PLZ4-Coated Paclitaxel-Loaded Micelles for the Treatment of Patients With Recurrent or Refractory Non-Muscle Invasive Bladder Cancer

Inclusion Criteria:

Histologically confirmed non muscle invasive bladder cancer (NMIBC), defined as noninvasive papillary carcinoma (Ta), carcinoma in situ (CIS) or carcinoma invading the subepithelial connective tissue (T1), determined via transurethral resection of bladder tumor (TURBT) within 3 months of enrollment

Participant must have Bacillus Calmette Guerin (BCG)-unresponsive NMIBC or intolerance of treatment with BCG. BCG-unresponsive disease is defined as being at least one of the following:

Persistent or recurrent CIS alone or with recurrent Ta/T1 (noninvasive papillary disease/tumor invades the subepithelial connective tissue) disease within 12 months of completion of adequate BCG therapy
Recurrent high-grade Ta/T1 disease within 12 months of completion of adequate BCG therapy

T1 high-grade disease at the first evaluation following an induction BCG course. In this context, adequate BCG therapy is defined as at least one of the following:

At least five of six doses of an initial induction course plus at least two of three doses of maintenance therapy
At least five of six doses of an initial induction course plus at least two of six doses of a second induction course
Refuse or intolerant of a radical cystectomy recommended by the treating urologist as the standard next therapy per American Urological Association (AUA) guideline
Age ≥ 18 years at time of consent
Performance status: Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
Patient with life expectancy greater than 24 months
No concurrent radiotherapy, chemotherapy, or other immunotherapy for bladder cancer. No BCG or other intravesical treatment within 4 weeks
No scheduled radiotherapy, chemotherapy, other immunotherapy, or surgery before the scheduled response evaluation
Recovery from prior treatment side effects that might interfere with the study treatment, in the judgment of the investigator
Absolute neutrophil count (absolute granulocyte count [AGC]/absolute neutrophil count [ANC]) ≥ 1,500/µL
Platelets ≥ 100,000/µL (Patients may be transfused to meet this requirement)
Hemoglobin ≥ 8 g/dL (Patients may be transfused to meet this requirement)
Calculated glomerular filtration rate (GFR) ≥ 30 mL/min
Total bilirubin ≤ 2.0 × institutional upper limit of normal (ULN) (< 3 × ULN for patients with Gilbert's syndrome)
Aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) ≤ 3.0 × institutional ULN
Adequate pulmonary function by clinical assessment with no clinical signs of severe pulmonary dysfunction
Participants of childbearing potential must agree to using adequate contraception (e.g., hormonal or barrier method of birth control; abstinence, an intrauterine device) for the duration of study participation (including dosing interruptions) and up to 3 months after last study treatment; or be surgically sterilized (e.g., hysterectomy, tubal ligation, or vasectomy)
Ability to understand and willingness to sign an informed consent form
Ability and willingness to adhere to the study visit schedule and other protocol requirements

Exclusion Criteria:

Existence of cancer at the upper urinary tract
Concurrent use of other investigational agents
Evidence of regional and/or distant metastasis
NYHA (New York Heart Association) class III or IV heart failure, uncontrollable supraventricular arrhythmias, any history of a ventricular arrhythmia, or other clinical signs of severe cardiac dysfunction
Symptomatic congestive heart failure (CHF), severe/unstable angina pectoris, or myocardial infarction within 6 months prior to study entry
Patient has an intractable bleeding disorder (e.g., coagulation factors deficiencies, Von Willebrand Disease)
Patient taking medications that affect coagulation, such as aspirin (though, aspirin 81 mg oral once daily is allowed), Coumadin/Warfarin, heparin, low molecular weight heparin, direct thrombin inhibitors, and direct factor Xa inhibitors. Other nonsteroidal antiinflammatory drugs (NSAIDs) are allowed as long as they are discontinued the day before therapy
History or evidence of uncontrollable central nervous system (CNS) disease
Active systemic infection requiring parenteral antibiotic therapy
Women who are pregnant or breast feeding

Any other malignancy diagnosed within 3 years of trial entry with the exception of the following:

Basal or squamous cell skin cancers, or
Noninvasive cancer of the cervix, or
Any other cancer deemed to be of low-risk for progression or patient morbidity during trial period, such as localized prostate cancer after definitive treatment and prostate-specific antigen (PSA) less than 0.2 ng/mL
Any condition that would prohibit the understanding or rendering of informed consent
Any condition that in the opinion of the investigator would interfere with the participant's safety or compliance while on trial