Study of Rogaratinib (BAY1163877) vs Chemotherapy in Patients With FGFR (Fibroblast Growth Factor Receptor)-Positive Locally Advanced or Metastatic Urothelial Carcinoma

Phase 2

Completed

Conditions: Carcinoma, Transitional Cell

Interventions: Drug: Rogaratinib (BAY1163877)
Drug: Chemotherapy

Registration Number: NCT03410693

Lead Sponsor: Bayer

Brief Summary: This is a randomized, open-label, multicenter Phase 2/3 study to evaluate the efficacy and safety of rogaratinib (BAY 1163877) compared to chemotherapy in patients with FGFR-positive locally advanced or metastatic urothelial carcinoma who have received prior platinum-containing chemotherapy.

The primary objective is to demonstrate the superiority of rogaratinib over chemotherapy in terms of objective response rate (before: overall survivial) of urothelial carcinoma patients with FGFR positive tumors.

At randomization, patients will have locally advanced or metastatic urothelial carcinoma and have received at least one prior platinum-containing chemotherapy regimen. Only patients with FGFR1 or 3 positive tumors can be randomized into the study. Archival tumor tissue is adequate for testing of FGFR1 and 3 mRNA expressions, which will be determined centrally using an RNA in situ hybridization (RNA-ISH) test. Approximately 42 % of UC patients with locally advanced or metastatic UC are identified as FGFR-positive by the RNA-ISH cut-off applied.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 175

Inclusion Criteria

Existence of archival or fresh biopsy for FGFR testing. Mandatory FGFR testing of patients will be performed prior to start of screening. The timing of the FGFR test is at the discretion of the investigator. Investigators should ensure all patients will be eligible in terms of disease status and lines of treatment.
Documented urothelial carcinoma (transitional cell carcinoma) including urinary bladder, renal pelvis, ureters, urethra meeting all of the following criteria
- Histologically confirmed (Patients with mixed histologies are required to have a dominant transitional cell pattern.)
- Locally advanced (T4, any N; or any T, N 2-3) or metastatic disease (any T, any N and M1). Locally advanced bladder cancer must be unresectable i.e. invading the pelvic or abdominal wall (stage T4b) or presenting with bulky nodal disease (N2-3).
ECOG (Eastern Cooperative Oncology Group) Performance Status of 0 or 1
Disease progression during or following treatment with at least one platinum-containing regimen (patients should have been treated for at least 2 cycles). In patients who received prior adjuvant/ neoadjuvant platinum-containing chemotherapy, progression had to occur within 12 months of treatment.
High FGFR1 or 3 mRNA expression levels in archival or fresh tumor biopsy specimen quantified as outlined in the lab manual
At least 1 measurable lesion according to Response Evaluation Criteria in Solid Tumors (RECIST v.1.1) in contrast enhanced (unless contraindicated) CT or MRI

Exclusion Criteria

Previous or concurrent cancer except
- cervical carcinoma in situ
- treated basal-cell or squamous cell skin carcinoma
- any cancer curatively treated > 3 years before randomization
- curatively treated incidental prostate cancer (T1/T2a)
Ongoing or previous treatment with anti-FGFR directed therapies (e.g. receptor tyrosine kinase inhibitors including rogaratinib or FGFR-specific antibodies) or with taxanes or vinflunine
More than two prior lines of systemic anti-cancer therapy for urothelial carcinoma given for advanced unresectable/ metastatic disease
Ongoing or previous anti-cancer treatment within 4 weeks before randomization.
Unresolved toxicity higher than National Cancer Institute's Common Terminology Criteria for Adverse Events, version 4.03 (CTCAE v.4.03) Grade 1 attributed to any prior therapy/ procedure excluding alopecia, anemia and/ or hypothyroidism
History or current condition of an uncontrolled cardiovascular disease including any of the following conditions:
- Congestive heart failure (CHF) NYHA (New York Heart Association) > Class 2
- Unstable angina (symptoms of angina at rest) or new-onset angina (within last 3 months before randomization)
- Myocardial infarction (MI) within past 6 months before randomization
- Unstable cardiac arrhythmias requiring anti-arrhythmic therapy. Patients with arrhythmia under control with anti-arrhythmic therapy such as beta-blockers or digoxin are eligible.
Arterial or venous thrombotic events or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within 3 months before randomization
Current evidence of endocrine alteration of calcium phosphate homeostasis (e.g. parathyroid disorder, history of parathyroidectomy, tumor lysis, tumoral calcinosis, paraneoplastic hypercalcemia)
Current diagnosis of any retinal detachment, retinal pigment epithelial detachment (RPED), serous retinopathy or retinal vein occlusion
Any hemorrhage / bleeding event ≥ CTCAE v.4.03 Grade 3 within 4 weeks before randomization

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Rogaratinib	Rogaratinib (BAY1163877)	Rogaratinib treatment study arm, comprising 1. Pre-treatment period, including FGFR testing and screening, 2. Treatment period, and 3. Follow-up period, including active follow-up and long-term follow-up. Patients will be considered "on study" during the pre-treatment, treatment and active followup periods. During the long-term follow-up period the patients will be considered "off study".
Chemotherapy	Chemotherapy	Chemotherapy treatment study arm, comprising 1. Pre-treatment period, including FGFR testing and screening, 2. Treatment period, and 3. Follow-up period, including active follow-up and long-term follow-up. Patients will be considered "on study" during the pre-treatment, treatment and active followup periods. During the long-term follow-up period the patients will be considered "off study".

Primary Outcome Measures

Name	Time	Method
Objective Response Rate (ORR) - Central Assessment	From start of treatment up to end of active follow-up, approximately 29 months	ORR is defined as the percentage of participants with complete response (CR) or partial response (PR). participants for whom overall best response is not CR or PR, as well as participants without any post-baseline tumor assessment will be considered non-responders.

Secondary Outcome Measures

Name	Time	Method
Duration of Response (DOR) - Central Assessment	From start of treatment till end of active follow-up, approximately 29 months	DOR (for patients with PR and CR only) was defined as the time from the first documented objective response of PR or CR, whichever was noted earlier, to disease progression (including symptomatic deterioration) or death, whichever was earlier
Number of Participants With Treatment Emergent Adverse Events	From start of treatment up to 30 days after the last administration of study treatment, approximately 29 months	A treatment-emergent event was defined as any event arising or worsening after the start of study drug administration until 30 days after the last administration of study treatment
Progression-free Survival (PFS) - Central Assessment	From start of treatment till end of active follow-up, approximately 29 months	Progression free survival (PFS) was defined as the time (days) from randomization to date of first observed disease progression (radiological or clinical assessment or both) or death due to any cause (if death occurred before progression was documented).
Disease-control Rate (DCR) - Central Assessment	From start of treatment till end of active follow-up, approximately 29 months	DCR was defined as the percentage of participants whose overall best response was not a progressive disease (i.e., CR, PR, stable disease \[SD\] or Non CR/Non PD).

Trial Locations

Locations (161): Alaska Clinical Research Center, LLC
🇺🇸
Anchorage, Alaska, United States
University of Arizona Cancer Center
🇺🇸
Tucson, Arizona, United States
University of Southern California
🇺🇸
Los Angeles, California, United States
UC Davis Comprehensive Cancer Center
🇺🇸
Sacramento, California, United States
Sansum Clinic
🇺🇸
Santa Barbara, California, United States
Rocky Mountain Cancer Centers
🇺🇸
Littleton, Colorado, United States
UF Cancer Center at Orlando Health
🇺🇸
Orlando, Florida, United States
University of Kansas Medical Center
🇺🇸
Westwood, Kansas, United States
Comprehensive Cancer Centers of Nevada
🇺🇸
Las Vegas, Nevada, United States
Compass Oncology
🇺🇸
Tigard, Oregon, United States
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Alaska Clinical Research Center, LLC
🇺🇸Anchorage, Alaska, United States