Efficacy and Safety of Multi-Instillations of Apaziquone in Patients With Non-Muscle Invasive Bladder Cancer

A Phase 3 International, Multicenter, Double-Blind, Placebo-Controlled, Randomized Trial Evaluating the Efficacy and Safety of Multiple Instillations of Intravesical Apaziquone vs. Placebo in Patients With Low-Intermediate Risk Non-Muscle Invasive Bladder Cancer (NMIBC)

This is an international, multicenter, double-blind, placebo-controlled, randomized study. All eligible patients entering the open label phase of the study will receive a single immediate instillation of apaziquone (4 mg in 40 mL diluent), post transurethral resection-bladder tumor (TURBT). Following Central Pathology review of histology and Double Blind Phase qualification, patients with confirmed eligibility will be randomized to receive either 6 weekly intravesical instillations of apaziquone or matching placebo and undergo cystoscopic and safety assessments every 3 months for 24 months from randomization. Patients with histologic evidence of recurrent disease during the study will be treated according to current treatment guidelines or local standard of care. Safety and efficacy assessments will be performed at 3 month intervals for all randomized patients throughout the study. Patients who receive single dose of apaziquone immediately following TURBT and are not eligible for randomization will be followed for 3 months by cystoscopic exam and safety assessments.

Study Overview

• Status: Terminated
• Conditions: Bladder Cancer
• Intervention / Treatment: Drug: Apaziquone; Drug: Placebo

• Study Type: Interventional
• Enrollment (Actual): 66
• Phase: Phase 3

Contacts and Locations

Study Locations

• Canada
  • Quebec, Canada, G1R3S3
    • Centre Hospitalier Universitaire de Quebec
  • British Columbia
    • Victoria, British Columbia, Canada, V8V3N1
      • G. Steinhoff Clinical Research Pacific Urologic Research
  • Nova Scotia
    • Halifax, Nova Scotia, Canada, B3H 1V7
      • Queen Elizabeth II Health Science Center
  • Ontario
    • Barrie, Ontario, Canada, L4M7G1
      • The Male/Female Health and Research Centre - Royal Court Medical Centre
    • Brantford, Ontario, Canada, N3R4N3
      • Brantford Urology Research
    • Burlington, Ontario, Canada, L7N3V2
      • G. Kenneth Jansz Medicine Professional Corporation
    • Burlington, Ontario, Canada, L7S1V2
      • Urology Resource Centre
    • Kingston, Ontario, Canada, K7L3J7
      • Kingston General Hospital / Queen's University
    • Kitchener, Ontario, Canada, N2N2B9
      • Urology Associates, Urologic Medical Research
    • Newmarket, Ontario, Canada, L3X1W1
      • Mor Urology, Inc.
    • North Bay, Ontario, Canada, P1B7K8
      • Office of Bernard Goldfarb
    • North York, Ontario, Canada, M2J1V1
      • Stanley Flax Medical Professional Corporation
    • Oakville, Ontario, Canada, L6H3P1
      • The Fe/Male Health Centre
    • Oshawa, Ontario, Canada, L1H7K4
      • Urotec
    • Scarborough, Ontario, Canada, M1S4V5
      • Urology/Male Infertility
    • Toronto, Ontario, Canada, M4N3M5
      • Sunnybrook Health Sciences Centre
    • Toronto, Ontario, Canada, M5G2M9
      • University Health Network Princess Margaret Hospital
  • Quebec
    • Montreal, Quebec, Canada, H3G1A4
      • Centre universitaire de sante McGill
    • Sherbrooke, Quebec, Canada, J1H5N4
      • Centre hospitalier universitaire de Sherbrooke
• United States
  • Arizona
    • Glendale, Arizona, United States, 85308
      • Valley Urologic Associates
    • Phoenix, Arizona, United States, 85032
      • Precision Trials, LLC
  • California
    • Laguna Woods, California, United States, 92653
      • South Orange County Medical Research Center
  • Colorado
    • Denver, Colorado, United States, 80211
      • The Urology Center of Colorado
  • Connecticut
    • Middlebury, Connecticut, United States, 06762
      • Connecticut Clinical Research Center
  • Georgia
    • Marietta, Georgia, United States, 30060
      • Urology Enterprises
  • Idaho
    • Coeur d'Alene, Idaho, United States, 83814
      • North Idaho Urology
    • Meridian, Idaho, United States, 83642
      • Idaho Urologic Institute, P.A.
  • Indiana
    • Ft. Wayne, Indiana, United States, 46825
      • Northeast Indiana Research, LLC
    • Jeffersonville, Indiana, United States, 47130
      • First Urology, PSC
  • Louisiana
    • Shreveport, Louisiana, United States, 71106
      • Regional Urology, LLC
  • Maryland
    • Annapolis, Maryland, United States, 21401
      • Anne Arundel Urology
  • Michigan
    • Grand Rapids, Michigan, United States, 49546
      • Spectrum Health Medical Group
  • Minnesota
    • Minneapolis, Minnesota, United States, 55418
      • University of Minnesota
  • Montana
    • Missoula, Montana, United States, 59802
      • Five Valleys Urology
  • New Jersey
    • Voorhees, New Jersey, United States, 08043
      • Delaware Valley Urology, LLC - Voorhees
    • Westampton, New Jersey, United States, 08060
      • Delaware Valley Urology, LLC-Westampton
  • New York
    • New York, New York, United States, 10016
      • University Urology Associates
    • Rochester, New York, United States, 14618
      • Urology Associates of Rochester, LLC
  • Ohio
    • Cincinnati, Ohio, United States, 45212
      • TriState Urologic Services PSC, Inc.
  • Pennsylvania
    • Bala Cynwyd, Pennsylvania, United States, 19004
      • Urologic Consultants of Southeastern Pennsylvania, LLP
    • Bryn Mawr, Pennsylvania, United States, 19010
      • Urology Health Specialists
    • Lancaster, Pennsylvania, United States, 17604
      • Urological Associates of Lancaster
  • South Carolina
    • Myrtle Beach, South Carolina, United States, 29572
      • Carolina Urologic Research Center
  • Texas
    • McAllen, Texas, United States, 78503
      • Urology Associates of South Texas
  • Virginia
    • Virginia Beach, Virginia, United States, 23454
      • Urology of Virginia, PC
    • Virginia Beach, Virginia, United States, 23462
      • Urology of Virginia, PLLC
  • Washington
    • Mountlake Terrace, Washington, United States, 98043
      • Integrity Medical Research, LLC

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

Open Phase Inclusion Criteria:

1. Has the patient given written informed consent and is the patient willing and able to abide by the protocol?
2. Is the patient 18 years old or above?
3. If the patient is a female of childbearing potential, is she using an acceptable/effective method of contraception?
4. Does the female patient of childbearing potential have a negative serum pregnancy test at screening?

5. Does the patient with clinically apparent primary or recurrent low grade Ta NMIBC have :

   • multiple tumors (2-7)
   • No single Tumor > 3 cm
   • No history / evidence of Tis

   Or does the patient with clinically apparent primary or recurrent high grade Ta NMIBC have:

   • A single tumor that is ≤ 3 cm
   • No history / evidence of Tis
6. Is the patient able to retain bladder instillations for a minimum of 60 minutes?
7. Did the patient have upper urinary tract evaluation to exclude urothelial carcinoma, hydronephrosis or renal cell carcinoma or other renal cancers in the 6 months prior to study screening?
8. Is patient's urethra (including prostatic urethra in men) endoscopically free of any visible TCC?
9. For patients with recurrent tumor, did the patient have at least a 6-month cystoscopically-confirmed tumor-free interval between the last tumor recurrence and the time of screening?
10. Has the male patient with a prostate specific antigen (PSA) between 4 and 10 ng/mL had a diagnostic evaluation that reasonably excludes the diagnosis of prostate cancer in the opinion of the Investigator?

Double-Blind Phase Inclusion Criteria:

1. Was all visible tumor resected at the initial TURBT?

2. Does Central Pathology review of the patient's bladder tumor confirm:

   • Low grade Ta disease for multiple tumors (2 - 7) or
   • High Grade Ta disease for single tumor
   • No microscopic evidence of lymphovascular invasion and/or evidence of tumor thromboemboli

Exclusion Criteria:

Open Phase Exclusion Criteria:

1. Has the patient received any previous pelvic radiotherapy (includes external beam and/or brachytherapy)?
2. Has the patient ever received apaziquone?
3. Has the patient received an induction course (completed 5 of 6 scheduled weekly instillations) of intravesical BCG (± interferon) with the last dose given less than 12 months ago?
4. Has the patient had any prior intravesical chemotherapy, exclusive of single-dose adjuvant intravesical chemotherapy immediately post-TURBT?
5. Does the patient have a history of urinary retention or a post void residual ≥ 250 cc by bladder scan or ultrasound (post void residual test may be repeated up to 3 times)?
6. Does the patient have or has the patient had any bladder tumor with histology other than transitional cell carcinoma?
7. Does the patient have or has the patient had micro-papillary transitional cell carcinoma?
8. If the patient has recurrent papillary disease of the bladder, has the pathology been anything other than pTa in the past?
9. Does the patient have an active urinary tract infection confirmed by culture or a documented history of recurrent UTI (≥ 6 for females and ≥2 for males per year) in the prior 2 years?
10. Does the patient have a bleeding disorder or a screening platelet count < 50 x 109/L?
11. Does the patient have a screening hemoglobin < 10 mg/dL?
12. Does the male patient have a serum PSA > 10 ng/mL?
13. Does the patient have a history of Acquired Immunodeficiency Syndrome or HIV positive?
14. Does the patient have a condition or a concurrent severe and/or uncontrolled medical or psychiatric disease (e.g., uncontrolled diabetes, decompensated congestive heart failure, myocardial infarction within 6 months of study, unstable and uncontrolled hypertension, or an active uncontrolled infection), which could compromise participation, compliance with scheduled visits and/or completion of the study?
15. Has the patient participated in an investigational protocol within the past 90 days?
16. Is the patient pregnant or breast feeding?
17. Does the patient have a life expectancy of <3 years?

18. Has the patient had any other malignancy or received therapy for any malignancy in the last five years except

    • non-melanoma skin tumors
    • stage 0 (in situ) cervical carcinoma
    • undetectable PSA for ≥1 year following definitive therapy for localized prostate cancer?
19. Does the patient have documented vesicoureteral reflux or an indwelling ureteral stent?
20. Does the patient have tumor in a bladder diverticulum?
21. Does the patient have a known allergy to red color food dye?

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo	Drug: Placebo; Placebo for Double Blind Phase
Active Comparator: Apaziquone	Drug: Apaziquone; Apaziquone 4 mg in 40 mL diluent; Other Names: EO9; EOquin

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to Recurrence	Time to recurrence is the time from randomization to the date of first histologically confirmed recurrence of bladder cancer (for eligible patients with Low- intermediate risk NMIBC, who had undergone TURBT followed by, a single instillation of apaziquone immediately post TURBT and multiple instillations of apaziquone or placebo).	Recurrence of cancer in the bladder during 24 months of follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recurrence Rate at 24 Months	Measurement the number of participants with the recurrence at 24 months.	24 months
Participants With Treatment Emergent Adverse Events (TEAEs)	TEAEs will be mainly characterized by the number of treatment emergent adverse events and treatment related AEs that occur or worsen after the first dose of study treatment.	24 Months from Randomization

Collaborators and Investigators

• Sponsor: Spectrum Pharmaceuticals, Inc
• Collaborators: Allergan
• Investigators: Study Director: Show-Li Sun, MD, Spectrum Pharmaceuticals, Inc

Publications and helpful links

General Publications

• Cai T, Nesi G, Tinacci G, Zini E, Mondaini N, Boddi V, Mazzoli S, Bartoletti R. Can early single dose instillation of epirubicin improve bacillus Calmette-Guerin efficacy in patients with nonmuscle invasive high risk bladder cancer? Results from a prospective, randomized, double-blind controlled study. J Urol. 2008 Jul;180(1):110-5. doi: 10.1016/j.juro.2008.03.038. Epub 2008 May 15.
• Schellens JH, Planting AS, van Acker BA, Loos WJ, de Boer-Dennert M, van der Burg ME, Koier I, Krediet RT, Stoter G, Verweij J. Phase I and pharmacologic study of the novel indoloquinone bioreductive alkylating cytotoxic drug E09. J Natl Cancer Inst. 1994 Jun 15;86(12):906-12. doi: 10.1093/jnci/86.12.906.
• Stenzl A, Hennenlotter J, Schilling D. Can we still afford bladder cancer? Curr Opin Urol. 2008 Sep;18(5):488-92. doi: 10.1097/MOU.0b013e32830b8925.

Study record dates

Study Major Dates

• Study Start: July 1, 2011
• Primary Completion (Actual): March 1, 2014
• Study Completion (Actual): March 1, 2014

Study Registration Dates

• First Submitted: August 1, 2011
• First Submitted That Met QC Criteria: August 4, 2011
• First Posted (Estimate): August 5, 2011

Study Record Updates

• Last Update Posted (Estimate): December 13, 2016
• Last Update Submitted That Met QC Criteria: December 12, 2016
• Last Verified: December 1, 2016

More Information

Terms related to this study

• Keywords: NMIBC; Bladder Cancer; Non-Muscle Invasive Bladder Cancer; TURBT; Apaziquone; EOquin; GU Cancer
• Additional Relevant MeSH Terms: Neoplasms; Urologic Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Urologic Diseases; Urinary Bladder Diseases; Urinary Bladder Neoplasms; Antineoplastic Agents; Apaziquone
• Other Study ID Numbers: SPI-1011