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NCT Number: NCT07804056

A Study to Investigate the Efficacy and Safety of Alpha1H as a Neoadjuvant Therapy in Participants With Low- to Intermediate-Risk/Low-Grade Papillary Non-Muscle Invasive Bladder Cancer

The goal of this clinical trial is to learn if the drug Alpha1H works to treat low-to-intermediate risk non-muscle-invasive bladder cancer in adults. It will also learn about the safety of drug Alpha1H.

The main questions it aims to answer are:

* Does giving drug Alpha1H before surgery lower the risk of cancer returning or worsening compared to standard care alone? * Is drug Alpha1H safe and well-tolerated by participants? Researchers will compare participants receiving drug Alpha1H before standard surgery to participants receiving standard care alone to see if drug Alpha1H lowers the risk of cancer returning or progressing.

Participants will:

* Be randomly assigned to receive either drug Alpha1H before surgery or standard care alone. * Receive drug Alpha1H directly into the bladder 6 times over about 1 month if assigned to the Alpha1H group. * Hold the liquid in the bladder for up to 2 hours during each visit. * Undergo standard surgery through the urethra (TURBT) to remove remaining tumor tissue. * Visit the clinic regularly for follow-up checkups (including bladder examinations and urine tests) to check if the cancer returns. * Fill out questionnaires about their quality of life.

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Key information

Conditions

Urinary Bladder Neoplasms Carcinoma Female Urogenital Diseases Female Urogenital Diseases and Pregnancy Complications Male Urogenital Diseases Neoplasms Neoplasms by Histologic Type Neoplasms by Site Neoplasms, Glandular and Epithelial Non-Muscle Invasive Bladder Neoplasms Non-muscle Invasive Bladder Cancer (NMIBC) Urinary Bladder Diseases Urogenital Diseases Urogenital Neoplasms Urologic Diseases Urologic Neoplasms

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 3

Primary location

Fakultni nemocnice Motol a Homolka

Prague, 15000, Czechia

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Signed and dated informed consent.
  • Low- or intermediate-risk non-muscle-invasive bladder cancer (NMIBC) meeting one of the following definitions:
  • Low-risk NMIBC: Primary, solitary, Ta, low-grade, 0.5 cm to 3 cm.
  • Intermediate-risk NMIBC (low-to-intermediate risk subgroup per IBCG classification):
  • Primary multifocal (<10 lesions), Ta, low-grade, 0.5 cm to 3 cm;
  • Recurrent solitary, Ta, low-grade, 0.5 cm to 3 cm; or
  • Recurrent multifocal (<10 lesions), Ta, low-grade, >1 year after previous recurrence.
  • Men and women aged 18 years or older.
  • Negative pregnancy test at screening for women of childbearing potential.
  • Women of childbearing potential must agree to use highly effective contraception methods throughout study participation; men of childbearing potential must refrain from donating sperm during the study.
  • Ability to retain bladder contents for 2 hours.

Exclusion criteria

  • Patient with non-papillary tumor appearance at the time of initial cystoscopy.
  • Previous history of T1 or high-grade disease in recurrent tumors.
  • Patients with T1 or high-grade non-muscle invasive papillary bladder cancer (NMIBC).
  • Previous intravesical BCG immunotherapy.
  • Patients with any other cancer diagnosis within the last 5 years (except for skin basalioma).
  • Acute urinary tract infection requiring antibiotic treatment.
  • Prior radiotherapy or systemic chemotherapy.
  • WHO performance status of 3 or 4.
  • Any other investigational agent or non-marketed product within one month prior to Visit 1 and during the trial.
  • Known active HIV infection, defined as detectable HIV viral load at screening.
  • Active hepatitis B virus (HBV) infection, defined as hepatitis B surface antigen (HBsAg) positivity with detectable HBV DNA at screening.
  • Active hepatitis C virus (HCV) infection, defined as anti-HCV antibody positivity with detectable HCV RNA at screening in a patient not on stable antiviral treatment.
  • Any concurrent illness that may render a participant ineligible or limit compliance with study requirements.
  • Previously enrolled in this trial.

Treatment and study plan

Alpha1H

Drug

Administered via intravesical instillation directly into the urinary bladder. Participants in the experimental group receive a total of 6 instillations on Days 1, 3, 5, 8, 15, and 22 over approximately 1 month prior to TURBT. During each treatment, participants are asked to retain the solution in the bladder for up to 2 hours.

Transurethral Resection of Bladder Tumor (TURBT)

Procedure

Standard endoscopic surgical procedure performed through the urethra to resect and remove papillary bladder tumor tissue. Performed approximately 30 days after study entry (on Visit 8). Resected tumor tissue is collected for histopathology and central analysis.

Intravesical Chemotherapy

Drug

A single early intravesical instillation of standard-of-care chemotherapy (epirubicin, mitomycin, or gemcitabine) administered into the urinary bladder shortly following TURBT surgery in accordance with local institutional guidelines.

Primary outcomes

  1. Event-Free Survival (EFS)

    Time frame: From randomization until the occurrence of an EFS event or study completion, assessed at 3, 6, 9 (optional), and 12 months post-randomization, and every 6 months thereafter for up to 3 years.

Secondary outcomes

  1. Complete Response (CR) Rate

    Time frame: Day 30 (±5 days), prior to TURBT

  2. Overall Survival (OS)

    Time frame: From randomization through study completion (assessed at 3, 6, 9 [optional], and 12 months, and every 6 months thereafter for up to 3 years).

  3. Tumor Response (Morphological and Cellular)

    Time frame: Baseline (Day 1) to Day 30 (±5 days)

    Assessed as: (1) change in papillary tumor size (% reduction from baseline); (2) tumor cell shedding in urine (cells/mL); (3) apoptosis in shed cells (% TUNEL-positive cells); (4) Alpha1H uptake in shed cells (% Alpha1H-positive cells). Each parameter reported separately.

  4. Tumor Gene Expression

    Time frame: Baseline (Day 1) to Day 30 (±5 days)

    Assessed by RNA sequencing (whole transcriptome) in tumor tissue and urine RNA. Reported as number of differentially expressed cancer-related genes and pathways between the Alpha1H and SOC arms.

  5. Urinary Biomarkers and Immune Response

    Time frame: Day 1, 3, 5, 8, 15, and 22 (pre- and post-instillation), and Day 30 (±5 days)

    Assessed by proteomic profiling of urine samples. Reported as change in concentration (pg/mL) of cytokines, chemokines, and interferons between pre- and post-instillation samples, compared between the Alpha1H and SOC arms.

  6. Incidence and Severity of Adverse Events (AEs)

    Time frame: From Visit 1 (Screening) through Visit 9 (Day 40/50) and follow-up period (up to 3 years)

  7. Change in Quality of Life (QoL) as Assessed by the QLQ-NMIBC24 Questionnaire

    Time frame: From Visit 1 (Screening) through follow-up visits (up to 3 years)

    Quality of life will be assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Non-Muscle-Invasive Bladder Cancer Module (EORTC QLQ-NMIBC24), a 24-item, disease-specific patient-reported outcome instrument. Each domain score is linearly transformed to range from 0 to 100. On functional scales (e.g., sexual function), higher scores indicate better functioning; on symptom-related scales (e.g., urinary symptoms, future perspective), higher scores indicate greater symptom burden. Scores are calculated per the EORTC scoring manual.

Study contacts

Contact information is provided by the study sponsor or research team.

Catharina Svanborg, MD, PhD.

CONTACT

[email protected]

+46709426549

Petr Bouska

CONTACT

[email protected]

+420773076076

Sponsors and collaborators

Lead sponsor

Hamlet Pharma AB

Industry

Registry information

Official study title

A Randomized Phase III Study to Investigate the Efficacy and Safety of Alpha1H as a Neoadjuvant Therapy in Participants With Low- to Intermediate-Risk/Low-Grade Papillary Non-Muscle Invasive Bladder Cancer

Important dates

Study start
2026
Primary completion
2029
Study completion
2029
First posted
Sep 4, 2026
Registry last updated
Sep 4, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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