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A Phase 2b Study of UGN-102 for Low Grade Intermediate Risk Non-Muscle-Invasive Bladder Cancer (OPTIMA II)

Primary Purpose

Bladder Cancer, Urothelial Carcinoma, Urothelial Carcinoma Bladder

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
UGN-102
Sponsored by
UroGen Pharma Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bladder Cancer focused on measuring Non-muscle invasive bladder cancer, Low grade non-muscle invasive bladder cancer, Intermediate risk non-muscle invasive bladder cancer, NMIBC, UGN-102, Mitomycin

Eligibility Criteria

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

Inclusion Criteria:

  1. Willing and able to sign an informed consent and comply with the protocol.
  2. Has newly diagnosed or historic LG NMIBC (Ta) histologically confirmed by cold cup biopsy at screening or within 6 weeks of screening.
  3. Is at intermediate risk of recurrence, defined as having 1 or 2 of the following:

    • Presence of multiple tumors;
    • Solitary tumor > 3 cm;
    • Recurrence (≥ 1 occurrence of LG NMIBC within 1 year of the current diagnosis).
  4. Has negative voiding cytology for high grade (HG) disease at or within 6 weeks of enrollment.
  5. Willing to use 2 acceptable forms of effective contraception from enrollment through 6 months post treatment if the participant is female or the female partner of a male participant and is of childbearing potential (defined as premenopausal women who have not been sterilized).
  6. Has adequate organ and bone marrow function as determined by routine laboratory tests as below:

    • Leukocytes ≥ 3,000 per μL;
    • Absolute neutrophil count ≥ 1,500 per μL;
    • Platelets ≥ 100,000 per μL;
    • Hemoglobin ≥ 9.0 g/dL;
    • Total bilirubin ≤ 1.5 x upper limit of normal (ULN);
    • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 × ULN;
    • Alkaline phosphatase ≤ 2.5 × ULN;
    • Estimated glomerular filtration rate (eGFR) ≥ 30 mL/min.
  7. Has no evidence of active urinary tract infection (UTI) at Screening and Baseline visits.

    • In the case of symptomatic UTI, the patient will be treated with a full course of antibiotics, and study drug will be postponed until resolution. In the case of asymptomatic bacteriuria, the use of prophylactic antibiotics and postponement of study drug is left to the discretion of the Principal Investigator (PI).

Exclusion Criteria:

  1. History of carcinoma in situ (CIS) on preliminary cystoscopy within 5 years of enrollment.
  2. Received Bacillus Calmette-Guérin (BCG) treatment for urothelial carcinoma (UC) within previous 2 years.
  3. History of HG papillary UC in the past 2 years.
  4. Known allergy or sensitivity to mitomycin.
  5. Clinically significant urethral stricture that would preclude passage of a urethral catheter.
  6. History of pelvic radiotherapy.
  7. History of:

    • Neurogenic bladder;
    • Active urinary retention;
    • Any other condition that would prohibit normal voiding.
  8. Past or current muscle invasive (ie, T2, T3, T4) or metastatic UC or concurrent upper tract urothelial carcinoma (UTUC).
  9. Has participated in a study with an investigational agent or device within 30 days of enrollment.
  10. History of prior treatment with an intravesical chemotherapeutic agent with the exception of a single dose of chemotherapy immediately after any previous transurethral resection of bladder tumors (TURBT).
  11. Has an underlying substance abuse or psychiatric disorder such that, in the opinion of the investigator, the patient would be unable to comply with the protocol.

Sites / Locations

  • Mayo Clinic Cancer Center
  • Arkansas Urology
  • Loma Linda University
  • Providence Medical Institute
  • Clinical Research Center of Florida
  • John Hopkins University
  • Adult & Pediatric Urology, PC
  • Urology Las Vegas
  • Manhattan Medical Research
  • Weill Cornell Medical College
  • Montefiore Medical Center (Albert Einstein)
  • Western New York Urology Associates
  • The University of North Carolina
  • Penn State Hershey State College
  • Carolina Urologic Research Center
  • Urology Associates, PC
  • Urology San Antonio
  • Carmel Medical Center
  • Rabin Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

UGN-102

Arm Description

Patients were treated with 6 once-weekly intravesical instillations of UGN-102.

Outcomes

Primary Outcome Measures

Complete Response (CR) Rate for UGN-102 Treatment
To evaluate the tumor ablative effect of UGN-102 in patients with LG NMIBC. CR rate was defined as the percentage of patients with no detectable disease (NDD) as determined by cystoscopy, for cause biopsy, and urine cytology.

Secondary Outcome Measures

Durable Complete Response (DCR) Rate
To evaluate the durability of response in patients with LG NMIBC who achieve CR. DCR rate was defined as the percentage of patients who maintained CR at the respective time point.
Number of Participants With Treatment-emergent Adverse Events (TEAEs), Study Drug or Procedure Related TEAEs, TEAEs by Maximum Severity, TEAEs Leading to Treatment Discontinuation, and Serious TEAEs.
The number of patients with each type of event will be summarized. Adverse event severity was graded according to Common Terminology Criteria for Adverse Events version 5.0 as follows: Grade 1 (mild), Grade 2 (moderate), Grade 3 (severe or medically significant), Grade 4 (life-threatening), Grade 5 (fatal).
Number of Participants With Post-baseline Potentially Clinically Significant (PCS) Laboratory Values
The number of patients who met PCS criteria for chemistry or hematology parameters post-baseline will be summarized
Number of Participants With Post-baseline PCS Vital Signs Values
The number of patients who met PCS criteria for vital signs parameters post-baseline will be summarized
Number of Participants With Post-baseline Clinically Significant (CS) Physical Examination Findings
The number of patients with abnormal, CS physical examination findings post-baseline will be summarized
Number of Participants With Post-baseline CS Urology-oriented Physical Examination Findings
The number of patients with abnormal, CS urology-oriented physical examination findings post-baseline will be summarized

Full Information

First Posted
May 8, 2018
Last Updated
September 1, 2022
Sponsor
UroGen Pharma Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT03558503
Brief Title
A Phase 2b Study of UGN-102 for Low Grade Intermediate Risk Non-Muscle-Invasive Bladder Cancer
Acronym
OPTIMA II
Official Title
A Phase 2b, Single-Arm, Multicenter Trial to Evaluate the Efficacy and Safety of UGN-102 as Primary Chemoablative Therapy in Patients With Low Grade (LG) Non-Muscle-Invasive Bladder Cancer (NMIBC) at Intermediate Risk of Recurrence
Study Type
Interventional

2. Study Status

Record Verification Date
September 2022
Overall Recruitment Status
Completed
Study Start Date
October 15, 2018 (Actual)
Primary Completion Date
January 3, 2020 (Actual)
Study Completion Date
October 21, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
UroGen Pharma Ltd.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
This Phase 2b, single-arm, multicenter study evaluated the efficacy and safety of UGN-102 as primary chemoablative therapy in patients with low grade intermediate risk non-muscle-invasive bladder cancer (LG IR NMIBC).
Detailed Description
Eligible patients were treated with 6 once-weekly intravesical instillations of UGN-102. The ablative effect of UGN-102 was evaluated at the 3-month Visit, which occurred 5 weeks ± 1 week after the last weekly instillation (3 months after initiation of study drug). Response was determined based on visual evaluation by cystoscopy (appearance, number, and size of the lesions) and, if there were remaining lesions, by histopathology of the remaining lesions. Complete response (CR) was defined as having no detectable disease (NDD) and was assessed visually during cystoscopy and also by urine cytology. In the event that the investigator was not sure, and there was suspect tissue, a small biopsy was taken from the suspect tissue to confirm CR in addition to cystoscopy and urine cytology. Patients who achieved a CR continued to have monthly telephone contacts to document any adverse events (AEs) and changes in concomitant medications and were assessed at 6, 9, and 12 months after the first instillation of UGN-102 for evidence of disease recurrence. Patients who had a non-complete response (non-CR) discontinued the study and continued with standard of care according to their treating physician. Safety was determined based on a review of AEs, laboratory assessments, and physical examination findings.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bladder Cancer, Urothelial Carcinoma, Urothelial Carcinoma Bladder
Keywords
Non-muscle invasive bladder cancer, Low grade non-muscle invasive bladder cancer, Intermediate risk non-muscle invasive bladder cancer, NMIBC, UGN-102, Mitomycin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
63 (Actual)

8. Arms, Groups, and Interventions

Arm Title
UGN-102
Arm Type
Experimental
Arm Description
Patients were treated with 6 once-weekly intravesical instillations of UGN-102.
Intervention Type
Drug
Intervention Name(s)
UGN-102
Other Intervention Name(s)
UGN-102 (mitomycin) for intravesical solution
Intervention Description
UGN-102 consists of mitomycin and sterile hydrogel (a proprietary thermally responsive gel) that is used to reconstitute mitomycin before instillation. The reverse thermal properties of UGN-102 allow for local administration of mitomycin as a liquid, with subsequent conversion to a semi-solid gel depot following instillation into the bladder. The UGN-102 admixture for intravesical instillations contains 75 mg mitomycin in 56 mL admixture (1.33 mg mitomycin per 1 mL).
Primary Outcome Measure Information:
Title
Complete Response (CR) Rate for UGN-102 Treatment
Description
To evaluate the tumor ablative effect of UGN-102 in patients with LG NMIBC. CR rate was defined as the percentage of patients with no detectable disease (NDD) as determined by cystoscopy, for cause biopsy, and urine cytology.
Time Frame
3 months after the first instillation of UGN-102
Secondary Outcome Measure Information:
Title
Durable Complete Response (DCR) Rate
Description
To evaluate the durability of response in patients with LG NMIBC who achieve CR. DCR rate was defined as the percentage of patients who maintained CR at the respective time point.
Time Frame
6, 9, and 12 months after the first instillation of UGN-102
Title
Number of Participants With Treatment-emergent Adverse Events (TEAEs), Study Drug or Procedure Related TEAEs, TEAEs by Maximum Severity, TEAEs Leading to Treatment Discontinuation, and Serious TEAEs.
Description
The number of patients with each type of event will be summarized. Adverse event severity was graded according to Common Terminology Criteria for Adverse Events version 5.0 as follows: Grade 1 (mild), Grade 2 (moderate), Grade 3 (severe or medically significant), Grade 4 (life-threatening), Grade 5 (fatal).
Time Frame
Up to 12 months
Title
Number of Participants With Post-baseline Potentially Clinically Significant (PCS) Laboratory Values
Description
The number of patients who met PCS criteria for chemistry or hematology parameters post-baseline will be summarized
Time Frame
Up to 12 months
Title
Number of Participants With Post-baseline PCS Vital Signs Values
Description
The number of patients who met PCS criteria for vital signs parameters post-baseline will be summarized
Time Frame
Up to 12 months
Title
Number of Participants With Post-baseline Clinically Significant (CS) Physical Examination Findings
Description
The number of patients with abnormal, CS physical examination findings post-baseline will be summarized
Time Frame
Up to 12 months
Title
Number of Participants With Post-baseline CS Urology-oriented Physical Examination Findings
Description
The number of patients with abnormal, CS urology-oriented physical examination findings post-baseline will be summarized
Time Frame
Up to 12 months
Other Pre-specified Outcome Measures:
Title
Mitomycin Plasma Concentrations
Description
Mitomycin plasma concentrations were assessed in a subset of 6 patients treated with UGN-102
Time Frame
0 (pre-instillation), 0.5, 1, 2, 3, 4, 5, and 6 hours after the first instillation of UGN-102
Title
Mitomycin Area Under the Plasma Concentration-time Curve (AUC)
Description
Mitomycin AUC was assessed in a subset of 6 patients treated with UGN-102
Time Frame
0 (pre-instillation) to 6 hours after the first instillation of UGN-102
Title
Mitomycin Maximum Plasma Concentration (Cmax)
Description
Mitomycin Cmax was assessed in a subset of 6 patients treated with UGN-102
Time Frame
0 (pre-instillation), 0.5, 1, 2, 3, 4, 5, and 6 hours after the first instillation of UGN-102

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Willing and able to sign an informed consent and comply with the protocol. Has newly diagnosed or historic LG NMIBC (Ta) histologically confirmed by cold cup biopsy at screening or within 6 weeks of screening. Is at intermediate risk of recurrence, defined as having 1 or 2 of the following: Presence of multiple tumors; Solitary tumor > 3 cm; Recurrence (≥ 1 occurrence of LG NMIBC within 1 year of the current diagnosis). Has negative voiding cytology for high grade (HG) disease at or within 6 weeks of enrollment. Willing to use 2 acceptable forms of effective contraception from enrollment through 6 months post treatment if the participant is female or the female partner of a male participant and is of childbearing potential (defined as premenopausal women who have not been sterilized). Has adequate organ and bone marrow function as determined by routine laboratory tests as below: Leukocytes ≥ 3,000 per μL; Absolute neutrophil count ≥ 1,500 per μL; Platelets ≥ 100,000 per μL; Hemoglobin ≥ 9.0 g/dL; Total bilirubin ≤ 1.5 x upper limit of normal (ULN); Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 × ULN; Alkaline phosphatase ≤ 2.5 × ULN; Estimated glomerular filtration rate (eGFR) ≥ 30 mL/min. Has no evidence of active urinary tract infection (UTI) at Screening and Baseline visits. In the case of symptomatic UTI, the patient will be treated with a full course of antibiotics, and study drug will be postponed until resolution. In the case of asymptomatic bacteriuria, the use of prophylactic antibiotics and postponement of study drug is left to the discretion of the Principal Investigator (PI). Exclusion Criteria: History of carcinoma in situ (CIS) on preliminary cystoscopy within 5 years of enrollment. Received Bacillus Calmette-Guérin (BCG) treatment for urothelial carcinoma (UC) within previous 2 years. History of HG papillary UC in the past 2 years. Known allergy or sensitivity to mitomycin. Clinically significant urethral stricture that would preclude passage of a urethral catheter. History of pelvic radiotherapy. History of: Neurogenic bladder; Active urinary retention; Any other condition that would prohibit normal voiding. Past or current muscle invasive (ie, T2, T3, T4) or metastatic UC or concurrent upper tract urothelial carcinoma (UTUC). Has participated in a study with an investigational agent or device within 30 days of enrollment. History of prior treatment with an intravesical chemotherapeutic agent with the exception of a single dose of chemotherapy immediately after any previous transurethral resection of bladder tumors (TURBT). Has an underlying substance abuse or psychiatric disorder such that, in the opinion of the investigator, the patient would be unable to comply with the protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elyse Seltzer, MD
Organizational Affiliation
UroGen Pharma
Official's Role
Study Director
Facility Information:
Facility Name
Mayo Clinic Cancer Center
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85054
Country
United States
Facility Name
Arkansas Urology
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72211
Country
United States
Facility Name
Loma Linda University
City
Loma Linda
State/Province
California
ZIP/Postal Code
92350
Country
United States
Facility Name
Providence Medical Institute
City
Santa Monica
State/Province
California
ZIP/Postal Code
90404
Country
United States
Facility Name
Clinical Research Center of Florida
City
Pompano Beach
State/Province
Florida
ZIP/Postal Code
33060
Country
United States
Facility Name
John Hopkins University
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21218
Country
United States
Facility Name
Adult & Pediatric Urology, PC
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68114
Country
United States
Facility Name
Urology Las Vegas
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89144
Country
United States
Facility Name
Manhattan Medical Research
City
New York
State/Province
New York
ZIP/Postal Code
10016
Country
United States
Facility Name
Weill Cornell Medical College
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Name
Montefiore Medical Center (Albert Einstein)
City
New York
State/Province
New York
ZIP/Postal Code
10461
Country
United States
Facility Name
Western New York Urology Associates
City
New York
State/Province
New York
ZIP/Postal Code
14225
Country
United States
Facility Name
The University of North Carolina
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27572
Country
United States
Facility Name
Penn State Hershey State College
City
Hershey
State/Province
Pennsylvania
ZIP/Postal Code
17033
Country
United States
Facility Name
Carolina Urologic Research Center
City
Myrtle Beach
State/Province
South Carolina
ZIP/Postal Code
29572
Country
United States
Facility Name
Urology Associates, PC
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37209
Country
United States
Facility Name
Urology San Antonio
City
Fredericksburg
State/Province
Texas
ZIP/Postal Code
78233
Country
United States
Facility Name
Carmel Medical Center
City
Haifa
ZIP/Postal Code
3436212
Country
Israel
Facility Name
Rabin Medical Center
City
Petah tikva
ZIP/Postal Code
49372
Country
Israel

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
34433303
Citation
Chevli KK, Shore ND, Trainer A, Smith AB, Saltzstein D, Ehrlich Y, Raman JD, Friedman B, D'Anna R, Morris D, Hu B, Tyson M, Sankin A, Kates M, Linehan J, Scherr D, Kester S, Verni M, Chamie K, Karsh L, Cinman A, Meads A, Lahiri S, Malinowski M, Gabai N, Raju S, Schoenberg M, Seltzer E, Huang WC. Primary Chemoablation of Low-Grade Intermediate-Risk Nonmuscle-Invasive Bladder Cancer Using UGN-102, a Mitomycin-Containing Reverse Thermal Gel (Optima II): A Phase 2b, Open-Label, Single-Arm Trial. J Urol. 2022 Jan;207(1):61-69. doi: 10.1097/JU.0000000000002186. Epub 2021 Aug 26.
Results Reference
result
PubMed Identifier
35640276
Citation
Stover AM, Basak R, Mueller D, Lipman R, Teal R, Hilton A, Giannone K, Waheed M, Smith AB. Minimal Patient-Reported Side Effects for a Chemoablative Gel (UGN-102) Used as Frontline Treatment in Adults with Nonmuscle-Invasive Bladder Cancer. J Urol. 2022 Sep;208(3):580-588. doi: 10.1097/JU.0000000000002747. Epub 2022 May 31.
Results Reference
derived

Learn more about this trial

A Phase 2b Study of UGN-102 for Low Grade Intermediate Risk Non-Muscle-Invasive Bladder Cancer

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