Optimus: An Umbrella Study to Determine the Safety and Efficacy of Various Monotherapy or Combination Therapies in Neoadjuvant Urothelial Carcinoma
Study Details
Study Description
Brief Summary
This is a multicenter, open-label, randomized, Phase 2 umbrella study of various neoadjuvant treatment combinations in participants who have muscle-invasive urothelial carcinoma of the bladder and are cisplatin-ineligible or refusing cisplatin therapy and awaiting radical cystectomy.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2 |
Detailed Description
Participants will be stratified based on Programmed cell Death-Ligand 1 (PD-L1) Combined Positive Score ( CPS) < 10 and PD-L1 CPS ≥ 10.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Treatment Group A epacadostat will be administered in combination with retifanlimab. |
Drug: retifanlimab
retifanlimab will be administered via IV over 30 minutes (+ 15 min) on Day 1 of each 28-day cycle, up to 3 cycles,
Drug: epacadostat
epacadostat will be administered daily twice daily orally up to and including day of surgery.
|
Experimental: Treatment Group B retifanlimab will be administered as monotherapy. |
Drug: retifanlimab
retifanlimab will be administered via IV over 30 minutes (+ 15 min) on Day 1 of each 28-day cycle, up to 3 cycles,
|
Experimental: Treatment Group C epacadostat will be administered as monotherapy. |
Drug: epacadostat
epacadostat will be administered daily twice daily orally up to and including day of surgery.
|
Experimental: Treatment Group D retifanlimab will be administered in combination with INCAGN02385. |
Drug: retifanlimab
retifanlimab will be administered via IV over 30 minutes (+ 15 min) on Day 1 of each 28-day cycle, up to 3 cycles,
Drug: INCAGN02385
INCAGN02385 will be administered via IV over 30 minutes (-5/+10 min) every 2 weeks.
|
Experimental: Treatment Group E retifanlimab will be administered in combination with INCAGN02385 and INCAGN02390. |
Drug: retifanlimab
retifanlimab will be administered via IV over 30 minutes (+ 15 min) on Day 1 of each 28-day cycle, up to 3 cycles,
Drug: INCAGN02385
INCAGN02385 will be administered via IV over 30 minutes (-5/+10 min) every 2 weeks.
Drug: INCAGN02390
INCAGN02390 will be administered via IV over 30 minutes (-5/+10 min) every 2 weeks.
|
Outcome Measures
Primary Outcome Measures
- Immunologic intratumoral changes [up to 3 months]
Defined as change from baseline in CD8+ lymphocytes within resected tumor
Secondary Outcome Measures
- Number of Treatment Emergent Adverse Events (TEAE) [up to 6 months]
Defined as any adverse event either reported for the first time or worsening of a pre-existing event after first dose of study drug up to 30 days after last dose of study drug.
- pathological complete response [up to 3 months]
Defined as percentage of participants with absence of tumor as well as no observed tumor in the nodes post neoadjuvant therapy and pre-surgery.
- Major pathological response [up to 3 months]
Defined as absence of tumor cells determined pre- surgery or in-Situ absence of tumor cells in the nodes and no metastases.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Histologically confirmed transitional cell urothelial carcinoma. Participants with mixed histologies are required to have a dominant (ie, 50% at least) transitional cell pattern.
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Clinical stage T2-T3b, N0, M0 muscle invasive urothelial carcinoma by CT (or MRI) (Stage II-IIIA per AJCC 2018)
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Refuse cisplatin therapy (does not apply in France) or are ineligible for cisplatin therapy per modified Galsky criteria with exclusion of Eastern Cooperative Oncology Group( ECOG) PS 2 participants
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Eligible for radical cystectomy
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Eastern Cooperative Oncology Group (ECOG) Performance Status( PS) 0 or 1.
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Pretreatment tumor biopsy must be a tumor block or 20 unstained slides from biopsy of primary tumor containing at least 20% tumor.
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Willingness to avoid pregnancy or fathering children from screening through 100 days in the US and 190 days in Europe after the last dose of study drug
Exclusion Criteria:
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Participation in any other study in which receipt of an investigational study drug or device occurred within 28 days or 5 half-lives (whichever is longer) before first dose.
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Previously received systemic therapy for bladder cancer or received prior treatment with checkpoint inhibitor agents (such as anti-PD-1, anti-PD-L1, anti-PD-L2, or anti-CTLA-4).
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Evidence of measurable nodal or metastatic disease.
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Concurrent anticancer therapy.
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Has had major surgery within 4 weeks before enrollment (C1D1).
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Has had known additional malignancy other than muscle-invasive Urothelial Bladder Cancer ( miUBC) that is progressing or requires active treatment, along with some protocol exceptions, or history of other malignancy within 2 years of study entry, with some predefined-protocol exceptions.
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Has active autoimmune disease requiring systemic immunosuppression with corticosteroids (> 10 mg daily doses of prednisone or equivalent) or immunosuppressive drugs within 2 years of Day 1 of study treatment.
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Participants with laboratory values outside of protocol defined ranges.
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Active autoimmune disease requiring systemic immunosuppression in excess of physiologic maintenance doses of corticosteroids (> 10 mg/day of prednisone or equivalent).
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Has a known active hepatitis B (defined as HBsAg and total anti-HBc positive results) or hepatitis C (HCV Ab positive result and HCV RNA >LLoD) or HIV,HBV, HCV or hepatitis virus coinfection.
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Participants with HIV+ disease along with protocol defined exceptions that don't have undetectable viral load along with other protocol exceptions.
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Has known carcinomatous meningitis.
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Active infection requiring systemic antibiotics ≤ 14 days from first dose of study drug.
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Participants with known or suspected active COVID-19 infection.
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Use of probiotics within 28 days from first dose of study drug.
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Current use of prohibited medication as per protocol.
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Has not recovered to ≤ Grade 1 from toxic effects of previous therapy and/or complications from previous surgical intervention.
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History or presence of an abnormal ECG that, in the investigator's opinion, is clinically meaningful. A screening QTcF interval > 450 milliseconds is excluded.
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History of a gastrointestinal condition (eg, inflammatory bowel disease, Crohn's disease, ulcerative colitis) that may affect oral drug absorption.
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Has received a live vaccine within 30days of planned start of study therapy
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Participants with impaired cardiac function or clinically significant cardiac disease
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Prior allogenic tissue/solid organ transplant
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Evidence of interstitial lung disease or active, noninfectious pneumonitis.
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Has known hypersensitivity to any of the study drugs, excipients, including mannitol or another monoclonal antibody which cannot be controlled with standard measures (eg, antihistamines and corticosteroids).
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Any ≥ Grade 2 immune-related toxicity while receiving prior immunotherapy.
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History of serotonin syndrome after receiving 1 or more serotonergic drugs.
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Concomitant use of medications that are known to be substrates of CYP1A2, CYP2C8, or CYP2C19 with narrow therapeutic window are prohibited (see Section 6.6.3).
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Patients who are receiving or required to receive medications that are known to be UGT1A9 inhibitors (see Section 6.6.3).
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | University of Iowa | Iowa City | Iowa | United States | 52242 |
2 | University of Cincinnati | Cincinnati | Ohio | United States | 45267 |
3 | Ohio State University Medical Center Division of H | Columbus | Ohio | United States | 43210 |
4 | Oregon Health & Science University | Portland | Oregon | United States | 97239-4501 |
5 | Hospital Saint Louis | Paris Cedex 10 | France | 75475 | |
6 | Hopital Europeen Georges Pompidou (Hegp) | Paris Cedex 15 | France | 75015 | |
7 | Institut Gustave Roussy | Villejuif Cedex | France | 94805 | |
8 | Istituto Tumori Giovanni Paolo Ii Irccs Ospedale Oncologico Bari | Bari | Italy | 70124 | |
9 | L AZIENDA OSPEDALIERO-UNIVERSITARIA DI BOLOGNA POLICLINICO S. ORSOLA � MALPIGHI | Bologna | Italy | 40138 | |
10 | Istituto Di Ricovero E Cura A Carattere Scientifico (Irccs) Ospedale San Raffaele | Milano | Italy | 20132 | |
11 | Universita Campus Bio Medico Di Roma | Roma | Italy | 00128 | |
12 | Azienda Ospedaliera Universitaria Integrata Verona (Ospedale Borgo Roma) | Verona | Italy | 37124 |
Sponsors and Collaborators
- Incyte Corporation
Investigators
- Study Director: Diane Hershock, MD, Incyte Corporation
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- INCB 24360-901