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Talimogene Laherparepvec in Treating Patients With Non-Muscle Invasive Bladder Transitional Cell Carcinoma

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ClinicalTrials.gov Identifier: NCT03430687
Recruitment Status : Withdrawn (Investigators prefer to pursue other studies)
First Posted : February 13, 2018
Last Update Posted : May 18, 2018
Sponsor:
Collaborator:
Amgen
Information provided by (Responsible Party):
University of California, San Francisco

Brief Summary:
This phase I trial studies the side effects and best dose of talimogene laherparepvec and to see how well it works in treating patients with non-muscle invasive bladder transitional cell carcinoma. Biological therapies, such as talimogene laherparepvec, use substances made from living organisms that may attack specific tumor cells and stop them from growing or kill them.

Condition or disease Intervention/treatment Phase
Stage 0 Bladder Urothelial Carcinoma AJCC v6 and v7 Stage 0a Bladder Urothelial Carcinoma AJCC v6 and v7 Stage 0is Bladder Urothelial Carcinoma AJCC v6 and v7 Stage I Bladder Urothelial Carcinoma AJCC v6 and v7 Other: Laboratory Biomarker Analysis Biological: Talimogene Laherparepvec Phase 1

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I Study of Intravesical Talimogene Laherparepvec for Non-Muscle Invasive Transitional Cell Carcinoma
Estimated Study Start Date : June 1, 2018
Estimated Primary Completion Date : December 31, 2019
Estimated Study Completion Date : December 31, 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Treatment (talimogene laherparepvec)
Patients receive talimogene laherparepvec intravesically (10ml of 10^6 PFU/mL) on days 1, 8, 15, 22, 29, and 36 or days 1, 15, and 29 in the absence of disease progression or unacceptable toxicity.
Other: Laboratory Biomarker Analysis
Correlative studies

Biological: Talimogene Laherparepvec
Given intravesically
Other Names:
  • ICP34.5-, ICP47-deleted Herpes Simplex Virus 1 (HSV-1) Incorporating the Human GM-CSF Gene
  • Imlygic
  • JS1 34.5-hGMCSF 47- pA-
  • T-VEC




Primary Outcome Measures :
  1. Incidence of treatment-related toxicities according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 (Dose escalation) [ Time Frame: Up to 2 years ]
    The distribution for the maximum observed grade for each adverse event will be tabulated and reported with 95% confidence interval.

  2. Pathologic T0 rate (Dose expansion) [ Time Frame: At 6 months ]
    Point estimates and 95% confidence intervals will be obtained for each dose level of talimogene laherparepvec. Will be estimated for the expansion cohort and compared with the null hypothesis rate separately by using one-sample proportion test.

  3. Relapse-free survival rate (Dose expansion) [ Time Frame: From study start until recurrence of disease or death from any cause, assessed at 2 years ]
    Point estimates and 95% confidence intervals will be obtained for each dose level of talimogene laherparepvec. Will be estimated for the expansion cohort and compared with the null hypothesis rate separately by using one-sample proportion test.


Secondary Outcome Measures :
  1. Change in antigen presenting cell (APC) within bladder tumor tissue by immunohistochemical (IHC) assessment [ Time Frame: Baseline up to 2 years ]
    APC infiltration (CD68+, CD11c+, or CD83+) will be assessed by IHC staining, and quantitated by the number of APCs/um^2. Therefore, the number of APCs will be normalized per unit area. APC will be enumerated from 3 tissue regions: tumor/benign tissue interface (from here on referred to as the ?tumor interface?), tumor center, and benign glands

  2. Change in circulating immune cells following intravesical talimogene laherparepvec, by flow cytometric assessment [ Time Frame: Baseline up to 2 years ]
    Flow cytometry will be performed in both pre- and post-treatment peripheral blood mononuclear cells to determine the change in T cell activation (both regulatory T cells and T effector cells) after intravesical talimogene laherparepvec therapy. Descriptive statistics for continuous measurements will be used to summarize the changes.

  3. Change in T cell and other immune cell infiltration within bladder tumor tissue by IHC assessment [ Time Frame: Baseline up to 2 years ]
    T cell tumor infiltration (of selected T cell subsets) will be scored by IHC assessment, and scored by the number of T cells/um^2. Therefore, the number of T cells will be normalized per unit area. T cell-infiltration for both the pre- treatment diagnostic biopsy specimen and the post-treatment specimen will be quantitated in this fashion. Separate scores will be reported for further characterization of T cell infiltration for tumor interface, tumor center, and benign tissue.

  4. Herpes simplex virus (HSV) status assessed by rate of HSV seroconversion in patients who were previously HSV-seronegative and relationship between HSV status and immunologic infiltration within tumor [ Time Frame: Up to day 43 ]
    In patients who were previously HSV-seronegative, the proportion of patients with HSV seroconversion will be reported, with 95% confidence intervals. The relationship between APC infiltration and baseline HSV status will be reported as a binary outcome: positive or negative. Patients with baseline HSV negative status who experience seroconversion will be assessed by the chi-square test separately.

  5. Viral replication as measured by viral titers [ Time Frame: Up to 2 years ]
    Viral replication will be assessed by urinary viral titers drawn and assessed by polymerase chain reaction and cellular based assays as previously described. These assays will be performed prior to each dose, as well as at +1 hour (h), +2 h, +24 h and +168 h, with a window of 6 hours for the +24 and +168 h to accommodate for logistical issues patients returning to the clinic. Results will be summarized descriptively as change from baseline using appropriate statistical methods.


Other Outcome Measures:
  1. Antibody responses measured by spotted antigen arrays [ Time Frame: Up to 6 weeks following therapy ]
    To characterize antibody responses to a broad panel of antigens, sera will be collected at baseline and 6 weeks following therapy, and profiled using spotted antigen array. After standard preprocess of the protein array data, Cluster and Treeview software will be used for unsupervised clustering of the data with Pearson correlation and complete linkage. For each array, an antigen is identified as being detected if its value is above the median. To determine the number of up- and down modulated antibodies, the difference in log2 intensity values of pretreatment and posttreatment samples will be

  2. Apoptosis by IHC assessment of cleaved caspase-3 [ Time Frame: Up to 2 years ]
    Will be scored on a 0-100 continuous scale based on % area that is positive for stain in regions of tumor. Special attention will be paid to areas of high grade tumor for scoring purposes; areas of interface, benign, and tumor tissue will be scored separately. For each subject, the change in cleaved caspase-3 IHC score following talimogene laherparepvec will be calculated in order to characterize the biological impact of talimogene laherparepvec in NMIBC. Descriptive statistics for continuous measurements will be used to summary the IHC score change for each location. Furthermore, univariate a

  3. Change in PD-L1 expression by IHC assessment [ Time Frame: Baseline up to 2 years ]
    For each subject, the change in PD-L1 expression score defined as either an increase of decrease by at least 1 (on a scale of 1-3) following talimogene laherparepvec will be calculated for exploratory characterization of the impact on PD-L1 expression of talimogene laherparepvec in non-muscle invasive bladder cancer. Descriptive statistics for categorical measurements will be used to summary the PD-L1 expression change for each location. Furthermore, univariate analysis (proportion test) will be applied to explore the PD-L1 expression score change between locations.

  4. Pyroptosis by IHC assessment of cleaved caspace-1 [ Time Frame: Up to 2 years ]
    Will be scored on a 0-100 continuous scale based on % area that is positive for stain in regions of tumor. Special attention will be paid to areas of high grade tumor for scoring purposes; areas of interface, benign, and tumor tissue will be scored separately. For each subject, the change in cleaved caspace-1 IHC score following talimogene laherparepvec will be calculated in order to characterize the biological impact of talimogene laherparepvec in NMIBC. Descriptive statistics for continuous measurements will be used to summary the IHC score change for each location. Furthermore, univariate a

  5. T cell receptor deep sequencing of tissue samples from pre-treatment biopsies [ Time Frame: Up to 2 years ]
  6. T cell receptor deep sequencing of tissue samples from post-treatment resected tissues [ Time Frame: Up to 2 years ]
  7. T cell responses to candidate antigens measured by IFNgamma enzyme-linked immunosorbent spot assay [ Time Frame: Up to 2 years ]


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:

  • Histologically document transitional cell carcinoma with the presence of any of the following stages: carcinoma in situ (CIS), high-grade Ta, or any grade T1, detectable at the time of study accrual; combinations of the aforementioned stages are acceptable; subjects with mixed histology are required to have a dominant transitional cell carcinoma (TCC) pattern
  • Failure of prior intravesical treatment(s), one of which must include a course of BCG; failure is defined as evidence of TCC on cystoscopic examination and biopsy or cystoscopic examination and urine cytology at least 6 weeks from completion of last treatment
  • Patient is either ineligible for or declines radical cystectomy; the investigator must explain that a delay in cystectomy may increase the patient?s chance of disease progression
  • Eastern Cooperative Oncology Group (ECOG) performance status 0 - 2
  • Ability to understand and willingness to sign written informed consent
  • Aspartate aminotransferase (AST), alanine aminotransferase (ALT) < 2.5 x institutional upper limit of normal (ULN) and total bilirubin < 1.5 x institutional ULN
  • Absolut neutrophil count (ANC) > 1500/uL
  • Platelets >= 75,000/uL
  • Hemoglobin > 8 mg/dL without need for hematopoetic growth factor or transfusion support
  • Estimated glomerular filtration rate (GFR) > 30 ml/min
  • Serum creatinine less than 1.5 x upper limit of normal (ULN), OR 24-hour creatinine clearance = or 60 mL/min for subject with creatinine levels more than 1.5 x ULN; (Note: creatinine clearance need not be determined if the baseline serum creatinine is within normal limits; creatinine clearance should be determined per institutional standard)
  • Prothrombin time (PT)/international normalized ratio (INR), partial thromboplastin time (PTT) =< 1.5 x ULN
  • No known history of human immunodeficiency virus (HIV) 1/2, human T-lymphotropic virus (HTLV)-I/II
  • No currently active hepatitis B or C
  • Males with partners of childbearing potential, must agree for the duration of the treatment with talimogene laherparepvec and continuing for 3 months after the last tumor injection of talimogene laherparepvec to either:

    • Abstain from sexual activity
    • Use highly effective barrier protection (latex condom)
  • Female subjects of childbearing potential should have a negative urine or serum pregnancy test within 72 hours prior to enrollment; if urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required

    • If a pregnancy occurs, the study doctor must be notified; the study doctor should notify the study sponsor as well as Amgen of the pregnancy, discuss any follow-up with the subject (and/or his partner), and ask for information on the pregnancy outcome; the patient should be asked if she wishes to consent to follow up through the Amgen pregnancy surveillance program
    • If the female partner is already pregnant when the male subject begins treatment with talimogene laherparepvec, he must refrain from any sort of sexual activity that could expose his partner or the unborn baby to talimogene laherparepvec through semen, or wear a latex condom during sexual activity while receiving treatment with talimogene laherparepvec and for at least 3 months after the last talimogene laherparepvec administration

Exclusion Criteria:

  • Any subjects with muscle-invasive TCC (stages T2 - T4) OR any known TCC of the ureter or renal pelvis are not allowed
  • Any history of metastatic TCC; subjects with suspected malignant lymphadenopathy in the abdomen or pelvis are not allowed
  • Known active central nervous system (CNS) metastases; subjects with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids > 10 mg/day of prednisone or equivalent; the exception does not include carcinomatosus meningitis which is excluded regardless of clinical stability
  • Patients whom, in the opinion of the treating urologic oncologist, should undergo cystectomy due to high-risk features
  • Intravesical chemo- or biologic therapy within 6 weeks of first treatment
  • Prior systemic chemotherapy for transitional cell carcinoma of the bladder; subjects who have received prior intravesical chemotherapy are allowed if completed 28 days prior to cycle 1 day
  • Prior radiation therapy for TCC
  • History or evidence of active autoimmune disease, requiring systemic steroid therapy within 28 days of study screening or other systemic immunosuppressive medications (including but not limited to cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [anti-TNF] agents) or anticipated requirement for systemic immunosuppressive medications during the trial

    • Patients on inhaled or topical steroids are eligible
    • Patients who have received acute, low-dose, systemic immunosuppressant medications (e.g., a one-time dose of dexamethasone for nausea) may be enrolled in the study after discussion with and approval by the principal investigator
    • Replacement therapy (e.g., thyroxin, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment
  • Major surgery (requiring the use of a general anesthetic) within 4 weeks of study enrollment with the exception of transurethral resection of bladder tumor (TURBT)
  • Concurrent use of investigational agents
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to talimogene laherparepvec
  • Malignancies other than urothelial cancer (UC) within 5 years prior to cycle 1, day 1, with the exception of those with a negligible risk of metastasis or death treated with expected curative outcome (such as adequately treated carcinoma in situ of the cervix, basal or squamous cell skin cancer, localized prostate cancer treated with curative intent and absence of PSA relapse, or ductal carcinoma in situ of the breast treated surgically with curative intent) or incidental prostate cancer

    • Patients are considered to be free of active malignancy if they have completed therapy and have a < 30% risk of relapse
  • Uncontrolled cystitis, gross hematuria, bladder pain, or bladder spasms, other uncontrolled concurrent illness, or any underlying medical condition, including any underlying conditions resulting in chronic immunosuppression which in the Investigator?s opinion will make the administration of talimogene laherparepvec hazardous, or obscure the interpretation of adverse events
  • Currently known active infection with HIV, hepatitis B or C virus
  • Clinically significant obstructive airway disease
  • Active HSV infection requiring treatment, or requiring intermittent or chronic systemic (intravenous or oral) treatment with an antiherpetic drug (e.g. acyclovir)
  • Pregnant or nursing women are excluded
  • Female subject of childbearing potential who is unwilling to use acceptable method(s) of effective contraception during study treatment and through 3 months after the last dose of talimogene laherparepvec
  • Received live vaccine within 28 days prior to enrollment
  • Active herpetic skin lesions or prior complications of herpetic infection (e.g., herpetic keratitis or encephalitis)
  • Previous treatment with talimogene laherparepvec or any other oncolytic virus

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): NCT03430687


Locations
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United States, California
University of California, San Francisco
San Francisco, California, United States, 94115
Sponsors and Collaborators
University of California, San Francisco
Amgen
Investigators
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Principal Investigator: Terence Friedlander University of California, San Francisco

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Responsible Party: University of California, San Francisco
ClinicalTrials.gov Identifier: NCT03430687     History of Changes
Other Study ID Numbers: 15521
NCI-2018-00109 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
15-17558
15521 ( Other Identifier: UCSF Medical Center-Mount Zion )
P30CA082103 ( U.S. NIH Grant/Contract )
First Posted: February 13, 2018    Key Record Dates
Last Update Posted: May 18, 2018
Last Verified: May 2018

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Carcinoma
Carcinoma, Transitional Cell
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Talimogene laherparepvec
Antineoplastic Agents, Immunological
Antineoplastic Agents