Oral Lenalidomide and Intravesical BCG for Therapy of Bladder Cancer

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2014 by H. Lee Moffitt Cancer Center and Research Institute
Sponsor:
Collaborator:
Celgene Corporation
Information provided by (Responsible Party):
H. Lee Moffitt Cancer Center and Research Institute
ClinicalTrials.gov Identifier:
NCT01373294
First received: June 13, 2011
Last updated: June 13, 2014
Last verified: June 2014
  Purpose

The purposes of this study are to:

  • find out whether participants' cancer returns or gets worse while they are taking lenalidomide and bacilli calmette-guerin (BCG);
  • evaluate the safety and tolerability of the combination of lenalidomide and BCG;
  • compare the cancer progression of participants taking lenalidomide and BCG versus participants taking only BCG

Condition Intervention Phase
Bladder Cancer
Drug: bacilli calmette-guerin (BCG)
Drug: lenalidomide
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Immune Modulation by Addition of Oral Lenalidomide to Intravesical BCG (Bacille Calmette-Guerrin) for Therapy of Non-muscle-invasive Transitional Cell Bladder Cancer

Resource links provided by NLM:


Further study details as provided by H. Lee Moffitt Cancer Center and Research Institute:

Primary Outcome Measures:
  • Number of Participants with Progression Free Survival (PFS) [ Time Frame: 1 year ] [ Designated as safety issue: No ]
    The 1-year progression free/ recurrence free/ bladder-intact survival will be tabulated and the estimate and confidence interval will be computed. The progression free/ recurrence free/ bladder-intact survival is defined as the time from start of study treatment to first documentation of objective tumor progression, recurrence, bladder resection or irradiation or to death due to any cause, which ever comes first.


Secondary Outcome Measures:
  • Number of Participants With Serious Adverse Events (SAEs) [ Time Frame: Duration of study treatment and follow-up - average of 12 months ] [ Designated as safety issue: Yes ]
    Patients will be assessed at monthly intervals (corresponding to Revlimid™ refill points for adverse events, classified by Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, and these will be tabulated.

  • Number of Participants Showing Effect of Addition of Revlimid on Cytokines [ Time Frame: Duration of study treatment and follow-up - average of 12 months ] [ Designated as safety issue: No ]
    The immunologic impact of the addition of Revlimid™ to BCG for secondary prevention of non-muscle-invasive transitional cell bladder cancer, in terms of a panel of correlative assays. The effect of addition of Revlimid on cytokines associated with generation of immune response and on cytotoxic T lymphocytes and memory phenotype lymphocytes.


Estimated Enrollment: 70
Study Start Date: November 2011
Estimated Study Completion Date: July 2015
Estimated Primary Completion Date: July 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: bacilli calmette-guerin
Participants will be assigned to receive BCG or BCG and lenalidomide based on their cancer.
Drug: bacilli calmette-guerin (BCG)
Participants will receive BCG instillations once per week for the first 6 weeks. At 3 months and 6 months, participants will receive BCG instillations once per week for three weeks.
Other Name: BCG
Experimental: bacilli calmette-guerin and lenalidomide
Participants will be assigned to receive BCG or BCG and lenalidomide based on their cancer.
Drug: bacilli calmette-guerin (BCG)
Participants will receive BCG instillations once per week for the first 6 weeks. At 3 months and 6 months, participants will receive BCG instillations once per week for three weeks.
Other Name: BCG
Drug: lenalidomide
Participants may also receive capsules of lenalidomide 10 mg to swallow once per day for 7 months. The study doctor will tell participants if they will be taking lenalidomide.
Other Name: Revlimid®

Detailed Description:

About 100 people with bladder cancer who are 18 years of age or older will be screened for this study throughout the United States. It is expected that about 70 people will take part, with 30 people at Moffitt Cancer Center.

This is a multi-center study combining two marketed drugs, one of which has not been used previously in people with transitional cell cancer. Lenalidomide (Revlimid®) is a drug that alters the immune system and it may also interfere with the development of tiny blood vessels that help support tumor growth. Therefore, in theory, it may reduce or prevent the growth of cancer cells. Lenalidomide is approved by the U.S. Food and Drug Administration (FDA) for the treatment of specific types of myelodysplastic syndrome (MDS) and in combination with dexamethasone for patients with multiple myeloma (MM) who have received at least 1 prior therapy. MDS and MM are cancers of the blood. Lenalidomide is currently being tested in a variety of cancer conditions. It is not approved by the FDA for use in people with bladder cancer, so in this case it is considered experimental.

The other drug used in this study is bacilli calmette-guerin (BCG). BCG is approved by the FDA for use in people with bladder cancer.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria - Either control group or combination treatment:

  • Understand and voluntarily sign an informed consent form
  • Able to adhere to the study visit schedule and other protocol requirements
  • Ta high grade, T1 high grade or Tis transitional cell bladder cancer, s/p transurethral resection of bladder tumor (TURBT) with no remaining resectable disease
  • Adequate cardio-pulmonary function (</= Class II ) as defined by New York Heart Association Classification, at the time of screening, and no history of myocardial infarction or heart failure within 6 months of start
  • Laboratory test results within these ranges:

    • Absolute neutrophil count ≥ 1500/mm³
    • Platelet count ≥ 75,000
    • Serum creatinine for which computed creatinine clearance is ≥ 30 ml/min, or directly measured creatinine clearance ≥ 30 ml/min
    • Total bilirubin ≤ 1.5 mg/dL
    • Aspartate transaminase (AST) [serum glutamic oxaloacetic transaminase (SGOT)] and Alanine transaminase (ALT) [serum glutamate pyruvic transaminase (SGPT)] ≤ 2 x upper limit of normal (ULN)
  • Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1 or 2

Inclusion Criteria - Combination treatment:

  • Prior BCG treatment for non-muscle invasive transitional cell carcinoma (TCC) last administered < 2 years for Ta high-grade, T1 high grade, Cis, or combination thereof
  • Must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®
  • Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of starting lenalidomide and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy.
  • Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (patients intolerant to aspirin may use warfarin or low molecular weight heparin.

Exclusion Criteria:

  • Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the participant from providing informed consent
  • Pregnant or breast feeding (lactating females must agree not to breast feed while taking lenalidomide)
  • Any condition, including the presence of laboratory abnormalities, which places the patient at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study
  • Use of any other experimental drug or therapy within 28 days of baseline
  • Known hypersensitivity to thalidomide
  • Known hypersensitivity to BCG or tuberculosis vaccination
  • The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs
  • Any prior use of lenalidomide
  • Concurrent use of other anti-cancer agents or treatments.
  • Known presence of autoimmune disease or immune deficit or chronic disease such as HIV, infectious hepatitis (type B or C), or tuberculosis
  • T2+, or N1+, or M+ disease
  • Ta or T1 low grade disease only
  • Concurrent use of chronic oral steroids, for any indication
  • Recent history of deep venous thrombosis currently receiving anticoagulation therapy, with the clot event being in the last 6 months
  • Diagnosis of any prior malignancies for the last 5 years with exception of definitively treated basal cell, squamous cell carcinoma of the skin, or carcinoma in-situ of the cervix or breast
  • Life expectancy less than 1 year, by treating physician estimate
  • Known exposure to person with active tuberculosis within 48 hours of starting treatment
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01373294

Contacts
Contact: Mayer Fishman, M.D., Ph.D. 813-745-8343 mayer.fishman@moffitt.org

Locations
United States, Florida
H. Lee Moffitt Cancer Center and Research Institute Recruiting
Tampa, Florida, United States, 33612
Contact: Mayer Fishman, M.D., Ph.D.         
Contact: Inez Sims    813-745-3982    inez.sims@moffitt.org   
Principal Investigator: Mayer Fishman, M.D., Ph.D.         
Sub-Investigator: Wade Sexton, M.D.         
Sub-Investigator: Scott Antonia, M.D., Ph.D.         
Sub-Investigator: Hui-Yi Lin, Ph.D.         
Sub-Investigator: Shilpa Gupta, M.D.         
Sub-Investigator: Michael Poch, M.D.         
Sub-Investigator: Philippe Spiess, M.D.         
Sub-Investigator: Julio Pow-Sang, M.D.         
Sponsors and Collaborators
H. Lee Moffitt Cancer Center and Research Institute
Celgene Corporation
Investigators
Principal Investigator: Mayer Fishman, M.D., Ph.D. H. Lee Moffitt Cancer Center and Research Institute
  More Information

Additional Information:
No publications provided

Responsible Party: H. Lee Moffitt Cancer Center and Research Institute
ClinicalTrials.gov Identifier: NCT01373294     History of Changes
Other Study ID Numbers: MCC-16295, RV-BLD-PI-0330
Study First Received: June 13, 2011
Last Updated: June 13, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by H. Lee Moffitt Cancer Center and Research Institute:
non-muscle-invasive
transitional cell
oral lenalidomide
intravesical

Additional relevant MeSH terms:
Urinary Bladder Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Urinary Bladder Diseases
Urologic Diseases
BCG Vaccine
Thalidomide
Lenalidomide
Adjuvants, Immunologic
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Immunosuppressive Agents
Leprostatic Agents
Anti-Bacterial Agents
Anti-Infective Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors

ClinicalTrials.gov processed this record on July 26, 2014