PhIII TOOKAD (Padeliporfin) Vascular Targeted Photodynamic Therapy Tx of Upper Tract Urothelial Ca
Study Description
The ENLIGHTED study will recruit patients with low-grade non-invasive upper tract urothelial carcinoma in either the kidney or the ureter. The disease may be new or recurrent, and the patients may be either treatment-naïve or have undergone prior intervention in the affected kidney.
Patients will be treated with TOOKAD (padeliporfin) VTP in two phases: An Induction Treatment Phase and a Maintenance Treatment Phase, and will be followed-up for up to an additional 48 months in the long term (non-intervention) follow up phase with the specific duration depending on the patient’s response to treatment.
Eligibility
- Male and female patients 18 years or older
- Able to understand and provide written informed consent and willing to comply with all tests and procedures associated with the study
- New or recurrent low-grade, non-invasive UTUC disease
- Biopsy-proven disease . A concurrence of the central pathology reader will be required for eligibility.
- Up to 2 biopsy-proven sites of low-grade involvement with the largest tumor (index tumor) between 5 mm and 15 mm in diameter (as measured by endoscopy), both located in the calyces,renal pelvis or in the ureter of the ipsilateral kidney, with an absence of high-grade cells on cytology. (Ureter involvement should be in one anatomical location with no more than 20 mm of contiguous ureteral length)
- Karnofsky Performance Status ≥ 50%
- Adequate organ function defined at baseline as:
ANC ≥1,000/ μl,
Platelets ≥75,000/ μl, Hb ≥9 g/dl,
INR ≤ 2
Estimated glomerular giltration rate (eGFR) ≥30 ml/min (using CKD-EPI Method)
Total serum bilirubin <3 mg/dL, AST/ALT ≤5× upper limit of normal
- Current high-grade or muscle invasive (>pT1) urothelial carcinoma of the bladder
- Carcinoma in situ (CIS) current or previous in the upper urinary tract
- History of invasive T2 or higher urothelial cancer in past 2 years
- Participation in another clinical study involving an investigational product within 1 month before study entry
- BCG or local chemotherapy treatment (including VEGF-targeted therapy) in the upper urinary tract within 2 months prior to inclusion
- Systemic chemotherapy treatment (including VEGF-targeted therapy) within 2 months prior to enrollment
- Prohibited medication that could not be adjusted or discontinued prior to study treatment
• Patients with photosensitive skin diseases or porphyria
- Any other medical or psychiatric co-morbidities, including decompensated heart failure, unstable angina or coronary artery disease or severe pulmonary or liver disease or current heavy smoker that, in the opinion of the study investigator, would make the patient a poor candidate for the study
- Pregnant or breast-feeding women.Women of childbearing potential (WOCBP) must undergo a negative serum pregnancy test prior to study entry.
- Men and women of reproductive potential not willing to observe conventional and effective birth control for the duration of treatment and for 90 days following the last padeliporfin VTP treatment.
*A man is considered fertile after puberty unless permanently sterile by bilateral orchidectomy. Men should refrain from sperm donation during study treatment and up to 90 days following the last VTP treatment
*WOCBP includes any woman who has experienced menarche and who has not undergone sur gical sterilization (hysterectomy, bilateral tubal ligation or bilateral oophorectomy) or who is not post-menopausal (defined as amenorrheic ≥12 consecutive months for no known medical reason)
*For WOCBP, and for men patients with a non-pregnant female partner of WOCBP the following birth control methods with a failure rate of less than 1% per year when used consistently and correctly are recommended during study participation:
*Combined estrogen and progesterone containing hormonal contraception associated with inhibition of ovulation given orally, intravaginally, or transdermally
*Progesterone-only hormonal contraception associated with inhibition of ovulation given orally, by injection, or by implant
*Intrauterine device (IUD)
*Intrauterine hormone-releasing system (IUS)
*Bilateral tubal occlusion
*Vasectomized partner
*Sexual abstinence:
*Sexual abstinence is considered a highly effective method only if defined as refraining from heterosexual intercourse during the entire period of risk associated
with the study treatments. The reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical
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