A Phase Ib/II Study to Assess the Safety and Activity of DURvalumab (MEDI4736) in Combination With S-488210/S-488211 vAccine in Non-muscle Invasive Bladder CancEr (DURANCE)

  • STATUS
    Recruiting
  • End date
    May 31, 2029
  • participants needed
    64
  • sponsor
    University College, London
Updated on 12 October 2022
radical cystectomy
carcinoma
gilbert's syndrome
neutrophil count
durvalumab
invasive bladder cancer
bladder tumor

Summary

DURANCE is a two part, phase Ib/II, multi-centre study to assess the safety and activity of S-488210/S-488211 in combination with durvalumab, in patients with non-muscle invasive bladder cancer (NMIBC).

Description

DURANCE is a registered, phase Ib/II study in patients with surgically debulked bacillus Calmette-Guerin (BCG) unresponsive (resistant or relapsing) or intolerant non-muscle invasive bladder cancer (NIMBC). Patients will receive up to 24 weeks of durvalumab (a PD-L1 immune checkpoint inhibitor) in combination with S-488210/S-488211 (a 5-peptide cancer vaccine).

Durvalumab will be given as 1500 mg IV infusion every 4 weeks for up to 7 doses, in combination with S-488210/S-S488211 which will be administered as two subcutaneous injections of S-488210/Montanide and S-488211/Montanide starting the day after the first durvalumab dose, then weekly for 6 doses and every 2 weeks for a further 9 doses (up to a maximum of 16 doses).

All patients must have a cystoscopy at the end of week 12 (from start of trial treatment) for disease evaluation and to assess suitability to continue trial treatment. Patients with complete response, as shown from the cystoscopy, may continue treatment for up to 24 weeks in the absence of progressive disease, unacceptable toxicity or withdrawal of consent; all other patient will be withdrawn from further trial treatment.

The phase Ib part of the DURANCE study will look to assess the safety and tolerability of the treatment combination of durvalumab + S-488210/S-488211 by reviewing Dose Limiting Toxicities (DLTs) which have at least a reasonable possibility of being related to the trial treatments (durvalumab and/or S-488210/S-488211). Up to 14 evaluable patients will be registered into phase Ib and provided the DLTs do not exceed the DLT thresholds defined in the trial protocol, the trial will proceed to the expansion phase of the study (phase 2). In phase 2 the trial will look to assess the disease free survival rate at 1 year following start of treatment.

Details
Condition Bladder Cancer
Treatment durvalumab, S-488210/S-488211
Clinical Study IdentifierNCT04106115
SponsorUniversity College, London
Last Modified on12 October 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Histologically proven high risk non-muscle invasive bladder cancer (NMIBC)
Adequate archival tissue sample available for histological assessment (date sample taken must be within 6 months of planned start of treatment)
Predominant histologic component (> 50%) must be urothelial (transitional cell) carcinoma
Bacillus Calmette-Guerin (BCG) unresponsive disease or are intolerant of BCG therapy
Refused or deemed clinically inappropriate for radical cystectomy
≥18 years of age
Body weight >30 kg
World Health Organisation (WHO) performance status 0-1
Must have undergone each of the following procedures within 8 weeks of registration
Complete excision of all papillary disease (T1/TaHG) and demonstration of no muscle invasive disease in the resected specimens (muscle must be present in the tumour sample)
Bladder 'Mapping biopsies' taken
CT of the chest
CT Urogram or MRI of the abdomen and pelvis (if CT is not possible)
Adequate haematological status
Haemoglobin ≥9.0 g/dL
Absolute neutrophil count ≥1.5 x 10^9/L (≥150,000 per mm3)
Platelet count ≥100 x 10^9/L (≥100,000 per mm3)
International Normalised Ratio (INR) ≤1.5 and Activated Partial Thromoplastin Time (APTT) ≤1.5 x Upper Limit Normal (ULN). NB: This applies only to patients who are not receiving therapeutic anticoagulation; patients receiving therapeutic anticoagulation should be on a stable dose
Adequate liver function
Total bilirubin ≤1.5 X ULN (<3.0 x ULN for patients with Gilbert's syndrome)
Aspartate Aminotransferase (AST) or Alanine Aminotransferase (ALT) ≤2.5 x ULN
Adequate renal function: Measured creatinine clearance ≥40 mL/min or calculated
creatinine clearance ≥40 mL/min using Cockcroft-Gault formula or by 24-hour
urine collection for determination of creatinine clearance
Life expectancy of ≥6 months
Willing and able to give informed consent (which includes compliance with the requirements and restrictions listed in the patient information sheet (PIS) and in this protocol). NB: Consent must be obtained from the patient/legal representative prior to performing any protocol-related procedures, including screening evaluations
Patients of child-bearing potential and male patients with female partners of child-bearing potential must agree to use highly effective contraception methods from date of consent, which must be continued for up to 90 days after last treatment administration
Female patients must not be pregnant. There should be sufficient evidence of post-menopausal status or a negative serum pregnancy test for pre-menopausal female patients
Willingness and ability to comply with scheduled visits, treatment plan, laboratory tests and any other study procedures

Exclusion Criteria

Any history of autoimmune or inflammatory disease including (any patients with a history of an autoimmune condition but without active disease in the last 5 years may be included only after consultation with the CI/TMG)
Inflammatory bowel disease (e.g. colitis or Crohn's disease)
Diverticulitis (with the exception of diverticulosis)
Systemic lupus erythematous (SLE)
Sarcoidosis syndrome
Wegener syndrome (granulomatosis with polyangitis, Grave's disease, rheumatoid arthritis, hypophysitis, uveitis, etc.)
Patients with prior allogeneic stem cell or solid organ transplantation
Patients who have had prior treatment with anti- PD-1, PD-L1 or CTLA-4 monoclonal antibody or other novel immune-oncology agent(s)
Active invasive malignancy in the previous 2 years excluding non-melanoma skin cancer
History of idiopathic pulmonary fibrosis (including pneumonitis), drug-induced pneumonitis, organizing pneumonia (i.e. bronchiolitis obliterans, cryptogenic organizing pneumonia) or evidence of active pneumonitis on screening chest CT scan (history of radiation pneumonitis in the radiation field is permitted)
Patients with interstitial lung disease that is symptomatic or may interfere with the detection or management of suspected drug-related pulmonary toxicity
QTcF value of >470 ms. If prolonged, this should be confirmed by 2 further ECGs each separated by at least 5 minutes
Patients with the following risk factors for bowel perforation
History of acute diverticulitis or intra-abdominal abcess in the last 3 years
History of mechanical GI obstruction or abdominal carcinomatosis
Any unresolved toxicity CTCAE Grade ≥2 from previous anti-cancer therapy with the
exception of alopecia, vitiligo, and the laboratory values defined in the
inclusion criteria. Patients with any irreversible toxicity not reasonably
expected to be exacerbated by treatment with durvalumab may be included only
after consultation with the CI/TMG
Receipt of last dose of anti-cancer therapy (chemotherapy, immunotherapy, endocrine therapy, targeted therapy, biologic therapy, embolisation, monoclonal antibodies) within 30 days prior to first dose of trial treatment. NB: If sufficient washout time has not occurred due to the schedule or pharmacokinetic (PK) properties of an agent, a longer washout period will be required, as agreed by the Trial Management Group (TMG) and/or Chief Investigator (CI)
Treatment with any experimental drug within 30 days or 5 half-lives (whichever is longer) of the first dose of trial treatment
Concurrent enrolment in another clinical study, unless it is an observational (non-interventional) clinical study or during the follow-up period of an interventional study
Any evidence of severe or uncontrolled systemic diseases or laboratory finding that in the view of the investigator makes it undesirable for the patient to participate in the trial
Received therapeutic oral antibiotics that cannot be discontinued at least 14 days prior to starting treatment or received intravenous (IV) antibiotics within 14 days prior to registration. NB: Patients receiving prophylactic antibiotics (e.g. for prevention of a urinary tract infection or COPD) are eligible
Any psychiatric or other disorder (e.g. brain metastases) that impacts the patients ability to give informed consent or comply with trial treatment and activities
History of leptomeningeal carcinomatosis
Active infection of tuberculosis (TB) (clinically evaluated in accordance with local guidelines, e.g. clinical history, examination and radiographic findings with or without TB testing as clinically indicated)
Patients must not have had systemic corticosteroid therapy (>10 mg daily prednisolone equivalent) within 14 days prior to registration or concomitant use of other immunosuppressive medications. NB: The use of inhaled corticosteroids, physiologic replacement doses of glucocorticoids (i.e. for adrenal insufficiency) and mineralocorticoids (e.g. fludrocortisone) are allowed
Administration of a live, attenuated vaccine within 4 weeks prior to planned start of treatment or anticipation that such a live, attenuated vaccine will be required during the study
Evidence of significant uncontrolled concomitant disease that could substantially increase the risk of incurring adverse events (AEs), affect compliance with the protocol or interpretation of results, including significant liver disease (such as cirrhosis), uncontrolled hypertension, serious chronic gastrointestinal conditions associated with diarrhoea and uncontrolled major seizure disorder
Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of trial treatment. This does not include rigid cystoscopy and biopsies
Significant cardiovascular disease, such as
New York Heart Association cardiac disease (Class II or greater)
Myocardial infarction within 3 months prior to registration
Unstable arrhythmias
Unstable angina
Patients with uncontrolled Type 1 diabetes mellitus. Patients controlled on a stable
insulin regimen are eligible
Patients with uncontrolled adrenal insufficiency
Patients with active hepatitis infection (defined as having a positive hepatitis B surface antigen [HBsAg] test at screening) or hepatitis C. Patients with past hepatitis B virus (HBV) infection or resolved HBV infection (defined as having a negative HBsAg test and a positive antibody to hepatitis B core antigen [anti-HBc] antibody test) are eligible. Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction (PCR) is negative for HCV RNA
Known active primary immune deficiency, including but not limited to, uncontrolled human immunodeficiency virus (HIV) (detectable viral load) or acquired immunodeficiency syndrome (AIDS)-related illness
Women who are pregnant or breast feeding. Female or male patient of reproductive potential who is not willing to employ highly effective birth control from screening to 90 days after the last dose of trial treatment
Known allergy or hypersensitivity to any of the investigational products or their excipients
Prior enrolment to, or treatment in a previous durvalumab clinical study, regardless of treatment arm assignment
Patients must not donate blood while participating in this study and for at least 90 days following the last dose of trial treatment
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