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Safety and Tolerability of GemRIS 225 mg in Subjects With Muscle-Invasive Bladder Cancer

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ClinicalTrials.gov Identifier: NCT02722538
Recruitment Status : Recruiting
First Posted : March 30, 2016
Last Update Posted : May 10, 2017
Sponsor:
Information provided by (Responsible Party):

Study Description
Brief Summary:
The purpose of this study is to determine if TAR-200, an investigational drug-delivery system, is safe and tolerable in patients with muscle-invasive bladder cancer (MIBC) between diagnosis and radical cystectomy (RC).

Condition or disease Intervention/treatment Phase
Urinary Bladder Cancer Drug: Gemcitabine-Releasing Intravesical System (GemRIS)/TAR-200 Phase 1

Study Design

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 26 participants
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1b, Multicenter, Open Label Study Evaluating Safety, Tolerability and Preliminary Efficacy of GemRIS 225 mg in Subjects With Muscle-Invasive Transitional Cell Carcinoma of the Bladder
Study Start Date : May 2016
Estimated Primary Completion Date : June 2017


Arms and Interventions

Arm Intervention/treatment
Experimental: Residual Tumor following TURBT
TAR-200 is placed into the bladder through an inserter on Study Day 0 and is removed on Study Day 7. TAR-200 releases gemcitabine gradually during the 7 day indwelling time. A second TAR-200 is placed in the bladder on Study Day 21 and is removed on Study Day 28, which is the day of the Radical Cystectomy (RC).
Drug: Gemcitabine-Releasing Intravesical System (GemRIS)/TAR-200
TAR-200 is a passive, nonresorbable gemcitabine-releasing intravesical drug delivery system, regulated as a drug, whose primary mode of action is the controlled release of gemcitabine into the bladder over a 7-day period.
Experimental: No Residual Tumor Following TURBT
TAR-200 is placed into the bladder through an inserter on Study Day 0 and is removed on Study Day 7. TAR-200 releases gemcitabine gradually during the 7 day indwelling time. A second TAR-200 is placed in the bladder on Study Day 21 and is removed on Study Day 28, which is the day of the Radical Cystectomy (RC).
Drug: Gemcitabine-Releasing Intravesical System (GemRIS)/TAR-200
TAR-200 is a passive, nonresorbable gemcitabine-releasing intravesical drug delivery system, regulated as a drug, whose primary mode of action is the controlled release of gemcitabine into the bladder over a 7-day period.


Outcome Measures

Primary Outcome Measures :
  1. Number of participants with treatment emergent adverse events (TEAEs) coded with MedDRA and graded for severity with CTCAE v4.0 [ Time Frame: Maximum 132 days ]

Secondary Outcome Measures :
  1. Number of participants who are tolerant of TAR-200 indwelling [ Time Frame: From Day 0 up to Day 7 ]
  2. Percentage of participants who are tolerant of TAR-200 indwelling [ Time Frame: From Day 0 up to Day 7 ]
  3. Number of participants who are tolerant of TAR-200 indwelling [ Time Frame: From Day 21 up to Day 28 ]
  4. Percentage of participants who are tolerant of TAR-200 indwelling [ Time Frame: From Day 21 up to Day 28 ]
  5. Cmax, plasma dFdU [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Cmax (maximum concentration achieved over time) of diflourodeoxyuridine (dFdU) in plasma.

  6. Tmax, plasma dFdU [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Tmax (Day at which maximum concentration was achieved) of diflourodeoxyuridine (dFdU) in plasma.

  7. Cavg, plasma dFdU [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Descriptive statistics (e.g. sample size, mean and median, quartiles, minimum and maximum and box plots) of the concentration of diflourodeoxyuridine (dFdU) in plasma

  8. Cmax, plasma dFdC [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Cmax (maximum concentration achieved over time) of gemcitabine (deoxydifluorocytidine hydrochloride - dFdC) in plasma

  9. Tmax, plasma dFdC [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Tmax (Day at which maximum concentration was achieved) of gemcitabine (deoxydifluorocytidine hydrochloride - dFdC) in plasma

  10. Cavg, plasma dFdC [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Descriptive statistics (e.g. sample size, mean and median, quartiles, minimum and maximum and box plots) of the concentration of gemcitabine (deoxydifluorocytidine hydrochloride - dFdC) in plasma

  11. Cmax, urine dFdU (Arm 1 only) [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Cmax (maximum concentration achieved over time) of diflourodeoxyuridine (dFdU) in urine

  12. Tmax, urine dFdU (Arm 1 only) [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Cmax (maximum concentration achieved over time) of diflourodeoxyuridine (dFdU) in urine

  13. Cavg, urine dFdU (Arm 1 only) [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Descriptive statistics (e.g. sample size, mean and median, quartiles, minimum and maximum and box plots) of the concentration of diflourodeoxyuridine (dFdU) in urine

  14. Cmax, urine dFdC (Arm 1 only) [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Cmax (maximum concentration achieved over time) of gemcitabine (deoxydifluorocytidine hydrochloride - dFdC) in urine

  15. Tmax, urine dFdC (Arm 1 only) [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Tmax (Day at which maximum concentration was achieved) of gemcitabine (deoxydifluorocytidine hydrochloride - dFdC) in urine

  16. Cavg, urine dFdC (Arm 1 only) [ Time Frame: From Day 0 up to Day 28 ]
    Analysis of Descriptive statistics (e.g. sample size, mean and median, quartiles, minimum and maximum and box plots) of the concentration of gemcitabine (deoxydifluorocytidine hydrochloride - dFdC) in urine.

  17. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (AKT) (Arm 1) [ Time Frame: Anti-tumor analysis will occur at study visit Day 28. ]
  18. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (CD31) (Arm 1) [ Time Frame: Anti-tumor analysis will occur at study visit Day 28. ]
  19. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (Ki67) (Arm 1) [ Time Frame: Anti-tumor analysis will occur at study visit Day 28. ]
  20. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (TUNEL) (Arm 1) [ Time Frame: Anti-tumor analysis will occur at study visit Day 28. ]
  21. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (CD4) (Arm 1) [ Time Frame: Anti-tumor analysis will occur at study visit Day 28. ]
  22. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (CD8) (Arm 1) [ Time Frame: Anti-tumor analysis will occur at study visit Day 28. ]
  23. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (PD-L1) (Arm 1) [ Time Frame: Anti-tumor analysis will occur at study visit Day 28. ]
  24. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (AKT) (Arm 2) [ Time Frame: Anti-tumor analysis will occur at study visit Day 42. ]
  25. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (CD31) (Arm 2) [ Time Frame: Anti-tumor analysis will occur at study visit Day 42. ]
  26. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (Ki67) (Arm 2) [ Time Frame: Anti-tumor analysis will occur at study visit Day 42. ]
  27. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (TUNEL) (Arm 2) [ Time Frame: Anti-tumor analysis will occur at study visit Day 42. ]
  28. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (CD4) (Arm 2) [ Time Frame: Anti-tumor analysis will occur at study visit Day 42. ]
  29. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (CD8) (Arm 2) [ Time Frame: Anti-tumor analysis will occur at study visit Day 42. ]
  30. Preliminary anti-tumor effects assessed in tumor material (post-treatment) for immunohistochemical tissue biomarkers of drug-induced cell death (PD-L1) (Arm 2) [ Time Frame: Anti-tumor analysis will occur at study visit Day 42. ]

Eligibility Criteria

Information from the National Library of Medicine

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

Inclusion Criteria:

  • Histological proof of muscle-invasive transitional cell carcinoma of the bladder (stage II-III). Subjects with evidence of metastatic nodal disease to the obuturator or presacral lymph nodes only may be included (N1 M0). Subjects with any degree of fixation of the pelvic sidewall are not eligible.
  • In Arm 1, subjects must have residual visible tumor following TURBT. In Arm 2, subjects must be fully resected (i.e., no visible tumor or as little tumor as possible) after restaging TURBT 2-6 weeks prior to Study Day 0.
  • Adequate bone marrow, liver, and renal function, as assessed by the following requirements conducted within 21 days prior to dosing:

    1. Hemoglobin ≥ 9.0 g/dL
    2. Absolute neutrophil count (ANC) ≥ 1,500/mm3
    3. Platelet count ≥ 100,000/mm3
    4. Total bilirubin ≤ 1.5xULN (upper limit of normal)
    5. Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) ≤ 2.5xULN
    6. Glomerular Filtration Rate (GFR) ≥ 30% (≥ 30 ml/min/1.73 m2)
  • Subjects must be willing to undergo a cystoscopy on study for investigational product removal.
  • Eligible for and willing to undergo RC per the attending urologist.
  • Subjects must be deemed ineligible for cisplatin-based combination chemotherapy by the attending medical oncologist.
  • Subjects medically eligible for neoadjuvant cisplatin-based combination chemotherapy who refuse this therapeutic option and understand the risks and benefits of doing so.
  • Prior radiation therapy is allowed provided that no radiation therapy was administered to the urinary bladder.
  • Written informed consent and Health Insurance Portability and Accountability Act of 1966 (HIPAA) authorization for release of personal health information.
  • Age > 18 years at the time of consent.

Exclusion Criteria:

  • Active malignancies within 12 months with the exception of those with a negligible risk of metastasis or death treated with expected curative outcome.
  • Prior systemic chemotherapy for transitional cell carcinoma of the bladder. Any other prior systemic chemotherapy for a non-urothelial carcinoma must have been completed > 5 years prior to initiation of study.
  • Previous exposure to gemcitabine instillations.
  • Currently receiving other intravesical chemotherapy.
  • Concurrent clinically significant infections as determined by the treating investigator.
  • Presence of any bladder or urethral anatomic feature that in the opinion of the investigator may prevent the safe placement, indwelling use or removal of TAR-200.
  • Documented history of vesicoureteral reflux or the presence of an indwelling ureteral stent or nephrostomy tube at the time of screening.
  • Pelvic radiotherapy administered within less than 6 months prior to enrollment. Subjects who received radiotherapy ≥ 6 months prior to enrollment must demonstrate no cystoscopic evidence or symptoms of radiation cystitis.
  • Bladder Post-Void Residual Volume (PVR) of > 250-mL.
  • Active, uncontrolled urogenital bacterial, viral or fungal infections, including urinary tract infection that in the opinion of the investigator, contraindicates participation. Skin/nail fungal infections are not exclusionary. Subjects with active shingles (varicella zoster infection) will be excluded from the study.
  • History or presence of any significant cardiovascular, pulmonary, hepatic, renal, gastrointestinal, gynecological, endocrine, immunological, dermatological, neurological or psychiatric disease or disorder that, in the opinion of the investigator, contraindicates participation.
  • History of diagnosis of neurogenic bladder.
  • Concomitant immunosuppressive medications, such as methotrexate or TNF inhibitors, within 2 weeks of Study Day 0, exclusive of steroid doses ≤ 5 mg daily.
  • Difficulty providing blood samples.
  • Unwilling or unable to provide informed consent or comply with the requirements of this protocol, including the presence of any condition (physical, mental or social) that is likely to affect the subject's return for scheduled visits and follow-up.
  • Other unspecified reasons that, in the opinion of the investigator or TARIS, make the subject unsuitable for enrollment.
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02722538


Contacts
Contact: TARIS Biomedical 781-676-7750 clinops@tarisbio.com

Locations
United States, California
University of Southern California Norris Comprehensive Cancer Center Recruiting
Los Angeles, California, United States
Contact: Siamak Daneshmand, MD         
United States, Illinois
University of Chicago Medical Center Recruiting
Chicago, Illinois, United States
Contact: Gary Steinberg, MD         
United States, Maryland
Johns Hopkins Hospital Recruiting
Baltimore, Maryland, United States
Contact: Trinity Bivalaqua, MD         
United States, New York
Columbia University Medical Center Recruiting
New York, New York, United States, 10032
Contact: Joel DeCastro, MD         
United States, Ohio
Ohio State University Wexner Medical Center Recruiting
Columbus, Ohio, United States
Contact: Kamal Pohar, MD         
Sponsors and Collaborators
Taris Biomedical LLC
Investigators
Principal Investigator: Siamak Daneshmand, MD University of Southern California
More Information

Responsible Party: Taris Biomedical LLC
ClinicalTrials.gov Identifier: NCT02722538     History of Changes
Other Study ID Numbers: TAR-200-101
First Posted: March 30, 2016    Key Record Dates
Last Update Posted: May 10, 2017
Last Verified: May 2017

Studies a U.S. FDA-regulated Drug Product: Yes

Additional relevant MeSH terms:
Urinary Bladder Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Urinary Bladder Diseases
Urologic Diseases
Gemcitabine
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Antiviral Agents
Anti-Infective Agents
Enzyme Inhibitors
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs