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UGN-104 treatment for low-grade upper tract urothelial cancer

A Phase 3, Single-arm, Multicenter Study to Evaluate the Efficacy and Safety of UGN-104, a Novel Formulation of UGN-101, for the Treatment of Patients With Low-grade Upper Tract Urothelial Cancer (LG-UTUC)

Phase 3 Interventional UroGen Pharma Ltd. · NCT06774131

This Phase 3 trial tests whether weekly UGN-104 instillations can clear low-grade upper tract urothelial cancer in patients with small papillary tumors in the renal pelvis.

Quick facts

PhasePhase 3
Study typeInterventional
Enrollment70 (estimated)
Ages18 Years and up
SexAll
SponsorUroGen Pharma Ltd. Industry-sponsored
Drugs / interventionschemotherapy
Locations52 sites (Homewood, Alabama and 51 other locations)
Trial IDNCT06774131 on ClinicalTrials.gov

What this trial studies

This is a single-arm Phase 3 trial giving UGN-104 once weekly for six weeks to patients with biopsy-proven low-grade, non-invasive upper tract urothelial carcinoma. Efficacy is measured as the complete response rate at the Primary Disease Evaluation about three months after the first instillation, using ureteroscopic visual assessment, upper tract wash cytology, and biopsy where feasible. Patients with a complete response may receive monthly maintenance doses for up to 11 months and will have clinic evaluations every three months. Patients without a complete response at the primary evaluation will end study treatment and follow standard care.

Who should consider this trial

Good fit: Patients with biopsy-proven low-grade, non-invasive UTUC in the pyelocalyceal system who have at least one papillary tumor ≤15 mm (and ≥5 mm post-biopsy) are ideal candidates.

Not a fit: Patients with high-grade or invasive disease, tumors larger than 15 mm, or disease not accessible by ureteroscopy are unlikely to receive benefit from this protocol.

Why it matters

Potential benefit: If successful, UGN-104 could eliminate visible low-grade tumors in the upper urinary tract and reduce the need for invasive surgery such as nephroureterectomy.

How similar studies have performed: Yes — prior trials of UGN-101 (JELMYTO, mitomycin) have produced complete responses in similar low-grade UTUC patients, and UGN-104 is a reformulation intended to build on that evidence.

Eligibility criteria

Show full inclusion / exclusion criteria 
Inclusion Criteria:

1. Provide written informed consent, which includes compliance with the requirements and restrictions listed in the informed consent form and protocol.
2. Naive or recurrent patients with LG, non-invasive UTUC in the pyelocalyceal system, with the following disease characteristics:

   1. At least 1 measurable papillary LG tumor, evaluated visually, ≤ 15 mm. The largest lesion should not exceed 15 mm. Debulking to ≤ 15 mm is permitted.
   2. Biopsy taken from at least 1 tumor located above the ureteropelvic junction revealing LG urothelial carcinoma (UC). Patients who have been biopsied within 8 weeks before Screening for this study and shown to have LG UC may have these historical biopsies used for enrollment into the study and do not require repeat biopsy during Screening.
   3. Patient should have at least 1 remaining papillary LG tumor evaluated visually with a diameter of at least 5 mm post-biopsy.
   4. Wash urine cytology sampled from the pyelocalyceal system documenting the absence of high-grade (HG) UC, diagnosed not more than 8 weeks before Screening.
   5. Patients with bilateral LG-UTUC may be enrolled if at least 1 side meets the inclusion criteria for the study and if the other kidney does not require further treatments. (The disease in the other kidney must be completely ablated before receiving treatment in the study.) Note: If both upper tracts meet inclusion criteria, the treating urologist in consultation with the sponsor's medical monitor can decide which side to treat in the study. The pyelocalyceal system not under study must be free of cancer before the first instillation on the side to be treated in the study.
3. Patients with Eastern Cooperative Oncology Group (ECOG) performance status \< 3 (with Karnofsky \> 40).
4. Patients with life expectancy \> 24 months at time of Screening.
5. Patients must have adequate organ and bone marrow function as determined by the following routine laboratory tests:

   1. Leukocytes ≥ 3,000/μL (≥ 3 × 10\^9/L).
   2. Absolute neutrophil count ≥ 1,500/μL (≥ 1.5 × 10\^9/L).
   3. Platelets ≥ 100,000/μL (≥ 100 × 10\^9/L).
   4. Hemoglobin ≥ 9.0 g/dL.
   5. Total bilirubin ≤ 1.5 × upper limit of normal (ULN).
   6. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 × ULN.
   7. Alkaline phosphatase ≤ 2.5 × ULN.
   8. Estimated glomerular filtration rate (eGFR) ≥ 30 mL/min.
6. Patient has no active urinary tract infection (UTI) as confirmed by urine culture or urinalysis. Note: In case of a symptomatic UTI the patient will be treated with antibiotics and the instillation will be postponed until resolution. In the case of asymptomatic bacteriuria, the use of prophylactic antibiotics and postponement of treatment is at the discretion of the investigator.
7. Contraceptive use by men and women should be consistent with local regulations regarding the methods of contraception for clinical study participants.

Female patients of childbearing potential (defined as premenopausal women who have not been sterilized) and male patients with female partners of childbearing potential must agree to use 2 acceptable forms of effective contraception from enrollment through 6 months post treatment. Sexually active male patients must agree to use a condom during intercourse for at least 48 hours after each instillation.

Acceptable methods of birth control considered to have a low failure rate (ie, less than 1% per year) when used consistently and correctly include implants, injectable, combined (estrogen/progesterone) oral contraceptives, intrauterine devices (only hormonal), condoms with spermicide, sexual abstinence\* or vasectomized partner.

\* Sexual abstinence is defined as refraining from intercourse from enrollment through 6 months post treatment. Periodic abstinence (calendar, symptothermal, post-ovulation methods) is NOT an acceptable method of contraception.

Exclusion Criteria:

1. UC specific exclusions:

   1. Patient received Bacillus Calmette-Guérin (BCG) treatment for UC during the 6 months before enrollment.
   2. The patient has untreated concurrent UC in locations other than the target area (unless treated and resolved during Screening); ie, ureteral and lower urinary tract tumors must be completely ablated before entry.
   3. Patient has a history of carcinoma in situ (CIS) in the urinary tract.
   4. Patient has a history of invasive UC in the past 5 years.
   5. Patient has a history of HG papillary UC in the urinary tract in the past 2 years.
2. Patient is actively being treated or intends to be treated with systemic chemotherapy during the duration of the study.
3. Any other malignancy diagnosed within 2 years before enrollment with the exception of:

   1. Basal or squamous cell skin cancers.
   2. Noninvasive cancer of the cervix.
   3. Any other cancer deemed to be of low risk for progression or patient morbidity during the study period in the opinion of the investigator.
4. Patient with urinary obstruction such that there is an inability to deliver the study treatment to the pyelocalyceal system either via ureteral catheter (retrograde administration) or nephrostomy tube (antegrade administration).
5. Known allergy or sensitivity to any component of the study treatment (including excipients) that in the investigator's opinion cannot be readily managed.
6. Patient has an intractable bleeding disorder (eg, coagulation factors deficiencies, Von Willebrand disease).
7. Patient is currently receiving any other investigational product, has participated in a research protocol involving administration of an investigational product in the past 30 days, or plans to participate in a research protocol involving administration of an investigational product during study conduct.
8. Patient was previously treated with JELMYTO (product code UGN-101) for UTUC.
9. Women who are pregnant (positive urine or serum pregnancy test), planning to become pregnant during the study period, or who are breastfeeding are not eligible to enroll.
10. Patient has any other medical or mental condition(s) that make(s) his/her participation in the study unadvisable in the opinion of the investigator.
11. Where applicable per country regulation, the patient must not be currently committed to an institution by virtue of an order issued by either judicial or administrative authorities.

Where this trial is running

Homewood, Alabama and 51 other locations

+2 more sites — see ClinicalTrials.gov for the full list.

Study contacts

How to participate

  1. Review the eligibility criteria above with your treating physician.
  2. Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
  3. Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.
View on ClinicalTrials.gov → Find more trials like this →
Conditions Upper Urinary Tract Urothelial CarcinomaUrothelial CarcinomaUTUCLow Grade UTUCLow-grade Upper Tract Urothelial CancerUGN-104MitomycinNephrostomy Tube
Last reviewed 2026-06-13 by the Find a Trial editorial team. Information on this page is for educational purposes and is not medical advice. Always consult qualified healthcare professionals about clinical trial participation.