Durvalumab and Vicinium in Subjects With High-Grade Non-Muscle-Invasive Bladder Cancer Previously Treated With Bacillus Calmette-Guerin (BCG)

  • STATUS
    Recruiting
  • End date
    Dec 30, 2022
  • participants needed
    40
  • sponsor
    National Cancer Institute (NCI)
Updated on 30 April 2021
cancer
carcinoma
neutrophil count
luteinizing hormone
durvalumab
bladder cancer
invasive bladder cancer
transitional cell carcinoma
transurethral resection
cystoscopy
bladder tumor
intravesical bcg
bcg vaccine

Summary

Background

Non-muscle-invasive bladder cancer is in the early stages. But it usually comes back after treatment. The drugs Vicinium and Durvalumab may help the immune system find and destroy cancer cells.

Objective

To test if the drugs Durvalumab and Vicinium together are safe and effective to treat people with bladder cancer that has not spread to the muscle in the bladder.

Eligibility

People ages 18 and older who have bladder cancer that has not spread to the muscle in the bladder and was treated unsuccessfully with Bacillus Calmette-Guerin

Design

Participants will be screened with:

Medical history

Physical exam

Blood and urine tests

Tumor sample from previous surgery. If one is not available, they will have a biopsy: A small piece of tumor is removed.

Cystoscopy to examine the inside of the bladder. This may include a biopsy or removing tumors.

CT or MRI: They lie in a machine that takes pictures of the body.

Electrocardiogram to test heart function

Participants will receive Durvalumab and Vicinium in 2 phases:

First phase: Durvalumab every 4 weeks and Vicinium once a week for 3 months

Second phase: Durvalumab every 4 weeks and Vicinium once every other week

Participants will have tumor samples taken every 3 months. They will have blood and urine tests throughout the study.

Participants will continue treatment for up to 2 years.

Participants will have a visit about 30 days after their last treatment. This includes blood and urine tests. It may include a cytoscopy or additional biopsies.

Description

Background

In 2016, it is estimated that there will be 76,960 new cases of bladder cancer and 16,390 deaths associated with bladder cancer. Bladder cancer is associated with the highest costs among all types of cancer, due to the need for lifelong routine monitoring and treatment. Approximately 70% of cases are non-muscle invasive bladder cancer (NMIBC) at presentation and are treated by transurethral resection of bladder tumor (TURBT) followed by intravesical treatment with BCG (Bacillus Calmette-Guerin) or mitomycin C. However, in the setting of high grade disease, these therapies can become ineffective over time in up to two-thirds of patients and disease progression to muscle invasive bladder cancer (MIBC) can occur. In patients who present with CIS (carcinoma in situ) rates of progression are greater than 50%. Progression to MIBC portends a poor outcome as only 50% of patients will survive five years despite undergoing radical cystectomy. Clearly, there is a large unmet need in therapeutic options for NMIBC that recurs or progresses.

Vicinium is a recombinant fusion protein, VB4-845, that contains a humanized single-chain antibody fragment specific for the epithelial cell adhesion molecule (EpCAM) antigen linked to ETA (252-608), a truncated form of Pseudomonas exotoxin A (ETA). EpCAM is overexpressed on the surface of urothelial carcinoma cells and therefore represents a good target for Vicinium to bind to. In a previous phase II study in BCG refractory or BCG intolerant patients with high grade bladder cancer, 16% of patients treated with induction and maintenance therapy with Vicinium remained disease-free at 1 year. As a result, Vicinium is currently being evaluated as a single agent in a phase III trial.

Pre-clinical work with a drug called Proxinium, an earlier version of Vicinium, demonstrated an abscopal effect and synergy with the use of a checkpoint blockade inhibitor. Although it was done in a NSCLC model, the results were impressive in causing tumor shrinkage. Durvalumab is a human monoclonal antibody (MAb) that inhibits binding of programmed cell death ligand 1 (PD-L1) (B7 homolog 1 [B7-H1], cluster of differentiation [CD]274) to programmed cell death 1 (PD-1; CD279) and CD80 (B7-1). Durvalumab has been demonstrated to have activity against advanced metastatic urothelial bladder cancer whose tumor has progressed during or after one standard platinum-based regimen in a phase I trial.

Therefore, this trial will take two agents with single agent activity against urothelial cancer and combine them in a Phase I trial for patients with high-grade NMIBC Previously Treated with BCG.

Objectives

Primary Objectives:

-To evaluate the safety and tolerability of durvalumab and Vicinium when administered in combination to subjects with BCG-refractory high-grade NMIBC

Eligibility
  • Subjects must have a histologically-confirmed high-grade non-muscle invasive urothelial carcinoma (transitional cell carcinoma) of the bladder as follows:
  • Carcinoma-in-situ (CIS) with or without papillary tumors
  • High-grade Ta or T1 disease based on a biopsy/TURBT performed within 12 weeks of the initial dose of study treatment. If multiple bladder biopsies/TURBTs are required to confirm eligibility, the timing of the last bladder biopsy to the initial dose of study treatment must be within 12 weeks.
  • Subjects with BCG unresponsive disease as defined by the Society of Urologic Oncology and the FDA: Subjects must have received at least two courses of intravesical BCG (at least 5 of 6 induction doses of BCG and at least 2 of 3 maintenance doses of BCG under a maintenance regimen or at least 2 doses of a repeat induction course). See exception below for persistent T1 disease below. There is no upper limit on the amount of prior BCG a subject may have received.
  • Patients with persistent T1 high grade disease on TURBT following a single induction course of BCG (at least 5 of 6 doses) may also be eligible for this trial provided that the patient is surgically unfit for cystectomy as deemed by the investigator or the patient declines cystectomy
Design

This is a Phase I, open-label study of the combination of durvalumab and Vicinium in subjects with high-grade NMIBC previously treated with BCG.

  • All subjects will receive Vicinium intravesically and durvalumab systemically at the standard doses for both drugs as determined by Phase II trials for each drug, as no synergy or additive effect is expected for adverse events.
  • Vicinium is administered in a 12-week Induction Phase followed by a Maintenance Phase for at least one year with an option for a total of up to 2 years of treatment. During the Induction Phase, Vicinium is administered once weekly for 12 weeks. During the Maintenance Phase, Vicinium is administered every other week. The dose of Vicinium is 30 mg in 50 mL of saline.
  • Durvalumab 1500 mg is administered intravenously (IV) once every 4 weeks for 12 months with an option to continue therapy for an additional 12 months (total of 24 months) provided that patient is tolerating therapy and remains free of recurrent high grade NMIBC (see Treatment Period below). The dose of durvalumab is 1500 mg. If optional maintenance therapy continued in the second year, durvalumab 1500 mg will be administered intravenously once every 3 months to provide an immune boost.
  • Vicinium will be given as monotherapy for 1 week followed by treatment with the combination of Vicinium and durvalumab starting week 2.
  • In the initial six patients, three subjects at a time will enroll at these doses and schedules. Dose-liming toxicity (DLT) for each subject will be determined during the initial 6-week period that the subject is on treatment (i.e., the DLT period). When all subjects in the initial cohort have been on treatment through the DLT period, all available safety data will be considered in decisions to enroll additional subjects at this dose level, or to de-escalate the dose(s) of study drug(s), based on a standard 3 + 3 design. There will be no dose escalations in this study. The dose of durvalumab will remain at 1500 mg every 4 weeks, and the dose of each intravesical Vicinium treatment can be reduced to 20 mg if the initial doses in combination induce DLTs.
  • After the first six patients, an additional 18 subjects will be enrolled at the initial doses or at the reduced doses (if DLTs resulted in the first 6 patients) in order to obtain additional safety data, biomarker data and preliminary anti-tumor activity.

Each subject s course will consist of the following periods:

  • Screening/Baseline Period: The subject is consented and undergoes screening assessments to determine eligibility for the study.
  • Treatment Period: The subject is treated and monitored for safety. Biomarker data will be obtained prior to treatment and at periodic intervals during treatment. Subjects who remain free of high-grade NMIBC after 12 months of study treatment may continue to receive treatment for an additional 12 months until they develop recurrent high-grade disease, disease progression, or intolerable toxicity, or meet another withdrawal criterion (e.g., consent withdrawal, pregnancy).
  • Post-Treatment. The subject will return to the study site montly for up to 90 days after the last dose of immunotherapy for end-of-treatment assessments. Subjects with ongoing clinically significant related AEs or SAEs will have additional follow-up after the initial post-treatment visit.

Details
Condition urinary tract neoplasm, bladder cancer, bladder disorder, Urothelial Cancer, Bladder Disorders, Bladder Carcinoma, Urologic Cancer, bladder tumor
Treatment durvalumab, Vicinium
Clinical Study IdentifierNCT03258593
SponsorNational Cancer Institute (NCI)
Last Modified on30 April 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Do you have any of these conditions: Bladder Disorders or Bladder Carcinoma or bladder tumor or bladder cancer or Urothelial Cancer or Urologic Cancer or bladder disorder or urinary tract...?
Do you have any of these conditions: bladder tumor or Urologic Cancer or Urothelial Cancer or Bladder Carcinoma or bladder cancer or urinary tract neoplasm or bladder disorder or Bladder ...?
Do you have any of these conditions: Bladder Carcinoma or Urologic Cancer or bladder cancer or Urothelial Cancer or bladder tumor or bladder disorder or urinary tract neoplasm or Bladder ...?
Do you have any of these conditions: bladder tumor or bladder disorder or Urologic Cancer or urinary tract neoplasm or bladder cancer or Urothelial Cancer or Bladder Disorders or Bladder ...?
Do you have any of these conditions: bladder tumor or Bladder Disorders or Urologic Cancer or Bladder Carcinoma or bladder cancer or urinary tract neoplasm or Urothelial Cancer or bladder...?
Do you have any of these conditions: Urologic Cancer or Bladder Carcinoma or Urothelial Cancer or bladder disorder or urinary tract neoplasm or bladder tumor or bladder cancer or Bladder ...?
Do you have any of these conditions: Bladder Carcinoma or urinary tract neoplasm or Bladder Disorders or bladder cancer or Urologic Cancer or bladder tumor or Urothelial Cancer or bladder...?
Do you have any of these conditions: Bladder Disorders or Bladder Carcinoma or Urothelial Cancer or Urologic Cancer or bladder cancer or bladder disorder or bladder tumor or urinary tract...?
Do you have any of these conditions: bladder disorder or Urologic Cancer or bladder cancer or Bladder Carcinoma or Bladder Disorders or Urothelial Cancer or bladder tumor or urinary tract...?
Do you have any of these conditions: Urologic Cancer or bladder cancer or bladder disorder or Bladder Disorders or urinary tract neoplasm or Urothelial Cancer or bladder tumor or Bladder ...?
Do you have any of these conditions: urinary tract neoplasm or Bladder Carcinoma or bladder cancer or Urothelial Cancer or Bladder Disorders or Urologic Cancer or bladder tumor or bladder...?
Do you have any of these conditions: bladder tumor or urinary tract neoplasm or bladder cancer or bladder disorder or Bladder Disorders or Bladder Carcinoma or Urologic Cancer or Urotheli...?
Do you have any of these conditions: Urologic Cancer or bladder cancer or Urothelial Cancer or Bladder Disorders or Bladder Carcinoma or bladder disorder or urinary tract neoplasm or blad...?
Do you have any of these conditions: Urothelial Cancer or Urologic Cancer or Bladder Carcinoma or urinary tract neoplasm or bladder disorder or bladder tumor or Bladder Disorders or bladd...?
Do you have any of these conditions: Bladder Carcinoma or Urothelial Cancer or urinary tract neoplasm or Urologic Cancer or Bladder Disorders or bladder tumor or bladder disorder or bladd...?
Is your age greater than or equal to 18 yrs?
Do you have any of these conditions: Bladder Disorders or bladder cancer or Urologic Cancer or urinary tract neoplasm or Urothelial Cancer or bladder tumor or Bladder Carcinoma or bladder...?
Do you have any of these conditions: bladder disorder or Urothelial Cancer or Bladder Carcinoma or Bladder Disorders or urinary tract neoplasm or Urologic Cancer or bladder tumor or bladd...?
Do you have any of these conditions: Bladder Disorders or bladder disorder or Urothelial Cancer or Bladder Carcinoma or urinary tract neoplasm or bladder tumor or bladder cancer or Urolog...?
Do you have any of these conditions: bladder cancer or Bladder Carcinoma or Bladder Disorders or Urologic Cancer or bladder tumor or urinary tract neoplasm or bladder disorder or Urotheli...?
Do you have any of these conditions: Bladder Carcinoma or Urologic Cancer or bladder cancer or bladder tumor or bladder disorder or urinary tract neoplasm or Bladder Disorders or Urotheli...?
Do you have any of these conditions: bladder disorder or urinary tract neoplasm or Bladder Carcinoma or bladder cancer or Urologic Cancer or Bladder Disorders or Urothelial Cancer or blad...?
Do you have any of these conditions: Urothelial Cancer or bladder disorder or bladder cancer or bladder tumor or Bladder Carcinoma or urinary tract neoplasm or Urologic Cancer or Bladder ...?
Do you have any of these conditions: Bladder Carcinoma or Urologic Cancer or Bladder Disorders or bladder tumor or bladder cancer or bladder disorder or urinary tract neoplasm or Urotheli...?
Do you have any of these conditions: Bladder Disorders or bladder cancer or Urologic Cancer or bladder disorder or Urothelial Cancer or Bladder Carcinoma or bladder tumor or urinary tract...?
Do you have any of these conditions: Urologic Cancer or bladder cancer or Bladder Disorders or urinary tract neoplasm or Urothelial Cancer or bladder tumor or bladder disorder or Bladder ...?
Do you have any of these conditions: bladder tumor or Bladder Disorders or bladder disorder or Urothelial Cancer or Bladder Carcinoma or Urologic Cancer or urinary tract neoplasm or bladd...?
Do you have any of these conditions: Bladder Carcinoma or bladder disorder or urinary tract neoplasm or bladder cancer or Urothelial Cancer or Urologic Cancer or Bladder Disorders?
Gender: Male or Female
Subjects with Grade >=2 neuropathy will be evaluated on a case-by-case basis after consultation with the Principal Investigator
Subjects with irreversible toxicity not reasonably expected to be exacerbated by treatment with durvalumab may be included only after consultation with the Principal Investigator

Exclusion Criteria

Patients who are receiving any other investigational agents
QT interval corrected for heart rate using Fridericia s formula (QTcF) >=470 ms. (Any clinically significant abnormalities detected require triplicate ECG results and a mean QT interval corrected for heart rate using Fridericia s formula (QTcF) >=470 ms calculated from 3 ECGs.)
History of allergic reactions attributed to compounds of similar chemical or biologic composition to Vicinium or durvalumab or other agents used in the study
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Urinary tract infections (UTIs) are excluded from being an exclusion criterion for treatment unless they are grade 3 or higher
Pregnant women are excluded from this study because it is unknown whether Vicinium and/or durvalumab have any teratogenic effects. In nursing mothers, breastfeeding should be discontinued as these medications may have the potential risk for adverse events in nursing infants secondary to treatment of the mother
Any previous treatment with a PD1 or PD-L1 inhibitor, including durvalumab
Evidence of non-bladder urothelial (transitional cell) carcinoma by biopsy, cytology, or radiological imaging within the past 2 years of treatment (e.g. upper tract transitional cell carcinoma, urethral urothelial carcinoma)
Subjects with hydronephrosis, except for those subjects where hydronephrosis has been longstanding (i.e., predates the diagnosis of the CIS, Ta, or T1 by more than 2 years) and diagnostic evaluation at screening shows no evidence of tumor causing the hydronephrosis
Any other anticancer therapy (e.g., chemotherapy, biologic therapy, immunotherapy, targeted therapy, endocrine therapy, radiation therapy, intravesical therapy, investigational agent) within 28 days of the first dose of study therapy (and within 6 weeks for nitrosourea or mitomycin C) other than a single dose of intravesical chemotherapy which is permitted between 28 days and 14 days prior to the first dose of study treatment
The subject has a diagnosis of another malignancy within 2 years before the first dose of study treatment, except for superficial skin cancer, localized prostate cancer on active surveillance, or localized solid tumors deemed cured by surgery and not treated with systemic anticancer therapy and not expected to require anticancer therapy in the next 2 years i.e., while the subject may be taking study treatment
Current or prior use of immunosuppressive medication within 28 days before the first dose of durvalumab, with the exceptions of intranasal and inhaled corticosteroids or systemic corticosteroids at physiological doses, which are not to exceed 10 mg/day of prednisone, or an equivalent corticosteroid
Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [e.g. colitis or Crohn s disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves disease, rheumatoid arthritis, hypophysitis, uveitis, etc.]). The following are exceptions to this
criterion
Subjects with vitiligo or alopecia
Subjects with hypothyroidism (e.g. following Hashimoto syndrome) stable on hormonal replacement
Any chronic skin condition that does not require systemic therapy
Subjects without active disease in the last 5 years may be included but only after consultation with the Principal Investigator
Subjects with celiac disease controlled by diet alone
History of primary immunodeficiency
History of allogeneic organ transplant
History of hypersensitivity to durvalumab or any excipient
History of hypersensitivity to Vicinium or its components
Active infection with tuberculosis (clinical evaluation that includes clinical history, physical examination, and radiographic findings, and PPD testing if indicated), hepatitis B (known positive HBV surface antigen (HBsAg) result, hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients with HIV are excluded from participating on this clinical trial because their immunodeficiency would confound the evaluation of adverse events which would hinder meeting the primary objective. Subjects with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Subjects positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA
History of leptomeningeal carcinomatosis
Receipt of live attenuated vaccination within 30 days prior to the first dose of Vicinium or durvalumab
Any condition that, in the opinion of the investigator, would interfere with evaluation of study treatment or interpretation of patient safety or study results
Subjects with uncontrolled seizures
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