Treatment for recurrent or refractory non-muscle invasive bladder cancer using targeted nanoparticles

A Phase I Microtrial With PLZ4-Coated Paclitaxel-Loaded Micelles (PPM) in Patients With Recurrent or Refractory Non-Myoinvasive Bladder Cancer

This study is testing a new treatment using special nanoparticles to see if it can help people with recurring bladder cancer feel better and improve their chances of staying cancer-free.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 12 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University of California, Davis (Academic / other)
• Drugs / interventions: chemotherapy, immunotherapy
• Locations: 1 site (Sacramento, California)
• Trial ID: NCT06173349 on ClinicalTrials.gov

What this trial studies

This phase I trial evaluates the safety, tolerability, and effectiveness of PLZ4-coated paclitaxel-loaded micelles (PPM) for patients with recurrent or refractory non-muscle invasive bladder cancer. The treatment involves administering PPM intravesically once a week for six weeks, targeting tumor cells specifically in the bladder. The study also assesses tumor response and event-free survival rates following treatment. Patients will undergo imaging and cystoscopy with biopsy to monitor their condition throughout the trial.

Who should consider this trial

Good fit: Ideal candidates include patients with histologically confirmed non-muscle invasive bladder cancer who are BCG-unresponsive or intolerant to BCG treatment.

Not a fit: Patients with muscle-invasive bladder cancer or those who have not undergone prior BCG therapy may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a more effective and targeted option for patients with difficult-to-treat bladder cancer.

How similar studies have performed: Other studies using nanoparticle-based therapies for cancer treatment have shown promise, indicating potential for success with this novel approach.

Eligibility criteria

Inclusion Criteria:

* Histologically confirmed non muscle invasive bladder cancer (NMIBC), defined as noninvasive papillary carcinoma (Ta), carcinoma in situ (CIS) or carcinoma invading the subepithelial connective tissue (T1), determined via transurethral resection of bladder tumor (TURBT) within 3 months of enrollment
* Participant must have Bacillus Calmette Guerin (BCG)-unresponsive NMIBC or intolerance of treatment with BCG. BCG-unresponsive disease is defined as being at least one of the following:

  * Persistent or recurrent CIS alone or with recurrent Ta/T1 (noninvasive papillary disease/tumor invades the subepithelial connective tissue) disease within 12 months of completion of adequate BCG therapy
  * Recurrent high-grade Ta/T1 disease within 12 months of completion of adequate BCG therapy
  * T1 high-grade disease at the first evaluation following an induction BCG course. In this context, adequate BCG therapy is defined as at least one of the following:

    * At least five of six doses of an initial induction course plus at least two of three doses of maintenance therapy
    * At least five of six doses of an initial induction course plus at least two of six doses of a second induction course
* Refuse or intolerant of a radical cystectomy recommended by the treating urologist as the standard next therapy per American Urological Association (AUA) guideline
* Age ≥ 18 years at time of consent
* Performance status: Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
* Patient with life expectancy greater than 24 months
* No concurrent radiotherapy, chemotherapy, or other immunotherapy for bladder cancer. No BCG or other intravesical treatment within 4 weeks
* No scheduled radiotherapy, chemotherapy, other immunotherapy, or surgery before the scheduled response evaluation
* Recovery from prior treatment side effects that might interfere with the study treatment, in the judgment of the investigator
* Absolute neutrophil count (absolute granulocyte count \[AGC\]/absolute neutrophil count \[ANC\]) ≥ 1,500/µL
* Platelets ≥ 100,000/µL (Patients may be transfused to meet this requirement)
* Hemoglobin ≥ 8 g/dL (Patients may be transfused to meet this requirement)
* Calculated glomerular filtration rate (GFR) ≥ 30 mL/min
* Total bilirubin ≤ 2.0 × institutional upper limit of normal (ULN) (\< 3 × ULN for patients with Gilbert's syndrome)
* Aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) ≤ 3.0 × institutional ULN
* Adequate pulmonary function by clinical assessment with no clinical signs of severe pulmonary dysfunction
* Participants of childbearing potential must agree to using adequate contraception (e.g., hormonal or barrier method of birth control; abstinence, an intrauterine device) for the duration of study participation (including dosing interruptions) and up to 3 months after last study treatment; or be surgically sterilized (e.g., hysterectomy, tubal ligation, or vasectomy)
* Ability to understand and willingness to sign an informed consent form
* Ability and willingness to adhere to the study visit schedule and other protocol requirements

Exclusion Criteria:

* Existence of cancer at the upper urinary tract
* Concurrent use of other investigational agents
* Evidence of regional and/or distant metastasis
* NYHA (New York Heart Association) class III or IV heart failure, uncontrollable supraventricular arrhythmias, any history of a ventricular arrhythmia, or other clinical signs of severe cardiac dysfunction
* Symptomatic congestive heart failure (CHF), severe/unstable angina pectoris, or myocardial infarction within 6 months prior to study entry
* Patient has an intractable bleeding disorder (e.g., coagulation factors deficiencies, Von Willebrand Disease)
* Patient taking medications that affect coagulation, such as aspirin (though, aspirin 81 mg oral once daily is allowed), Coumadin/Warfarin, heparin, low molecular weight heparin, direct thrombin inhibitors, and direct factor Xa inhibitors. Other nonsteroidal antiinflammatory drugs (NSAIDs) are allowed as long as they are discontinued the day before therapy
* History or evidence of uncontrollable central nervous system (CNS) disease
* Active systemic infection requiring parenteral antibiotic therapy
* Women who are pregnant or breast feeding
* Any other malignancy diagnosed within 3 years of trial entry with the exception of the following:

  * Basal or squamous cell skin cancers, or
  * Noninvasive cancer of the cervix, or
  * Any other cancer deemed to be of low-risk for progression or patient morbidity during trial period, such as localized prostate cancer after definitive treatment and prostate-specific antigen (PSA) less than 0.2 ng/mL
* Any condition that would prohibit the understanding or rendering of informed consent
* Any condition that in the opinion of the investigator would interfere with the participant's safety or compliance while on trial

Where this trial is running

Sacramento, California

• University of California Davis Comprehensive Cancer Center — Sacramento, California, United States (Recruiting)

Study contacts

• Principal investigator: Mamta Parikh — University of California, Davis
• Study coordinator: Office of Clinical Research

Conditions Recurrent Non-Muscle Invasive Bladder Carcinoma; Stage 0a Bladder Cancer AJCC v8; Stage 0is Bladder Cancer AJCC v8; Stage I Bladder Cancer AJCC v8