DURANCE is a two part, phase Ib/II, multi-centre study to assess the safety and activity of S-488210/S-488211 in combination with durvalumab, in patients with non-muscle invasive bladder cancer (NMIBC).
DURANCE is a registered, phase Ib/II study in patients with surgically debulked bacillus Calmette-Guerin (BCG) unresponsive (resistant or relapsing) or intolerant non-muscle invasive bladder cancer (NIMBC). Patients will receive up to 24 weeks of durvalumab (a PD-L1 immune checkpoint inhibitor) in combination with S-488210/S-488211 (a 5-peptide cancer vaccine). Durvalumab will be given as 1500 mg IV infusion every 4 weeks for up to 7 doses, in combination with S-488210/S-S488211 which will be administered as two subcutaneous injections of S-488210/Montanide and S-488211/Montanide starting the day after the first durvalumab dose, then weekly for 6 doses and every 2 weeks for a further 9 doses (up to a maximum of 16 doses). All patients must have a cystoscopy at the end of week 12 (from start of trial treatment) for disease evaluation and to assess suitability to continue trial treatment. Patients with complete response, as shown from the cystoscopy, may continue treatment for up to 24 weeks in the absence of progressive disease, unacceptable toxicity or withdrawal of consent; all other patient will be withdrawn from further trial treatment. The phase Ib part of the DURANCE study will look to assess the safety and tolerability of the treatment combination of durvalumab + S-488210/S-488211 by reviewing Dose Limiting Toxicities (DLTs) which have at least a reasonable possibility of being related to the trial treatments (durvalumab and/or S-488210/S-488211). Up to 14 evaluable patients will be registered into phase Ib and provided the DLTs do not exceed the DLT thresholds defined in the trial protocol, the trial will proceed to the expansion phase of the study (phase 2). In phase 2 the trial will look to assess the disease free survival rate at 1 year following start of treatment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
52
1500 mg IV infusion every 4 weeks for up to 7 doses
S-488210/S-488211 is given as a 1 mL subcutaneous (SC) injection of S-488210/Montanide emulsion and a 1 mL SC injection of S-488211/Montanide emulsion starting the day after first dose of durvalumab and continuing weekly for 6 doses and then every 2 weeks for a further 9 doses
Cambridge University NHS FT
Cambridge, United Kingdom
RECRUITINGGuy's and St Thomas' NHS Foundation Trust
London, United Kingdom
RECRUITINGRoyal Free London NHS FT
London, United Kingdom
Occurrence of Dose Limiting Toxicity (Phase 1b)
Detailed adverse event monitoring will be conducted, assessed using CTCAE v5. Dose Limiting Toxicity (DLT) is defined as any adverse event or laboratory abnormality detailed in the trial protocol, that has a reasonable possibility of being related to trial treatment and occurring at anytime during the DLT evaluation period (28 days from the first administration of S-488210/S-488211 on cycle 1 day 2).
Time frame: At the end of cycle 1 (cycle 1 is 28 days)
Pathological Disease Free Survival Rate (DFSR) (Phase 2) from cystoscopy and mapping biopsies
Disease Free Survival will be calculated from start of trial treatment (cycle 1 day 1) until the time at which either primary disease is confirmed to have recurred, any secondary cancer is confirmed or death from any cause. The primary endpoint of Disease Free Survival Rate will be assessed at 1 year from start of treatment (and include patients that start trial treatment and receive combination treatment on cycle 2 day 1) and compared to the historical control rate of 20%.
Time frame: 1 year after start of treatment
1 year DFSR stratified by HLA-A*02:01
If the primary endpoint (DFSR) is statistically signification, comparison of DFSR at 1 year will be conducted between patients that are human leukocyte antigen-A (HLA-A\*02:01) positive versus negative.
Time frame: 1 year after start of treatment
Overall Survival rate
Overall survival will be assessed from time of starting treatment to time of death from any cause.
Time frame: Start of treatment to date of death, if applicable, or up to 60 months after last patient enrolled.
5 year Overall Survival rate stratified by HLA-A*02:01
Overall survival will be assessed from time of starting treatment to time of death from any cause, stratified by HLA-A\*02:01 positive or negative.
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The Royal Marsden NHS Foundation Trust
London, United Kingdom
RECRUITINGUniversity College London Hospital NHS Foundation Trust
London, United Kingdom
RECRUITINGThe Christie NHS Foundation Trust
Manchester, United Kingdom
RECRUITINGUniversity Hospital Southampton NHS Foundation Trust
Southampton, United Kingdom
RECRUITINGTime frame: 5 years from start of treatment to date of death, if applicable, or up to 60 months after last patient enrolled.
Assessment of Quality of Life using EORTC QLQ-C30 questionnaire
Quality of Life assessments will be undertaken using EORTC QLQ-C30 (version 3) questionnaire using Likert score (26 questions scored: 1=not at all, 2=a little, 3=quite a bit, 4=very much; 2 questions scored: 1-7, 1=very poor, 7=excellent) . Descriptions of mean change in EORTC QLQ scores will be presented and compared to baseline values from pre-treatment.
Time frame: Assessments will be performed at baseline (prior to starting treatment on cycle 1 days 1), every 12 weeks up to 12 months after start of treatment and 24 months after start of treatment.
Assessment of Quality of Life using EORTC QLQ-NMIBC24 questions
Quality of Life assessments will be undertaken using EORTC QLQ-C30 which will include QLQ-NMIBC24 questions using Likert score (24 questions scored: 1=not at all, 2=a little, 3=quite a bit, 4=very much. Descriptions of mean change in EORTC QLQ scores will be presented and compared to baseline values from pre-treatment.
Time frame: Assessments will be performed at baseline (prior to starting treatment on cycle 1 days 1), every 12 weeks up to 12 months after start of treatment and 24 months after start of treatment.
Assessment of Quality of Life using EQ-5D-5L questionnaire
Quality of Life assessments will be undertaken using EQ-5D-5L (self-reported) questionnaire using a combination of Likert score (5 questions with 5 dimensions of abilities) and visual analogue score (scored 0-100, 0=worst, 100=best). Descriptions of mean change in EQ-5D-5L scores will be presented and compared to baseline values from pre-treatment.
Time frame: Assessments will be performed at baseline (prior to starting treatment on cycle 1 days 1), every 12 weeks up to 12 months after start of treatment and 24 months after start of treatment.