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.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Correlative studies
Given intravesically
University of California, San Francisco
San Francisco, California, United States
Incidence of treatment-related toxicities according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 (Dose escalation)
The distribution for the maximum observed grade for each adverse event will be tabulated and reported with 95% confidence interval.
Time frame: Up to 2 years
Pathologic T0 rate (Dose expansion)
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.
Time frame: At 6 months
Relapse-free survival rate (Dose expansion)
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.
Time frame: From study start until recurrence of disease or death from any cause, assessed at 2 years
Change in antigen presenting cell (APC) within bladder tumor tissue by immunohistochemical (IHC) assessment
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
Time frame: Baseline up to 2 years
Change in circulating immune cells following intravesical talimogene laherparepvec, by flow cytometric assessment
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.
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Time frame: Baseline up to 2 years
Change in T cell and other immune cell infiltration within bladder tumor tissue by IHC assessment
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.
Time frame: Baseline up to 2 years
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
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.
Time frame: Up to day 43
Viral replication as measured by viral titers
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.
Time frame: Up to 2 years