energy = 90 J/cm^2) will be
irradiated using the spherical cavity diffuser.
10.6.1 Dosing Schedule
A single whole bladder intravesical PDT with TLD1433 and the TLC-3200 System is planned.
10.6.2 PDT Disruption
Only those patients in whom no papillary tumours remain after TURBT will be treated on this
protocol. If one or more papillary tumours are seen at the time of cystoscopy for laser light
application (maximum 6 weeks after TURBT), a patient must not be treated with the TLC-3200
System as scheduled, even though previously instilled with TLD1433. Procedures will be
followed as though the tumour were first detected at the 90-day follow-up evaluation. The
patient may then be treated in whatever manner the physician deems appropriate. However, such
patients must be followed for collection of safety information for at least 30 days after
TLD1433 instillation, even though alternate therapy may have been initiated during this time.
Adverse experiences, weekly assessment of urinary symptoms, and the results of laboratory
tests of blood and urine will be recorded. Full disclosure of the details of any alternate
therapy or other medications given during the 30-day observation period (e.g., drug, dose,
route, frequency and dates of administration) must be provided. After this 30-day period, an
interim medical history will be taken and the patient will undergo a physical examination
(including ECG), clinical laboratory tests, a Karnofsky Performance Status rating, and an
assessment of urinary symptoms and adverse experiences. The patient will then be considered
off study.
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