Because of the high risk for development of muscle invasive disease, cystectomy is recommended for CIS, high-grade Ta and T1 patients who experience disease recurrence following intravesical therapy. Vicinium is an experimental agent that may provide an alternative to cystectomy
Bladder cancer is the 6th most common cancer in the United States, affecting more men than women. The usual first treatment for NMIBC (Ta, T1, and CIS) is transurethral resection of the bladder tumors followed by intravesical immunotherapy, most commonly with bacillus Calmette-Guérin (BCG). Because of the high risk for development of muscle invasive disease, cystectomy is recommended for CIS and high-grade Ta and T1 patients who experience disease recurrence following intravesical therapy. For patients unable or unwilling to undergo cystectomy, treatment options are limited. Vicinium contains the active pharmaceutical ingredient VB4-845, which is a recombinant fusion protein produced in Escherichia coli (E. coli) that expresses a humanized single-chain antibody fragment specific for the epithelial cell adhesion molecule (EpCAM) antigen linked to ETA(252-608). Once bound to the EpCAM antigen on the surface of carcinoma cells, Vicinium is internalized through an endocytic pathway. The ETA(252-608) is cleaved off and induces cell death by irreversibly blocking protein synthesis. In vitro and in vivo pharmacology demonstrated that Vicinium exhibits potent activity \[inhibitory concentration 50% (IC50) = 0.001 - 10 pM\] against numerous cell lines and effectively inhibits tumor growth in several human xenograft animal models. A Phase 2 study evaluated once-weekly instillations of Vicinium 30 mg over 6 or 12 weeks, followed by up to 3 maintenance cycles (3 once-weekly instillations followed by a 9-week drug-free period) in 45 subjects with histologically-confirmed TCC of the bladder and residual CIS with or without concurrent Ta or T1 who were refractory or intolerant to BCG. A complete response (defined as no histological evidence of disease and negative urine cytology at the 3-monthly evaluations) was achieved by 44% of subjects, and 16% of subjects remained disease-free at 1-year. A post-study assessment found that these subjects were still disease-free at 18-25 months. The median time to recurrence was 134 days longer in subjects who received 12 weeks of induction therapy compared to 6 weeks. This is an open-label, non-randomized, multicenter study in adults with NMIBC, specifically CIS (with or without papillary disease), high-grade Ta or any grade T1 papillary disease, who have previously failed BCG treatment (i.e., not those who are intolerant) with or without interferon. The study consists of a Screening period, a 12-week Induction Phase, and a Maintenance Phase of up to 21 monthly cycles for a total treatment period of up to 104 weeks. This is an outpatient study, but all treatments are administered in the study clinic.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
133
Intravesical administration
Complete Response Rate at 3 Months
Complete response rate at 3 months in patients with CIS with or without resected papillary disease following initiation of Vicinium therapy. This is the percentage of patients who were free of high-grade disease at the post-induction (3 month) assessment timepoint. A patient was considered to have a complete response if the urine cytology was reported as negative or atypical AND the cystoscopy was reported as normal or any suspicious areas were deemed negative for high-grade disease upon biopsy assessment.
Time frame: 3 months from start of treatment
Duration of Complete Response
Duration of complete response in participants with CIS with or without resected papillary disease who achieved a complete response at the post-induction (3 month) assessment. This is the number of days from the date of first occurrence of complete response to the date of documented treatment failure or death, whichever occurs first
Time frame: Up to 24 months
Event-free Survival
Interval from the date of first dose of study treatment to the first event (persistent high-grade disease or low grade T1 if that was the baseline disease, high-grade disease tumor recurrence, tumor progression to muscle invasive bladder cancer, cystectomy due to treatment failure, or death) prior to treatment discontinuation
Time frame: Up to 24 months
Complete Response Rate at 6, 9, 12, 15, 18, 21, 24 Months
Complete response rate in subjects with CIS with or without resected papillary disease after 6, 9, 12, 15, 18, 21, and 24 months of Vicinium therapy. This is measured as a proportion of the total number of participants in this group that are free of high-grade disease at the respective 3-month intervals
Time frame: Participants on treatment were assessed at months 6, 9, 12, 15,18, 21, and 24
Time to Cystectomy
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Birmingham, Alabama, United States
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Phoenix, Arizona, United States
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Tucson, Arizona, United States
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Little Rock, Arkansas, United States
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Los Angeles, California, United States
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Los Angeles, California, United States
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Los Angeles, California, United States
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Los Angeles, California, United States
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Redwood City, California, United States
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San Bernardino, California, United States
...and 60 more locations
Time from the date of first dose of study treatment to physical removal of the bladder
Time frame: Up to 48 months
Time to Disease Recurrence
Time from the first dose of study treatment to the first occurrence of treatment failure or death on or prior to treatment discontinuation for participants with papillary disease only
Time frame: Up to 24 months
Progression-free Survival
Time from the date of first dose of study treatment to the date of disease progression (e.g., T2 or more advanced disease) or death on or prior to treatment discontinuation
Time frame: Up to 24 months
Overall Survival
All participants were followed for survival during the period of consent (up to 24 months of study treatment and up to 24 months after last dose of study treatment). Any participants who were alive at last follow-up were censored.
Time frame: Up to 48 months (up to 24 months while on study treatment and up to 24 months in the post-treatment follow-up period from the date of last dose of study drug)
Number of Participants Who Experienced an Adverse Event (AE)
An AE was defined as any untoward medical occurrence in a subject administered a pharmaceutical product and which did not necessarily have to have a causal relationship with this treatment. An AE could, therefore, be any unfavorable and unintended sign (that may include an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, whether or not related to the medicinal product. Any worsening of the participant's pre-existing medical conditions was also considered an AE, unless it was within the normal range of disease fluctuation for that participant.
Time frame: Up to 25 months (up to 24 months of study treatment + 30 days after the last dose of study drug)
Number of Participants That Discontinued Study Treatment Due to an AE
An AE was defined as any untoward medical occurrence in a participant administered a pharmaceutical product and which did not necessarily have to have a causal relationship with this treatment. An AE could, therefore, be any unfavourable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product or protocol-specified procedure, whether or not considered related to the medicinal product or protocol-specified procedure. Any worsening of a pre-existing condition that was temporally associated with the use of the Sponsor's product, was also an adverse event. The number of participants that discontinued study treatment due to an AE was reported.
Time frame: Up to 24 months