💬In plain words
What the trial is, and whether it could suit you
Recombinant oncolytic adenovirus injection (KD01) is an oncolytic virus product. Its main component is a conditionally replicative recombinant human type 5 adenovirus, where part of the E3 region has been replaced with the gene encoding the tBid apoptotic protein.AK104 is a humanized bispecific antibody co-targeting PD-1 (Programmed Cell Death Protein 1) and CTLA-4 (Cytotoxic T-Lymphocyte-Associated Antigen 4)-two key immune checkpoint receptors. It is designed as a novel tetrameric construct that preferentially binds to tumor-infiltrating lymphocytes (TILs) co-expressing PD-1 and CTLA-4 in the tumor microenvironment (with higher avidity than in peripheral tissues).This is a Phase I clinical study designed to evaluate the safety, tolerability, and preliminary efficacy of intravesical instillation of recombinant oncolytic adenovirus injection (KD01) in patients with bladder cancer.This st
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📋 Eligibility rules (as published)
Inclusion Criteria:
* 1.The Phase Ia will include histopathologically confirmed non-muscle-invasive bladder cancer (NMIBC) patients with high-risk stratification (including extremely high-risk). High-risk stratification criteria are defined as G3/high-grade tumors that meet any of the following criteria: carcinoma in situ (CIS); stage T1; diameter\>3 cm; multiple tumors; or recurrent tumors. The Phase Ib Cohort A will include BCG unresponsive NMIBC patients with carcinoma in situ \[CIS\], with or without Ta/T1 stage lesions, while Cohort B will include histopathologically confirmed muscle-invasive bladder cancer (cT2-4aN0-1M0).Note: BCG non-response is defined as meeting any of the following criteria: 1. Persistent or recurrent CIS within 12 months after completing adequate BCG treatment; 2. Recurrence of high-grade Ta/Tl disease within 6 months after completing adequate BCG treatment; 3. High-grade T1 disease at first evaluation after induction BCG treatment. (Adequate BCG treatment is defined as: Complete at least 5 out of 6 doses in the initial induction course. plus 2 out of 6 doses from the second induction course, or 2 doses from the 3-dose maintenance course.)
* 2.Excluding Phase Ib Cohort B, participants must either be medically ineligible for radical cystectomy as determined by urologists or have declined the procedure.
* 3.Age 18 to 75 (including 18 and 75).
* 4.Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) score of 0 to 1.
* 5.Estimated survival time is ≥2 years.6.No dysfunction of major organs, including but not limited to hematopoietic function and cardiac, pulmonary,hepatic and renal function.
Hematologic system (no history of blood transfusion or hematopoietic growth factor treatment within 14 days)
1. Absolute neutrophil count (ANC)≥1.5×109/L
2. Platelets (PLT)≥75×109/L
3. Hemoglobin (Hb)≥90g/L
Hepatic function
1. Total bilirubin (TBIL)≤1.5× upper limit (ULN)
2. Alanine aminotransferase (ALT)≤3×ULN
3. Aspartate aminotransferase (AST)≤3×ULN
Renal function
1. Creatinine (Cr)≤1.5×ULN
2. Creatinine clearance (Ccr) (Calculation required only if creatinine exceeds 1.5×ULN)\>50 mL/min (calculated using the Cockcroft-Gault formula)
Coagulation function
1. Activated Partial Thromboplastin Time (APTT)≤1.5×ULN
2. International normalized ratio (INR)≤1.5×ULN
* 7.Premenopausal patients must have a negative blood pregnancy test during the screening period;they must agree to use reliable contraceptive methods (barrier contraceptive method or abstinence) with their partners during the trial and for at least 6 months after the last dose.
* 8.Patients must provide informed consent to the trial and voluntarily sign of a written informed consent form before participating in the trial.
Exclusion Criteria:
* 1.Evidence of metastatic disease, or multiple regional lymph node positivity in the true pelvis, or common iliac lymph node positivity at the screening visit. Accompanied by hydronephrosis.
* 2.Received pelvic external beam radiation therapy within 5 years.
* 3.Prior treatment with adenovirus-based therapies (e.g., oncolytic adenovirus, CanSino's Ad5-nCoV COVID-19 vaccine).
* 4.Symptomatic urinary tract infection or bacterial cystitis (patients can enter the study once the treatment is satisfactory).
* 5.Clinically significant and unexplained elevation of liver or kidney function markers.
* 6.Women who are pregnant or breastfeeding or refuse to use contraception at any time during the study; male patients who are unwilling to use effective contraception.
* 7.A history of malignancy in another organ system in the past 5 years, which the investigator believes may interfere with the conduct of the study or requires systemic study treatment for the malignancy.
* 8.Patients who cannot tolerate intravesical instillation for 1 hour or bladder surgery.
* 9.In addition to immediate postoperative instillation after TURBT , patients who have received anti-tumor treatments (including chemotherapy, radiotherapy, biological therapy, endocrine therapy, targeted therapy, immunotherapy, etc.) within 4 weeks before the first study drug administration must be excluded. Specifically, patients who have used nitrosourea drugs or mitomycin C within 6 weeks prior to the initial study drug administration must be excluded Patients who have used oral fluorouracil and small-molecule targeted drugs within 2 weeks prior to the first administration of the study drug or within 5 half-lives of the drugs (whichever is longer) must be excluded. Patients who have used TCMs with anti-tumor indications within 2 weeks prior to the first administration must be excluded.
* 10.History of severe cardiovascular and cerebrovascular diseases, including but not limited to:
1. Severe cardiac rhythm or conduction abnormalities, such as ventricular arrhythmias requiring clinical intervention, or second-to third-degree atrioventricular block;
2. At rest, the QTcF (calculated from 12-lead ECG) is ≥460ms.
3. Acute coronary syndrome, congestive heart failure, aortic dissection, stroke or other cardiovascular and cerebrovascular events of grade 3 or above occurred within 6 months before the first administration;
4. Patients with NYHA class ≥II or left ventricular ejection fraction (LVEF) \<50%, or those with structural heart disease deemed high-risk by other researchers.
5. Hypertension that is not clinically controlled.
* 11.Patients with autoimmune diseases, or immune system dysfunction, or after organ transplantation.
* 12.Patients with active infection, or those requiring systemic anti-infective therapy (routine prophylactic anti-infective therapy at the clinical trial site is excluded), or those with unexplained fever \> 38.5℃ during screening.
* 13.Patients with positive HIV antibodies (HIV-Ab) or Treponema pallidum antibodies; those with active hepatitis B (HBsAg-positive with HBV-DNA\>500 IU/ml or above the clinical trial institution's lower limit of detection \[only if the lower limit o