A Phase 1 Dose-escalation Study of UGN-301 in Patients With Recurrent Non-muscle Invasive Bladder Cancer (NMIBC)

• ClinicalTrials.gov Identifier: NCT05375903
• Recruitment Status: Recruiting
• First Posted: May 17, 2022
• Last Update Posted: April 18, 2024
• Sponsor: UroGen Pharma Ltd.
• Information provided by (Responsible Party): UroGen Pharma Ltd.

Study Description

Brief Summary:

This study is being conducted to evaluate the safety and determine the recommended Phase 2 dose (RP2D) of UGN-301 (zalifrelimab) administered intravesically as monotherapy and in combination with other agents in patients with recurrent NMIBC.

Condition or disease	Intervention/treatment	Phase
Non-muscle Invasive Bladder Cancer; NMIBC; Carcinoma in Situ of Bladder; Bladder Cancer; Urothelial Carcinoma Bladder; Urothelial Carcinoma Recurrent	Drug: UGN-301; Drug: UGN-201; Drug: Gemcitabine	Phase 1

Detailed Description:

This master protocol will comprise multiple treatment arms designed to independently investigate intravesical delivery of UGN-301 either as monotherapy or in combination with other agents. Initial study treatment arms will include:

• UGN-301 monotherapy
• UGN-301 + UGN-201 (imiquimod) in combination
• UGN-301 + gemcitabine in combination

Additional study treatment arms investigating UGN-301 in combination with other agents may be added in the future.

The study will evaluate escalating doses of UGN-301 to determine the biologically effective dose (BED) and maximum tolerated dose (MTD) of UGN-301 either as monotherapy or in combination with other agents.

When evaluated in combination with other agents, the UGN-301 dose will begin at least 1 dose level lower than the highest dose level cleared in the monotherapy arm, or 1 dose level lower than the RP2D.

Eligible patients in each study treatment arm will enter a 12-week Induction Period.

Patients with noninvasive papillary carcinoma and/or tumor that invades the lamina propria (Ta and/or T1) who do not have disease recurrence and patients with carcinoma in situ (CIS) who have a complete response (CR) at 3 months after the start of treatment will return to the clinic for a Safety Follow-up Visit at 6 months after the start of treatment.

Ta/T1 patients without disease recurrence and CIS patients with CR at 6 months may enter an Optional Maintenance Period of up to 9 months.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 60 participants
• Allocation: Non-Randomized
• Intervention Model: Sequential Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 1, Open-label, Dose-escalation Study to Investigate the Safety, Tolerability, and Pharmacokinetics of UGN-301 (Zalifrelimab) Administered Intravesically as Monotherapy and in Combination With Other Agents in Patients With Recurrent NMIBC
• Actual Study Start Date: June 1, 2022
• Estimated Primary Completion Date: December 2025
• Estimated Study Completion Date: December 2025

Arms and Interventions

Arm	Intervention/treatment
Experimental: UGN-301 monotherapy dose escalation (Arm A); Dose escalation of UGN-301 monotherapy in patients with recurrent NMIBC with high grade (HG) Ta and/or T1 disease and/or CIS or recurrent intermediate risk (IR) low grade (LG) Ta and/or T1 disease.	Drug: UGN-301; Induction Period: Intravesical administration once weekly for 6 weeks. Optional Maintenance Period: Intravesical administration once every 3 months (at 6, 9, and 12 months after the start of treatment).; Other Name: UGN-301 (zalifrelimab) intravesical solution
Experimental: UGN-301 dose escalation + UGN-201 combination (Arm B); Dose escalation of UGN-301 in combination with a fixed dose of UGN-201 in patients with recurrent NMIBC with HG Ta and/or T1 disease and/or CIS.	Drug: UGN-301; Induction Period: Intravesical administration once weekly for 6 weeks. Optional Maintenance Period: Intravesical administration once every 3 months (at 6, 9, and 12 months after the start of treatment).; Other Name: UGN-301 (zalifrelimab) intravesical solution; Drug: UGN-201; Induction Period: Intravesical administration once weekly for 6 weeks. Optional Maintenance Period: Intravesical administration once every 3 months (at 6, 9, and 12 months after the start of treatment).; Other Name: UGN-201 (imiquimod) intravesical solution
Experimental: UGN-301 dose escalation + gemcitabine combination (Arm C); Dose escalation of UGN-301 in combination with a fixed dose of gemcitabine in patients with recurrent NMIBC with HG Ta and/or T1 disease and/or CIS.	Drug: UGN-301; Induction Period: Intravesical administration once weekly for 6 weeks. Optional Maintenance Period: Intravesical administration once every 3 months (at 6, 9, and 12 months after the start of treatment).; Other Name: UGN-301 (zalifrelimab) intravesical solution; Drug: Gemcitabine; Induction Period: Intravesical administration once weekly for 6 weeks. Optional Maintenance Period: Intravesical administration once every 3 months (at 6, 9, and 12 months after the start of treatment).

Outcome Measures

Primary Outcome Measures :

1. Incidence of dose-limiting toxicities (DLTs) and treatment-emergent adverse events (TEAEs) [ Time Frame: Up to 15 months ]
   The number of patients with each type of event will be summarized.
2. Concentration of UGN-301 in blood and urine [ Time Frame: 6 weeks ]
   Data will be summarized using descriptive statistics.
3. Complete response rate (CRR) [ Time Frame: 3 months ]
   CRR is defined as the proportion of CIS patients who achieved CR at the Week 12 (3-month) Visit.
4. Recurrence-free survival (RFS) rate [ Time Frame: 3 months ]
   RFS rate is defined as the proportion of patients with Ta/T1 disease who are recurrence-free at the Week 12 (3-month) Visit.

Secondary Outcome Measures :

1. Presence of anti-drug antibodies (ADA) in serum [ Time Frame: 3 months ]
   The number of patients with ADA will be summarized.
2. UGN-301 maximum serum concentration (Cmax) following single and repeat dose administration [ Time Frame: 6 weeks ]
   Data will be summarized using descriptive statistics.
3. UGN-301 area under the concentration-time curve (AUC) following single and repeat dose administration [ Time Frame: 6 weeks ]
   Data will be summarized using descriptive statistics.
4. UGN-301 time to maximum serum concentration (tmax) following single and repeat dose administration [ Time Frame: 6 weeks ]
   Data will be summarized using descriptive statistics.
5. UGN-301 terminal half-life (t1/2) following single and repeat dose administration [ Time Frame: 6 weeks ]
   Data will be summarized using descriptive statistics.
6. UGN-301 concentration in serum at the end of a dosing interval (Ctau) following single and repeat dose administration [ Time Frame: 6 weeks ]
   Data will be summarized using descriptive statistics.
7. Concentration of UGN-201 and its metabolites in blood and urine [ Time Frame: 6 weeks ]
   Data will be summarized using descriptive statistics.
8. UGN-201 Cmax following single and repeat dose administration [ Time Frame: 6 weeks ]
   Data will be summarized using descriptive statistics.
9. UGN-201 AUC following single and repeat dose administration [ Time Frame: 6 weeks ]
   Data will be summarized using descriptive statistics.
10. UGN-201 tmax following single and repeat dose administration [ Time Frame: 6 weeks ]
    Data will be summarized using descriptive statistics.
11. UGN-201 t1/2 following single and repeat dose administration [ Time Frame: 6 weeks ]
    Data will be summarized using descriptive statistics.
12. UGN-201 Ctau following single and repeat dose administration [ Time Frame: 6 weeks ]
    Data will be summarized using descriptive statistics.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Able to give informed consent.

2. Arm A: Have confirmed recurrent NMIBC with HG Ta and/or T1 disease and/or CIS or recurrent IR LG Ta and/or T1 disease.

   Arm B: Have confirmed recurrent NMIBC with HG Ta and/or T1 disease and/or CIS. Arm C: Have confirmed recurrent NMIBC with HG Ta and/or T1 disease and/or CIS.

3. Patients with HG Ta and/or T1 disease and/or CIS must meet one of the following criteria:

   • Have Bacillus Calmette-Guérin (BCG)-unresponsive disease, defined as 1) persistent or recurrent CIS alone or with recurrent Ta/T1 disease within 12 months of completion of adequate BCG therapy, or 2) recurrent HG Ta/T1 disease within 6 months of completion of adequate BCG therapy, or 3) HG T1 disease at the first evaluation following a BCG induction course.

   Notes: Adequate BCG therapy is defined as at least 5 of 6 doses of an initial induction course plus 1) at least 2 of 3 doses of maintenance therapy or 2) at least 2 of 6 doses of a second induction course. Patients with BCG-unresponsive disease also must be unwilling or unfit to undergo radical cystectomy.

   • Have otherwise failed adequate BCG therapy (eg, recurrence > 6 months [papillary] or > 12 months [CIS] after last BCG exposure).
   • Are BCG intolerant, defined as the inability to tolerate at least one full induction course of BCG.
   • Have HG Ta disease with tumors ≤ 3 cm and failed at least one previous course of therapy (eg, adjuvant intravesical chemotherapy).
4. Have all papillary tumors visible by white light resected, and obvious areas of CIS fulgurated during Screening or within 6 weeks before Screening. Note: Blue light cystoscopy is not permitted.
5. Eastern Cooperative Oncology Group (ECOG) status ≤ 2.
6. Absence of concomitant upper tract urothelial carcinoma (UTUC) or urothelial carcinoma (UC) within the prostatic urethra. Freedom from upper tract disease (if clinically indicated) as indicated by no evidence of upper tract tumor by either intravenous pyelogram, retrograde pyelogram, computerized tomography (CT) urogram with or without contrast, or magnetic resonance imaging (MRI) urogram with or without contrast performed within 6 months of enrollment.
7. Patients with prostate cancer on active surveillance at very low, low, or intermediate risk for progression, defined as Gleason Grade Group 1 or 2, Gleason score ≤ 7, with prostate-specific antigen < 20 ng/dL, and cT1-cT2b (NCCN, 2023) are permitted to be in the study at the discretion of the investigator (see exclusion criterion 8).
8. Female patients of childbearing potential must use maximally effective birth control during the period of therapy, must be willing to use contraception for 1 month following the last administration of study drug and must have a negative urine or serum pregnancy test upon entry into this study. Otherwise, female patients must be postmenopausal (no menstrual period for a minimum of 12 months) or surgically sterile. "Maximally effective birth control" means that the patient, if sexually active, should be using a combination of 2 methods of birth control that are approved and recognized to be effective by health authorities.
9. Male patients must be surgically sterile or willing to use 2 highly effective forms of birth control upon enrollment, during the course of the study, and for 1 month following the last study drug instillation.

10. Has adequate organ and bone marrow function within 14 days of treatment initiation as determined by routine laboratory tests outlined below:

    • Leukocytes ≥ 3,000/μL;
    • Absolute neutrophil count (ANC) ≥ 1,500/μL;
    • Platelets ≥ 100,000/μL;
    • Hemoglobin ≥ 9.0 g/dL;
    • Total bilirubin ≤ 1.5 × upper limit of normal (ULN);
    • Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ≤ 2.5 × ULN;
    • Alkaline phosphatase (ALP) ≤ 2.5 × ULN;
    • Estimated creatinine clearance ≥ 30 mL/min calculated using the Cockcroft-Gault equation.
11. Has a life expectancy > 12 months.

Exclusion Criteria:

1. Current or previous evidence of muscle invasive, locally advanced nonresectable, or metastatic urothelial carcinoma (ie, T2, T3, T4 and/or stage IV).
2. Current systemic therapy for bladder cancer.
3. Prior therapy with an anti-cytotoxic T lymphocyte antigen 4 (CTLA-4), anti-programmed cell death 1 (PD-1), anti-PD-ligand 1 (L1) agent, or with an agent directed to another co-inhibitory T-cell receptor.
4. Active infection requiring systemic therapy including urinary tract infection (once satisfactorily treated, patients can enter the study).
5. Active systemic autoimmune disease that required systemic treatment in the past 2 years. Short courses of steroids (≤ 14 days) for medical reasons without anticancer intent (eg, atopic dermatitis, psoriasis, infection, allergic reaction) are permitted if the last dose was ≥ 4 weeks before the first dose of study treatment.
6. Women who are pregnant or nursing.
7. Any medical psychological, familial, sociological, or geographical condition that, in the opinion of the Investigator, would preclude participation in the study.
8. History of malignancy of other organ system within the past 5 years, except previously treated UTUC, basal cell carcinoma or squamous cell carcinoma of the skin, and/or prostate cancer under active surveillance (see inclusion criterion 8).
9. Patients who cannot tolerate intravesical dosing or intravesical surgical manipulation.
10. Intravesical therapy within 4 weeks before starting study treatment.
11. Has participated in a study of an investigational agent and received study therapy or received investigational device within 4 weeks before the first dose of study treatment.
12. Has received an immune modulator therapy within 5 half-lives of starting study treatment.
13. Has received a vaccine within 2 weeks before starting study treatment.
14. Has a known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients.

Contacts and Locations

Contacts

Contact: Heather Lansford; +1 610-226-5111; heather.lansford@urogen.com

Locations

United States, Arkansas

Arkansas Urology; Recruiting

Little Rock, Arkansas, United States, 72211

Contact: Katie O'Brien 501-219-8900 ext 2002 katie@arkansasurology.com

Principal Investigator: R. Jonathan Henderson, MD

United States, California

UCLA - University of California; Recruiting

Los Angeles, California, United States, 90095

Contact: Karim Chamie, MD 310-794-5929 kchamie@mednet.ucla.edu

Principal Investigator: Karim Chamie, MD

United States, Florida

Florida Urology Partners, LLC; Recruiting

Tampa, Florida, United States, 33615

Contact: Linda Seibert 239-223-4488 linda@gulfcoastcta.com

Principal Investigator: Osvaldo Padron, MD

United States, Maryland

Johns Hopkins University; Completed

Baltimore, Maryland, United States, 21287

United States, New York

Manhattan Medical Research; Recruiting

New York, New York, United States, 10016

Contact: Luis Leanez 917-409-3919 lleanez@manhattanmedicalresearch.com

Principal Investigator: Jed Kaminetsky, MD

United States, Ohio

Clinical Research Solutions; Completed

Middleburg Heights, Ohio, United States, 44130

United States, Pennsylvania

Penn State Milton S Hershey Medical Center; Recruiting

Hershey, Pennsylvania, United States, 17033

Contact: Jay Raman, MD urologyresearch@pennstatehealth.psu.edu

Italy

I.R.C.C.S. Ospedale San Raffaele; Recruiting

Milan, Italy

Contact: Marco Moschini, MD

National Tumor Institute Fondazione G. Pascale; Active, not recruiting

Naples, Italy

Istituto Oncologico Veneto; Recruiting

Padova, Italy

Contact: Marco Maruzzo, MD PhD +39 049.8215953 marco.maruzzo@iov.veneto.it

Spain

NEXT Oncology IOB- Hospital Quironsalud Barcelona; Recruiting

Barcelona, Spain, 08023

Contact: Fabricio Racca, MD (+34) 932 381 661 fracca@nextoncology.eu

Hospital Clinic de Barcelona Instituto Clinic de Nefrologia y Urologia (ICNU); Recruiting

Barcelona, Spain, 08036

Contact: Maria Jose Ribal, MD (+34) 932 279 346 mjribal@clinic.cat

NEXT Oncology- Hospital Quironsalud Mardrid; Recruiting

Madrid, Spain, 28223

Contact: Valentina Boni, MD (+34) 914 521 900 vboni@nextoncology.eu

Sponsors and Collaborators

UroGen Pharma Ltd.

Investigators

• Study Director: Sunil Raju, MBBS; UroGen Pharma

More Information

• Responsible Party: UroGen Pharma Ltd.
• ClinicalTrials.gov Identifier: NCT05375903
• Other Study ID Numbers: UR001
• First Posted: May 17, 2022
• Last Update Posted: April 18, 2024
• Last Verified: April 2024

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Carcinoma; Urinary Bladder Neoplasms; Carcinoma, Transitional Cell; Carcinoma in Situ; Non-Muscle Invasive Bladder Neoplasms; Recurrence; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Disease Attributes; Pathologic Processes; Urologic Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Urinary Bladder Diseases; Urologic Diseases; Male Urogenital Diseases; Gemcitabine; Imiquimod; Pharmaceutical Solutions; Antimetabolites, Antineoplastic; Antimetabolites; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Toll-Like Receptor Agonists; Immunomodulating Agents; Immunologic Factors