E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Subjects with metastatic triple receptor-negative breast cancer (TNBC) who failed at least 2 and no more than 4 prior chemotherapies or alternatively
Subjects with metastatic transitional cell carcinoma (TCC) of the urinary bladder who failed at least 1 and no more than 2 prior chemotherapies.
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E.1.1.1 | Medical condition in easily understood language |
metastatic triple receptor-negative breast cancer or metastatic transitional cell carcinoma of the urinary bladder |
metastasierter dreifach rezeptor-negativer Brustkrebs oder metastasiertes Übergangszellkarzinom der Harnblase |
cancer du sein métastatique triple récepteur négatif ou carcinome métastatique à cellules transitionnelles de la vessie urinaire |
gemetastaseerde drievoudig receptor-negatieve borstkanker of gemetastaseerde kanker van de overgangsepitheelcellen van de blaas |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10071664 |
E.1.2 | Term | Bladder transitional cell carcinoma metastatic |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10055113 |
E.1.2 | Term | Breast cancer metastatic |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Phase I Part (Dose Escalation):To determine the dose-limiting toxicities (DLTs), the maximum tolerated dose (MTD) and the recommended Phase II dose (RPTD) of BT062 in patients with metastatic triple-negative breast cancer (TNBC) or metastatic transitional cell carcinoma of the urinary bladder ((TCCUB).
Phase IIa Part (Cohort Expansion):To assess the proportion of patients experiencing disease control (SD, PR or CR) according to RECIST criteria during the first 3 treatment cycles. |
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E.2.2 | Secondary objectives of the trial |
Phase I Part (Dose Escalation):
- To assess the safety and tolerability profiles of BT062 in patients with metastatic TNBC or metastatic TCCUB;
- To assess peak and through levels and a potential accumulation of BT062 after repeated dosing
- To assess the proportion of patients experiencing disease control during the first 3 treatment cycles
Phase IIa Part (Cohort Expansion):
• To assess the safety and tolerability profiles of BT062;
• To assess the frequency and duration of response categories;
• To assess the Progression Free Survival time;
• To assess Overall Survival Time
• To determine main PK parameters of BT062 and free DM4 (Cmax, Tmax) in plasma after multiple doses. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Signed written Informed Consent Form in accordance with institutional guidelines and applicable national law, prior to any study-related procedure;
2. Diagnosis:
• metastatic triple-negative breast cancer with histochemical confirmation of the absence of progesterone receptors, estrogen receptors and human epidermal growth factor receptors
or
• metastatic transitional celll carcinoma of the urinary bladder
3. Relapsed or relapsed / refractory disease at a stage that cannot be controlled adequately by surgery, radiotherapy or standard chemotherapy;
3a: Patients presenting with triple negative breast cancer and who failed at least 2, but not more than 4 previous chemotherapy / drug therapy regimens. In patients who failed more than 2 prior chemotherapy / drug therapy regimens, the last progression of disease must not have been observed earlier than within 9 weeks of the start of the treatment.
3b: Patients presenting with urinary bladder cancer and who failed at least 1, but not more than 2 previous chemotherapy regimens.
4. Measurable disease according to the RECIST (v1.1) with at least one measurable lesion and at least one tumor biopsy with histologically confirmed malignancy;
5. Histological confirmation of moderate to high CD138 expression for at least one lesion;
6. Female or male patients aged > 18 years;
7. Estimated life expectancy ≥ 12 weeks;
8. Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 2;
9. Absolute neutrophil count (ANC) ≥ 1500 cells / µL;
10. Hemoglobin (Hb) ≥ 9.0 g / dL;
11. Platelet count ≥ 100,000 / µL at screening;
12. Liver transaminases:
• In patients without liver metastases: AST (SGOT) and ALT (SGPT) ≤ 3 times the upper limit of normal (ULN);
• In patients with liver metastases: AST (SGOT) and ALT (SGPT) ≤ 5 times the ULN, provided that there is no evidence of other reasons for transaminase level increase,
13. Total bilirubin ≤ 1.5 times the ULN;
14. Lipase ≤ 3 times the ULN;
15. Renal function:
Serum creatinine ≤ 2 mg / dL; Creatinine clearance (CRCL) ≥ 50 mL / min;
16. Ability to understand, and willingness to sign a written Informed Consent Form;
17. Ability and willingness to adhere to the study visit schedule and all protocol procedures;
18. Subjects must use two acceptable methods of birth control from the point of signing Informed Consent Form (ICF) until 3 months after administration of the last dose of study drug;
19. Patients must agree not to donate blood from the point of signing the ICF until at least 1 month after administration of the last dose of the study drug;
20. Negative serum or urine pregnancy test in female patients of childbearing potential.
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E.4 | Principal exclusion criteria |
1. History of allergy against study drug related components or drugs
2. Administration of chemotherapy or radiotherapy within 3 weeks prior to day of first dose of study drug or during the study;
3. Chemotherapy with nitrosoureas or mitomycin C within 6 weeks prior to day 1
4. Antineoplastic therapy with biological agents within 2 weeks before day 1 or within 5 drug half-lifes (t½) prior to first dose, whichever time period is longer
5. Participation in an investigational therapeutic study within 3 weeks or within 5 drug half-lives (t1/2) prior to first dose, whichever time is longer.
6. Treatment with BT062 in previous studies;
7. Previous treatment with vinflunine;
8. Planned tumor-reduction surgery and surgical removal of well accessible metastases;
9. Anticipation of the need to apply radiotherapy during the first 3 cycles/12 weeks of the study.
10. Major surgery within 4 weeks prior to Day 1;
11. Persistence of clinically relevant symptoms of incomplete recovery from a previous major surgery;
12. Malignancy (other than the trial indications) within the past three years except:
• Treated non-melanoma skin cancer;
• Carcinoma in-situ of the cervix uteri;
• Prostate carcinoma (Gleason Grade ≤ 6) with stable prostate specific antigen (PSA) levels
13. Active metastasis of the central nervous System
14. In patients of the dose escalation part (first part) of the study: treatment with denosumab within 5 months before the first dose of BT062 and/or planned treatment with denosumab any time during the treatment with BT062.
15. In patients in the phase II part of the study who are scheduled to continue an ongoing denosumab treatment as a concomitant medication during the BT062 regimen:
a)treatment with denosumab that started less than 6 months before
the first dose of BT062
b)changes in the denosumab dose level of more than 33% in the
monthly dose in the last 3 months.
c)history of severe hypercalcemia or hypocalcemia (of any origin)
d)history of severe hypokalemia or severe hyperkalemia (of any origin)
e)history of osteonecrosis (of any origin)
f)history of severe adverse reactions that were assessed as
related to denosumab
g)history of severe pain that was assessed as related to denosumab
h)history of hypersensitivity reactions to denosumab or any of its
excipients
16. Severe inflammatory diseases of skin, colon, esophagus, stomach, small intestine, or eye within 1 year prior to first dose;
17. Acute active infection requiring systemic antibiotics, antivirals, or anti-fungals within 28 days prior to first dose;
18. Known or suspected HIV infection, known HIV seropositivity, or active hepatitis A, B, or C infection, active tuberculosis or any other concurrent disease which disqualifies the patient for enrollment
19. Acute or clinically relevant abnormalities in electrocardiogram (ECG);
20. Significant cardiac disease(≤ 6 months prior to Day 1)
21. Uncontrolled hypertension (recurrent or persistent increases in systolic blood pressure ≥ 180 mm Hg or diastolic blood pressure ≥ 110 mm Hg),
22. History of clinically significant drug or alcohol abuse or ongoing clinically significant alcohol or drug abuse;
23. Unwillingness or inability to adhere to the requirements of the study;
24. Serious psychiatric or any other medical condition (including laboratory abnormalities), that could interfere with treatment and puts the patient at an unacceptable risk;
25. Subject is a pregnant or nursing woman or is considering becoming pregnant during the study
26. Subject is a woman of childbearing potential (unless surgically sterile or post-menopausal > 52 weeks) who is not using two independent effective contraceptive methods during the study
OR
Subject is a man and is not vasectomized or is not using two independent effective contraceptive methods during the study |
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E.5 End points |
E.5.1 | Primary end point(s) |
The endpoint of the phase I part is the identification of the recommended part II dose (RPTD).
The doses of BT062 will be escalated / de-escalated in a stepwise manner to determine the MTD, and to accordingly determine the RPTD for the patient population of interest (classical “3+3” approach).
Participants will be evaluated for dose-limiting toxicities (DLTs) and /or adverse events (AE). Their safety and tolerability data will be used to identify the maximum tolerated dose (MTD) and the recommended Phase II dose (RPTD) of BT062. The MTD is defined as the highest dose of BT062 at which less than 2 out of 6 subjects experience a DLT. The MTD will normally be used as the RPTD. Alternatively, a RPTD can also be defined at a lower dose level or without reaching the maximum administered dose (MAD).
The endpoints of the Phase II part of the study is derived from the fraction of patients who show at least disease control or a better outcome at the tumor staging during the first 3 cycles of chemotherapy of BT062 at the RPTD.
The two tumor entities (TNBC and TCCUB) will be studied independently in parallel.
The first endpoint (part I) will consist of the observation whether or not at least 5 out of 18 patients experienced disease control or a better. The observation will be made independently in 18 patients with TNBC and again in 18 other patients with TCCUB.
If sufficient anti-tumor activity is observed at the first endpoint the recruitment will be expanded in the respective tumor entity/s by an additional 15 patients.
The second primary endpoint (part II) will consist of the observation whether or not at least 11 out of 33 patients experienced disease control or better. If 11 or more responses are observed out of the 33 patients there will be sufficient evidence to reject the null hypothesis that the disease control rate is 20% or lower in the respective tumor entity.
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Phase I part: Assessment of DLTs after first treatment cycle (28d)
Phase II part: Assessment of tumor progression during the first 3 treatment cycles (84d) |
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E.5.2 | Secondary end point(s) |
Phase I Part (Dose Escalation):
To assess the proportion of patients experiencing disease control during the first 3 treatment cycles (according to RECIST v1.1. criteria)
To assess the safety and tolerability profiles of BT062 in patients with metastatic TNBC or metastatic TCCUB.
To assess peak and through levels and a potential accumulation of BT062 after repeated dosing.
To assess the frequency and duration of response categories (DOR);
To assess the progression-free survival (PFS) time;
To assess the overall survival (OS)
Phase IIa (Cohort Expansion):
To assess the safety and tolerability profiles of BT062 in patients with metastatic TNBC or metastatic TCCUB.
To assess the frequency and duration of response categories (DOR);
To assess the progression-free survival (PFS) time;
To assess the overall survival (OS)
To determine main PK parameters of BT062 and free DM4 (Cmax, Tmax) in plasma after multiple doses.
To assess potential immunogenicity of BT062 after repeated doses.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Safety and tolerability: From study start until 30 days after the last dose of BT062.
Anti-tumor efficacy: Regular tumor staging every 3 cycles (90d)
Peak and trough levels of BT062 in plasma: Every treatment day (day 1, 8, 15 of a 28d cycle)
Detailed Pharmacokinetic parameters: Cycle 1 Day 1, Cycle 1 Day 15
Progression free survival, Overall survival: long term follow-up contacts every 90 days if possible, Data cut off time point 1 year after start of treatment in the last patient
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | Yes |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | Yes |
E.7.1.3.1 | Other trial type description |
Pharmacokinetics after repeated dose |
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E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Phase I / IIa study with initial dose-escalation phase, followed by a two-stage part |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 10 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 15 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The trial ends one year after the last patient started treatment or when the last patient is lost to follow up or deceases, whatever occurs earlier. Data up to this timepoint included in the clinical study report. However, if patients continue to experience disease control and adequate tolerability, they may continue to receive the study drug for an undefined period of time, also beyond this time point. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |