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Safety of Pre-TURBT Intravesical Instillation of Escalating Doses of TC-3 Gel and MMC in NMIBC Patients

Primary Purpose

Bladder Cancer, Neoplasms, Urinary Bladder Diseases

Status
Completed
Phase
Phase 2
Locations
Israel
Study Type
Interventional
Intervention
120 mg MMC in 90ml gel
140 mg MMC in 90ml gel
160 mg MMC in 90ml gel
120 mg MMC in 60ml gel
140 mg MMC in 60ml gel
160 mg MMC in 60ml gel
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 TC-3 Gel, MMC, NMIBC, Non Muscle Invasive Bladder Cancer, Hydrogel Reverse thermal gelation, Drug retention, Urinary Bladder Neoplasms, Urologic Neoplasms, Urinary Bladder Diseases, Urologic Diseases

Eligibility Criteria

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

Inclusion Criteria:

  • Patient is 18 years of age or older.
  • Patient has signed Informed Consent Form and is willing and able to abide by the protocol.
  • Patients diagnosed with Low Grade (LG) or High grade (HG) NMIBC.
  • No active urinary tract infection as confirmed by urine culture.
  • If the patient is a female of childbearing potential, she is using two acceptable & effective methods of contraception, until 6 months post treatment
  • A negative serum pregnancy test at screening for female patient with childbearing potential
  • If the patient is a male he should use a condom during intercourse, for at least 48 hours post each instillation.
  • If the patient is a male that has a partner that is a female of childbearing potential, he should be advised to use two acceptable & effective methods of contraception until 6 months post treatment.

Exclusion Criteria:

  • Tumor located in prostatic urethra (for male patient) or in the bladder diverticulum.
  • Prior or required pelvic radiotherapy.
  • Systemic chemotherapy within 1 year prior the screening.
  • Pregnant or breastfeeding female patient.
  • Treatment of bladder cancer with BCG within the last 12 months prior to screening visit . Exception: For patient that had BCG treatment within 6-12 months prior to screening visit and are not symptomatic, the patient may enroll at the investigator discretion.
  • Treatment (full course) with intravesical chemotherapy within the 3 months, prior to screening visit.
  • Contraindication to MMC treatment as per investigator determination, or known sensitivity to MMC or TC-3 ingredients.
  • The patient has a known current urinary retention which requires intermittent catheterization to empty the bladder.
  • The patient has a bleeding disorder or a screening platelet count <100X109/L.
  • The patient has screening hemoglobin <10g/dL OR white blood cells < 4000 mm3.
  • GFR<30
  • Hepatic values exceeding 2 times the upper normal limit.
  • The patient has a concurrent severe and/or uncontrolled medical condition (e.g., uncontrolled diabetes, compensated congestive heart failure [NYHA III and over], myocardial infarction within 6 months of screening visit, unstable or uncontrolled hypertension or an active uncontrolled infection) or psychiatric disease, which could compromise participation, compliance with scheduled visits, and/or completion of the study in the opinion of the investigator.
  • The patient has a documented severe vesico-ureteral reflux or has an in-dwelling ureteral stent.
  • The patient participated in an investigational interventional study within the past 90 days, prior to screening visit.

Sites / Locations

  • Wolfson Medical Center of Holon, Department of Urology
  • Meir Medical Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Cohort A2

Cohort B2

Cohort C2

Cohort A

Cohort B

Cohort C

Arm Description

120 mg MMC in 90ml gel

140 mg MMC in 90ml gel

160 mg MMC in 90ml gel

120 mg MMC in 60ml gel

140 mg MMC in 60ml gel

160 mg MMC in 60ml gel

Outcomes

Primary Outcome Measures

Rate of Adverse Events (AE) findings considered to be dose limiting according to the CTCAE V 4.0
Vital signs findings considered to be dose limiting according to the CTCAE V 4.0
Clinical evaluation findings considered to be dose limiting according to the CTCAE V 4.0
Lab results considered to be dose limiting according to the CTCAE V 4.0

Secondary Outcome Measures

Rates of all adverse events or clinically relevant physical examination
Vital signs and laboratory findings
MMC maximum plasma concentration and concentration time curve during 6 hr post instillation
Duration of MMC retention in the bladder as detected by urine MMC levels post instillation (6-7 hours)

Full Information

First Posted
October 28, 2014
Last Updated
June 15, 2017
Sponsor
UroGen Pharma Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT02307487
Brief Title
Safety of Pre-TURBT Intravesical Instillation of Escalating Doses of TC-3 Gel and MMC in NMIBC Patients
Official Title
Evaluation of the Safety of Pre-TURBT Intravesical Instillation of Escalating Doses of TC-3 Gel Mixed With Mitomycin C (MMC) in Non-muscle Invasive Bladder Cancer (NMIBC) Patients
Study Type
Interventional

2. Study Status

Record Verification Date
June 2017
Overall Recruitment Status
Completed
Study Start Date
December 2014 (undefined)
Primary Completion Date
April 2016 (Actual)
Study Completion Date
June 2017 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A prospective, open label, modified 3+3 dose escalation study. This dose-escalation study is designed to carefully assess the safety of successive cohorts of patients (3 patients/cohort), each cohort treated with a fixed dose of TC-3 and MMC Intravesical instillations.
Detailed Description
A prospective, open label, modified 3+3 dose escalation study. This dose-escalation study is designed to carefully assess the safety of successive cohorts of patients. A total of 10 patients will be treated in the first cohort with 120mg MMC-TC-3 Gel unless DLT is reached in more than 1/3 of the patients in the cohort. The next cohorts will have 3 patients/cohort, each cohort treated with a fixed dose of TC-3 and MMC Intravesical instillations. Since data is already available for 40 and 80 mg MMC in TC-3 gel, the initial cohort is 120mg MMC mixed with of 60 mL TC-3. Subsequent cohorts will be given dose levels of 140mg & 160mg MMC mixed with 60 mL TC-3. Thus, if 160mg MMC mixed in 60ml TC-3 will be found to be safe and tolerable, no higher doses will be further explored at this stage. If 120 mg MMC in 60 ml TC-gel (2 mg/ml) is found to be intolerable, higher concentrations will not be tested. Instead, a dose of 120 mg in 90 cc TC gel and a subsequent doses of 140 and 160 mg MMC in 90 cc TC gel will be tested in the same dose escalating manner. This will allow testing similar doses at lower concentrations (up to 1.78 mg/ml) but with a longer dwell time due to the larger volume of TC-gel. Dose escalation is to be halted when the maximum tolerated dose (MTD) will be reached; MTD is defined as one dose level below which dose limited toxicity (DLT) is Any adverse event (AE) related to TC-3+MMC and qualified per National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) as grade 3 or 4 will be evaluated by board of 2 independent physicians to determine if it qualifies as DLT based on the known safety profile of MMC. If the NCI grade will not apply, the adverse event to be graded as mild, moderate, or severe. If one of the three patients in a cohort experienced a DLT, three more patients will be added to the cohort for AE confirmation, only if 3 patients from the given cohort will experienced DLT, the MTD will be reached If no further DLTs are observed in the cohort, the three patients will be enrolled in the next successive cohort.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bladder Cancer, Neoplasms, Urinary Bladder Diseases, Urologic Diseases
Keywords
TC-3 Gel, MMC, NMIBC, Non Muscle Invasive Bladder Cancer, Hydrogel Reverse thermal gelation, Drug retention, Urinary Bladder Neoplasms, Urologic Neoplasms, Urinary Bladder Diseases, Urologic Diseases

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Cohort A2
Arm Type
Experimental
Arm Description
120 mg MMC in 90ml gel
Arm Title
Cohort B2
Arm Type
Experimental
Arm Description
140 mg MMC in 90ml gel
Arm Title
Cohort C2
Arm Type
Experimental
Arm Description
160 mg MMC in 90ml gel
Arm Title
Cohort A
Arm Type
Experimental
Arm Description
120 mg MMC in 60ml gel
Arm Title
Cohort B
Arm Type
Experimental
Arm Description
140 mg MMC in 60ml gel
Arm Title
Cohort C
Arm Type
Experimental
Arm Description
160 mg MMC in 60ml gel
Intervention Type
Drug
Intervention Name(s)
120 mg MMC in 90ml gel
Other Intervention Name(s)
Mitomycin C
Intervention Description
120 mg of Mitomycin C mixed with 90 ml UroGen's TC-3 gel
Intervention Type
Drug
Intervention Name(s)
140 mg MMC in 90ml gel
Other Intervention Name(s)
Mitomycin C
Intervention Description
140 mg of Mitomycin C mixed with 90 ml UroGen's TC-3 gel
Intervention Type
Drug
Intervention Name(s)
160 mg MMC in 90ml gel
Other Intervention Name(s)
Mitomycin C
Intervention Description
160 mg of Mitomycin C mixed with 90 ml UroGen's TC-3 gel
Intervention Type
Drug
Intervention Name(s)
120 mg MMC in 60ml gel
Other Intervention Name(s)
Mitomycin C
Intervention Description
120 mg of Mitomycin C mixed with 60 ml UroGen's TC-3 gel
Intervention Type
Drug
Intervention Name(s)
140 mg MMC in 60ml gel
Other Intervention Name(s)
Mitomycin C
Intervention Description
140 mg of Mitomycin C mixed with 60 ml UroGen's TC-3 gel
Intervention Type
Drug
Intervention Name(s)
160 mg MMC in 60ml gel
Other Intervention Name(s)
Mitomycin C
Intervention Description
160 mg of Mitomycin C mixed with 60 ml UroGen's TC-3 gel
Primary Outcome Measure Information:
Title
Rate of Adverse Events (AE) findings considered to be dose limiting according to the CTCAE V 4.0
Time Frame
6 weeks
Title
Vital signs findings considered to be dose limiting according to the CTCAE V 4.0
Time Frame
6 weeks
Title
Clinical evaluation findings considered to be dose limiting according to the CTCAE V 4.0
Time Frame
6 weeks
Title
Lab results considered to be dose limiting according to the CTCAE V 4.0
Time Frame
6 weeks
Secondary Outcome Measure Information:
Title
Rates of all adverse events or clinically relevant physical examination
Time Frame
15 months
Title
Vital signs and laboratory findings
Time Frame
15 months
Title
MMC maximum plasma concentration and concentration time curve during 6 hr post instillation
Time Frame
15 months
Title
Duration of MMC retention in the bladder as detected by urine MMC levels post instillation (6-7 hours)
Time Frame
15 months
Other Pre-specified Outcome Measures:
Title
Rate of patients with Complete Response (CR) to treatment
Description
Complete Response (CR) rate defined as percent of patients with CR at the Primary Disease Evaluation (PDE) Visit
Time Frame
8-10 weeks post treatment
Title
Rate of patients with durable Complete Response (CR) to treatment
Description
Durable Complete Response (CR) rate defined as percent of patients who continue to display CR at 3, 6, 9 and 12 months following the last treatment.
Time Frame
3, 6, 9 and 12 months post PDE visit

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient is 18 years of age or older. Patient has signed Informed Consent Form and is willing and able to abide by the protocol. Patients diagnosed with Low Grade (LG) or High grade (HG) NMIBC. No active urinary tract infection as confirmed by urine culture. If the patient is a female of childbearing potential, she is using two acceptable & effective methods of contraception, until 6 months post treatment A negative serum pregnancy test at screening for female patient with childbearing potential If the patient is a male he should use a condom during intercourse, for at least 48 hours post each instillation. If the patient is a male that has a partner that is a female of childbearing potential, he should be advised to use two acceptable & effective methods of contraception until 6 months post treatment. Exclusion Criteria: Tumor located in prostatic urethra (for male patient) or in the bladder diverticulum. Prior or required pelvic radiotherapy. Systemic chemotherapy within 1 year prior the screening. Pregnant or breastfeeding female patient. Treatment of bladder cancer with BCG within the last 12 months prior to screening visit . Exception: For patient that had BCG treatment within 6-12 months prior to screening visit and are not symptomatic, the patient may enroll at the investigator discretion. Treatment (full course) with intravesical chemotherapy within the 3 months, prior to screening visit. Contraindication to MMC treatment as per investigator determination, or known sensitivity to MMC or TC-3 ingredients. The patient has a known current urinary retention which requires intermittent catheterization to empty the bladder. The patient has a bleeding disorder or a screening platelet count <100X109/L. The patient has screening hemoglobin <10g/dL OR white blood cells < 4000 mm3. GFR<30 Hepatic values exceeding 2 times the upper normal limit. The patient has a concurrent severe and/or uncontrolled medical condition (e.g., uncontrolled diabetes, compensated congestive heart failure [NYHA III and over], myocardial infarction within 6 months of screening visit, unstable or uncontrolled hypertension or an active uncontrolled infection) or psychiatric disease, which could compromise participation, compliance with scheduled visits, and/or completion of the study in the opinion of the investigator. The patient has a documented severe vesico-ureteral reflux or has an in-dwelling ureteral stent. The patient participated in an investigational interventional study within the past 90 days, prior to screening visit.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ifat Klein, PhD
Organizational Affiliation
UroGen Pharma
Official's Role
Study Director
Facility Information:
Facility Name
Wolfson Medical Center of Holon, Department of Urology
City
Holon
Country
Israel
Facility Name
Meir Medical Center
City
Kfar Saba
Country
Israel

12. IPD Sharing Statement

Links:
URL
http://www.urogen.com/
Description
UroGen pharma official website

Learn more about this trial

Safety of Pre-TURBT Intravesical Instillation of Escalating Doses of TC-3 Gel and MMC in NMIBC Patients

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