Patients will have tests and exams to see if they are eligible for the clinical trial. If
found eligible, the patient will receive treatment with avelumab and AVB-S6-500 by vein once
every two weeks.
This study has two parts in order to determine the maximum tolerated dose of AVB-S6-500. If
the patient is enrolled on the first dose level, the patient will be treated at a higher dose
every two weeks with AVB-S6-500. If the patient is enrolled on the second dose level, the
patient will be receive AVB-S6-500 only once a week at a lower dose. The patient would
continue to receive avelumab twice weekly at the same dose.
Patients will receive the study treatment as long as there is evidence that the tumor is not
growing or spreading and they are not having any unacceptable, bad side effects.
Patients will be monitored during treatment with tests and exams and after treatment
completion for up to one year.
1. Age ≥18 years
2. Histologically confirmed locally advanced unresectable (T4b or N2/N3 disease) or
metastatic urothelial cancer (including renal pelvis, ureters, urinary bladder,
3. Eligible patients must have had either:
1. Progressed after treatment with at least 1 prior platinum-containing regimen,
(e.g., received at least 2 cycles of cisplatin or carboplatin-based regimen) for
inoperable locally advanced unresectable or metastatic urothelial carcinoma, OR
2. Unable to tolerate platinum (cisplatin or carboplatin) based chemotherapy due to
3. Experienced disease progression or recurrence within 12 months of completion of
neoadjuvant or adjuvant cisplatin-based chemotherapy, OR
4. Ineligible for cisplatin-based chemotherapy due to eastern co-operative oncology
group (ECOG) performance status 2, grade ≥2 neuropathy, GFR<60 mL/Hr, grade ≥2
hearing loss and New York Heart Association class III or worse congestive heart
4. Available pretreatment baseline tumor specimen or willingness to undergo biopsy of
primary or metastatic lesion if archived specimen is not available.
5. ECOG performance status of ≤2
6. At least one measurable lesion by RECIST version 1.1
7. Patients who are able to understand and sign the informed consent form.
8. Ability to comply with protocol
9. Adequate hematologic and end-organ function per protocol
10. For women of childbearing potential: Negative serum or urine pregnancy test at
11. For both male and female subjects: agreement to remain abstinent (refrain from
heterosexual intercourse) or use highly effective contraceptive methods that result in
a failure rate of <1% per year during the treatment period and for at least 30 days
after the last dose of study drug
1. Concurrent systemic treatment with an anticancer treatment or investigational drug
within 28 days. Palliative radiation to symptomatic primary tumor or metastases is
permitted as long as there are other measurable lesions present outside of the
2. Prior therapy with anti-PD-1 or PD-L1 agents.
3. Concurrent systemic therapy with corticosteroids (>10 mg prednisone equivalent) or
other immunosuppressive agents within 28 days before starting trial drug. Short-term
administration of systemic steroids (less than 7 days), adrenal replacement steroid
doses (≤10 mg daily prednisone equivalent), topical, intranasal and inhaled steroid
use is permitted.
4. Patients with untreated or symptomatic central nervous metastases will be excluded.
Appropriately treated CNS metastases with either surgery or radiation therapy are
permitted to participate in the study.
5. Active second malignancy or previous history of malignant disease (other than
urothelial carcinoma) diagnosed within the last 3 years, with the exclusion of basal
or squamous cell carcinoma of the skin, cervical carcinoma in situ and prostate
adenocarcinoma with Gleason score ≤7, pT2b.
6. Prior organ transplantation, including allogenic stem-cell transplantation.
7. Known history of testing positive for HIV/AIDS, HBV, or HCV (including acute and
8. Known hypersensitivity to monoclonal antibody or any biologic drug, history of
anaphylaxis, or uncontrolled asthma.
9. Persisting toxicity related to prior therapy that was > grade 1; grade ≤2 sensory
neuropathy is allowed.
10. Pregnant or lactating, or intending to become pregnant during the study
a. Women who are not postmenopausal (≥ 12 months of non−therapy-induced amenorrhea) or
surgically sterile must have a negative pregnancy test result within 14 days prior to
the first dose of study treatment.
11. Diagnosis of active autoimmune disease requiring systemic immunosuppression. Patients
with type 1 diabetes, vitiligo, psoriasis, hypo- or hyperthyroid disease not requiring
systemic immunosuppression are eligible.
12. History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis
obliterans), drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active
pneumonitis on screening chest CT scan.
a. History of radiation pneumonitis in the radiation field (fibrosis) is permitted.
13. Active infection requiring systemic therapy.
14. Severe infections within 4 weeks prior to the first dose of study treatment, including
but not limited to hospitalization for complications of infection, bacteremia, or
15. Administration of a live/attenuated vaccine within 4 weeks prior to the first dose of
study treatment, within 5 months following the administration of the last dose of
study drug, or anticipation that such a live/attenuated vaccine will be required
during the study.
16. Other severe acute or chronic medical conditions per protocol