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Adding Mitomycin C to Bacillus of Calmette-Guerin (BCG) as Adjuvant Intravesical Therapy for High-risk, Non-Muscle-invasive Bladder Cancer (BCG+MMC)

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ClinicalTrials.gov Identifier: NCT02948543
Recruitment Status : Recruiting
First Posted : October 28, 2016
Last Update Posted : May 9, 2018
Sponsor:
Collaborators:
Australian and New Zealand Urogenital and Prostate Cancer Trials Group
Cancer Australia
Information provided by (Responsible Party):
University of Sydney

Brief Summary:
Open label, randomised phase 3 trial of the addition of Mitomycin C to BCG as adjuvant intravesical therapy for high-risk, non-muscle-invasive bladder cancer. The study aim is to compare disease-free survival between treatment arms: BCG alone versus Mitomyicn C in addition to BCG.

Condition or disease Intervention/treatment Phase
Bladder Cancer Biological: Bacillus of Calmette-Guerin (BCG) Drug: Mitomycin C (MMC) Phase 3

Detailed Description:

PROTOCOL SYNOPSIS

Background:

Instillation of Bacillus of Calmette-Guerin (BCG) into the urinary bladder (intravesical administration) improves rates of disease recurrence and progression after transurethral resection (TUR) of high risk, non-muscle-invasive bladder cancer (NMIBC), but over 30% of people still recur despite optimal therapy with adjuvant intravesical BCG. The meta-analysis, including a recent randomised phase 2 trial, suggests that outcomes might be improved further by using an adjuvant intravesical regimen that includes both Mitomycin C (MMC) and BCG. These promising findings require corroboration in a definitive, large scale, randomised phase 3 trial using standard techniques for intravesical administration.

General Aim:

To determine the efficacy and safety of MMC in addition to BCG in patients with NMIBC.

Design:

Open label, randomised, stratified, 2-arm multicentre phase 3 clinical trial. Population: The target population is adults with resected, high-risk NMIBC (high grade Ta or any grade T1) suitable for intravesical chemotherapy treatment. Key eligibility criteria include: prior transurethral resection of all visible tumour, adequate organ function, and ECOG performance status 0-2.

Study Treatments:

Arm A: Intravesical BCG Alone (standard): Induction (weekly x 6), followed by Maintenance (monthly x 10); or Arm B: Intravesical BCG + MMC (experimental): Induction (weekly x 9), followed by Maintenance (monthly x 9).

Statistical Considerations:

A sample size of 500 (followed until 213 events are observed) provides 85% power to detect a 10% improvement in DFS rate at 2 years from 70% on BCG alone to 80% on BCG and MMC (hazard ratio 0.63) at a significance level of 0.05, allowing for 10% non-compliance.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 500 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Adding Mitomycin C to Bacillus of Calmette-Guerin (BCG) as Adjuvant Intravesical Therapy for High-risk, Non-Muscle-invasive Bladder Cancer: a Randomised Phase 3 Trial
Study Start Date : July 2013
Estimated Primary Completion Date : December 2020
Estimated Study Completion Date : December 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Bladder Cancer

Arm Intervention/treatment
Experimental: Treatment (Arm B):Intravesical BCG + MMC

Induction (weekly x 9); and followed by Maintenance (monthly x 9) beginning 3 months after randomisation.

Dosage of Bacillus of Calmette-Guerin (BCG) dependent on preferred brand of BCG by participating institution. Either 2-8 x 10^8 CFU for OncoTICE or, 81mg for ImmuCYST and TheraCys. Prior to treatment commencement, investigators should nominate which BCG brand will be used. The same brand of BCG must be used for all treatment administered to an individual participant throughout the study.

Dosage of Mitomycin (MMC) fixed at 40mg per instillation.

Biological: Bacillus of Calmette-Guerin (BCG)
A strain of tubercle bacillus which modifies biologic response.
Other Names:
  • OncoTICE
  • ImmuCYST
  • TheraCys

Drug: Mitomycin C (MMC)
An antibiotic produced by a soil actinomycete which inhibits DNA synthesis.

Treatment (Arm A): Intravesical BCG

Induction (weekly x 6); and followed by Maintenance (monthly x 10) beginning 3 months after randomisation.

Dosage of Bacillus of Calmette-Guerin (BCG) dependent on preferred brand of BCG by participating institution. Either 2-8 x 10^8 CFU for OncoTICE or, 81mg for ImmuCYST and TheraCys. Prior to treatment commencement, investigators should nominate which BCG brand will be used. The same brand of BCG must be used for all treatment administered to an individual participant throughout the study.

Biological: Bacillus of Calmette-Guerin (BCG)
A strain of tubercle bacillus which modifies biologic response.
Other Names:
  • OncoTICE
  • ImmuCYST
  • TheraCys




Primary Outcome Measures :
  1. Disease free survival (death or recurrence) [ Time Frame: Up to 5 years ]

Secondary Outcome Measures :
  1. Activity (Clear cystoscopy at 3 months) [ Time Frame: At 3 months after patient randomised ]
  2. Time to recurrence (recurrence) [ Time Frame: Up to 5 years ]
  3. Time to progression (disease progression) [ Time Frame: Up to 5 years ]
  4. Safety (Adverse events graded according to CTC AE V4.0) [ Time Frame: Measured before day 1 of each instillation during treatment. ]
  5. Health-Related Quality of Life [ Time Frame: Up to 5 years ]
    Health related quality life is a composite outcome aggregated to arrive at one reported value to ensure multiple aspects of the participants life are adequately assessed and measured. The following questionnaires will be used; the 24-item EORTC Bladder Symptoms Quality of Life module (QLM-BLS24); the EORTC Core Quality of Life Questionnaire (QLQ-C30); and the International Prostate Symptom Score (I-PSS).

  6. Overall survival time (death from any cause) [ Time Frame: Up to 5 years ]
  7. Treatment Completion [ Time Frame: Measured at end of study treatment (12 months after patient randomized). ]
    Treatment completion is defined as having received 75% or more of the planned numbers of induction and maintenance doses.

  8. Marginal resource use [ Time Frame: 5 years after last patient randomized (or date last patient has died, whichever sooner). ]
    Assessed via a specifically designed resource utilisation form (collecting information such as number, type and duration of visits).


Other Outcome Measures:
  1. Exploratory Tissue Biomarker Investigation [ Time Frame: Baseline ]
    Optional donation of formalin-fixed paraffin embedded (FFPE) tumour tissue for future biological or translational sub-studies. These future studies may include investigations of how BCG + MM may work in people with Non-Muscle-invasive Bladder Cancer as well as studies that may help to understand the pathogenic course of this cancer and related diseases.



Information from the National Library of Medicine

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

Inclusion Criteria:

  1. Males or females with confirmed high grade pTa or stage pT1 (any grade) non-muscle invasive bladder cancer on initial or re-resection histology (concurrent carcinoma in situ is allowed).
  2. Age >= 18 yrs
  3. No macroscopically visible disease at cystoscopy within 8 weeks prior to randomisation. This may be either the initial Transurethral Resection of the Bladder Tumour (TURBT) at which the primary tumour was completely resected, or a planned second cystoscopy and/or re-resection done within 8 weeks of the initial TURBT.
  4. ECOG Performance Status of 0-2
  5. Adequate bone marrow function
  6. Adequate renal function
  7. Adequate liver function
  8. Study treatment both planned and able to start within 4 weeks of randomisation
  9. Has completed the HRQL questionnaires or is unable to complete them because of literacy, insufficient English or limited vision
  10. Willing and able to comply with all study requirements, including treatment, timing and/or nature of all required assessments
  11. Signed, written informed consent

Exclusion Criteria:

  1. Contraindications or hypersensitivity to investigational products, BCG and Mitomycin C
  2. Prior treatment with any other intravesical agent including BCG or Mitomycin C (excludes single doses given post TURBT)
  3. Current or past transitional cell carcinoma (TCC) of the upper urinary tract
  4. Prior muscle-invasive (stage T2 or higher) transitional-cell carcinoma of the bladder
  5. Bladder dysfunction precluding intravesical therapy eg. Severe urinary incontinence or overactive or spastic bladder
  6. Life expectancy < 3 months
  7. Congenital or acquired immune deficiencies, whether due to a concurrent disease (e.g. acquired immune deficiency syndrome (AIDS), leukaemia, lymphoma) or immunosuppressive therapy (e.g. corticosteroids), or cancer therapy (cytotoxic drugs, radiation)
  8. Prior radiotherapy of the pelvis
  9. Prior or current treatment with radiotherapy-response or biological-response modifiers
  10. Clinical evidence of existing active tuberculosis
  11. History of another malignancy within 5 years prior to registration. Patients with non-melanomatous carcinoma of the skin are eligible for this study.
  12. Serious medical or psychiatric conditions that might limit the ability of the patient to comply with the protocol.
  13. Pregnancy, lactation, or inadequate contraception. Women must be post menopausal, infertile, or use a reliable means of contraception. Women of childbearing potential must have a negative pregnancy test done within 7 days prior to registration. Men must have been surgically sterilised or use a (double if required) barrier method of contraception.

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): NCT02948543


Contacts
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Contact: BCG+MMC Trial Coordinator +61 2 9562 5000 bcgmmc@ctc.usyd.edu.au

Locations
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Australia, New South Wales
Concord Repatriation General Hospital Recruiting
Concord, New South Wales, Australia, 2139
Contact       bcgmmc@ctc.usyd.edu.au   
Principal Investigator: Andrew Mitterdorfer         
Northern Cancer Institute, St Leonards Recruiting
St Leonards, New South Wales, Australia, 2065
Contact       bcgmmc@ctc.usyd.edu.au   
Principal Investigator: Laurence Krieger         
The Tweed Hospital Recruiting
Tweed Heads, New South Wales, Australia, 2485
Contact       bcgmmc@ctc.usyd.edu.au   
Principal Investigator: Ehtesham Abdi         
Sydney Adventist Hospital Recruiting
Wahroonga, New South Wales, Australia, 2076
Contact       bcgmmc@ctc.usyd.edu.au   
Principal Investigator: Gavin Marx         
Australia, Victoria
Footscray Hospital Recruiting
Footscray, Victoria, Australia, 3011
Contact       bcgmmc@ctc.usyd.edu.au   
Principal Investigator: Conrad Bishop         
Frankston Hospital Recruiting
Frankston, Victoria, Australia, 3199
Contact       bcgmmc@ctc.usyd.edu.au   
Principal Investigator: Emma Beardsley         
Austin Health - Austin Hospital Recruiting
Heidelberg, Victoria, Australia, 3084
Contact       bcgmmc@ctc.usyd.edu.au   
Principal Investigator: Shomik Sengupta         
The Alfred Hospital Recruiting
Melbourne, Victoria, Australia, 3004
Contact       bcgmmc@ctc.usyd.edu.au   
Principal Investigator: Jeremy Grummet         
Royal Melbourne Hospital - City Campus Recruiting
Parkville, Victoria, Australia, 3050
Contact       bcgmmc@ctc.usyd.edu.au   
Principal Investigator: Paul Anderson         
Australia, Western Australia
Fiona Stanley Hospital Recruiting
Murdoch, Western Australia, Australia, 6150
Contact       bcgmmc@ctc.usyd.edu.au   
Principal Investigator: Dickon Hayne         
Sponsors and Collaborators
University of Sydney
Australian and New Zealand Urogenital and Prostate Cancer Trials Group
Cancer Australia
Investigators
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Study Chair: Dickon Hayne Fiona Stanley Hospital

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Responsible Party: University of Sydney
ClinicalTrials.gov Identifier: NCT02948543    
Other Study ID Numbers: ANZUP 1301
12613000513718 ( Registry Identifier: Australian New Zealand Clinical Trials Registry (ANZCTR) )
First Posted: October 28, 2016    Key Record Dates
Last Update Posted: May 9, 2018
Last Verified: May 2018
Additional relevant MeSH terms:
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Urinary Bladder Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Urinary Bladder Diseases
Urologic Diseases
Mitomycins
Mitomycin
BCG Vaccine
Antibiotics, Antineoplastic
Antineoplastic Agents
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Nucleic Acid Synthesis Inhibitors
Enzyme Inhibitors
Adjuvants, Immunologic
Immunologic Factors
Physiological Effects of Drugs