Brief Summary
This study, BC-819-18-204, is a Phase 2, open-label, monotherapy, single-arm, multicenter clinical trial of BC-819 (inodiftagene vixteplasmid) in patients with NMIBC adequately treated with Bacillus Calmette-Guerin (BCG) whose disease is BCG unresponsive according to the US Food and Drug Administration (FDA) guidance.
Brief Title
Codex: Study of Inodiftagene Vixteplasmid (BC-819) in Unresponsive NMIBC
Detailed Description
BC-819 (inodiftagene vixteplasmid) is a recombinant DNA plasmid that directs the expression of a potent toxin specifically in malignant cells but not in normal tissue. It has been designed to exploit the established biology of the H19 gene, which is upregulated and expressed at high levels only in malignant cells, to produce bacterial diphtheria toxin only in bladder cancer tissue. BC-819 is administered directly into the bladder to enable maximal topical exposure to target bladder cancer cells.
Categories
Completion Date
Completion Date Type
Actual
Conditions
Non-muscle Invasive Bladder Cancer (NMIBC)
Eligibility Criteria
Inclusion Criteria:
1. Male or female patients ≥18 years of age at the time of consent
2. Patient must have been adequately treated with BCG defined as at least one of the following (FDA 2018):
1. At least five of six doses of an initial induction course plus at least two of three doses of maintenance therapy
2. At least five of six doses of an initial induction course plus at least two of six doses of a second induction course
3. A single course of induction BCG can qualify if the patient has T1 high-grade disease at first evaluation (see 3c)
3. Patient must be BCG-unresponsive defined as at least one of the following (FDA 2018):
1. Persistent or recurrent CIS alone or with recurrent Ta/T1 disease within 12 months of completion of adequate BCG therapy. An assessment within 15 months can also qualify when no assessment was done 12 months after completion of adequate BCG therapy.
2. Recurrent high-grade Ta/T1 disease within 6 months of completion of adequate BCG therapy. An assessment within 9 months can also qualify when no assessment was done 6 months after completion of adequate BCG therapy.
3. T1 high-grade disease at the first evaluation following a single course of induction BCG qualifies (Lerner et al. 2015, Steinberg et al. 2016)
4. Patient must have, at study entry, NMIBC indicated by 1 or more of the following:
1. Ta or T1 high-grade disease
2. CIS disease
5. Patient must have no known evidence of concomitant upper tract urothelial carcinoma or urothelial carcinoma within the prostatic urethra within 6 months of enrollment
6. Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status ≤2
7. Patient must have adequate hematologic function, as demonstrated by the following:
1. Hemoglobin level ≥10 g/dL
2. Absolute neutrophil count ≥1.5 x 109/L
3. Platelet count ≥100 x 109/L
8. Patient must have adequate liver and renal function as demonstrated by the following:
1. Aspartate aminotransferase and alanine aminotransferase each ≤3.0 x upper limit of normal
2. Total bilirubin ≤1.5 x upper limit of normal, unless prior documentation of Gilbert's syndrome in which case, 3.0 mg/dL is allowed
3. Serum creatinine ≤1.5 x upper limit of normal or measured or calculated creatinine clearance ≥30 mL/min
9. Female patients of childbearing potential must use maximally effective birth control during the period of therapy and for 1 month after the last study drug infusion
10. Male patients who are sexually active must be willing to use a double barrier contraceptive method upon study enrollment, during the course of the study, and for 1 month after the last study drug infusion
Exclusion Criteria:
1. Patient has current or previous evidence of muscle invasive (muscularis propria) or metastatic bladder cancer disease
2. Patient has received prior investigational therapy for NMIBC
3. Patient has received any therapy for NMIBC within 10 weeks before the start of study treatment other than surgical resection, 1 dose of chemotherapy, and previous BCG
4. Patient is intolerant to previous BCG treatment in the absence of meeting other criteria for BCG unresponsiveness and adequate BCG therapy
5. Patient has received external beam radiation therapy for bladder cancer at any time or for any other condition
6. Patient has an active infection, including urinary tract infection (viral, bacterial, or fungal) and cystitis
7. Patient has urinary tract signs or symptoms that preclude retention of drug in the bladder; this does not include anticholinergic drugs
8. Patient is known to have tested positive for human immunodeficiency virus (HIV). No HIV testing is required if patient is not known have tested positive
9. Patient is female and is pregnant or breastfeeding
10. Patient has a known presence or history of malignancy of other organ system within the 5 years before study start, with the exception of non-melanoma skin cancer; very low or low-risk prostate cancer; or patients who have been disease free for at least 2 years following stage 1 or 2 cancer
1. Male or female patients ≥18 years of age at the time of consent
2. Patient must have been adequately treated with BCG defined as at least one of the following (FDA 2018):
1. At least five of six doses of an initial induction course plus at least two of three doses of maintenance therapy
2. At least five of six doses of an initial induction course plus at least two of six doses of a second induction course
3. A single course of induction BCG can qualify if the patient has T1 high-grade disease at first evaluation (see 3c)
3. Patient must be BCG-unresponsive defined as at least one of the following (FDA 2018):
1. Persistent or recurrent CIS alone or with recurrent Ta/T1 disease within 12 months of completion of adequate BCG therapy. An assessment within 15 months can also qualify when no assessment was done 12 months after completion of adequate BCG therapy.
2. Recurrent high-grade Ta/T1 disease within 6 months of completion of adequate BCG therapy. An assessment within 9 months can also qualify when no assessment was done 6 months after completion of adequate BCG therapy.
3. T1 high-grade disease at the first evaluation following a single course of induction BCG qualifies (Lerner et al. 2015, Steinberg et al. 2016)
4. Patient must have, at study entry, NMIBC indicated by 1 or more of the following:
1. Ta or T1 high-grade disease
2. CIS disease
5. Patient must have no known evidence of concomitant upper tract urothelial carcinoma or urothelial carcinoma within the prostatic urethra within 6 months of enrollment
6. Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status ≤2
7. Patient must have adequate hematologic function, as demonstrated by the following:
1. Hemoglobin level ≥10 g/dL
2. Absolute neutrophil count ≥1.5 x 109/L
3. Platelet count ≥100 x 109/L
8. Patient must have adequate liver and renal function as demonstrated by the following:
1. Aspartate aminotransferase and alanine aminotransferase each ≤3.0 x upper limit of normal
2. Total bilirubin ≤1.5 x upper limit of normal, unless prior documentation of Gilbert's syndrome in which case, 3.0 mg/dL is allowed
3. Serum creatinine ≤1.5 x upper limit of normal or measured or calculated creatinine clearance ≥30 mL/min
9. Female patients of childbearing potential must use maximally effective birth control during the period of therapy and for 1 month after the last study drug infusion
10. Male patients who are sexually active must be willing to use a double barrier contraceptive method upon study enrollment, during the course of the study, and for 1 month after the last study drug infusion
Exclusion Criteria:
1. Patient has current or previous evidence of muscle invasive (muscularis propria) or metastatic bladder cancer disease
2. Patient has received prior investigational therapy for NMIBC
3. Patient has received any therapy for NMIBC within 10 weeks before the start of study treatment other than surgical resection, 1 dose of chemotherapy, and previous BCG
4. Patient is intolerant to previous BCG treatment in the absence of meeting other criteria for BCG unresponsiveness and adequate BCG therapy
5. Patient has received external beam radiation therapy for bladder cancer at any time or for any other condition
6. Patient has an active infection, including urinary tract infection (viral, bacterial, or fungal) and cystitis
7. Patient has urinary tract signs or symptoms that preclude retention of drug in the bladder; this does not include anticholinergic drugs
8. Patient is known to have tested positive for human immunodeficiency virus (HIV). No HIV testing is required if patient is not known have tested positive
9. Patient is female and is pregnant or breastfeeding
10. Patient has a known presence or history of malignancy of other organ system within the 5 years before study start, with the exception of non-melanoma skin cancer; very low or low-risk prostate cancer; or patients who have been disease free for at least 2 years following stage 1 or 2 cancer
Inclusion Criteria
Inclusion Criteria:
1. Male or female patients ≥18 years of age at the time of consent
2. Patient must have been adequately treated with BCG defined as at least one of the following (FDA 2018):
1. At least five of six doses of an initial induction course plus at least two of three doses of maintenance therapy
2. At least five of six doses of an initial induction course plus at least two of six doses of a second induction course
3. A single course of induction BCG can qualify if the patient has T1 high-grade disease at first evaluation (see 3c)
3. Patient must be BCG-unresponsive defined as at least one of the following (FDA 2018):
1. Persistent or recurrent CIS alone or with recurrent Ta/T1 disease within 12 months of completion of adequate BCG therapy. An assessment within 15 months can also qualify when no assessment was done 12 months after completion of adequate BCG therapy.
2. Recurrent high-grade Ta/T1 disease within 6 months of completion of adequate BCG therapy. An assessment within 9 months can also qualify when no assessment was done 6 months after completion of adequate BCG therapy.
3. T1 high-grade disease at the first evaluation following a single course of induction BCG qualifies (Lerner et al. 2015, Steinberg et al. 2016)
4. Patient must have, at study entry, NMIBC indicated by 1 or more of the following:
1. Ta or T1 high-grade disease
2. CIS disease
5. Patient must have no known evidence of concomitant upper tract urothelial carcinoma or urothelial carcinoma within the prostatic urethra within 6 months of enrollment
6. Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status ≤2
7. Patient must have adequate hematologic function, as demonstrated by the following:
1. Hemoglobin level ≥10 g/dL
2. Absolute neutrophil count ≥1.5 x 109/L
3. Platelet count ≥100 x 109/L
8. Patient must have adequate liver and renal function as demonstrated by the following:
1. Aspartate aminotransferase and alanine aminotransferase each ≤3.0 x upper limit of normal
2. Total bilirubin ≤1.5 x upper limit of normal, unless prior documentation of Gilbert's syndrome in which case, 3.0 mg/dL is allowed
3. Serum creatinine ≤1.5 x upper limit of normal or measured or calculated creatinine clearance ≥30 mL/min
9. Female patients of childbearing potential must use maximally effective birth control during the period of therapy and for 1 month after the last study drug infusion
10. Male patients who are sexually active must be willing to use a double barrier contraceptive method upon study enrollment, during the course of the study, and for 1 month after the last study drug infusion
1. Male or female patients ≥18 years of age at the time of consent
2. Patient must have been adequately treated with BCG defined as at least one of the following (FDA 2018):
1. At least five of six doses of an initial induction course plus at least two of three doses of maintenance therapy
2. At least five of six doses of an initial induction course plus at least two of six doses of a second induction course
3. A single course of induction BCG can qualify if the patient has T1 high-grade disease at first evaluation (see 3c)
3. Patient must be BCG-unresponsive defined as at least one of the following (FDA 2018):
1. Persistent or recurrent CIS alone or with recurrent Ta/T1 disease within 12 months of completion of adequate BCG therapy. An assessment within 15 months can also qualify when no assessment was done 12 months after completion of adequate BCG therapy.
2. Recurrent high-grade Ta/T1 disease within 6 months of completion of adequate BCG therapy. An assessment within 9 months can also qualify when no assessment was done 6 months after completion of adequate BCG therapy.
3. T1 high-grade disease at the first evaluation following a single course of induction BCG qualifies (Lerner et al. 2015, Steinberg et al. 2016)
4. Patient must have, at study entry, NMIBC indicated by 1 or more of the following:
1. Ta or T1 high-grade disease
2. CIS disease
5. Patient must have no known evidence of concomitant upper tract urothelial carcinoma or urothelial carcinoma within the prostatic urethra within 6 months of enrollment
6. Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status ≤2
7. Patient must have adequate hematologic function, as demonstrated by the following:
1. Hemoglobin level ≥10 g/dL
2. Absolute neutrophil count ≥1.5 x 109/L
3. Platelet count ≥100 x 109/L
8. Patient must have adequate liver and renal function as demonstrated by the following:
1. Aspartate aminotransferase and alanine aminotransferase each ≤3.0 x upper limit of normal
2. Total bilirubin ≤1.5 x upper limit of normal, unless prior documentation of Gilbert's syndrome in which case, 3.0 mg/dL is allowed
3. Serum creatinine ≤1.5 x upper limit of normal or measured or calculated creatinine clearance ≥30 mL/min
9. Female patients of childbearing potential must use maximally effective birth control during the period of therapy and for 1 month after the last study drug infusion
10. Male patients who are sexually active must be willing to use a double barrier contraceptive method upon study enrollment, during the course of the study, and for 1 month after the last study drug infusion
Gender
All
Gender Based
false
Keywords
BCG-unresponsive
Healthy Volunteers
No
Last Update Post Date
Last Update Post Date Type
Actual
Last Update Submit Date
Minimum Age
18 Years
NCT Id
NCT03719300
Org Class
Industry
Org Full Name
Anchiano Therapeutics Israel Ltd.
Org Study Id
BC-819-18-204
Overall Status
Terminated
Phases
Phase 2
Primary Completion Date
Primary Completion Date Type
Actual
Official Title
A Phase 2 Study of BC-819 in Patients With Non-Muscle Invasive Bladder Cancer Whose Disease is Unresponsive to Bacillus Calmette-Guerin
Primary Outcomes
Outcome Description
Complete response is defined as at least one of the following:
* Negative cystoscopy and negative (including atypical) urine cytology
* Positive cystoscopy with biopsy-proven benign or low-grade NMIBC and negative cytology
* Negative cystoscopy with malignant urine cytology if cancer is found in the upper tract or prostatic urethra and random bladder biopsies are negative
The complete response in patients with CIS for this endpoint was documented on or after the Week 12 response assessment and on or prior to the Week 48 assessment. Duration of complete response in patients with CIS was calculated from the documented onset of the complete response to the assessment where the patient no longer met the definition of complete response.
* Negative cystoscopy and negative (including atypical) urine cytology
* Positive cystoscopy with biopsy-proven benign or low-grade NMIBC and negative cytology
* Negative cystoscopy with malignant urine cytology if cancer is found in the upper tract or prostatic urethra and random bladder biopsies are negative
The complete response in patients with CIS for this endpoint was documented on or after the Week 12 response assessment and on or prior to the Week 48 assessment. Duration of complete response in patients with CIS was calculated from the documented onset of the complete response to the assessment where the patient no longer met the definition of complete response.
Outcome Measure
The Percentage of Patients With Baseline CIS That Achieve a Complete Response After Treatment With BC-819 (Measured at 12 Weeks)
Outcome Time Frame
12 weeks
Secondary Outcomes
Outcome Description
Time to recurrence (Kaplan-Meier plot) recurrence is defined as the reappearance or persistence of high-grade disease, or new high-grade disease. Recurrence must be biopsy proven. Persistence, appearance, or presence of lower grade disease was not considered to be a recurrence event
Outcome Time Frame
48 weeks
Outcome Measure
Percentage of Patients With Absence of High-grade Recurrent or Persistent Disease at 48 Weeks (Overall Population and Subgroup of Patients With CIS)
Outcome Description
Time to recurrence (Kaplan-Meier plot) recurrence is defined as the reappearance or persistence of high-grade disease, or new high-grade disease. Recurrence must be biopsy proven. Persistence, appearance, or presence of lower grade disease was not considered to be a recurrence event.
Outcome Time Frame
12, 24, 36, 72, and 96 weeks
Outcome Measure
Percentage of Patients With Absence of High-grade Recurrent or Persistent Disease at 12, 24, 36, 72, and 96 Weeks (Overall Population and Subgroup of Patients With CIS)
Outcome Description
The incidence of PFS at 48, 72, and 96 weeks as well as time to progression estimated using Kaplan-Meir methods. Progression is defined as the development of T2 or greater disease. Sensitivity analyses was performed and included any of the following as progressions:
* An increase in stage from Ta or CIS to T1, or
* Development of T2 or greater, or
* Lymph node disease, or
* Distant metastasis
* An increase in stage from Ta or CIS to T1, or
* Development of T2 or greater, or
* Lymph node disease, or
* Distant metastasis
Outcome Time Frame
48, 72, and 96 weeks
Outcome Measure
Percentage of Patients Who Are Progression-free at 48, 72, and 96 Weeks
Outcome Description
Overall survival of patients enrolled in the study at 48, 72, and 96 weeks and survival time was estimated using Kaplan-Meier methods
Outcome Time Frame
48, 72, and 96 weeks
Outcome Measure
Overall Survival of Patients Enrolled in the Study at 48, 72, and 96 Weeks
Outcome Description
Measured by the The European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30), a general questionnaire for assessing quality of life in cancer patients, and the Non-Muscle Invasive Bladder Cancer Questionnaire (QLQ-NMIBC24 ) for patients with NBIMC disease. EORTC QLQ-C30 include five functional scales , three symptom scales, a global health status/quality of life scale, and six single items. QLQ-NMIBC24 include five multi-item symptom scales, one multi-item functional scale, and five single-item measures.These scales range in score 0-100 scale and an for functional scales, a higher a higher score corresponds to greater function or quality of life. For symptom scales, a higher score corresponds to greater symptom burden.
Outcome Time Frame
48, 72, and 96 weeks
Outcome Measure
Quality of Life in Patients Treated With BC-819
Outcome Description
The safety was evaluated by assessment of AEs according to CTCAE version 5.0, regardless of relationship to study medication.
Outcome Time Frame
9 months
Outcome Measure
Assessment of Safety
Outcome Description
Time to recurrence (Kaplan-Meier plot) recurrence is defined as the reappearance or persistence of high-grade disease, or new high-grade disease. Recurrence must be biopsy proven. Persistence, appearance, or presence of lower grade disease was not considered to be a recurrence event
Outcome Time Frame
12, 24, 36, 72, and 96 weeks
Outcome Measure
Time to Recurrence (Kaplan-Meier Plot)
Start Date
Start Date Type
Actual
Status Verified Date
First Post Date
First Post Date Type
Actual
First Submit Date
First Submit QC Date
Std Ages
Adult
Older Adult
Maximum Age Number (converted to Years and rounded down)
999
Minimum Age Number (converted to Years and rounded down)
18
Investigators
Investigator Type
Principal Investigator
Investigator Name
Alexander Sankin
Investigator Email
asankin@montefiore.org
Investigator Phone