Study of 2141-V11 in People With Non-muscle Invasive Bladder Cancer That Did Not Respond to Standard Treatment

  • STATUS
    Recruiting
  • End date
    Nov 15, 2023
  • participants needed
    25
  • sponsor
    Memorial Sloan Kettering Cancer Center
Updated on 15 December 2021

Summary

The purpose of this study is to test the safety of the study drug 2141-V11 in people whose NMIBC did not respond to standard treatment, and who will not have the standard surgical procedure to remove the bladder. The researchers will test different doses of 2141-V11 to see which dose is safest in people. The researchers will also do tests to see how the body absorbs, distributes, and gets rid of 2141-V11. This study is one of the first to test 2141-V11 in people, and the first to test 2141-V11 delivered through a catheter into the bladder.

Details
Condition Non-muscle Invasive Bladder Cancer
Treatment 2141-V11
Clinical Study IdentifierNCT05126472
SponsorMemorial Sloan Kettering Cancer Center
Last Modified on15 December 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

High-grade (HG) NMIBC (HG Ta, CIS, and/or T1) of urothelial histology that is unresponsive to adequate BCG therapy
Stage, grade, and histology must be confirmed by the MSK Department of Pathology
Subjects with tumors of mixed urothelial/non-urothelial histology may be included, but urothelial carcinoma must be the predominant histology; subjects with predominant or exclusively non-urothelial histology are excluded
In those subjects with CIS, the CIS must be present on the tumor sample from the most recent cystoscopy/TURBT
In this context, adequate BCG therapy is defined as at least one of the
following
At least five of six doses of an initial induction course plus at least two of three
At least five of six doses of an initial induction course plus at least two of six doses of a second induction course
doses of maintenance therapy
Persistent or recurrent CIS alone or with recurrent Ta/T1 disease (noninvasive papillary disease/tumor invades the subepithelial connective tissue) within 12 months of completion of adequate BCG therapy
° Disease unresponsive to adequate BCG therapy is defined as
Recurrent HG Ta/T1 disease within 6 months of completion of adequate BCG therapy
HG T1 disease at the first evaluation following an induction BCG course
In subjects with papillary tumors (Ta and T1), a complete TURBT must have been performed, as characterized by
Attainment of a visually complete resection of all papillary tumors (Ta and T1)
Residual CIS not amenable to complete transurethral resection is acceptable
Most recent cystoscopy/TURBT must have been performed within 60 days of the first dose of trial treatment
Receipt of restaging transurethral resection for any tumor with invasion into the
Absence of urothelial carcinoma involving the upper urinary tract (documented by radiological imaging or ureteroscopy)
lamina propria (HG T1) as part of standard care, with documented presence of
Have elected not to undergo or are considered ineligible for radical cystectomy, as determined by the treating surgeon. Reasons for ineligibility or refusal of radical cystectomy should be discussed with the subject as part of the informed consent process. Ineligibility factors for radical cystectomy may include, but are not limited
uninvolved detrusor muscle
to
Cardiovascular disease (e.g., recent acute coronary syndrome, arrhythmia, heart failure)
Chronic obstructive pulmonary disease that would preclude a safe surgical procedure, as determined by the treating surgeon
Poor performance status
Prior major abdominal and pelvic surgery that would preclude a safe surgical procedure, as determined by the treating surgeon
Required values for screening laboratory tests, performed within 28 days prior to treatment initiation
In subjects previously treated with pembrolizumab for BCG-unresponsive NMIBC that are
found to have disease persistence, the disease persistence must have been
Platelets >75,000/mm^3 without receiving transfusion within 4 weeks prior to screening
confirmed no earlier than 12 weeks after initiation of pembrolizumab; subjects
Hemoglobin >8 g/dL without receiving transfusion within 4 weeks prior to screening
previously treated with pembrolizumab that are found to have disease
Creatinine clearance (measured or calculated per institutional standard) >40 mL/min; estimated GFR can also be used in place of creatinine clearance
recurrence or progression from HG Ta and/or CIS to T1 disease prior to 12
weeks after initiation of pembrolizumab may be included after discussion with
the Principal Investigator
Age ≥18 years on day of signing informed consent
Eastern Cooperative Oncology Group (ECOG) performance status ≤2 / Karnofsky performance status ≥60%, as assessed within 28 days prior to treatment initiation
following
Absolute neutrophil count (ANC) ≥1000/mm^3 independent of growth factor support
Have had a hysterectomy and/or bilateral oophorectomy, bilateral salpingectomy, or bilateral tubal ligation/occlusion, at least 6 weeks prior to screening
Has a congenital or acquired condition that prevents childbearing
Male and female subjects of childbearing potential must agree, if participating in sexual activity that could lead to pregnancy, to use of an adequate method of contraception from the day of study medication initiation (or 14 days prior to the initiation of study medication for oral contraception) throughout the study period up to 120 days after the last dose of trial therapy. Subjects should be informed that taking the study medication(s) may involve unknown risks to the fetus (unborn baby) if pregnancy were to occur during the study
Male subjects will be considered of non-reproductive potential if they have azoospermia (whether due to vasectomy or an underlying medical condition). Female subjects will be considered of non-reproductive potential if as described above
AST/ALT ≤3 times the institutional upper limit of normal (ULN)
Acceptable methods of contraception
Total bilirubin ≤1.5 times the institutional ULN (except for participants with Gilbert's Syndrome or of non-hepatic origin)
Female subjects of childbearing potential must have a negative serum pregnancy test
Combination method (requires use of two of the following): diaphragm with spermicide (cannot be used in conjunction with cervical cap/spermicide), cervical cap with spermicide (nulliparous women only), contraceptive sponge (nulliparous women only), male condom or female condom (cannot be used together), or hormonal contraceptive [oral contraceptive pill (estrogen/progestin pill or progestin-only pill), contraceptive skin patch, vaginal contraceptive ring, or subcutaneous contraceptive injection]
within 72 hours prior to receiving the first dose of study treatment
Male subjects must agree not to donate sperm during and after the study
°Female subjects will be considered of non-reproductive potential if any of
Willing and able to provide written informed consent/assent for the trial
the
Able to comply with the treatment schedule as determined by the participant and the licensed practitioner
Postmenopausal [defined as at least 12 months with no menses without an alternative
medical cause; in women <45 years of age a high follicle stimulating hormone
(FSH) level in the post-menopausal range may be used to confirm a post-
menopausal state in women not using hormonal contraception or hormonal
replacement therapy. In the absence of 12 months of amenorrhea, a single FSH
measurement is insufficient.]
Single method (one of the following is acceptable): intrauterine device, vasectomy of
a female subject's male partner, or contraceptive rod implanted into the skin

Exclusion Criteria

History of or currently being treated for muscle-invasive (T2, T3, T4) locally-advanced non-resectable or metastatic urothelial carcinoma
Evidence of concurrent extravesical (i.e., urethra, ureter, or renal pelvis) urothelial cell carcinoma
Concurrent anti-cancer therapy, including investigational agents; exceptions include subjects on topical therapy (e.g. topical 5-fluorouracil)
Has undergone any intervening intravesical chemotherapy or immunotherapy from the time of most recent cystoscopy/TURBT to starting trial treatment (a single dose of intravesical treatment given as part of the most recent cystoscopy/TURBT, during the screening period, such as with chemotherapy as per local/regional practices, is acceptable)
Major surgery or a wound that has not fully healed within 4 weeks prior to the first dose of trial treatment
If subject has undergone major surgery greater than 4 weeks prior, subject must have recovered adequately from the toxicity and/or complications from the intervention prior to starting trial therapy
Basal cell carcinoma of the skin
Squamous cell carcinoma of the skin that has undergone potentially curative therapy
In situ cervical cancer
Diagnosis of immunodeficiency, concurrent immune suppressive disease, or is receiving systemic corticosteroid therapy or any other form of immunosuppressive therapy within 4 weeks prior to the planned first dose of trial treatment. The use of physiologic doses of corticosteroids as replacement therapy (for adrenal or pituitary insufficiency, etc.) is acceptable. Topical and inhaled corticosteroids in standard doses are acceptable
Known contraindications to intravesical therapy
Febrile illness, symptomatic urinary tract infection, or persistent gross hematuria
Traumatic catheterization or gross hematuria on day of treatment
Severe infection within 4 weeks prior to the first dose of trial treatment, including, but not limited to, hospitalization for complications of infection, bacteremia, or severe pneumonia
History of (non-infectious) pneumonitis that required steroids or current pneumonitis
Has had prior chemotherapy, targeted small molecule therapy, cytokine therapy, or radiation therapy within 2 weeks prior to the first dose of trial treatment or who has not recovered (i.e., Grade ≤1 or at baseline) from AEs due to a previously administered agent
History of Human Immunodeficiency Virus (HIV) infection (e.g., positive HIV-1/2 antibodies)
Subjects with Grade ≤2 neuropathy or Grade ≤2 alopecia are an exception to this criterion and may qualify for the study
Active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C [e.g., HCV RNA (qualitative) detected] infection; subjects with past/resolved Hepatitis B Virus (HBV) infection (defined as having a negative HBsAg and a positive antibody to Hepatitis B core antigen) or Hepatitis C Virus (HCV) infection are eligible only if polymerase chain reaction (PCR) testing is negative for HBV DNA or HCV RNA, respectively (must be obtained within 28 days prior to treatment initiation)
History of treatment with checkpoint inhibitor immunotherapy, other antibody-based
Pregnant or breastfeeding, or expecting to conceive within the projected duration of the trial, starting with the screening visit through 120 days after the last dose of trial treatment
therapy, or investigational agent or device within 4 weeks of the first dose
History of stroke or intracranial hemorrhage within 6 months prior to enrollment History of pulmonary embolism or any other thromboembolic event within 6 months prior to enrollment
of trial treatment; exceptions include subjects treated with vaccines or other
History of undergoing an allogeneic tissue/solid organ transplant
agents with FDA Emergency Use Authorization for the prevention of COVID-19
History or current evidence of any condition, therapy, or laboratory abnormality that might interfere with the subject's participation for the full duration of the trial, interfere with the subject's ability to cooperate with the requirements of the trial, confound the results of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator
Known additional malignancy that has had progression or has required active treatment
in the last three years. Exceptions include
History of prostate cancer treated with definitive intent (surgical or radiation with a Gleason score ≤7 and prostate-specific antigen (PSA) undetectable for at least 1 year while off androgen deprivation therapy, that was either treated with definitive intent or untreated in active surveillance that has been stable for the past year prior to study enrollment
Active autoimmune disease that has required systemic treatment in the past 2 years
(i.e., with use of disease-modifying agents, corticosteroids, or
immunosuppressive agents). Replacement therapy (e.g., thyroxine, insulin, or
physiologic corticosteroid replacement therapy for adrenal or pituitary
insufficiency, etc.) is not considered a form of systemic treatment
Active infection requiring systemic therapy, including active or intractable urinary
tract infection within 4 weeks prior to the first dose of trial treatment
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