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Proliposomal Intravesical Paclitaxel for Treatment of Low-Grade, Stage Ta, Non Muscle Invasive Bladder Cancer

Primary Purpose

Bladder Cancer Cell Transitional, Non-Muscle Invasive Bladder Cancer, Bladder Cancer

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
TSD-001
Sponsored by
Lipac Oncology LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bladder Cancer Cell Transitional focused on measuring NMIBC, Paclitaxel, Antineoplastic Agents

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Has a diagnosis of low grade (G1 or G2), uni- or multifocal papillary appearing bladder tumor, stage Ta.
  • For part 1, subject will have ≥ 1 and ≤ 5 tumors (prior to TURBT), none of which exceeds 3.0 cm in diameter; for part 2, patient will have ≥ 2 and ≤ 5 tumors (prior to TURBT), none of which exceeds 3.0 cm in diameter (resection loop ~1 cm), OR, for part 2, subject meets this inclusion if on cystoscopic assessment they have a solitary papillary tumor (> 0.5 cm and ≤ 2.0 cm in diameter)..
  • Subject is surgical candidate for TURBT as part of normal NMIBC treatment plan. For part 1, successful completion of TURBT procedure. For part 2, successful completion of cystoscopic assessment/TURBT procedure with one marker lesion left intact; the marker lesion should be > 0.5 cm and < 2.0 cm in diameter.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
  • Peripheral neuropathy grade 1 or less.
  • Adequate hematological, hepatic, and renal parameters; i.e., hemoglobin > 10 g/dL, creatinine < 3.5 mg/dL, bilirubin < 1.5 mg/dL , and aspartate aminotransferase, alanine aminotransferase < 50 U/L, and alkaline phosphatase < 130 U/L.
  • All sexually active subjects of reproductive potential are required to use or start using a reliable method of birth control at least 2 weeks prior to study enrollment, throughout the study, and for at least 3 months following completion of study therapy.
  • Females of childbearing potential must have a negative pregnancy test within 30 days prior to enrollment. Females who are postmenopausal for at least 1 year (defined as more than 12 months since last menses) or are surgically sterilized do not require this test.
  • For male subjects, the digital rectal examination must not be suspicious for carcinoma of the prostate.
  • Able to retain bladder instillations for up to 120 minutes (± 15 minutes).

Exclusion Criteria:

  • Has an active concurrent malignancy/life-threatening disease. If there is a history of prior malignancies/life-threatening diseases, the subject is to be disease free for at least 5 years. Subjects with other prior malignancies less than 5 years before study entry may still be enrolled if they have received treatment resulting in complete resolution of the cancer and currently have no clinical, radiologic, or laboratory evidence of active or recurrent disease. Subjects will not be excluded for recurrent NMIBC, basal or squamous cell skin cancers, or noninvasive cancer of the cervix.
  • Has positive urine cytology for urothelial malignancy at screening.
  • Has an active uncontrolled infection, including a urinary tract infection, underlying medical condition, or other serious illness that would impair the ability of the subject to receive protocol treatment.
  • Previous intravesical therapy within 6 months of study entry.
  • Prior radiation to the pelvis.
  • Participated in a previous clinical trial or used any investigational drugs, biologics, or devices within 90 days prior to study treatment or plans to use any of these during the course of the study.
  • Has had any previous exposure to paclitaxel or docetaxel in the last 5 years.
  • Has or has ever had: upper tract TCC; urethral tumor (prostatic urethra included); any invasive bladder tumor known to be other than tumor Ta, low-grade (G1-G2); any evidence of lymph node or distant metastasis; any bladder tumor with histology other than TCC; or carcinoma in situ (CIS).
  • Has a tumor in a bladder diverticulum
  • Concurrent treatment with any chemotherapeutic agent.
  • History of vesicoureteral reflux.
  • An indwelling ureteral stent.
  • Has received any pelvic radiotherapy (including external beam and/or brachytherapy.)
  • Has a bleeding disorder or a screening platelet count < 100×109/L.
  • Has an active diagnosis of interstitial cystitis.
  • For subjects with recurrent tumor, the subject had at least a 6-month cystoscopically confirmed tumor-free interval between the last tumor recurrence and screening cystoscopic examination.
  • Presence of poorly controlled diabetes mellitus (glycated hemoglobin [HgbA1c] > 9.0%).

Sites / Locations

  • Urological Associates of Southern Arizona, PC
  • Trovare Clinical Research
  • Tower Urology
  • Chesapeake Urology Associates
  • Carolina Urologic Research Clinic

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

TSD-001 Administration Part 1, Cohort 1

TSD-001 Administration Part 1, Cohort 2

TSD-001 Administration Part 2

Arm Description

Part 1, Cohort 1: For the first 3 subjects enrolled, the initial dose will be 10 mg in Sterile Water for Injection (SWFI). TSD-001 will be retained in the bladder for 2 hours (1 hour or more will be acceptable, depending on subject's tolerability of the procedure). If Dose Limiting Toxicity(DLT) does not develop, intravesical instillation 14 days later will be titrated up according to the schedule (25, 50, 75, 100, 150 mg in SWFI) until DLT (defined as any grade 3 or 4 toxicity or prolonged [greater than 14 days] grade 2 toxicity) is observed.

Part 1, Cohort 1: For the next 3 subjects enrolled, the initial dose will be 90 mg in SWFI. TSD-001 will be retained in the bladder for 2 hours (1 hour or more will be acceptable, depending on subject's tolerability of the procedure). If DLT does not develop, intravesical instillation 14 days later will be titrated up according to the schedule (180, 270, 360, 450, and 540 mg in SWFI) until DLT (defined as any grade 3 or 4 toxicity or prolonged [greater than 14 days] grade 2 toxicity) is observed. If no DLT is observed in the first 6 subjects (cohorts 1 and 2) after titration up to 540 mg, then the maximum deliverable dose (MDD) will be defined and dose recommended for part 2 of the study.

In part 2, the dose will be selected as the MTD/MDD, established in part 1 and provided weekly via the intravesical route. During part 2, up to 10 additional subjects will receive intravesical instillations of TSD-001 via urethral catheterization of the urinary bladder at the MTD/MDD established in part 1 at weekly intervals for 6 consecutive weeks. TSD-001 will be retained in the bladder for 2 hours (1 hour or more will be acceptable, depending on subject's tolerability of the procedure).

Outcomes

Primary Outcome Measures

Part 1: Maximum Tolerated Dose
Dose immediately preceding the dose at which DLT occurs or when a MDD is reached.
Part 2: Marker Lesion Response Rate
Determine the marker lesion response rate using the MTD established in part 1.

Secondary Outcome Measures

Part 1: Determine paclitaxel concentrations
Determine the local (bladder urine) and systemic (peripheral blood) paclitaxel concentrations before and after intravesical exposure to TSD-001 at all doses. Blood and urine samples will be collected 15 (± 15) minutes before and 2 hours (± 10 minutes) after each instillation.
Part 2: Determine paclitaxel concentrations
Determine the local (bladder urine) paclitaxel concentrations 15 (± 15) minutes before, and 2 hours (± 10 minutes) after the third intravesical instillation of TSD-001. Determine the systemic (peripheral blood) paclitaxel concentration 2 hours (± 10 minutes) after the first intravesical instillation of TSD-001. Determine the systemic (peripheral blood) paclitaxel concentrations 15 (± 15) minutes before, and 2 hours (± 10 minutes) after the third intravesical instillation of TSD-001.
Severity and Frequency of Adverse Events
Characterize the severity and frequency of AEs following intravesical administration of TSD-001.

Full Information

First Posted
March 10, 2017
Last Updated
January 18, 2022
Sponsor
Lipac Oncology LLC
Collaborators
TesoRx Pharma, LLC
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1. Study Identification

Unique Protocol Identification Number
NCT03081858
Brief Title
Proliposomal Intravesical Paclitaxel for Treatment of Low-Grade, Stage Ta, Non Muscle Invasive Bladder Cancer
Official Title
A Phase 1/2a Pilot Study of Intravesical TSD-001 for Treatment of Low-Grade, Stage Ta, Non Muscle Invasive Bladder Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
January 2022
Overall Recruitment Status
Completed
Study Start Date
May 17, 2018 (Actual)
Primary Completion Date
August 27, 2020 (Actual)
Study Completion Date
August 5, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Lipac Oncology LLC
Collaborators
TesoRx Pharma, LLC

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a single-arm, phase 1/2a study of formulated paclitaxel in subjects with low-grade, noninvasive papillary carcinoma (stage Ta) of the bladder. Part 1 of the study will enroll 6 subjects (3 per cohort) with low-grade, stage Ta transitional cell carcinoma (TCC) of the bladder who will receive escalating doses of paclitaxel formulated as TSD-001 every 2 weeks for 6 treatments until Dose Limiting Toxicity (or until the Maximum Deliverable Dose) is observed (Maximum Tolerated Dose established). Part 2 of the study will enroll an additional 10 subjects with low-grade, stage Ta (uni-or multifocal) TCC of the bladder who will receive weekly TSD-001 for 6 weeks at the highest nontoxic dose (i.e., MTD) established in part 1 of the study. May meet definition of low grade without histological tissue diagnosis if on cystoscopic assessment they have a solitary papillary tumor. Part 3 of the study will continue to track subjects enrolled in Parts 1 and 2 to determine rates of disease-free survival.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bladder Cancer Cell Transitional, Non-Muscle Invasive Bladder Cancer, Bladder Cancer, Urinary Bladder, Transitional Cell Carcinoma of the Bladder, Urinary Bladder Neoplasms, Urologic Neoplasms, Urogenital Neoplasms, Urinary Bladder Diseases, Urologic Diseases
Keywords
NMIBC, Paclitaxel, Antineoplastic Agents

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
TSD-001 Administration Part 1, Cohort 1
Arm Type
Experimental
Arm Description
Part 1, Cohort 1: For the first 3 subjects enrolled, the initial dose will be 10 mg in Sterile Water for Injection (SWFI). TSD-001 will be retained in the bladder for 2 hours (1 hour or more will be acceptable, depending on subject's tolerability of the procedure). If Dose Limiting Toxicity(DLT) does not develop, intravesical instillation 14 days later will be titrated up according to the schedule (25, 50, 75, 100, 150 mg in SWFI) until DLT (defined as any grade 3 or 4 toxicity or prolonged [greater than 14 days] grade 2 toxicity) is observed.
Arm Title
TSD-001 Administration Part 1, Cohort 2
Arm Type
Experimental
Arm Description
Part 1, Cohort 1: For the next 3 subjects enrolled, the initial dose will be 90 mg in SWFI. TSD-001 will be retained in the bladder for 2 hours (1 hour or more will be acceptable, depending on subject's tolerability of the procedure). If DLT does not develop, intravesical instillation 14 days later will be titrated up according to the schedule (180, 270, 360, 450, and 540 mg in SWFI) until DLT (defined as any grade 3 or 4 toxicity or prolonged [greater than 14 days] grade 2 toxicity) is observed. If no DLT is observed in the first 6 subjects (cohorts 1 and 2) after titration up to 540 mg, then the maximum deliverable dose (MDD) will be defined and dose recommended for part 2 of the study.
Arm Title
TSD-001 Administration Part 2
Arm Type
Experimental
Arm Description
In part 2, the dose will be selected as the MTD/MDD, established in part 1 and provided weekly via the intravesical route. During part 2, up to 10 additional subjects will receive intravesical instillations of TSD-001 via urethral catheterization of the urinary bladder at the MTD/MDD established in part 1 at weekly intervals for 6 consecutive weeks. TSD-001 will be retained in the bladder for 2 hours (1 hour or more will be acceptable, depending on subject's tolerability of the procedure).
Intervention Type
Drug
Intervention Name(s)
TSD-001
Other Intervention Name(s)
Proliposomal Intravesical Paclitaxel
Intervention Description
Administered via intravesical instillation.
Primary Outcome Measure Information:
Title
Part 1: Maximum Tolerated Dose
Description
Dose immediately preceding the dose at which DLT occurs or when a MDD is reached.
Time Frame
12 weeks
Title
Part 2: Marker Lesion Response Rate
Description
Determine the marker lesion response rate using the MTD established in part 1.
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Part 1: Determine paclitaxel concentrations
Description
Determine the local (bladder urine) and systemic (peripheral blood) paclitaxel concentrations before and after intravesical exposure to TSD-001 at all doses. Blood and urine samples will be collected 15 (± 15) minutes before and 2 hours (± 10 minutes) after each instillation.
Time Frame
10 weeks
Title
Part 2: Determine paclitaxel concentrations
Description
Determine the local (bladder urine) paclitaxel concentrations 15 (± 15) minutes before, and 2 hours (± 10 minutes) after the third intravesical instillation of TSD-001. Determine the systemic (peripheral blood) paclitaxel concentration 2 hours (± 10 minutes) after the first intravesical instillation of TSD-001. Determine the systemic (peripheral blood) paclitaxel concentrations 15 (± 15) minutes before, and 2 hours (± 10 minutes) after the third intravesical instillation of TSD-001.
Time Frame
5 weeks
Title
Severity and Frequency of Adverse Events
Description
Characterize the severity and frequency of AEs following intravesical administration of TSD-001.
Time Frame
Part 1: 16 weeks, Part 2: 13 Weeks
Other Pre-specified Outcome Measures:
Title
Part 3: Rates of disease-free survival
Description
Long term follow-up (2 years post initial treatment) to determine when histological tissue diagnosis evidence of recurrence occurs for subjects exposed to TSD-001 in part 1 or part 2. Cystoscopic surveillance will be performed as standard of care approximately every 3 months from last endoscopic assessment in part 1 or part 2 until 24 months (from initial instillation).
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Has a diagnosis of low grade (G1 or G2), uni- or multifocal papillary appearing bladder tumor, stage Ta. For part 1, subject will have ≥ 1 and ≤ 5 tumors (prior to TURBT), none of which exceeds 3.0 cm in diameter; for part 2, patient will have ≥ 2 and ≤ 5 tumors (prior to TURBT), none of which exceeds 3.0 cm in diameter (resection loop ~1 cm), OR, for part 2, subject meets this inclusion if on cystoscopic assessment they have a solitary papillary tumor (> 0.5 cm and ≤ 2.0 cm in diameter).. Subject is surgical candidate for TURBT as part of normal NMIBC treatment plan. For part 1, successful completion of TURBT procedure. For part 2, successful completion of cystoscopic assessment/TURBT procedure with one marker lesion left intact; the marker lesion should be > 0.5 cm and < 2.0 cm in diameter. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Peripheral neuropathy grade 1 or less. Adequate hematological, hepatic, and renal parameters; i.e., hemoglobin > 10 g/dL, creatinine < 3.5 mg/dL, bilirubin < 1.5 mg/dL , and aspartate aminotransferase, alanine aminotransferase < 50 U/L, and alkaline phosphatase < 130 U/L. All sexually active subjects of reproductive potential are required to use or start using a reliable method of birth control at least 2 weeks prior to study enrollment, throughout the study, and for at least 3 months following completion of study therapy. Females of childbearing potential must have a negative pregnancy test within 30 days prior to enrollment. Females who are postmenopausal for at least 1 year (defined as more than 12 months since last menses) or are surgically sterilized do not require this test. For male subjects, the digital rectal examination must not be suspicious for carcinoma of the prostate. Able to retain bladder instillations for up to 120 minutes (± 15 minutes). Exclusion Criteria: Has an active concurrent malignancy/life-threatening disease. If there is a history of prior malignancies/life-threatening diseases, the subject is to be disease free for at least 5 years. Subjects with other prior malignancies less than 5 years before study entry may still be enrolled if they have received treatment resulting in complete resolution of the cancer and currently have no clinical, radiologic, or laboratory evidence of active or recurrent disease. Subjects will not be excluded for recurrent NMIBC, basal or squamous cell skin cancers, or noninvasive cancer of the cervix. Has positive urine cytology for urothelial malignancy at screening. Has an active uncontrolled infection, including a urinary tract infection, underlying medical condition, or other serious illness that would impair the ability of the subject to receive protocol treatment. Previous intravesical therapy within 6 months of study entry. Prior radiation to the pelvis. Participated in a previous clinical trial or used any investigational drugs, biologics, or devices within 90 days prior to study treatment or plans to use any of these during the course of the study. Has had any previous exposure to paclitaxel or docetaxel in the last 5 years. Has or has ever had: upper tract TCC; urethral tumor (prostatic urethra included); any invasive bladder tumor known to be other than tumor Ta, low-grade (G1-G2); any evidence of lymph node or distant metastasis; any bladder tumor with histology other than TCC; or carcinoma in situ (CIS). Has a tumor in a bladder diverticulum Concurrent treatment with any chemotherapeutic agent. History of vesicoureteral reflux. An indwelling ureteral stent. Has received any pelvic radiotherapy (including external beam and/or brachytherapy.) Has a bleeding disorder or a screening platelet count < 100×109/L. Has an active diagnosis of interstitial cystitis. For subjects with recurrent tumor, the subject had at least a 6-month cystoscopically confirmed tumor-free interval between the last tumor recurrence and screening cystoscopic examination. Presence of poorly controlled diabetes mellitus (glycated hemoglobin [HgbA1c] > 9.0%).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael Oefelein, MD
Organizational Affiliation
Lipac Oncology LLC
Official's Role
Study Director
Facility Information:
Facility Name
Urological Associates of Southern Arizona, PC
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85741
Country
United States
Facility Name
Trovare Clinical Research
City
Bakersfield
State/Province
California
ZIP/Postal Code
93301
Country
United States
Facility Name
Tower Urology
City
Los Angeles
State/Province
California
ZIP/Postal Code
90048
Country
United States
Facility Name
Chesapeake Urology Associates
City
Hanover
State/Province
Maryland
ZIP/Postal Code
21076
Country
United States
Facility Name
Carolina Urologic Research Clinic
City
Myrtle Beach
State/Province
South Carolina
ZIP/Postal Code
29572
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Proliposomal Intravesical Paclitaxel for Treatment of Low-Grade, Stage Ta, Non Muscle Invasive Bladder Cancer

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