Study With TMX-101 in Patients With Carcinoma In Situ (CIS) Bladder Cancer

Phase II Pilot Study With TMX 101 in Patients With Carcinoma In Situ (CIS) Bladder Cancer

This is a Phase II pilot study to explore the effect of intravesical TMX-101 in patients with CIS bladder cancer, as assessed by histology and cytology after TMX-101 treatment.

Study Overview

• Status: Completed
• Conditions: Carcinoma in Situ; Non Muscle Invasive Bladder Cancer
• Intervention / Treatment: Drug: TMX-101

Detailed Description

This study is an open label, pilot study of TMX-101 in the treatment of carcinoma in situ. TMX-101 is a new formulation of Imiquimod optimized for intravesical delivery. Imiquimod possesses immune-stimulatory properties. TMX-101 is being developed as a potential treatment for patients with non-invasive bladder cancer, including patients with CIS bladder cancer.

Following confirmation of CIS by histology, patients will receive weekly instillations of TMX-101 for 6 weeks. Five to seven weeks after the last instillation, biopsies and cytology will be performed. Response to treatment will be determined based on cytology and tissue sample histology findings.

• Study Type: Interventional
• Enrollment (Actual): 12
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Phoenix, Arizona, United States, 85032
      • BCG Oncology
  • Colorado
    • Denver, Colorado, United States, 80211
      • The Urology Center of Colorado
  • Pennsylvania
    • Bala Cynwyd, Pennsylvania, United States, 19004
      • Urologic Consultants of SE PA
  • South Carolina
    • Myrtle Beach, South Carolina, United States, 29572
      • Carolina Urologic Research Center

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:

1. Males or female patient is aged ≥18 years.
2. Pathologically-proven, recurrent, primary, secondary or concomitant carcinoma in situ disease, defined by having either Ta or T1 with CIS, or CIS alone. In cases with T1 tumor lesions, muscularis propria tissue should be in the resected specimen to confirm that it is tumor-free.
3. Patient has undergone mapping of the bladder between Days -28 and -14, with at least one biopsy providing pathological confirmation of CIS of the bladder. Slides must be available for a central pathology review.
4. Patient has undergone bladder washing for cytology between Days -28 and -1. In patients in whom Ta or T1 lesion(s) were resected, the bladder washing must have occurred after the resection. Slides must be available for a central cytology review.
5. Patient has an ECOG performance status 0-2.
6. Patient has adequate bone marrow, hepatic, and renal function within 4 weeks before Day 0.
7. Patient has read and understood the informed consent form and is willing and able to give informed consent.
8. Patient fully understands the requirements of the study and is willing to comply with all study visits and assessments.
9. If a woman of childbearing potential (WCBP), patient has a negative blood pregnancy test at the Screening visit. For the purposes of this study, WCBP is defined as a post-pubescent female, unless post-menopausal for at least 2 years, surgically sterile, or sexually inactive.
10. If patient is a WCPB or male patient with a female partner of childbearing potential, must be willing to avoid pregnancy by using an adequate method of contraception from 2 weeks before through 4 weeks after the last study drug treatment. Adequate contraception is defined as follows: 2 barrier methods or 1 barrier method with a spermicide or intrauterine device.

Exclusion Criteria:

1. Patient has evidence of muscle-invasive disease (i.e., T2 or higher)
2. In the Investigator's opinion, patient is not able to hold instillation for at least 1 hour.
3. In the Investigator's opinion, patient cannot tolerate intravesical administration or intravesical surgical manipulation.
4. Patient has received radiation therapy of pelvis within 12 months before the first study drug treatment.
5. Patient requires perioperative intravesical chemotherapy.
6. Patient has a history of malignancy of the upper urinary tract.

7. Patient has bone marrow impairment as evidenced by:

   • Hemoglobin <9.0 g/dL
   • Absolute neutrophil count (ANC) <1.5×109/L
   • Platelet count <120×109/L.

8. Patient has renal impairment, as evidenced by:

   • Serum creatinine >2× the upper limit of normal (ULN), and/or
   • Calculated creatinine clearance <40 mL/min.

9. Patient has liver function abnormality, as evidenced by:

   • Total bilirubin >1.5×ULN, or
   • Aspartate aminotransferase (AST)/Alanine aminotransferase (ALT) >2.5×ULN.
10. Patient has a bleeding disorder, as evidenced by an international normalized ratio (INR) >1.5×ULN.
11. Patient is known to be positive for human immunodeficiency virus (HIV) or has active hepatitis B or C infection.
12. Patient has a clinically significant active infection at the time of the first study drug treatment.
13. Patient has any medical or psychiatric condition that, in the Investigator's opinion, might impair the patient's well-being or preclude adherence to the protocol or completing the study as per protocol.
14. Patient has suspected hypersensitivity to imidazoquinoline compounds, poloxamer 407, hydroxy propyl betacyclodextrin, or lactic acid.
15. If female, patient is pregnant or breast feeding.
16. Patient participated in any other protocol involving administration of an investigational agent within 3 months before Day 0.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: TMX-101; TMX-101 0.4% (200 mg in 50 ml) instilled in the bladder once weekly for 6 weeks	Drug: TMX-101; Other Names: Imiquimod

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
To assess the activity of TMX-101, as determined by the number of patients who experience complete response (CR).	5 to 7 weeks after the last TMX -101 instillation

Secondary Outcome Measures

Outcome Measure	Time Frame
Proportion of patients experiencing adverse events (AEs), including serious adverse events (SAEs) and AEs leading to discontinuation from the study.	Patients will be followed through treatment and follow-up, for an expected total period of up to 13 weeks.

Collaborators and Investigators

• Sponsor: Telormedix SA

Publications and helpful links

General Publications

• Donin NM, Chamie K, Lenis AT, Pantuck AJ, Reddy M, Kivlin D, Holldack J, Pozzi R, Hakim G, Karsh LI, Lamm DL, Belkoff LH, Belldegrun AS, Holden S, Shore N. A phase 2 study of TMX-101, intravesical imiquimod, for the treatment of carcinoma in situ bladder cancer. Urol Oncol. 2017 Feb;35(2):39.e1-39.e7. doi: 10.1016/j.urolonc.2016.09.006. Epub 2016 Oct 26.

Study record dates

Study Major Dates

• Study Start: February 1, 2013
• Primary Completion (Actual): February 1, 2014
• Study Completion (Actual): October 1, 2014

Study Registration Dates

• First Submitted: November 12, 2012
• First Submitted That Met QC Criteria: November 21, 2012
• First Posted (Estimate): November 22, 2012

Study Record Updates

• Last Update Posted (Estimate): February 10, 2015
• Last Update Submitted That Met QC Criteria: February 9, 2015
• Last Verified: February 1, 2015

More Information

Terms related to this study

• Keywords: bladder cancer; carcinoma in situ; non muscle invasive bladder cancer
• Additional Relevant MeSH Terms: Neoplasms by Histologic Type; Neoplasms; Urologic Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Urologic Diseases; Neoplasms, Glandular and Epithelial; Urinary Bladder Diseases; Carcinoma in Situ; Carcinoma; Urinary Bladder Neoplasms; Physiological Effects of Drugs; Antineoplastic Agents; Immunologic Factors; Adjuvants, Immunologic; Interferon Inducers; Imiquimod
• Other Study ID Numbers: TMX-101-003