A study of ONCOFID-P-B administered intravesically to patients with Carcinoma in Situ of the bladder who have not responded to the standard treatment (Orion-BC)

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Fidia Farmaceutici S.p.A.

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male and Female

Therapeutic area

Diseases [C] - Neoplasms [C04]

Trial duration

24 Feb 2023 → ongoing

Decision date (initial)

2024-05-17

Transition trial

Yes

Low-intervention

No

Rare-disease indication

No

Vulnerable population

Yes

Funding sources

Fidia Farmaceutici S.p.A.

External identifiers

EU CT number

2024-512568-72-00

EudraCT number

2022-001236-28

WHO UTN

U1111-1305-8007

ClinicalTrials.gov

NCT05024773

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Efficacy

To evaluate the antitumor activity of ONCOFID-P-B using centrally assessed complete response rate (CRR) at any time within 24 Months after induction or re-induction start.

Secondary objectives 9

1. 1. To evaluate the antitumor activity of ONCOFID-P-B using centrally assessed CRR at EOIT/EORIT, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42 and 48 months after induction or re-induction start.
2. 2. To evaluate the duration of response (DoR).
3. 3. To evaluate the DoR rates at 6, 9, 12, 15, 18, 21 and 24, 30, 36, 42 and 48 after induction or re-induction start.
4. 4. To evaluate progression rates at EOIT/EORIT, 15 and 24, 48 months after induction or re-induction start.
5. 5. To evaluate time to progression.
6. 6. To evaluate the rate of patients undergoing cystectomy at the EOIT/EORIT, 9, 15, 24 and 48 months after induction or re-induction start.
7. 7. To evaluate time to cystectomy.
8. 8. To evaluate event-free survival (EFS).
9. 9. To evaluate overall survival (OS).

Conditions and MedDRA coding

BCG-unresponsive Carcinoma in Situ of the bladder with or without Ta-T1 papillary disease

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 10

1. 1. Willing and able to freely provide written informed consent (in presence of an Independent Witness if applicable) prior to performing study procedures.
2. 2. Age 18 years or older, male or female.
3. 3. Persistent or recurrent CIS of the bladder histologically confirmed, with or without concomitant recurrent HG Ta-T1 and with no evidence of metastases demonstrated by abdominal CT scan or MRI.
4. 4. BCG unresponsive patients who refuse or are unfit for radical cystectomy. BCG-unresponsive disease is defined as persistent or recurrent CIS alone or with recurrent HG Ta-T1 disease within 12 months of completion of adequate BCG therapy. Adequate BCG therapy is defined as at least one of the following: 1) At least five full doses of six doses of an initial induction course plus at least two full doses of three doses of maintenance therapy. 2) At least five full doses of six doses of an initial induction course plus at least two full doses of six doses of a second induction course.
5. 5. Complete resection of Ta-T1 papillary lesions before entering the trial in patients with concomitant CIS and papillary tumors (residual CIS acceptable, obvious areas of CIS should also be fulgurated). a. In patients with T1 papillary lesions undergoing resection of the base of the lesion, the biopsy should contain muscle fibers. b. In patients undergoing transurethral resection of their bladder tumors, absence of locally advanced disease should be confirmed by pelvic examination under anesthesia.
6. 6. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2.
7. 7. Adequate organ function: absolute neutrophil count ≥ 1,500/mm3, platelets ≥ 100,000/mm3, hemoglobin ≥ 8.5 g/dL, ALT/AST ≤ 1.5 x upper limit of normal (ULN), alkaline phosphatase ≤ 5 x ULN, total serum bilirubin ≤ 1.5 x ULN, for patients with Gilbert’s Syndrome ≤ 3 x ULN, serum creatinine ≤ 2.2 mg/dL.
8. 8. Women in non-reproductive years (defined as surgically sterile or one year postmenopausal). Women of childbearing potential (WOCBP*) must have a negative serum pregnancy test upon entry into this study and agree to use highly effective contraceptive methods, i.e. methods that can achieve a failure rate of less than 1% per year when used consistently and correctly. Such methods include: • combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation: − oral − intravaginal − transdermal • progestogen-only hormonal contraception associated with inhibition of ovulation: − oral − injectable − implantable • intrauterine device (IUD) • intrauterine hormone-releasing system ( IUS) • bilateral tubal occlusion • vasectomised partner (**) • sexual abstinence (***) (*) Women of childbearing potential (WOCBP): fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilization methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a postmenopausal state in women not using hormonal contraception or hormonal replacement therapy (HRT). However, in the absence of 12 months of amenorrhea, confirmation with more than one FSH measurement is required. (**) Vasectomised partner is a highly effective birth control method provided that partner is the sole sexual partner of the WOCBP trial participant and that the vasectomised partner has received medical assessment of the surgical success. (***) Sexual abstinence is considered a highly effective method only if defined as refraining from heterosexual intercourse during the entire period of risk associated to the study treatment. The reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the subject.
9. 9. Male patients with WOCBP partners must agree to use effective contraceptive methods, i.e.: • condom • consider contraception for non-pregnant WOCBP partner.
10. 10. Able and willing to comply with the scheduled visits, therapy plans, and laboratory tests required in this protocol.

Exclusion criteria 18

1. 1. Current or previous muscle-invasive disease (T2-T4) or metastatic urothelial carcinoma.
2. 10. Subjects who, in the opinion of the Investigator, cannot tolerate intravesical administration or intravesical surgical manipulation (cystoscopy, biopsy) due to the presence of serious comorbid condition(s) (e.g., uncontrolled cardiac or respiratory disorders).
3. 11. Presence of significant urologic disease interfering with intravesical therapy.
4. 12. Current enrollment or participation in another therapeutic clinical trial within 6 months preceding screening. Patients previously included in a BCG-only study arm might be enrolled following discussion with the medical monitor and/or sponsor if the definition of adequate BCG therapy is met.
5. 13. Known substance and/or alcohol abuse.
6. 14. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or may interfere with the interpretation of study results and, in the judgment of the Investigator, would make the patient inappropriate for entry in this study or could compromise protocol objectives.
7. 15. Pregnancy, lactating women or women of childbearing potential (WOCBP) unwilling to use adequate birth control measures for the duration of the study and until 6 months after the end of treatment.
8. 16. Male patients with WOCBP partners unwilling to use contraceptive methods for the duration of the study and until 6 months after the end of treatment.
9. 17. Subjects who have a mean QTc >450 msec for males and >470 msec for females at baseline and who need concomitant medications which may cause QT prolongation.
10. 2. Patient with more than 12 months between inclusion (week 1) and the last BCG instillation.
11. 3. Suspected hypersensitivity to paclitaxel or to any of the ONCOFID-P-B constituents.
12. 4. Previous or concomitant urothelial carcinoma of the upper urinary tract or the prostatic urethra. Freedom from upper tract disease must be demonstrated by intravenous pyelogram, retrograde pyelogram, CT scan or MRI.
13. 5. Current or prior systemic therapy for bladder cancer.
14. 6. Intravesical therapy within 4 weeks prior to beginning study treatment with the exception of cytotoxic agents (e.g. mitomycin C, doxorubicin and epirubicin) when administered as a single instillation immediately following a TURBT procedure between 14 to 60 days prior to beginning study treatment.
15. 7. Symptomatic urinary tract infection or bacterial cystitis.
16. 8. Major surgery, other than diagnostic, within 4 weeks prior to treatment.
17. 9. Patients who have previous or concurrent malignancies that require treatment and are not clinically stable; examples of permitted concurrent recent second malignancies are: adequately treated basal cell, squamous cell skin cancer, in situ carcinoma of the cervix or prostate cancer on active surveillance at low risk for progression, defined as prostate-specific antigen (PSA) <10 ng/mL, Gleason score 6 or less and cT1.
18. 18. Applies to France only: Persons deprived of liberty by judicial or administrative decisions, adults subject to a legal protection measure (under guardianship/curators), persons under protective measures and persons not affiliated with social security will be excluded from the study.

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. CRR at any time within 24 months after induction or re-induction start calculated as the proportion of patients achieving a CR at any time within 24 months after induction or re-induction start. For analysis purpose, CRR will be based on central assessment of response.

Secondary endpoints 9

1. 1. CRR calculated as the proportion of patients achieving a CR at EOIT/EORIT, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42 and 48 months after induction or re-induction start.
2. 2. DoR defined as the time from first documented evidence of CR to time of documented recurrence (CIS or HG Ta-T1), progression to MIBC, to extravesical disease or death.
3. 3. DoR rate calculated as the proportion of patients who maintained a CR after 6, 9, 12, 15, 18, 21, 24, 30, 36, 42 and 48 months after induction or re-induction start.
4. 4. Progression rate calculated as the proportion of patients with tumor progression to MIBC or extravesical disease at EOIT/EORIT, 15, 24 and 48 months after induction or re-induction start.
5. 5. Time to progression defined as time from induction start to time of documented tumor progression to MIBC or extravesical disease.
6. 6. Proportion of patients undergoing cystectomy for disease progression at EOIT/EORIT, 9, 15, 24 and 48 months after induction or re-induction start.
7. 7. Time to cystectomy defined as time from start of treatment to the date of cystectomy.
8. 8. EFS defined as time from treatment start to the time of documented recurrence after CR, or progression or death due to any cause.
9. 9. OS defined as time from treatment start to death due to any cause.

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 1

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Fidia Farmaceutici S.p.A.

Sponsor organisation

Fidia Farmaceutici S.p.A.

Address

Via Ponte Della Fabbrica 3 A

City

Abano Terme

Postcode

35031

Country

Italy

Scientific contact point

Organisation

Fidia Farmaceutici S.p.A.

Contact name

Nicola Giordan

Public contact point

Organisation

Fidia Farmaceutici S.p.A.

Contact name

Nicola Giordan

Third parties 5

Locations

4 EU/EEA countries · 29 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Oversight and notifications

Regulatory notifications under CTR Articles 38, 52, 53, 54 and 77

Urgent safety measures 1 · Art. 54 CTR

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 63 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

8 submissions — initial application plus substantial / non-substantial modifications