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RecruitingInterventionalPhase 3

A Phase 3, Randomised, Multi-center, Open Label Trial to Evaluate the Safety and Efficacy of Intravesical Nadofaragene Firadenovec Alone or in Combination With Chemotherapy or Immunotherapy in Participants With High-grade Bacillus Calmette-Guerin Therapy (BCG) Unresponsive Non-muscle Invasive Bladder Cancer (NMIBC)

NCT ID: NCT06545955Sponsor: Ferring PharmaceuticalsLast updated: 2026-06-17

Summary

The pivotal phase 3 trial (rAd-IFN-CS 003) evaluating the efficacy of nadofaragene firadenovec showed that 55 (53.4%) of 103 subjects with CIS ± high-grade Ta/T1 achieved a complete response (CR) at 3 months. In this trial, the safety and efficacy of intravesical instillation of nadofaragene firadenovec alone or in combination with chemotherapy or immunotherapy will be evaluated in participants with NMIBC CIS (± high-grade Ta/T1).

Arms & interventions

  • DrugNadofaragene Firadenovec

    vector-based gene therapy for NMIBC treatment to potentiate durable therapeutic responses by interferon (IFN) alfa-2b (IFN-α2b) amplification. It is a non-replicating recombinant adenovirus serotype 5 vector containing a transgene encoding the human IFN-α2b gene.

  • DrugGemcitabine

    Intravesical Gemcitabine chemotherapy, used in combination with Docetaxel.

  • DrugDocetaxel

    Intravesical Docetaxel chemotherapy, used in combination with Gemcitabine.

  • DrugPembrolizumab

    Pembrolizumab is an FDA approved immune checkpoint inhibitor which restores the anti-tumour immune response by blocking the programmed cell death protein 1 (PD-1). Pembrolizumab is administered via intravenous (IV) infusion.

Outcome measures

Primary

  • Complete response

    Complete response (CR) at any time from first treatment (defined as absence of high-grade (HG) recurrence).

    Time frame: up to 6 months

Secondary

  • Complete response at month 3

    Time frame: 3 months

  • Complete response at month 6

    Time frame: 6 months

  • Durability of complete response

    Time frame: Up to 24 months

  • Muscle-invasive progression of disease

    Time frame: up to 36 months

  • Cystectomy-free survival

    Time frame: up to 36 months

  • Pathological staging

    Time frame: up to 36 months

  • Overall survival

    Time frame: up to 36 months

  • Evidence of malignant lesions of the upper tract and/or prostatic urethra

    Time frame: up to 24 months

  • Adverse events

    Time frame: up to 36 months

Eligibility criteria

Sex: AllAge: 18 Years and olderHealthy volunteers: No
Inclusion Criteria: * Diagnosed, as documented, with carcinoma in situ (CIS) ±Ta/T1 high-grade disease. * For T1 disease biopsies should contain muscle fibres. * Unresponsive to ≥2 courses of Bacillus Calmette-Guerin (BCG) therapy within the last 12 months. BCG-unresponsive refers to participants with high-grade non-muscle invasive bladder cancer (NMIBC) who are unlikely to benefit from and who will not be receiving further intravesical BCG. The term "BCG-Unresponsive" includes participants who did not respond to BCG treatment and have a persistent high-grade recurrence within 12 months after BCG was initiated, and those who despite an initial complete response to BCG, relapse with CIS within 12 months of their last intravesical treatment with BCG or relapse with high-grade Ta/T1 NMIBC within 6 months of their last intravesical treatment with BCG. The following criteria define the participants who may be included in the trial: * Have received at least 2 courses of BCG within a 12 month period - defined as at least 5 of 6 induction BCG instillations and at least 2 of 3 instillations of maintenance BCG, or at least 2 of 6 instillations of a second induction course, where maintenance BCG is not given. o Exception: those who have T1 high-grade disease at 1st evaluation after induction BCG alone (at least 5 of 6 doses) may qualify in the absence of disease progression * At the time of tumour recurrence, participants with CIS alone or high-grade Ta/T1 with CIS should be within 12 months of last exposure to BCG * No maximum limit to the amount of BCG administered * All visible papillary tumours must be resected and those with persistent T1 disease on transurethral resection of bladder tumour (TURBT) should undergo an additional re-TURBT within 14 to 70 days prior to beginning trial treatment. Obvious areas of CIS should also be fulgurated * Eastern Cooperative Oncology Group (ECOG) status ≤2 * Aged ≥18 years at the time of consent * Available for the whole duration of the trial * Life expectancy \>2 years, in the opinion of the investigator * Absence of concomitant upper tract urothelial carcinoma or urothelial carcinoma within the prostatic urethra. Freedom from upper tract disease (if clinically indicated) as indicated by no evidence of upper tract tumour by either intravenous pyelogram, retrograde pyelogram, computed tomography (CT) scan with or without urogram, or magnetic resonance imaging (MRI) with or without urogram performed within 6 months of enrolment. Absence of locally advanced disease as assessed by CT scan or MRI * Participants who elect not to undergo cystectomy * Participants with prostate cancer on active surveillance at low risk for progression are permitted to be included into the trial at the discretion of the investigator * Females of reproductive potential must have a negative highly sensitive urine or serum pregnancy test upon entry into this trial and be willing to use highly effective contraception during treatment with the investigational medicinal product and for 6 months following the last dose. Otherwise, female participants must be post-menopausal (no menstrual period for a minimum of 12 months, as confirmed by follicle-stimulating hormone levels) or surgically sterile * Male subjects must be willing to use a male condom and effective contraception during sex throughout the treatment period and for 3 months following the last dose. Exclusion Criteria: * Current or previous evidence of muscle-invasive (muscularis propria) or metastatic disease presented at the screening visit. Examples of increased risk of muscle-invasive disease include but are not limited to: * Presence of lymphovascular invasion and / or micropapillary, sarcomatoid, plasmacytoid and / or neuroendocrine disease as shown in the histology of the biopsy sample * Participants with CIS+T1 disease accompanied by the presence of hydronephrosis secondary to the primary tumour * Current systemic therapy for bladder cancer other than investigational medicinal products used in randomisation arm * Current or prior investigational treatment for BCG-unresponsive NMIBC or any other investigational drug (drug used in a clinical trial, i.e drug used in a Ferring sponsored non interventional study does not apply) within 1 month prior to screening * Current or prior pelvic external beam radiotherapy within 2 years of screening * Prior treatment with nadofaragene firadenovec at any time * Prior systemic therapy for bladder cancer at any time * Prior intravesical chemotherapy for the treatment of BCG-unresponsive NMIBC

Study locations (38)

Center for Neurosciences

Tucson, Arizona, 85718

Recruiting

Arkansas Urology, North Little Rock

Little Rock, Arkansas, 72211

Recruiting

American Institute of Research

Los Angeles, California, 90017

Recruiting

USC Kenneth Norris Jr Cancer Hospital

Los Angeles, California, 90080

Recruiting

University of California, Irvine

Orange, California, 92868

Recruiting

Genesis Research, LLC - San Diego

San Diego, California, 92123

Recruiting

Advent Health

Denver, Colorado, 80210

Recruiting

Colorado Urology - St. Anthony Hospital Campus

Lakewood, Colorado, 80228

Recruiting

Yale School of Medicine

New Haven, Connecticut, 06519

Recruiting

Medstar Georgetown University Hospital

Washington D.C., District of Columbia, 20007

Recruiting

Sarasota Memorial Healthcare System

Sarasota, Florida, 34239

Recruiting

Emory University

Atlanta, Georgia, 30322

Recruiting

Georgia Urology

Atlanta, Georgia, 30328

Recruiting

Boise VA Medical Center

Boise, Idaho, 83702

Recruiting

NextStage Clinical Research

Lisle, Illinois, 60532

Recruiting

Indiana University

Indianapolis, Indiana, 46202

Recruiting

Wichita Urology Group

Wichita, Kansas, 67226

Recruiting

Anne Arundel Urology, PA

Annapolis, Maryland, 21401

Recruiting

Chesapeake Urology Research Associates

Hanover, Maryland, 21076

Recruiting

Atlantic Health

Morristown, New Jersey, 07960

Recruiting

Roswell Park Cancer Institute

Buffalo, New York, 14263

Recruiting

Great Lakes Physician PC d/b/a Western new York Urology Associates

Cheektowaga, New York, 14225

Recruiting

Northwell Health -The Arthur Smith Institute for Urology

Lake Success, New York, 11042

Recruiting

Veterans Affairs New York Harbor Healthcare System - Manhattan VA Medical Center

New York, New York, 10010

Recruiting

James J. Peters VA Medical Center

The Bronx, New York, 10468

Recruiting

University of Cincinnati

Cincinnati, Ohio, 45267

Recruiting

MidLantic Urology

Bala-Cynwyd, Pennsylvania, 19004

Recruiting

Keystone Urology Specialists

Lancaster, Pennsylvania, 17601

Recruiting

University of Pennsylvania - Perelman Center for Advanced Medicine - Penn Urology

Philadelphia, Pennsylvania, 19104

Recruiting

University of Pittsburgh Medical Center - Shadyside Medical Building

Pittsburgh, Pennsylvania, 15232

Recruiting

Carolina Urologic Research Center

Myrtle Beach, South Carolina, 29572

Recruiting

The Conrad Pearson Clinic - Wolf River Office (Urology Center of the South)

Germantown, Tennessee, 38138

Recruiting

Urology Associates, P.C.

Nashville, Tennessee, 37209

Recruiting

Urology Austin

Austin, Texas, 78759

Recruiting

Urology Clinics of North Texas PLLC (Dallas)

Dallas, Texas, 75231

Recruiting

University of Texas Southwestern Medical Center - Urology Clinic

Dallas, Texas, 75390

Recruiting

Houston Methodist Hospital (Houston)

Houston, Texas, 77030

Recruiting

Virginia Mason Medical Center

Seattle, Washington, 98101

Recruiting