Clinical Trials /

Open-Label, Randomised, Multi-Drug, Biomarker-Directed, Phase 1b Study in Pts w/ Muscle Invasive Bladder Cancer

NCT02546661

Description:

This is an open label, multi-drug, biomarker-directed, multi-centre, multi-arm, Phase 1b study in patients with muscle invasive bladder cancer (MIBC) (urothelial) who have progressed on prior treatment. This study is modular in design, allowing evaluation of the safety, tolerability, pharmacokinetics and anti-tumour activity of multiple agents as monotherapy and as combinations of different novel anti-cancer agents. The study will consist of a number of study modules (sub-studies), each evaluating the safety and tolerability of a specific agent or combination.

Related Conditions:
  • Bladder Carcinoma
  • Urothelial Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Open-Label, Randomised, Multi-Drug, Biomarker-Directed, Phase 1b Study in Pts w/ Muscle Invasive Bladder Cancer
  • Official Title: An Open-Label, Randomised, Multi-Drug, Biomarker-Directed, Multi-Centre, Multi-arm Phase 1b Study in Patients With Muscle Invasive Bladder Cancer (MIBC) Who Have Progressed on Prior Treatment (BISCAY).

Clinical Trial IDs

  • ORG STUDY ID: D2615C00001
  • SECONDARY ID: GU 118
  • SECONDARY ID: BISCAY
  • NCT ID: NCT02546661

Conditions

  • Muscle Invasive Bladder Cancer

Interventions

DrugSynonymsArms
AZD4547Module A: AZD4547 Monotherapy
MEDI4736DurvalumabModule A: MEDI4736 (durvalumab) + AZD4547
OlaparibLynparzaModule B: MEDI4736 (durvalumab) + Olaparib
AZD1775Module C: MEDI4736 (durvaluamb) + AZD1775
VistusertibModule E: MEDI4736 (durvalumab) + Vistusertib
AZD9150Module F: MEDI4736 (durvaluamb) + AZD9150
SelumetinibModule G: MEDI4736 + Selumetinib

Purpose

This is an open label, multi-drug, biomarker-directed, multi-centre, multi-arm, Phase 1b study in patients with muscle invasive bladder cancer (MIBC) (urothelial) who have progressed on prior treatment. This study is modular in design, allowing evaluation of the safety, tolerability, pharmacokinetics and anti-tumour activity of multiple agents as monotherapy and as combinations of different novel anti-cancer agents. The study will consist of a number of study modules (sub-studies), each evaluating the safety and tolerability of a specific agent or combination.

Detailed Description

      This is an open label, multi-drug, biomarker-directed, multi-centre, multi-arm, Phase 1b
      study in patients with muscle invasive bladder cancer (MIBC) (urothelial) who have progressed
      on prior treatment. This study is modular in design, allowing evaluation of the safety,
      tolerability, pharmacokinetics and anti-tumour activity of multiple agents as monotherapy and
      as combinations of different novel anti-cancer agents.

      The study will consist of a number of study modules (sub-studies), each evaluating the safety
      and tolerability of a specific agent or combination in patients whose tumours express
      specific genomic alterations relevant to the molecules under investigation and whose disease
      has progressed following prior therapy. The allocation of patients to specific modules will
      depend on the specific eligible genomic alterations identified in their tumours.

      Each module will determine the appropriate combination dose for further clinical evaluation
      based on safety, tolerability and efficacy profile. A maximum tolerated dose will be defined
      and each arm expanded appropriately to explore further the safety, tolerability,
      pharmacokinetics and biological activity at the selected combination doses.

      Module A includes an AZD4547 monotherapy arm and a MEDI4736 (durvalumab) + AZD4547
      combination therapy arm and will investigate the safety and tolerability of MEDI4736 given
      intravenously, in combination with AZD4547 given orally to selected patients with MIBC with
      tumours that have fibroblast growth factor receptor mutations or fibroblast growth factor
      receptor fusions.

      Module B will investigate the safety and tolerability of MEDI4736 given intravenously in
      combination with olaparib (AZD2281, Lynparza) given orally to selected patients with MIBC
      whose tumors have mutations in a homologous recombination repair gene panel and whose disease
      had progressed following prior therapy.

      Module C will investigate the safety and tolerability of MEDI4736 given intravenously, in
      combination with AZD1775 given orally to selected patients with MIBC whose tumours have
      mutations in genes involved in cell cycle regulation (e.g., loss of either retinoblastoma 1
      or cyclin-dependent kinase inhibitor 2A or amplification of cyclin E1 or MYC family genes).

      Module D will investigate the safety and tolerability of MEDI4736 given intravenously as
      monotherapy to patients with MIBC who do not qualify for Modules A, B or C.

      Module E will investigate the safety and tolerability of MEDI4736 given intravenously, in
      combination with vistusertib (AZD2014) given orally to patients with MIBC whose tumours do
      not show genomic alterations that would be eligible for other study modules. Patients whose
      MIBC tumours harbour the following genomic alterations that have potential to respond to a
      mammalian target of rapamycin (mTOR) inhibitor will also be included in Module E: RICTOR
      amplification, or TSC1/1 mutations.

      Module F will investigate the safety and tolerability of MEDI4736 given intravenously in
      combination with AZD9150 given intravenously to patients with MIBC whose tumours do not show
      genomic alterations that would be eligible for other modules.

      Module G will investigate the safety and tolerability of MEDI4736 given intravenously in
      combination with selumetinib (AZD6244) given orally to patients with MIBC. Patients in this
      module will not be selected for any specific tumour genomic alteration.
    

Trial Arms

NameTypeDescriptionInterventions
Module A: AZD4547 MonotherapyExperimentalAZD4547 will be given orally twice daily until disease progression. Patients who receive AZD4547 as monotherapy will have the option to cross over to durvalumab as monotherapy at the point of objective progression, as long as the following criteria are met: The investigator believes it is in the patient's interest to receive durvalumab; The patient consents to the continued treatment; It is clinically appropriate for the patient to continue on durvalumab treatment; The patient satisfies the key eligibility criteria for receiving durvalumab treatment.
  • AZD4547
Module A: MEDI4736 (durvalumab) + AZD4547ExperimentalAZD4547 will be given orally twice daily until disease progression. Patients will also receive MEDI 4736 (durvalumab) by IV infusion once every 4 weeks.
  • AZD4547
  • MEDI4736
Module B: MEDI4736 (durvalumab) + OlaparibExperimentalMEDI4736 (durvalumab) will be given by IV infusion once every 4 weeks. Olaparib will be given orally twice daily.
  • MEDI4736
  • Olaparib
Module C: MEDI4736 (durvaluamb) + AZD1775ExperimentalMEDI4736 (durvalumab) will be given by IV infusion once every 4 weeks. AZD1775 will be given orally in approximate 12 hour intervals over 3 days (6 doses) on Days 1-3, 8-10, and 15-17 of 28 day cycles.
  • MEDI4736
  • AZD1775
Module D: MEDI4736 (durvalumab) monotherapyExperimentalMEDI 4736 (durvalumab) will be given by IV infusion once every 4 weeks.
  • MEDI4736
Module E: MEDI4736 (durvalumab) + VistusertibExperimentalMEDI4736 (durvalumab) will be given by IV infusion once every 4 weeks. Vistusertib will be given orally twice per day on an intermittent schedule (2 days on, 5 days off).
  • MEDI4736
  • Vistusertib
Module F: MEDI4736 (durvaluamb) + AZD9150ExperimentalAZD9150 will be given as monotherapy on Days -7, -5, and -3 of a one week lead-in period. Combination dosing with IV AZD9150 followed by IV MEDI4736 (durvalumab) begins on Day 1 of each 28 day cycle. Thereafter AZD9150 is given weekly and MEDI4736 is given once every 4 weeks.
  • MEDI4736
  • AZD9150
Module G: MEDI4736 + SelumetinibExperimental
  • MEDI4736
  • Selumetinib

Eligibility Criteria

        Inclusion Criteria for all Modules:

          1. Metastatic MIBC

          2. 2nd/3rd line

          3. Failed adjuvant/neo-adjuvant chemotherapy <1 yr

          4. 1 lesion ≥10 mm at baseline in the longest diameter suitable for accurate repeated
             measurement

          5. WHO perf. status 0-1

        For Module A:

          1. M/F ≥25

          2. Confirmation of FGFR3 mutation or FGFR fusion

        For Module B:

          1. Hgb ≥10 g/dL

          2. Deleterious mutation, deletion or truncation in any HRR genes

        For Module C:

        1. Tumour harbours a deletion or inactivating mutation of the CDKN2A or RB1 genes and/or
        amplification of CCNE1, MYC, MYCL or MYCN genes

        For Module E:

        1. Contraception must be sustained throughout treatment with vistusertib and 16 wks after
        last dose

        For Module F:

          1. Adequate organ and marrow function, defined as Leukocytes ≥3.0x10(exp9)/L; ANC
             ≥1.5x10(exp9)/L; platelets ≥100x10(exp9)/L

          2. Contraceptive measures must be sustained throughout treatment with AZD9150 and for 180
             days after the last dose.

        Exclusion Criteria for all Modules:

          1. Immunotherapy, chemotherapy, anticancer agents, radiotherapy <4 weeks, or radiotherapy
             for palliation <2 weeks, any study drugs <30 days.

          2. Major surgery <4 weeks

          3. Unresolved toxicities from prior therapy

          4. Concurrent chemotherapy, immunotherapy, biologic or hormonal therapy

          5. Immunosuppressive drugs <28 days

          6. Any of the following: Autoimmune disease ≤2 yr; IBD; primary immunodeficiency; organ
             transplant requiring immunosuppressives

          7. Spinal cord compression or brain metastases, treated and stable & not requiring
             steroids for at least 4 weeks

          8. Severe or uncontrolled systemic disease

          9. Any of the following: Mean QTc ≥470 ms; abnormalities in resting ECG; factors that
             increase the risk of QTc prolongation or arrhythmia; uncontrolled hyper/hypotension;
             LVEF <55%; atrial fibrillation; NYHA Grade II-IV; severe valvular disease;
             uncontrolled angina; stroke/TIA <6 months; acute coronary syndrome <6 months

         10. Any of the following laboratory values: ANC <1.5x10(exp9)/L; Platelets
             <100x10(exp9)/L; Hgb <9.0 g/dL; ALT >2.5xULN or >5xULN with liver mets; Total
             bilirubin >1.5 times ULN or with Gilbert's disease ≥2×ULN; Creatinine >1.5xULN
             concurrent with creatinine clearance <50 mL/min; Corrected Ca >ULN, PO4 >ULN

         11. Active infection including tuberculosis, hepatitis B (HBV), hepatitis C (HCV), or
             human immunodeficiency virus. Patients with a past or resolved HBV infection are
             eligible. Patients positive for HCV antibody are eligible only if polymerase chain
             reaction is negative for HCV RNA.

         12. Live attenuated vaccination <30 days

        For Module A:

          1. Prior exposure to: Nitrosourea or mitomycin C <6 weeks; any agent with FGFR inhibition
             as its primary pharmacology; AZD4547; potent inhibitors/inducers of CYP3A4, inhibitors
             of CYP2D6 or substrates of CYP3A4 <2 wks

          2. Ophthalmological criteria: RPED; laser treatment or intraocular injection for macular
             degeneration; age-related macular degeneration; retinal vein occlusion; retinal
             degenerative disease; other clinically relevant chorioretinal defect

          3. Refractory nausea/vomiting, chronic GI diseases, or previous bowel resection

        For Module B:

          1. Transfusion <120 days

          2. Concurrent medications that are strong inhibitors of cytochrome P450 (CYP) 3A (CYP3A)
             or strong inducers of CYP3A4.

          3. Previous treatment with PARP inhibitor, including olaparib

          4. Patients with history of MDS or AML

        For Module C:

          1. Prior exposure to any of the following: Nitrosourea or mitomycin C <6 wks; any agent
             with Wee1 inhibition as its primary pharmacology; prior treatment with AZD1775

          2. Any drugs or products known to be sensitive to CYP3A4 substrates or CYP3A4 substrates
             with narrow therapeutic index, or moderate to strong inhibitors/inducers of CYP3A4

          3. Herbal preparations

          4. Refractory nausea and vomiting or chronic GI diseases

          5. Cardiac disease <6 months

        For Module E:

          1. Minor surgery <14 days of first dose

          2. Exposure to specific substrates of OATP1B1, OATP1B3, MATE1 and MATE2K <5x half-life
             before treatment. Exposure to strong/moderate inhibitors/inducers of CYP3A4/5, Pgp
             (MDR1) and BRCP if taken within washout periods before the first dose

          3. Haemopoietic growth factors (filgrastim, sargramostim, GM-CSF) <14 days prior to
             treatment

          4. Other mTOR inhibitors

          5. Renal disease or renal tubular acidosis

          6. Uncontrolled Type 1 or 2 diabetes

        For Module F:

        1. AST ≤ 2.5xULN or ≤5xULN with liver metastases

        For Module G:

          1. Have had prior treatment with a MEK, Ras or Raf inhibitor.

          2. Any of the following ophthalmic criteria: Current or past history of central serous
             retinopathy, detachment of retinal pigmented epithelium, or retinal vein occlusion;
             intraocular pressure (IOP) >21 mmHg; uncontrolled glaucoma (irrespective of IOP)

          3. Baseline left ventricular ejection fraction (LVEF) <55% measured by echocardiogram
             (ECHO) or, if allowed, a multigated acquisition (MUGA) scan. Appropriate correction to
             be used if a MUGA is performed.

          4. Previous moderate or severe impairment of LVEF (<45% on echocardiography or equivalent
             on MUGA) even if full recovery has occurred.

          5. Male or female patients with reproductive potential and, as judged by the
             investigator, are not employing an effective method of birth control and female
             patients who are breastfeeding.

          6. Past medical history of interstitial lung disease (ILD), drug-induced ILD, radiation
             pneumonitis which required steroid treatment, or any evidence of clinically active
             ILD.

          7. Receiving or have received systemic therapy with nitrosoureas, mitomycin or suramin
             within 6 weeks prior to starting study treatment.
      
Maximum Eligible Age:130 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Module A: The frequency and nature of adverse events related to AZD4547 monotherapy.
Time Frame:Adverse events will be assessed at each clinic visit, and at study discontinuation and 90 days after the end of treatment. Clinic visits are generally scheduled weekly.
Safety Issue:
Description:The frequency and nature of adverse events will be assessed in order to determine the safety and tolerability of AZD4547 monotherapy given orally to selected patients with MIBC who have progressed following prior therapy.

Secondary Outcome Measures

Measure:Objective response rate (ORR)
Time Frame:16 weeks and 52 weeks
Safety Issue:
Description:The percentage of patients who have a confirmed visit response of Complete Response (CR) or Partial Response (PR) as assessed by the investigator per RECIST 1.1. Data obtained up until progression, or the last evaluable assessment in the absence of progression, will be included in the assessment of ORR.
Measure:Disease control rate (DCR)
Time Frame:16 weeks and 52 weeks
Safety Issue:
Description:Percentage of patients who have a confirmed visit response of CR or PR or stable disease (SD) ≥16 weeks as assessed by the investigator as per RECIST 1.1
Measure:Progression free survival (PFS)
Time Frame:up to 12 months
Safety Issue:
Description:The time from randomization until the date of objective disease progression or death (from any cause in the absence of progression) regardless of whether the patient withdraws from assigned therapy or receives another anticancer therapy prior to progression. Patients who have not progressed or died at the time of analysis will be censored at the time of the latest date of assessment from their last evaluable RECIST 1.1 assessment.
Measure:Duration of response (DoR)
Time Frame:up to 12 months
Safety Issue:
Description:Duration of response is defined as the elapsed time from the date of first documented response (CR/PR) as per RECIST Version 1.1 as assessed by the investigator until the date of documented progression or death in the absence of disease progression. The time of the initial response is defined as the latest of the dates contributing towards the first visit response of PR or CR.
Measure:Overall survival (OS) rate at 1 year
Time Frame:1 year
Safety Issue:
Description:Defined as the proportion of patients surviving after 1 year from the start of treatment.
Measure:Plasma concentration of AZD4547 (Module A)
Time Frame:Blood samples will be taken pre-dose on Days 1 and 8 of Cycle 1; pre-dose and 2, 3, 4 and 6 hours post-dose on Day 1 of Cycle 2; and pre-dose and 2 to 4 hours post-dose on Day 1 of Cycle 3.
Safety Issue:
Description:The timing of the PK samples may be adjusted during the study, dependent on emerging data, in order to ensure appropriate characterisation of the plasma concentration-time profiles.
Measure:Plasma concentration of MEDI4736 (durvalumab) (Module A)
Time Frame:Blood samples will be taken pre-dose and end of infusion for Day 1 of Cycles 1 to 7 and for the post-Cycle 7 8-weekly assessments, and pre-dose for Day 8 of Cycle 1.
Safety Issue:
Description:The timing of the PK samples may be adjusted during the study, dependent on emerging data, in order to ensure appropriate characterisation of the plasma concentration-time profiles.
Measure:Plasma concentration of olaparib (Module B)
Time Frame:Blood samples will be taken on Day 3 of Cycles 1 and pre-dose and 4 hr post-dose. Serial samples on Day 3 of Cycle 3, pre-dose, 1, 2, 4, 6, 8, and 10 hr post-dose.
Safety Issue:
Description:The timing of the PK samples may be adjusted during the study, dependent on emerging data, in order to ensure appropriate characterisation of the plasma concentration-time profiles.
Measure:Plasma concentration of AZD1775 (Module C)
Time Frame:Blood samples will be taken on Day 8 at steady state at the following time points: pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 12 hr post-dose.
Safety Issue:
Description:The timing of the PK samples may be adjusted during the study, dependent on emerging data, in order to ensure appropriate characterisation of the plasma concentration-time profiles.
Measure:Plasma concentration of MEDI4736 (durvalumab) (Module C)
Time Frame:Blood samples will be taken on Days 1 and 8 of Cycle 1 pre-dose and at the end of infusion (1 hour). Samples will also be collected on Day 1 of Cycles 2 to 7 pre-dose and at the end of infusion.
Safety Issue:
Description:The timing of the PK samples may be adjusted during the study, dependent on emerging data, in order to ensure appropriate characterisation of the plasma concentration-time profiles.
Measure:Plasma concentration of MEDI4736 (durvalumab) (Module D)
Time Frame:Blood samples will be taken on Days 1 and 8 of Cycle 1
Safety Issue:
Description:The timing of the PK samples may be adjusted during the study, dependent on emerging data, in order to ensure appropriate characterisation of the plasma concentration-time profiles.
Measure:Plasma concentration of vistusertib (Module E)
Time Frame:Blood samples will be collected pre-dose, and 2 and 4 hr post-dose on Day 1 of Cycle 1; and pre-dose and 2 to 6 hr post-dose (matched to biopsy) on Day 2 of Cycle 2.
Safety Issue:
Description:The timing of the PK samples may be adjusted during the study, dependent on emerging data, in order to ensure appropriate characterisation of the plasma concentration-time profiles.
Measure:Plasma concentration of Medi4736 (durvalumab) (Module E).
Time Frame:Blood samples will be taken pre-dose and end of infusion for Day 1 of Cycles 1 to 7 and every 8 weeks thereafter and pre-dose for Day 8 of Cycle 1.
Safety Issue:
Description:The timing of the PK samples may be adjusted during the study, dependent on emerging data, in order to ensure appropriate characterisation of the plasma concentration-time profiles.
Measure:Plasma concentration of AZD9150 (Module F)
Time Frame:Blood samples will be taken pre-dose of Days -7, -5, and -3 of the lead-in portion and thereafter prior to dosing and at the ned of infusion on Day 1 of Cycles 1, 2, 3, 4, 6, and 8 (approximately 8 months).
Safety Issue:
Description:The timing of the PK samples may be adjusted during the study, dependent on emerging data, in order to ensure appropriate characterisation of the plasma concentration-time profiles.
Measure:Plasma concentration of MEDI4736 (durvalumab) (Module F).
Time Frame:Blood samples will be taken pre-dose and end of infusion for Day 1 of Cycles 1 to 7 and every 8 weeks thereafter and pre-dose for Day 8 of Cycle 1.
Safety Issue:
Description:The timing of the PK samples may be adjusted during the study, dependent on emerging data, in order to ensure appropriate characterisation of the plasma concentration-time profiles.
Measure:The presence of Anti-Drug Antibodies (ADA) and ADA neutralising antibodies to MEDI4736 will be assessed in patients receiving MEDI4736 in any sub-study module.
Time Frame:Blood samples will be collected prior to MEDI4736 dosing on Day 1 of Cycles 1, 2 and 4 and every 12 weeks thereafter (up to 12 months).
Safety Issue:
Description:The formation of anti-drug antibodies and neutralizing antibodies will be assessed by validated methods.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:AstraZeneca

Trial Keywords

  • Durvalumab
  • Olaparib
  • Vistusertib
  • Selumetinib
  • Muscle invasive bladder cancer
  • MIBC
  • BISCAY
  • MEDI4736
  • AZD4547
  • AZD2281
  • AZD1775
  • AZD2014
  • AZD9150
  • AZD6244

Last Updated

July 23, 2020