Clinical Trials /

Phase I BLASST-3 Trial

NCT04972253

Description:

The aim of this research is to see whether using a drug that blocks a protein called FGFR (fibroblast growth factor receptor) prior to surgery is safe and effective in patients with bladder cancer that have mutations in FGFR3 or FGFR2 and who cannot receive chemotherapy with cisplatin prior to surgery The name of the study drug involved in this study is: - Infigratinib

Related Conditions:
  • Bladder Urothelial Carcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Phase I BLASST-3 Trial
  • Official Title: Biomarker-directed Neoadjuvant Therapy for Cisplatin-ineligible or Cisplatin-refusing Muscle-invasive Bladder Cancer: Phase I Bladder Cancer Signal Seeking Trial

Clinical Trial IDs

  • ORG STUDY ID: 21-162
  • NCT ID: NCT04972253

Conditions

  • Bladder Transitional Cell Carcinoma
  • Bladder Cancer
  • Fibroblast Growth Factor Receptor

Interventions

DrugSynonymsArms
InfigratinibBGJ-398Infigratinib

Purpose

The aim of this research is to see whether using a drug that blocks a protein called FGFR (fibroblast growth factor receptor) prior to surgery is safe and effective in patients with bladder cancer that have mutations in FGFR3 or FGFR2 and who cannot receive chemotherapy with cisplatin prior to surgery The name of the study drug involved in this study is: - Infigratinib

Detailed Description

      This is a single-center (DF/HCC) prospective feasibility study to assess biomarker-directed
      neoadjuvant therapy in patients with cT2-T4aN0 MIBC who are candidates for radical cystectomy
      (RC) and ineligible for, or refuse, cisplatin-based neoadjuvant chemotherapy (NAC).

      This research study involves using a drug that inhibits FGFR in patients with bladder cancer
      (that have mutations in FGFR) prior to surgery.

      The name of the study drug involved in this study is:

      - Infigratinib

      The research study procedures include pre-screening for eligibility and study treatment
      including evaluations and follow up visits. This pre-screening is already done as clinical
      care. Study participants will receive study treatment for 2 months prior to surgery and will
      be followed for at least 1 year after undergoing surgery.

      It is expected that about 12 people will take part in this research study.

      This research study is a Phase I clinical trial, which tests the safety of an investigational
      drug (infigratinib) and also tries to define the appropriate dose of the investigational drug
      to use for further studies. "Investigational" means that the drug is being studied.

      This research study is also a Feasibility Study, which is the first time investigators are
      examining this drug in patients with bladder cancer that has not spread to other organs. The
      U.S. Food and Drug Administration (FDA) has not approved infigratinib as a treatment for any
      disease.
    

Trial Arms

NameTypeDescriptionInterventions
InfigratinibExperimentalInfigratinib daily dosage per protocol 3-week on/1-week off schedule. 4 weeks will constitute 1 cycle of therapy. Participants will receive 2 cycles (i.e. 8 weeks) and the treatment will be administered as an outpatient. After completion of therapy, patients will undergo a CT of the chest, abdomen and pelvis (within 2 weeks of the last dose of therapy) and then proceed to Radical cystectomy 2-4 weeks after the last dose of therapy.
  • Infigratinib

Eligibility Criteria

        Inclusion Criteria:

          -  Written informed consent and any locally-required authorization (e.g. HIPAA) obtained
             from the patient prior to performing any protocol-related procedures, including
             screening evaluations

          -  Age ≥ 18 years at time of study entry (no safety data in pediatric patients is
             available for infigratinib).

          -  Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 (See Appendix
             A).

          -  Histologically confirmed bladder transitional cell carcinoma (TCC)

             -- Patients with mixed histology are required to have a component of TCC, and no
             component of small cell histology

          -  cT2-T4a N0 M0 disease after radiographic staging of chest, abdomen and pelvis,
             considered appropriate and planned for radical cystectomy as assessed by a Urologic
             Oncologist.

          -  Presence of the following FGFR3/2 activating alterations, as detected by either plasma
             or urine cfDNA or cfRNA or by tissue-based NGS (Predicine, Hayward, CA):

               -  Mutations in exon 7 (R248C, S249C)

               -  Mutations in exon 10 (G372C, A393E, Y375C)

               -  Mutations in exon 15 (K652M/T, K652E/Q)

               -  Any FGFR3/2 gene fusion (Availability of baseline archival tumor tissue for
                  identification of FGFR3/2 alterations is not required, but tissue will be
                  obtained when available including either FFPE tumor tissue block or a minimum of
                  fifteen 5μm unstained FFPE slides and fifteen 10μm unstained FFPE slides with an
                  associated pathology report is required)

          -  Ineligibility for cisplatin-based chemotherapy, defined by any of the following:

               -  Creatinine clearance (CL) <60 mL/min. GFR should be calculated from serum/plasma
                  creatinine using the Cockcroft-Gault formula.

               -  CTCAE v5.0 Grade > 1 hearing loss

               -  CTCAE v5.0 Grade > 1 neuropathy

               -  NYHA Class > II cardiac dysfunction

               -  Patients not meeting the above criteria are eligible if he/she declines
                  neoadjuvant cisplatin-based chemotherapy after specific informed consent
                  describing the known benefits of cisplatin-based chemotherapy. The reason for
                  cisplatin-ineligibility based on the above criteria or cisplatin refusal should
                  be documented on the case report form.

          -  Adequate organ function laboratory values as defined below:

               -  Hemoglobin ≥ 9.0 g/dL

               -  Absolute neutrophil count (ANC) 1.5 x (> 1500 per mm3)

               -  Platelet count ≥100 x 109/L (>75,000 per mm3)

               -  International Normalized Ratio (INR) or activated partial thromboplastin time
                  (aPTT) < 1.5 x ULN, unless the patient is receiving anticoagulation therapy
                  provided INR or PTT is within the therapeutic range of the intended anticoagulant
                  therapy.

          -  Serum bilirubin ≤1.5 x institutional upper limit of normal (ULN)

             -- This will not apply to patients with confirmed Gilbert's syndrome (persistent or
             recurrent hyperbilirubinemia that is predominantly unconjugated in the absence of
             hemolysis or hepatic pathology), who will be allowed only in consultation with their
             physician.

          -  AST (SGOT)/ALT (SGPT) ≤1.5 x institutional upper limit of normal

          -  Measured creatinine CL >30 mL/min or Calculated creatinine CL>30 mL/min by the
             Cockcroft-Gault formula or by 24-hour urine collection for determination of creatinine
             clearance:

               -  Males: Creatinine CL (mL/min) = Weight (kg) x (140 - Age)/72 x serum creatinine
                  (mg/dL)

               -  Females: Creatinine CL (mL/min) = Weight (kg) x (140 - Age) x 0.85/ 72 x serum
                  creatinine (mg/dL)

          -  Evidence of post-menopausal status or negative urinary or serum pregnancy test for
             female pre-menopausal patients. Women will be considered post-menopausal if they have
             been amenorrheic for 12 months without an alternative medical cause. The following
             agespecific requirements apply:

               -  Women <50 years of age would be considered post-menopausal if they have been
                  amenorrheic for 12 months or more following cessation of exogenous hormonal
                  treatments and if they have luteinizing hormone and follicle-stimulating hormone
                  levels in the post-menopausal range for the institution or underwent surgical
                  sterilization (bilateral oophorectomy or hysterectomy).

               -  Women ≥50 years of age would be considered post-menopausal if they have been
                  amenorrheic for 12 months or more following cessation of all exogenous hormonal
                  treatments, had radiation-induced menopause with last menses >1 year ago, had
                  chemotherapy-induced menopause with last menses >1 year ago, or underwent
                  surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or
                  hysterectomy).

          -  Patient has ability and willingness to sign a written informed consent document and is
             willing and able to comply with the protocol for the duration of the study including
             undergoing treatment and scheduled visits and examinations including follow up.

        Exclusion Criteria:

          -  Patients with primary TCC of the ureter, urethra, or renal pelvis without TCC of the
             bladder

          -  Inoperable tumor(s) with fixation to the pelvic wall on clinical exam

          -  Any previous systemic chemotherapy or radiotherapy for TCC of bladder

          -  Participation in another clinical study with an investigational product during the
             last 6 months

          -  Any prior participation in a study involving an FGFR inhibitor.

          -  Concurrent enrolment in another clinical study, unless it is an observational
             (noninterventional) clinical study or during the follow-up period of an interventional
             study

          -  History of another primary malignancy except for:

               -  Malignancy treated with curative intent and with no known active disease ≥5 years
                  before the first dose of study drug and of low potential risk for recurrence

               -  Adequately treated non-melanoma skin cancer or lentigo maligna without evidence
                  of disease

               -  Adequately treated carcinoma in situ without evidence of disease (e.g. cervical
                  cancer in situ)

          -  Receipt of the last dose of intravesical chemotherapy or biologic therapy ≤ 42 days (6
             weeks) prior to the first dose of study drug for patients who have received prior
             intravesical chemotherapy or biologic therapy (e.g. BCG)

          -  Any unresolved toxicity NCI CTCAE version 5.0 Grade ≥2 from previous anticancer
             therapy with the exception of alopecia, vitiligo, and the laboratory values defined in
             the inclusion criteria

          -  Patients currently receiving treatment with drugs that are known to be strong CYP3A4
             inducers or inhibitors, including anti-epileptic drugs.

          -  Use of medications that are known to prolong the QT interval and/or associated with a
             risk of torsade de pointes 7 days prior to the first dose of infigratinib.

          -  Use of amiodarone within 90 days prior to first dose of infigratinib.

          -  Use of medications that increase serum levels of calcium and/or phosphorus.

          -  Concurrent use of warfarin or other coumadin-derivative anticoagulants; heparin and/or
             low molecular-weight heparins are permitted.

          -  Inorganic phosphorus and/or total/ionized serum calcium outside normal limits prior to
             study entry.

          -  Have clinically significant cardiac disease, including any of the following:

               -  New York Heart Association (NYHA) Class ≥2B; subjects with known history or
                  current symptoms of cardiac disease, or history of treatment with cardiotoxic
                  agents, should have a clinical risk assessment of cardiac function using the NYHA
                  classification.

               -  Presence of Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Grade ≥2
                  ventricular arrhythmias, atrial fibrillation, bradycardia, or conduction
                  abnormality

               -  Unstable angina pectoris or acute myocardial infarction ≤3 months prior to first
                  dose of study drug

               -  QTcF >470 msec (males and females). Note: If the QTcF is >470 msec in the first
                  ECG, a total of 3 ECGs separated by at least 5 minutes should be performed. If
                  the average of these 3 consecutive results for QTcF is ≤470 msec, the subject
                  meets eligibility in this regard

               -  Known history of congenital long QT syndrome.

          -  Any concurrent chemotherapy, IP, biologic, or hormonal therapy for cancer treatment.
             Concurrent use of hormonal therapy for non-cancer-related conditions (e.g. hormone
             replacement therapy) is acceptable.

          -  Major surgical procedure (as defined by the Investigator) within 28 days prior to the
             first dose of infigratinib. NB: local surgery of isolated lesions for palliative
             intent is acceptable.

          -  History of allogeneic organ transplantation

          -  Current evidence of corneal or retinal disorder/keratopathy

          -  Uncontrolled intercurrent illness, including but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable
             angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic
             gastrointestinal conditions associated with diarrhea, or psychiatric illness/social
             situations that would limit compliance with study requirement, substantially increase
             risk of incurring AEs or compromise the ability of the patient to give written
             informed consent

          -  Female patients who are pregnant or breastfeeding, or patients of reproductive
             potential who are not willing to employ effective birth control from screening to 90
             days after the last dose of infigratinib monotherapy.

          -  Known allergy or hypersensitivity to any of the study drugs or any of the study drug
             excipients

          -  Inability to swallow oral medications

          -  Judgement by the investigator that the patient is unsuitable to participate in the
             study and the patient is unlikely to comply with study procedures, restrictions and
             requirements.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:≥ 70% of patients receiving at least 1 dose of study treatment followed by completion of radical cystectomy (Feasibility)
Time Frame:time of first administration of study treatment until 4 weeks after RC up to 3 months
Safety Issue:
Description:Feasibility is defined as ≥ 70% of patients receiving at least 1 dose of study treatment followed by completion of radical cystectomy in the absence of DLT up to 4 weeks post-RC. Dose-limiting toxicities (DLTs) will be graded using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria). DLT will be defined as an adverse event (AE) or abnormal laboratory value deemed related to therapy with infigratinib, including those AEs and abnormal laboratory values that result in a failure to meet the criteria for re-treatment.

Secondary Outcome Measures

Measure:Pathologic response (<ypT2N0) at time of RC.
Time Frame:3 months
Safety Issue:
Description:Pathologic response is defined as <pT2N0 disease at the time of RC (e.g. pT0N0, pT1N0, pTaN0, or pTisN0)
Measure:Pathologic complete response (pCR) at time of RC.
Time Frame:3 months
Safety Issue:
Description:Pathologic complete response (pCR) is defined as achievement of pT0N0 disease at RC.
Measure:Relapse-free survival (RFS) after RC.
Time Frame:4 weeks after end of treatment, then every 12-24 weeks up to 1 year
Safety Issue:
Description:Relapse-free survival (RFS) is defined as the duration of time from time of RC to time of documented disease relapse or recurrence after RC, or death from any cause. Patients who have received at least one cycle of therapy and have undergone RC will be considered evaluable for RFS.
Measure:Progression-free proportion after neoadjuvant infigratinib, prior to RC
Time Frame:2 months
Safety Issue:
Description:Progression prior to RC will be defined as radiologic progression by RECIST 1.1 with development of radiologic T4b and/or N1/N2/N3 and/or or M1 disease (per RECIST 1.1) in scans obtained after commencement of neoadjuvant therapy and prior to RC

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Guru P. Sonpavde

Trial Keywords

  • Bladder transitional cell carcinoma
  • Bladder Cancer
  • Fibroblast growth factor receptor

Last Updated

July 22, 2021