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    Clinical Trial Results:
    A Phase 3, Randomized, Double-blind Trial of Nivolumab in Combination with Intravesical BCG versus Standard of Care BCG Alone in Participants with High-risk Non-muscle Invasive Bladder Cancer That Is Persistent or Recurrent After Treatment with BCG

    Summary
    EudraCT number
    2019-002567-96
    Trial protocol
    FR   ES   NL   GR   SE   GB   DE   AT   IT  
    Global end of trial date
    31 Oct 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    24 Oct 2024
    First version publication date
    24 Oct 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CA209-7G8
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Bristol-Myers Squibb
    Sponsor organisation address
    Chaussée de la Hulpe 185, Brussels, Belgium, 1170
    Public contact
    EU Study Start-Up Unit, Bristol-Myers Squibb International Corporation, Clinical.Trials@bms.com
    Scientific contact
    Bristol-Myers Squibb Study Director, Bristol-Myers Squibb, Clinical.Trials@bms.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    31 Oct 2023
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Oct 2023
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    To compare the EFS per PRC of nivolumab plus BCG vs BCG alone in all randomized participants
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and in compliance with all International Conference on Harmonization Good Clinical Practice Guidelines. All the local regulatory requirements pertinent to safety of trial subjects were followed.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    09 Dec 2019
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Greece: 1
    Country: Number of subjects enrolled
    France: 4
    Country: Number of subjects enrolled
    Spain: 2
    Country: Number of subjects enrolled
    Argentina: 3
    Country: Number of subjects enrolled
    Russian Federation: 2
    Worldwide total number of subjects
    12
    EEA total number of subjects
    7
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    5
    From 65 to 84 years
    6
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    12 subjects randomized and treated

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Arm A
    Arm description
    Nivolumab 480 mg intravenous (IV) every 4 weeks (Q4W) for up to 24 months (104 weeks) and intravesical BCG (induction) weekly for 6 weeks followed by maintenance intravesical BCG weekly for 3 weeks at 3, 6, 12, 18, 24, 30, and 36 months
    Arm type
    Experimental

    Investigational medicinal product name
    Nivolumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravascular use
    Dosage and administration details
    10mg/mL

    Investigational medicinal product name
    BCG
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Intravesical solution
    Routes of administration
    Intravesical use
    Dosage and administration details
    BCG dose should be prepared and administered according to the package insert

    Arm title
    Arm B
    Arm description
    Nivolumab-placebo IV Q4W for up to 24 months (104 weeks) and intravesical BCG (induction) weekly for 6 weeks followed by maintenance intravesical BCG weekly for 3 weeks at 3, 6, 12, 18, 24, 30, and 36 months
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravascular use
    Dosage and administration details
    480mg

    Number of subjects in period 1
    Arm A Arm B
    Started
    8
    4
    Completed
    8
    4

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Arm A
    Reporting group description
    Nivolumab 480 mg intravenous (IV) every 4 weeks (Q4W) for up to 24 months (104 weeks) and intravesical BCG (induction) weekly for 6 weeks followed by maintenance intravesical BCG weekly for 3 weeks at 3, 6, 12, 18, 24, 30, and 36 months

    Reporting group title
    Arm B
    Reporting group description
    Nivolumab-placebo IV Q4W for up to 24 months (104 weeks) and intravesical BCG (induction) weekly for 6 weeks followed by maintenance intravesical BCG weekly for 3 weeks at 3, 6, 12, 18, 24, 30, and 36 months

    Reporting group values
    Arm A Arm B Total
    Number of subjects
    8 4 12
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    4 1 5
        From 65-84 years
    4 2 6
        85 years and over
    0 1 1
    Age Continuous
    Units: Years
        arithmetic mean (standard deviation)
    61.1 ( 9.8 ) 73.0 ( 15.3 ) -
    Sex: Female, Male
    Units: Participants
        Female
    1 1 2
        Male
    7 3 10
    Race (NIH/OMB)
    Units: Subjects
        American Indian or Alaska Native
    0 0 0
        Asian
    0 0 0
        Native Hawaiian or Other Pacific Islander
    0 0 0
        Black or African American
    1 0 1
        White
    7 4 11
        More than one race
    0 0 0
        Unknown or Not Reported
    0 0 0
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    1 2 3
        Not Hispanic or Latino
    5 1 6
        Unknown or Not Reported
    2 1 3

    End points

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    End points reporting groups
    Reporting group title
    Arm A
    Reporting group description
    Nivolumab 480 mg intravenous (IV) every 4 weeks (Q4W) for up to 24 months (104 weeks) and intravesical BCG (induction) weekly for 6 weeks followed by maintenance intravesical BCG weekly for 3 weeks at 3, 6, 12, 18, 24, 30, and 36 months

    Reporting group title
    Arm B
    Reporting group description
    Nivolumab-placebo IV Q4W for up to 24 months (104 weeks) and intravesical BCG (induction) weekly for 6 weeks followed by maintenance intravesical BCG weekly for 3 weeks at 3, 6, 12, 18, 24, 30, and 36 months

    Primary: Event Free Survival

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    End point title
    Event Free Survival [1]
    End point description
    The time between the date of randomization and the date of first documented event or death due to any cause, whichever occurs first. Events include recurrence of disease (TaHG, T1, or CIS) and progression of disease. Here "9999" = NA
    End point type
    Primary
    End point timeframe
    Approximately 44 Months and 1 Week
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No statistical Analysis done for this endpoint
    End point values
    Arm A Arm B
    Number of subjects analysed
    8
    4
    Units: Months
        median (full range (min-max))
    9999 (9999 to 9999)
    9999 (9999 to 9999)
    No statistical analyses for this end point

    Secondary: Overall Survival

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    End point title
    Overall Survival
    End point description
    The time between the date of randomization and the date of death due to any cause. For participants still alive, OS is censored at the last date the participant is known to be alive. Here "9999" = NA
    End point type
    Secondary
    End point timeframe
    Approximately 44 months and 1 week
    End point values
    Arm A Arm B
    Number of subjects analysed
    8
    4
    Units: Months
        median (full range (min-max))
    9999 (9999 to 9999)
    9999 (9999 to 9999)
    No statistical analyses for this end point

    Secondary: Worsening-Free Survival

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    End point title
    Worsening-Free Survival
    End point description
    The time from randomization to progression to muscle-invasive disease (ie, T2), cystectomy, systemic chemotherapy, radiotherapy, or death from any cause. Here "9999" = NA
    End point type
    Secondary
    End point timeframe
    Approximately 44 months and 1 week
    End point values
    Arm A Arm B
    Number of subjects analysed
    8
    4
    Units: Months
        median (full range (min-max))
    9999 (9999 to 9999)
    9999 (9999 to 9999)
    No statistical analyses for this end point

    Secondary: Duration of Response

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    End point title
    Duration of Response
    End point description
    the time between the date of the first CR to the date of first documented recurrence, progression, or death due to any cause. Here "9999" = NA
    End point type
    Secondary
    End point timeframe
    Approximately 44 months and 1 week
    End point values
    Arm A Arm B
    Number of subjects analysed
    8
    4
    Units: Months
        median (full range (min-max))
    9999 (9999 to 9999)
    9999 (9999 to 9999)
    No statistical analyses for this end point

    Secondary: All-causality adverse events leading to discontinuation

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    End point title
    All-causality adverse events leading to discontinuation
    End point description
    An Adverse Event (AE) is defined as any new untoward medical occurrence or worsening of a preexisting medical condition in a clinical investigation participant administered study treatment and that does not necessarily have a causal relationship with this treatment.
    End point type
    Secondary
    End point timeframe
    24.6 months
    End point values
    Arm A Arm B
    Number of subjects analysed
    8
    4
    Units: Subjects
        Any Grade
    1
    3
        Grade 3-4
    0
    0
        Grade 5
    0
    0
    No statistical analyses for this end point

    Secondary: All-causality adverse events

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    End point title
    All-causality adverse events
    End point description
    An Adverse Event (AE) is defined as any new untoward medical occurrence or worsening of a preexisting medical condition in a clinical investigation participant administered study treatment and that does not necessarily have a causal relationship with this treatment.
    End point type
    Secondary
    End point timeframe
    24.6 months
    End point values
    Arm A Arm B
    Number of subjects analysed
    8
    4
    Units: Subjects
        Grade 1
    1
    2
        Grade 2
    4
    1
        Grade 3
    1
    1
    No statistical analyses for this end point

    Secondary: Drug-related adverse events

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    End point title
    Drug-related adverse events
    End point description
    An Adverse Event (AE) is defined as any new untoward medical occurrence or worsening of a preexisting medical condition in a clinical investigation participant administered study treatment and that does not necessarily have a causal relationship with this treatment.
    End point type
    Secondary
    End point timeframe
    24.6 months
    End point values
    Arm A Arm B
    Number of subjects analysed
    8
    4
    Units: Subjects
        Grade 1
    1
    1
        Grade 2
    4
    1
        Grade 3
    1
    1
    No statistical analyses for this end point

    Secondary: Complete Response Rate at 13 Weeks

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    End point title
    Complete Response Rate at 13 Weeks
    End point description
    CRR is defined as the proportion of participants with CIS (+/- TaHG/T1) per PRC at randomization who are disease free at the first disease assessment (Week 13) Here "9999" = NA
    End point type
    Secondary
    End point timeframe
    13 Weeks
    End point values
    Arm A Arm B
    Number of subjects analysed
    8
    4
    Units: Percentage of Participants
        arithmetic mean (standard deviation)
    9999 ( 9999 )
    9999 ( 9999 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse Events and Serious Adverse Events: (From first dose to last dose + 100 days): Approximately 44 months and 1 week All-Cause mortality (From randomization to end of study): Approximately 44 months and 1 week
    Adverse event reporting additional description
    The number at Risk for All-Cause Mortality represents all Randomized Participants. The number at Risk for Serious Adverse Events and Other (Not Including Serious) Adverse Events represents all participants that received at least 1 dose of study medication
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    26.1
    Reporting groups
    Reporting group title
    Arm B
    Reporting group description
    Nivolumab-placebo IV Q4W for up to 24 months (104 weeks) and intravesical BCG (induction) weekly for 6 weeks followed by maintenance intravesical BCG weekly for 3 weeks at 3, 6, 12, 18, 24, 30, and 36 months

    Reporting group title
    Arm A
    Reporting group description
    Nivolumab 480 mg intravenous (IV) every 4 weeks (Q4W) for up to 24 months (104 weeks) and intravesical BCG (induction) weekly for 6 weeks followed by maintenance intravesical BCG weekly for 3 weeks at 3, 6, 12, 18, 24, 30, and 36 months

    Serious adverse events
    Arm B Arm A
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 8 (25.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cystitis
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Arm B Arm A
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    4 / 4 (100.00%)
    5 / 8 (62.50%)
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 8 (0.00%)
         occurrences all number
    2
    0
    Pain
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 8 (0.00%)
         occurrences all number
    1
    0
    Mucosal inflammation
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Fatigue
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    2
    Immune system disorders
    Drug hypersensitivity
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Reproductive system and breast disorders
    Prostatitis
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 8 (25.00%)
         occurrences all number
    0
    4
    Perineal pain
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Pelvic pain
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 8 (0.00%)
         occurrences all number
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Sputum discoloured
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Rhinorrhoea
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Rhinitis allergic
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    1 / 4 (25.00%)
    1 / 8 (12.50%)
         occurrences all number
    1
    1
    Investigations
    Blood creatinine increased
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Cortisol decreased
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 8 (0.00%)
         occurrences all number
    1
    0
    Injury, poisoning and procedural complications
    Infusion related reaction
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    3
    Nervous system disorders
    Neuropathy peripheral
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 8 (0.00%)
         occurrences all number
    1
    0
    Headache
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Dizziness
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 8 (25.00%)
         occurrences all number
    0
    2
    Eye disorders
    Dry eye
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 8 (25.00%)
         occurrences all number
    0
    2
    Dyschezia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Gastrooesophageal reflux disease
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Stomatitis
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    2
    Umbilical hernia
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 8 (0.00%)
         occurrences all number
    1
    0
    Hepatobiliary disorders
    Hyperbilirubinaemia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Skin and subcutaneous tissue disorders
    Nail disorder
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Pruritus
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 8 (25.00%)
         occurrences all number
    0
    4
    Dermatitis
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Rash
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 8 (25.00%)
         occurrences all number
    0
    2
    Renal and urinary disorders
    Urinary tract obstruction
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Urinary tract disorder
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Urinary incontinence
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 8 (0.00%)
         occurrences all number
    1
    0
    Pollakiuria
         subjects affected / exposed
    1 / 4 (25.00%)
    1 / 8 (12.50%)
         occurrences all number
    1
    1
    Nocturia
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 8 (25.00%)
         occurrences all number
    0
    2
    Immune-mediated cystitis
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Haematuria
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 8 (0.00%)
         occurrences all number
    3
    0
    Dysuria
         subjects affected / exposed
    1 / 4 (25.00%)
    3 / 8 (37.50%)
         occurrences all number
    2
    5
    Endocrine disorders
    Hyperthyroidism
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Hypothyroidism
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    3
    Musculoskeletal and connective tissue disorders
    Polyarthritis
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Back pain
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Infections and infestations
    COVID-19
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Gastroenteritis
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 8 (0.00%)
         occurrences all number
    1
    0
    Nasopharyngitis
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Rhinitis
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Skin infection
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    1
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 8 (12.50%)
         occurrences all number
    0
    2
    Urinary tract infection
         subjects affected / exposed
    3 / 4 (75.00%)
    3 / 8 (37.50%)
         occurrences all number
    5
    5
    Cystitis
         subjects affected / exposed
    1 / 4 (25.00%)
    1 / 8 (12.50%)
         occurrences all number
    3
    2
    Metabolism and nutrition disorders
    Hyperglycaemia
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 8 (25.00%)
         occurrences all number
    0
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    11 Oct 2021
    As of May 2021, the CA2097G8 study enrollment was significantly behind the projected target enrollment, at 5% since first patient first visit; therefore, the study will be unable to meet its scientific objectives. As such, the primary reason for this protocol amendment is to implement the decision to close participant enrollment to the study as of 02-Jun-2021.  Details of closure of the study, with provision for participants currently on treatment to continue.  Clarification that all pharmacokinetic (PK), biomarker, patient-reported outcomes, and health care resource utilization assessments are no longer applicable per Protocol Amendment 01.  Clarification that study-related efficacy assessment and Pathology Review Committee are no longer applicable per Protocol Amendment 01. Sites should continue efficacy assessment as per local standards of care.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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