TLT news -The exploratory end point of efficacy is extremely encouraging as the fifth and sixth patients are clinically cancer free as of the 90-day cystoscopy examination."
Theralase completes phase 1b bladder cancer study
2018-05-30 09:08 ET - News Release
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Dr. Girish Kulkarni reports
THERALASE SUCCESSFULLY COMPLETES PHASE IB NON-MUSCLE INVASIVE BLADDER CANCER CLINICAL STUDY
Theralase Technologies Inc. has successfully completed its phase Ib non-muscle invasive bladder cancer clinical study.
On May 19, 2018, Theralase's medical and scientific advisory board was convened to examine the clinical results obtained from the first six patients enrolled and treated in the study utilizing TLD-1433-based photodynamic therapy, specifically: the primary end point of safety and tolerability, the secondary end point of pharmacokinetics (movement and exit of drug within tissue) and the exploratory end point of efficacy primarily at 90 days.
The MSAB comprises world-renowned experts in bladder cancer who have been retained by the company to provide advice and strategic guidance on the research, development and commercialization of the TLD-1433-based PDT technology in the treatment of patients inflicted with NMIBC.
After reviewing the clinical data presented by Dr. Girish Kulkarni, MD, PhD, FRCSC, an associate professor at the University of Toronto's department of surgery and the principal investigator of the study, the MSAB unanimously recommended the early termination of the study due to achievement of the primary and secondary end points. The MSAB also recommended that the clinical data collected from the first three patients treated at the maximum recommended starting dose (0.35 microgram per square centimetre) and the three patients treated at the therapeutic dose (0.70 mg per square cm) were sufficient to support the conclusion that the study had successfully achieved the its primary and secondary end points and had adequately addressed its scientific, technical and clinical questions, as per the approved study design and clinical protocol. The MSAB recommendation to the company was to terminate the study based on the six patients treated to date and suggest that the company pursue a pivotal phase II NMIBC clinical study approval with Health Canada and the FDA (United States Food and Drug Administration) with efficacy as the primary end point.
Dr. Kulkarni stated: "The primary and secondary end points of the study have been successfully accomplished from a clinical aspect. The treatment was safe and well tolerated by all patients treated, with no discernible difference in the number or severity of adverse events, regardless of whether the MRSD or therapeutic dose was utilized. All adverse events were either minor (grade 1) or moderate (grade 2) in severity and completely resolved within 90 days. There were no severe (grade 3), life threatening (grade 4) or deaths (grade 5) AEs, and the majority of AEs were transient and related to irritative lower urinary tract symptoms (that is, urination urgency). TLD-1433 systemic absorption was minimal (picograms concentration in plasma), which is magnitudes below the no observed adverse effect level for TLD-1433 and hence presents no significant clinical risk. I believe that TLD-1433 holds real potential as a treatment for NMIBC and I look forward to treating patients in a pivotal phase II NMIBC clinical study, pending Health Canada approval to commence the study."
Dr. Michael Jewett, MD, FRCSC, FACS, professor of surgery (urology) at the University of Toronto and the chairman of Theralase's MSAB, stated: "When NMIBC intravesical treatment with bacillus calmete guerin fails, the standard of care is cystectomy (removal of the patient's bladder), which is a major surgery with life-altering side effects that many patients may not accept despite the risk of cancer spread. The study clinical data presented by Dr. Kulkarni is very encouraging. TLD-1433 PDT appears safe and well tolerated in patients presenting with BCG-unresponsive NMIBC. I am pleased that the clinical results of the study met its objectives demonstrating that the Theralase PDT technology has demonstrated potential as a treatment for bladder cancer. The MSAB members and I unanimously support the view that the study achieved its primary and secondary end points after the treatment of six patients and concluded that the clinical data collected supports an early termination of the phase I study to commence a pivotal phase II NMIBC clinical study focused on efficacy. The phase II NMIBC study design has been discussed and collectively approved during the MSAB meeting. The exploratory end point of efficacy is extremely encouraging as the fifth and sixth patients are clinically cancer free as of the 90-day cystoscopy examination."
Dr. Ashish Kamat, MD, MBBS, professor of urologic oncology (surgery) and Wayne B. Duddlesten Professor of Cancer Research, University of Texas's MD Anderson Cancer Center, stated that: "The safety data presented by Dr. Kulkarni and Theralase is convincing and recruitment of an additional three patients at the therapeutic dose is not likely to add significant value to the understanding of the PDT technology in the treatment of NMIBC. If a larger multicentre study demonstrates efficacy of PDT technology in this patient population, it would provide our patients a useful alternative to avoid radical surgery. The more safe, reliable options we have to offer our patients, the better it is for everyone concerned. The MSAB thus recommended that the company truncate the study early to seek Health Canada and FDA approval to commence a larger and more statistically powered, single-arm, multicentre efficacy study. Moreover, the MSAB reviewed and approved in principle the phase II clinical protocol and the clinical study design presented by Dr. Jewett. BCG-unresponsive NMIBC is a potentially fatal disease that requires additional treatment options. Currently, cystectomy remains the safest treatment option available to patients, but if the Theralase PDT achieves its efficacy end point in a phase II clinical study, then this will present patients with an attractive additional treatment option. The clinical data presented by Dr. Kulkarni suggests that the Theralase PDT treatment option may be just what the doctor ordered."
Dr. Michael O'Donnell, MD, professor of urology, University of Iowa, Iowa City, Iowa, stated: "I am encouraged by the Theralase phase Ib clinical study data presented at the MSAB meeting. The top-line clinical results indicate that the TLD-1433-based PDT at tested doses has met its primary and secondary objectives in the studied population of BCG-unresponsive patients with NMIBC who refused cystectomy. The Theralase approach is an interesting treatment option with an early signal of treatment effectiveness, albeit in a small population, that will need to be confirmed in a phase II clinical study. This is a novel approach that addresses a bladder cancer population with a high unmet need. As designed, a successful phase II clinical study will confirm how this PDT therapy approach could shape future practice."
About the study
The study is being used to evaluate TLD-1433, Theralase's lead PDC, for the primary end point of safety and tolerability, secondary end point of pharmacokinetics (movement and exit of drug within tissue) and exploratory end point of efficacy.
Study outcome end points:
1. Primary: evaluate safety and tolerability. (Measured by patients who experience adverse events grade 4 or greater that do not resolve within 30 days; whereby: grade 1 equals mild AE, grade 2 equals moderate AE, grade 3 equals severe AE, grade 4 equals life-threatening or disabling AE and grade 5 AE equals death.)
2.Secondary: evaluate the pharmacokinetics (movement and exit of drug within tissue) of TLD-1433. (Measured by TLD-1433 concentration levels in plasma and urine over 72 hours.)
3. Exploratory: evaluate efficacy (Measured by recurrence-free survival, defined as the interval from day zero (day of PDT treatment) to documented recurrence or death from any cause, whichever occurs first. Recurrence is defined as any new tumour growth (that is, any biopsy-confirmed new or recurrent tumour), evaluated at 90 days for the first three patients treated at the MRSD and primarily at 90 days for the last six patients treated at the therapeutic dose and secondarily at 180 days after treatment.)
The company is planning to meet with Health Canada and the FDA, to discuss and finalize the design of a Health Canada and FDA pivotal phase II NMIBC clinical study, with a primary end point of efficacy.
