Durvalumab + BCG for Bladder Cancer

(POTOMAC Trial)

Recruiting at 110 trial locations

Age: 18+

Sex: Any

Trial Phase: Phase 3

Sponsor: AstraZeneca

Must not be taking: Immunosuppressants, Anticancer vaccines

Disqualifiers: Autoimmune disorders, Muscle-invasive cancer, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Pivotal Trial (Near Approval) This treatment is in the last trial phase before FDA approval

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: Unknown

Duration: Induction phase followed by maintenance phase

1018 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial is testing a new treatment that combines two therapies to help the immune system fight bladder cancer. It targets patients whose cancer has not spread into the muscle layer of the bladder. The treatment works by helping the body's defense system recognize and destroy cancer cells more effectively.

Do I need to stop my current medications for the trial?

The trial does not specify if you need to stop your current medications, but you cannot use immunosuppressive medications within 14 days before starting the trial. Hormonal therapy for non-cancer conditions is allowed.

What data supports the effectiveness of the drug Durvalumab + BCG for bladder cancer?

Research shows that Durvalumab, a drug that helps the immune system fight cancer, has been approved for treating certain types of bladder cancer. Additionally, BCG is a well-established treatment for bladder cancer, and combining it with immune therapies like Durvalumab may enhance its effectiveness. ^{1 2 3 4 5}

What safety data exists for Durvalumab + BCG treatment in humans?

BCG treatment for bladder cancer can cause side effects, which vary depending on the strain and dose used. Common side effects include bladder irritation and flu-like symptoms. There is no specific safety data for the combination of Durvalumab and BCG, but BCG alone has been studied extensively for bladder cancer. ^{2 6 7 8 9}

What makes the Durvalumab + BCG treatment for bladder cancer unique?

The Durvalumab + BCG treatment is unique because it combines an immune checkpoint inhibitor (Durvalumab) with BCG, an established bladder cancer therapy, to enhance the immune system's ability to fight cancer cells, especially in cases where BCG alone is not effective. ^{1 3 4 5 6}

Eligibility Criteria

This trial is for adults with high-risk non-muscle-invasive bladder cancer who haven't had immune therapy or BCG for bladder cancer, and no recent immunosuppressants. It's not for those with muscle-invasive or advanced cancer, certain autoimmune diseases, or a history of other cancers (with some exceptions).

Inclusion Criteria

I am 18 years old or older.

My bladder cancer is high-risk but hasn't spread beyond the inner layers.

I had surgery to remove bladder cancer not more than 4 months ago, and all visible cancer was removed.

Exclusion Criteria

I am not on cancer treatment but can take hormones for other conditions.

I have an autoimmune or inflammatory disorder but it's controlled or I've been stable for the last 5 years.

I had cancer before, but it's either been treated, is low risk, or hasn't come back in over 2 years.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Durvalumab + BCG combination therapy or BCG alone as standard of care

Induction phase followed by maintenance phase

Follow-up

Participants are monitored for safety and effectiveness after treatment

Up to 4 years

Treatment Details

Interventions

• Bacillus Calmette-Guerin (BCG)
• Durvalumab

Trial Overview The study tests Durvalumab combined with BCG against standard BCG treatment alone in patients with bladder cancer that hasn't invaded the muscle layer. The goal is to see if adding Durvalumab improves outcomes.

Participant Groups

Group I: Durvalumab plus BCG (induction only) Experimental Treatment 2 Interventions

Durvalumab (MEDI4736) plus Bacillus Calmette-Guerrin (BCG) combination therapy

Group II: Durvalumab plus BCG (induction + maintenance) Experimental Treatment 2 Interventions

Durvalumab (MEDI4736) plus Bacillus Calmette-Guerrin (BCG) combination therapy

Group III: BCG treatment (Standard of care therapy) Active Control 1 Intervention

Bacillus Calmette-Guerrin (BCG) standard of care treatment

Who Is Running the Clinical Trial?

AstraZeneca

Lead Sponsor

Trials

4,491

Recruited

290,540,000+

Sir Pascal Soriot

AstraZeneca

Chief Executive Officer since 2012

Veterinary Medicine from École nationale vétérinaire d'Alfort, MBA from HEC Paris

Dr. Cristian Massacesi

AstraZeneca

Chief Medical Officer since 2021

MD from Marche Polytechnic University, Oncology training at Royal Marsden Hospital, Kaplan Comprehensive Cancer Center, and European Institute of Oncology

Pascal Soriot

AstraZeneca

Chief Executive Officer since 2012

Veterinary Medicine from École nationale vétérinaire d'Alfort, MBA from HEC Paris

Cristian Massacesi

AstraZeneca

Chief Medical Officer since 2021

MD from Marche Polytechnic University, Medical Oncology training at Royal Marsden Hospital, Kaplan Comprehensive Cancer Center, and European Institute of Oncology

Findings from Research

In a phase II study involving 17 patients with BCG-unresponsive carcinoma in situ of the bladder, durvalumab showed a low complete response rate of only 12% at 6 months, indicating minimal efficacy for this condition.

The treatment was associated with some immune-related adverse events in 41% of patients, and a potential mechanism for resistance was identified through elevated complement activation genes post-treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Phase II Study of Durvalumab for Bacillus Calmette-Guerin (BCG) Unresponsive Urothelial Carcinoma In Situ of the Bladder. Li, R., Sexton, WJ., Dhillon, J., et al.[2023]

This study aims to systematically evaluate the efficacy and safety of Bacillus Calmette-Guerin (BCG) treatment for bladder cancer by reviewing high-quality trials from various databases, ensuring a comprehensive analysis.

The findings will provide crucial evidence to determine the effectiveness of BCG in treating bladder cancer, potentially influencing treatment decisions for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and safety of Bacillus Calmette-Guerin for bladder cancer: A protocol of systematic review. Zhang, ZH., Yin, L., Zhang, LL., et al.[2023]

Immunotherapy with Bacillus Calmette Guerin (BCG) is an effective long-term treatment for high-grade superficial bladder cancer, with a 35% recurrence rate and 74% of patients alive after a median follow-up of 71 months.

The study suggests that BCG therapy is a viable conservative option, as only 9% of patients required cystectomy, indicating that aggressive surgical intervention may not be necessary as a first-line treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High grade superficial (G3t1) transitional cell carcinoma of the bladder treated with intravesical Bacillus Calmette-Guerin (BCG). Pansadoro, V., Emiliozzi, P., depaula, F., et al.[2006]

Durvalumab is an FDA-approved monoclonal antibody that enhances T-cell responses against cancer by blocking the PD-L1 pathway, specifically for patients with advanced urothelial carcinoma who have progressed after platinum-based chemotherapy.

The drug is currently being tested in phase III trials for various cancers, including lung and head and neck cancers, indicating its potential broad application in oncology beyond urothelial carcinoma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Durvalumab: First Global Approval. Syed, YY.[2022]

The combination of intravesical Bacillus Calmette-Guérin (BCG) and systemic pembrolizumab was found to be safe in a phase I trial involving 18 patients with high-grade non-muscle-invasive bladder cancer, with 69% of treated patients showing no evidence of disease after 3 months.

Despite some treatment-related adverse events, including one severe case of adrenal insufficiency and several grade 3 adverse events, the overall safety profile supports further investigation, leading to the initiation of a phase III trial to evaluate the efficacy of this combination.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase I trial of intravesical Bacillus Calmette-Guérin combined with intravenous pembrolizumab in recurrent or persistent high-grade non-muscle-invasive bladder cancer after previous Bacillus Calmette-Guérin treatment. Alanee, S., Sana, S., El-Zawahry, A., et al.[2022]

In a study of 114 patients with non-muscle invasive bladder cancer, the BCG Danish 1331 strain showed a significantly lower incidence of moderate to severe adverse events compared to the BCG Moscow-I strain, indicating it may be a safer option for treatment.

Both strains demonstrated similar efficacy in terms of 3-year recurrence-free survival (80.0% for Danish 1331 vs. 72.9% for Moscow-I) and progression-free survival (96.5% for Danish 1331 vs. 97.8% for Moscow-I), suggesting that while safety profiles differ, their effectiveness in preventing cancer recurrence is comparable.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intravesical bacillus Calmette-Guerin (BCG) in treating non-muscle invasive bladder cancer-analysis of adverse effects and effectiveness of two strains of BCG (Danish 1331 and Moscow-I). Thyavihally, YB., Dev, P., Waigankar, S., et al.[2022]

In a study of 36 patients undergoing Mycobacterium bovis bacillus Calmette-Guérin (BCG) maintenance therapy for high-risk non-muscle-invasive bladder cancer, 86.7% of those who completed the therapy experienced local adverse reactions, indicating that while the therapy is common, side effects are prevalent.

The analysis suggested that severe adverse reactions, such as gross hematuria and systemic effects during the initial induction therapy, may contribute to a higher rate of discontinuation of the maintenance therapy, highlighting the importance of monitoring and managing these side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse reactions related to treatment compliance during BCG maintenance therapy for non-muscle-invasive bladder cancer. Miyazaki, J., Hinotsu, S., Ishizuka, N., et al.[2013]

In a study of 123 patients receiving intravesical BCG treatment for bladder cancer, 95.9% experienced adverse drug reactions, but serious reactions leading to discontinuation were rare, indicating that BCG instillation is generally well tolerated.

The necessity for treatment of adverse effects was significantly influenced by the purpose of the instillation and the BCG dose, suggesting that closer monitoring may be required for patients receiving higher doses (80 mg) for treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse drug reactions of intravesical bacillus Calmette-Guerin instillation and risk factors of the development of adverse drug reactions in superficial cancer and carcinoma in situ of the bladder. Koga, H., Kuroda, M., Kudo, S., et al.[2006]

References

1. United States pubmed.ncbi.nlm.nih.gov

A Phase II Study of Durvalumab for Bacillus Calmette-Guerin (BCG) Unresponsive Urothelial Carcinoma In Situ of the Bladder. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Efficacy and safety of Bacillus Calmette-Guerin for bladder cancer: A protocol of systematic review. [2023]

3. England pubmed.ncbi.nlm.nih.gov

High grade superficial (G3t1) transitional cell carcinoma of the bladder treated with intravesical Bacillus Calmette-Guerin (BCG). [2006]

4. New Zealand pubmed.ncbi.nlm.nih.gov

Durvalumab: First Global Approval. [2022]

5. Germany pubmed.ncbi.nlm.nih.gov

Phase I trial of intravesical Bacillus Calmette-Guérin combined with intravenous pembrolizumab in recurrent or persistent high-grade non-muscle-invasive bladder cancer after previous Bacillus Calmette-Guérin treatment. [2022]

6. Singapore pubmed.ncbi.nlm.nih.gov

Intravesical bacillus Calmette-Guerin (BCG) in treating non-muscle invasive bladder cancer-analysis of adverse effects and effectiveness of two strains of BCG (Danish 1331 and Moscow-I). [2022]

7. England pubmed.ncbi.nlm.nih.gov

Adverse reactions related to treatment compliance during BCG maintenance therapy for non-muscle-invasive bladder cancer. [2013]

8. Australia pubmed.ncbi.nlm.nih.gov

Adverse drug reactions of intravesical bacillus Calmette-Guerin instillation and risk factors of the development of adverse drug reactions in superficial cancer and carcinoma in situ of the bladder. [2006]

9. United States pubmed.ncbi.nlm.nih.gov

A prospective comparative study to assess the efficacy and tolerability of 2 different doses of intravesical bacillus Calmette-Guerin (BCG) in patients with non-muscle-invasive bladder cancer. [2021]