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    Summary
    EudraCT Number:2017-004512-19
    Sponsor's Protocol Code Number:UC-0160/1717
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-09-01
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2017-004512-19
    A.3Full title of the trial
    An open label, randomized, phase III trial, evaluating efficacy of Atezolizumab in addition to one year BCG (Bacillus CaLmette-Guerin) bladder instillation in BCG-naive patients with high-risk non-muscle invasive Bladder cANcer.
    ALBAN: un ensayo de fase III, aleatorizado y abierto, que evalúa la eficacia del atezolizumab administrado de forma concomitante con instilaciones vesicales de BCG (Bacilo de
    Calmette-Guérin) durante un año en pacientes con cáncer de vejiga sin invasión muscular con alto riesgo de recidiva y que no han sido tratados previamente con BCG.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Clinical trial evaluating the efficacy of the Atezolizumab (experimental treatment) in association to one year of standard treatment (BCG) in patient suffering from a bladder cancer which has not invaded the muscle but with high risk of relapse
    Un ensayo clínico para evaluar la eficacia de atezolizumab (tratamiento experimental) junto con un año de tratamiento estándar (BCG) en pacientes que padecen cáncer de vejiga que no se ha extendido al músculo pero que es de alto riesgo de recaída
    A.3.2Name or abbreviated title of the trial where available
    ALBAN
    ALBAN
    A.4.1Sponsor's protocol code numberUC-0160/1717
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorUnicancer
    B.1.3.4CountryFrance
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportLaboratoire ROCHE
    B.4.2CountrySwitzerland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationUNICANCER
    B.5.2Functional name of contact pointProject Manager
    B.5.3 Address:
    B.5.3.1Street Address101, rue de Tolbiac
    B.5.3.2Town/ cityParis cedex 13
    B.5.3.3Post code75654
    B.5.3.4CountryFrance
    B.5.4Telephone number33185 34 31 12
    B.5.5Fax number33185 34 33 79
    B.5.6E-mailm-chausson@unicancer.fr
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name TECENTRIQ
    D.2.1.1.2Name of the Marketing Authorisation holderROCHE REGISTRATION GmbH
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAtezolizumab
    D.3.2Product code MPDL3280A
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNATEZOLIZUMAB
    D.3.9.2Current sponsor codeATEZOLIZUMAB
    D.3.9.4EV Substance CodeSUB178312
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    High-risk non-muscle invasive bladder cancer (NMIBC) after transurethral resection of the bladder (TURBT) and pathological assessment.
    Cáncer de vejiga sin invasión muscular con alto riesgo de recidiva tras resección transuretral de la vejiga (RTU) y evaluación patológica
    E.1.1.1Medical condition in easily understood language
    Local bladder cancer
    Cáncer de vejiga local
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10005003
    E.1.2Term Bladder cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the efficacy of atezolizumab in association with BCG versus BCG alone in patients with high-risk NMIBC as measured by recurrence-free survival.
    Evaluar la eficacia del atezolizumab administrado en combinación con la terapia con BCG en comparación con la terapia con BCG sola en pacientes con tumor de vejiga sin invasión muscular con
    alto riesgo de recidiva. La eficacia del atezolizumab se medirá por la supervivencia sin recidiva.
    E.2.2Secondary objectives of the trial
    •To evaluate the efficacy of atezolizumab in association with BCG versus BCG alone as measured by progression free survival,
    •To evaluate the efficacy of atezolizumab in association with BCG versus BCG alone as measured by disease-specific survival,
    •To evaluate the efficacy of atezolizumab in association with BCG versus BCG alone as measured by overall survival,
    •To evaluate disease worsening in each arm,
    •To evaluate complete response rate in each arm,
    •To evaluate complete response rate among patient with CIS.
    Safety and patient self-reported treatment tolerance objectives
    •To evaluate the safety and tolerability of atezolizumab in association with BCG versus BCG alone,
    •To assess quality of life in patient treated by atezolizumab in association with BCG versus BCG alone as measured by the EORTC QLQ-C30.
    •Evaluar la eficacia de atezolizumab administrado en combinación con la terapia con BCG en comparación con la terapia con BCG sola, medida por la supervivencia sin progresión
    •Evaluar la eficacia de atezolizumab administrado en combinación con la terapia con BCG en comparación con la terapia con BCG sola medida por la supervivencia específica a la enfermedad
    •Evaluar la eficacia de atezolizumab administrado en combinación con la terapia con BCG en comparación con la terapia con BCG sola, medida por la supervivencia global
    •Evaluar la agravación de la enfermedad en cada grupo
    •Evaluar la respuesta completa en cada grupo
    •Evaluar la respuesta completa en cada grupo en los pacientes afectados por un Carcinoma In Situ (CIS)
    •Evaluar la seguridad y la tolerabilidad del atezolizumab administrado en combinación con la terapia con BCG en comparación con la terapia con BCG sola
    •Evaluar la calidad de vida medida por el cuestionario QLQ-C30 de la EORTC
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    To identify predictive and prognostic biomarkers of recurrence and bladder cancer detection in tumor tissue, blood and urine.
    Identificar los biomarcadores predictivos y de pronóstico del cáncer de vejiga y su recidiva en los tejidos tumorales, la sangre y la orina
    E.3Principal inclusion criteria
    1. Signed informed consent form after the last endoscopic surgery (TURBT)
    2. Adult man and women ( age > or= 18 years)
    3. Any high risk non muscle invasive urothelial carcinoma histologically confirmed (mixed histology tumors allowed if urothelial carcinoma histology is predominant) defined on the TURBT as any of the following
    T1 tumor and/or
    High grade (WHO 2004) and/or
    Grade 3 (WHO 1973) and/or
    Carcinoma in situ (CIS)
    4. Tumor tissue available from the surgery for central confirmation of the diagnosis and analysis the expression of PD-L1
    5. At least one additional (second) resection of the primary tumor has been performed in any of the following cases [without upstaging toward MIBC (EAU guidelines, 2017)] :
    - T1 tumors at physician’s discretion,
    - incomplete initial TURBT,
    - no muscle in the specimen (can be omitted if TaLG/G1 tumors or primary CIS only was found).
    6. Absence of metastasis in the pelvis, abdomen, or chest, as confirmed by a negative baseline computed tomography (CT) or magnetic resonance imaging (MRI) scan no more than 90 days prior to the first study treatment
    7. ECOG performance status of ≤ 2
    8. Life expectancy ≥ 12 weeks
    9. Systolic blood pressure (BP) <160 mmHg and diastolic BP <95 mmHg, as documented within 7 days prior to the first study treatment (hypertension allowed provided it is controlled)
    10. Adequate hematologic and end-organ function, as defined by the following laboratory results obtained within 7 days prior to the first study treatment:
    ANC > or= 1500 cells/microL
    WBC counts > 2500/microL
    Lymphocyte count > or= 300/microL
    Platelet count > or= 100,000/microL
    Hemoglobin > or= 9.0 g/dL
    ASAT, ALAT, and alkaline phosphatase ≤ 2.5 × the upper limit of normal (ULN)
    Serum bilirubin < or = 1.0 ×ULN
    Patients with known Gilbert disease who have serum bilirubin level < or = 3 × ULN may be enrolled.
    Partial thromboplastin time (PTT)/Prothrombin Time (PT) < or = 1.5 × ULN or INR < 1.7 × ULN
    Calculated creatinine clearance ≥ 20 mL/min (Cockcroft-Gault formula)
    11. For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 5 months after the last dose of atezolizumab
    12. Patients affiliated to the social security system
    13. Patient is willing and able to comply with the protocol for the duration of the trial including undergoing treatment and scheduled visits, and examinations including follow-up
    1. Pacientes que hayan firmado un consentimiento informado tras la última cirugía endoscópica (RTUV).
    2. Hombres y mujeres mayores de edad (> o = 18 años).
    3. Cualquier carcinoma urotelial no invasivo del músculo de la vejiga confirmado histológicamente (se admiten tumores de histología mixta si la histología predominante es la del carcinoma urotelial) definido en la RTUV de la siguiente manera:
    o Tumor T1 y/o
    o Alto grado (OMS 2004) y/o
    o Grado 3 (OMS 1973) y/o
    o Carcinoma in situ (CIS)
    4. Disponibilidad de una muestra tumoral procedente de la cirugía para la confirmación centralizada del diagnóstico y el análisis de la expresión de PD-L1.
    5. Paciente que se haya sometido al menos a una resección adicional (secundaria) del tumor primario en uno de los siguientes casos [sin poner de manifiesto el CVIM (directivas de la EAU, 2017):
    o tumor T1 a discreción del investigador
    o RTUV inicial incompleta
    o ausencia de músculo en la muestra (puede omitirse si se han encontrado tumores TaLG /G1 o tumores primarios CIS solos)
    6. Ausencia de metástasis en la pelvis, el abdomen y el tórax, confirmada por tomografía computarizada (TAC) o resonancia magnética (RM) en los 90 días anteriores a la primera administración del tratamiento del estudio.
    7. Índice de estado funcional ECOG ≤2.
    8. Esperanza de vida ≥12 semanas.
    9. Presión arterial sistólica (PAS) <160 mmHg y presión arterial diastólica (PAD) <95 mmHg, en los 7 días anteriores a la primera administración del tratamiento del estudio (se admite la hipertensión si está controlada).
    10. Función hematológica y función de los órganos objetivo adecuadas en los 7 días anteriores a la primera administración del tratamiento del estudio:
    o Recuento absoluto de neutrófilos > o = 1500 células/microL
    o Recuento de glóbulos blancos > 2500/microL
    o Recuento de linfocitos > o = 300/microL
    o Tasa de plaquetas > o = 100.000/microL
    o Hemoglobina (Hb) > o = 9,0 g/dL
    o Alanina aminotransferasa (ASAT), aspartato aminotransferasa (ALAT) y fosfatasa alcalina (PAL) < o = 2,5 X LNS
    o Bilirrubina total < o =1,0 X LNS
    o Se puede incluir a los pacientes con la enfermedad de Gilbert si los niveles totales de bilirrubina son < o = 3 × LNS
    o Tiempo de cefalina activado (TCA)/Tiempo de protrombina < or = 1,5 × LNS o international normalized ratio (INR) < 1,7 × LNS
    o Aclaramiento de creatinina ≥ 20 mL/min (según la fórmula de Cockcroft-Gault)
    11. Para las mujeres en edad de procrear: acuerdo de abstinencia sexual (no se recomiendan las relaciones heterosexuales) o utilización de métodos anticonceptivos con un índice de fracaso <1 % al año durante el periodo de tratamiento y al menos durante 5 meses después de la última dosis de atezolizumab.
    12. Los pacientes deben estar afiliados a la seguridad social.
    13. El paciente está dispuesto y es capaz de cumplir el protocolo durante todo el ensayo, incluido el tratamiento, las exploraciones y las visitas programadas, incluido el período de seguimiento.
    E.4Principal exclusion criteria
    1. Patient having received previous BCG therapy for bladder cancer
    2. Any approved anti-cancer therapy, including systemic chemotherapy, or hormonal therapy within 3 weeks prior to initiation of study treatment. Hormone-replacement therapy or oral contraceptives are allowed
    3. Treatment with any other investigational agent or participation in another clinical trial with therapeutic intent within 28 days or five half-lives of the drug, whichever is longer, prior to day 1 of study treatment
    4. Malignancies other than UC within 5 years prior to Day 1 of cycle 1 of treatment
    5. Pregnancy or breastfeeding
    6. History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
    7. Known hypersensitivity to biopharmaceuticals produced in Chinese hamster ovary cells or any component of the atezolizumab formulation
    8. History of autoimmune disease or history of immunosuppression, or conditions associated with congenital or acquired immune deficiency , including, but not limited to, myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener’s granulomatosis, Sjögren’s syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis
    9. Serum albumin < 2.5 g/dL
    10. Known HIV infection
    11. Patients with active hepatitis B virus (HBV; chronic or acute; defined as having a positive hepatitis B surface antigen [HBsAg] test prior to randomization) or hepatitis C.
    12. Known active tuberculosis
    13. Severe infections within 4 weeks prior to Cycle 1, Day 1, including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia.
    14. Signs or symptoms of urinary infection and/or other signs and symptoms > grade 1 (NCI CTCAE v5.0) within 2 weeks prior to Cycle 1, Day 1.
    Patients receiving therapeutic oral or IV antibiotics within 2 weeks prior to Cycle 1, Day 1 are not eligible. Patients receiving prophylactic antibiotics (e.g., for prevention of a urinary tract infection or to prevent chronic obstructive pulmonary disease exacerbation) are eligible.
    15. Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class II or greater), myocardial infarction within the previous 3 months before Cycle 1, Day 1, unstable arrhythmias, or unstable angina.
    16. Major surgical procedure other than for diagnosis within 4 weeks prior to Cycle 1, Day 1 or anticipation of need for a major surgical procedure during the course of the study
    17. Prior allogeneic stem cell or solid organ transplant
    18. Administration of a live, attenuated vaccine within 4 weeks before Cycle 1, Day 1 or anticipation if such a live, attenuated vaccine will be required during the study
    19. Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complications
    20. Prior treatment with CD137 agonists or immune checkpoint−blockade therapies, including anti-CD40, anti−CTLA-4, anti−PD-1, and anti−PD-L1 therapeutic antibodies
    21. Treatment with systemic immunostimulatory agents (including but not limited to interferons, IL-2) within 6 weeks or five half-lives of the drug, whichever is shorter, prior to Cycle 1, Day 1
    22. Treatment with systemic corticosteroids or other systemic immunosuppressive medications (including but not limited to prednisone, dexamethasone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti−tumor necrosis factor [anti-TNF] agents) within 2 weeks prior to Cycle 1, Day 1, or anticipated requirement for systemic immunosuppressive medications during the trial
    23. Person deprived of their liberty or under protective custody or guardianship
    1. Paciente con tratamiento previo de BCG para el cáncer de vejiga
    2. Cualquier tratamiento autorizado para el cáncer, incluyendo la quimioterapia sistémica o la terapia hormonal en las tres semanas previas a la primera administración del tratamiento del estudio. Se permiten la terapia hormonal sustitutiva o los anticonceptivos orales.
    3. Tratamiento con cualquier otro agente experimental o participación en otro ensayo clínico con intención terapéutica en un plazo de 28 días o cinco medias vidas del fármaco, el que sea más largo, antes de la primera administración del tratamiento del ensayo.
    4. Tumores malignos distintos del carcinoma urotelial dentro en los 5 años anteriores al Día 1 del Ciclo 1 del tratamiento
    5. Embarazo o lactancia.
    6. Antecedentes de reacciones alérgicas graves, anafilácticas u otras reacciones graves de hipersensibilidad a los anticuerpos o proteínas de fusión quiméricos o humanizados.
    7. Hipersensibilidad conocida a las sustancias biofarmacéuticas producidas en las células de ovario de hámster chino o a cualquier componente de la formulación del atezolizumab.
    8. Antecedentes de enfermedades autoinmunes o antecedentes de inmunosupresión, o afecciones asociadas con inmunodeficiencia congénita o adquirida, incluyendo, entre otras, miastenia grave, miositis, hepatitis autoinmune, lupus eritematoso sistémico, artritis reumatoide, enfermedad inflamatoria del intestino, trombosis vascular asociada al síndrome antifosfolípido, granulomatosis de Wegener, síndrome de Sjögren, síndrome de Guillain-Barré, esclerosis múltiple, vasculitis o glomerulonefritis
    9. Albúmina sérica <2,5 g/dL.
    10. Infección conocida de VIH.
    11. Pacientes con virus de hepatitis B activo (VHB crónico o agudo definido como positivo en la prueba del antígeno de superficie del virus de la hepatitis B (HBsAg) antes de la aleatorización) o hepatitis C.
    12. Tuberculosis activa conocida.
    13. Infecciones graves en las cuatro semanas previas al Ciclo 1 Día 1, incluyendo, pero sin limitarse a ello, la hospitalización debido a complicaciones de la infección, a una bacteriemia o a una neumonía grave.
    14. Signos o síntomas de infección urinaria y/u otros signos y síntomas > grado 1 (NCI-CTCAE v5.0) en las 2 semanas previas al Ciclo 1 Día 1. Pacientes que hayan recibido un tratamiento antibiótico oral o intravenoso en las dos semanas previas
    al Ciclo 1 Día 1 no son elegibles.
    15. Enfermedades cardiovasculares significativas, como la enfermedad cardíaca de la New York Heart Association (Clase II o superior), infarto de miocardio en los 3 meses anteriores al Ciclo 1 Día 1, arritmias
    16. Cirugía mayor distinta del diagnóstico en las 4 semanas previas al Ciclo 1 Día 1 o la previsión de dicha cirugía durante el estudio.
    17. Trasplante previo de células madre alogénicas u órganos sólidos
    18. Administración de una vacuna viva atenuada en las 4 semanas anteriores al Ciclo 1 Día 1 o previsión de la administración de dicha vacuna durante el estudio.
    19. Cualquier otra enfermedad, disfunción metabólica, resultado de una exploración física o hallazgo de laboratorio clínico que indique una sospecha razonable de una enfermedad o afección que contraindique el uso de un medicamento experimental o que pueda afectar a la interpretación de los resultados o poner al paciente en un alto riesgo de complicaciones del tratamiento.
    20. Tratamiento previo con agonistas de CD137 o bloqueadores de los puntos de control inmunológicos, incluyendo el tratamiento con anticuerpos terapéuticos anti-CD40, anti−CTLA-4, anti−PD-1 y anti−PD-L1
    21. Tratamiento con agentes inmunoestimulantes sistémicos (incluidos, pero sin limitarse a ellos, los interferones y la IL-2) en un plazo de 6 semanas o cinco medias vidas del medicamento, lo que sea más breve, antes del Ciclo 1 Día 1.
    22. Tratamiento con corticoesteroides sistémicos u otros medicamentos inmunosupresores sistémicos (incluidos, pero sin limitarse a ellos, la prednisona, la dexametasona, la ciclofosfamida, la azatioprina, el metotrexato, la talidomida y los agentes contra el factor de necrosis tumoral [anti-FNT]) en las 2 semanas anteriores al Ciclo 1 Día 1 o la previsión del uso de dichos tratamientos durante el estudio.
    corticosuprarrenal.
    23.Persona privada de libertad o bajo tutela o curatela.
    E.5 End points
    E.5.1Primary end point(s)
    Recurrence-free survival defined as the time from randomization to the time of first RFS event (recurrence or death). Recurrence is defined as reappearance of disease (local recurrence or occurrence of any metastasis) after the start of therapy.
    Supervivencia sin recidiva definida como el intervalo de tiempo entre la aleatorización y la recidiva o el fallecimiento. La recidiva se define como la reaparición de la enfermedad (recidiva local o metástasis) después del inicio del tratamiento.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Recurrence free survival (RFS) at 3 years after inclusion of the first patient (144 events expected)
    Supervivencia sin recidiva (SSR) a los 3 años tras la inclusión del primer paciente (se esperan 144 eventos)
    E.5.2Secondary end point(s)
    Efficacy:
    • Progression-free survival is defined as the time from randomization to the date of recurrence and progression defined as increase of stage from Ta to T1 or from CIS to T1; progression to MIBC (T≥ 2) or to lymph node N+ or to distant disease M+
    • Disease-specific survival defined as the time from randomization to the date of death from bladder cancer;
    • Overall Survival, defined as the time from randomization to the date of death from any cause;
    • Disease worsening, defined as cystectomy or indicative change in therapy, including systemic chemotherapy or radiation therapy. The date of diagnosis (cystoscopy or CT) leading to cystectomy or chemotherapy/radiotherapy will be considered as the time of disease worsening.
    •Complete response will measured one the whole population: 3 months after induction (ie about 6 weeks after inclusion) and 1 year after the end of treatment (ie 2 years after inclusion). It will be defined by normal cystoscopy and normal cytology.
    •Complete response will be measured among patients with In situ carcinoma with the same timeline

    Safety and patient self-reported treatment tolerance:
    • Frequency, nature, and severity of adverse events graded according to NCI CTCAE v5.0 and immune-related event (irAE)

    • Quality of life will be measured using EORTC QLQ-C30 assessed at baseline and then every 12 weeks for year 1-2 then every 24 weeks for year 3-5

    Exploratory endpoints:
    • Status of tumor immune-related biomarkers in archival and /or freshly obtained tissues;
    • Status of exploratory biomarkers in urine, plasma, whole blood collected before and during treatment with atezolizumab or at recurrence and association with outcome.
    Eficacia:
    • La supervivencia sin progresión se define como el intervalo de tiempo entre la fecha de la aleatorización y la fecha de recidiva y la progresión se define como la progresión del estadio Ta a T1 o del estadio CIS
    a T1; o como la progresión al cáncer de vejiga con invasión muscular (CVIM) (T≥ 2) o a un ganglio linfático N+ o a metástasis M+;
    • La supervivencia específica a la enfermedad se define como el intervalo de tiempo entre la fecha de aleatorización y la fecha de fallecimiento debida al cáncer de vejiga;
    • La supervivencia global se define como el intervalo de tiempo entre la fecha de aleatorización y la fecha de fallecimiento debida a cualquier causa;
    • La agravación de la enfermedad se define como la cistectomía o un cambio significativo en el tratamiento, incluida la quimioterapia o la radioterapia sistémicas. La fecha del diagnóstico (cistoscopia o TAC) que conduce a la cistectomía o a la quimioterapia/radioterapia se considerará como la fecha de agravación de la enfermedad;
    • La respuesta completa se medirá en toda la población 3 meses después de la inducción (es decir, 6 semanas después de la inclusión) y un año después de la finalización del tratamiento (es decir, 2 años
    después de la inclusión). Esto se determina mediante una cistoscopia y una citología normales.
    • La respuesta completa se medirá entre los pacientes con CIS al mismo tiempo.

    Seguridad y tolerancia al tratamiento declarada por los pacientes:
    • Frecuencia, naturaleza y gravedad de los eventos adversos evaluada conforme al sistema NCI CTCAE v5.0 y evento relacionado con la inmunidad (ILI).
    • La calidad de vida se evaluará utilizando el cuestionario QLQ-C30 de la EORTC en el momento de la inclusión, y posteriormente cada 12 semanas durante el año 1 y el año 2, y después cada 24 semanas durante los años de 3 a 5.

    Criterios de evaluación exploratorios:
    • Estado de los biomarcadores tumorales relacionados con la inmunidad en los tejidos archivados obtenidos;
    • Estado de los biomarcadores exploratorios en el plasma, la sangre total y la orina recogidos antes y durante el tratamiento con atezolizumab o en el momento de la recidiva y correlacionados con los
    resultados obtenidos.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Specific, overall and progression free survival: 1-year and 2-year specific, overall and progression free survival rates, as well as disease worsening rates, will be determined 3 years after the inclusion of the first patient.
    Other late endpoints (namely 3 and 5-year rates and median times) will be determined at the end of the trial.
    Supervivencia sin progresión, global y específica: 1 año y 2 años para estas tasas de supervivencia, así como la tasa de empeoramiento de la enfermedad, se determinarán también a los 3 años tras la inclusión del primer paciente.
    Los otros criterios de valoración tardíos (tasas a los 3 y 5 años y mediana de tiempos): al final del ensayo
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Biomarkers study
    estudio de biomarcadores
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    standard arm with BCG
    E.8.2.4Number of treatment arms in the trial2
    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.8.4.1Number of sites anticipated in Member State concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA60
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.7Trial 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
    LVLS
    Última visita del último paciente
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years8
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years8
    E.8.9.2In all countries concerned by the trial months6
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 258
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 258
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients No
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state65
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 516
    F.4.2.2In the whole clinical trial 516
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    Ninguno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2021-05-13
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-05-07
    P. End of Trial
    P.End of Trial StatusOngoing
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