A First-in-Human Study of alpha1H in Patients With Non-muscle Invasive Bladder Cancer

Protein‐lipid complexes represent a new type of tumouricidal biologicals, with broad effects against cancers of different origins. The investigational product alpha1H is a synthetic peptide, corresponding to the alpha1 domain of α‐lactalbumin, in complex with oleic acid. Alpha1H is a further development product of HAMLET, a complex between human alpha‐lactalbumin and oleic acid, which has shown broad anti‐tumor activity with a high degree of selectivity. This study is a combined phase 1/2, placebo controlled, double blind study in subjects with non‐muscle invasive bladder cancer awaiting transurethral resection of bladder (TURB). The first, main part of the study is randomized 1/1 and the subjects will receive intravesical instillation of either alpha1H or placebo on 6 occasions during a period of 22 days (on days 1, 3, 5, 8, 15 and 22). In a second, open, dose‐escalation (DE) part of the study, two additional groups will receive increased doses of alpha1H in a standard 3+3 design in order to determine a Maximum Tolerated Dose (MTD) or alternatively, a Maximum Administered Dose (MAD). The same treatment schedule as in part 1 will be followed. One group will receive a dose of 5 times the original dose and, if tolerated, the last group will receive a dose of 10 times the original dose. Cell shedding is quantified and characterized at each treatment occasion. The bladder tumors are characterized prior treatment and prior to the scheduled surgery. Remaining tumors will be removed by TURB (according to European Association of Urology (EAU) Guidelines recommendations) and tissues will be obtained for analyses. A follow‐up Visit will take place 30 days after the last administration of study treatment. The total study duration of the main study is 8 ‐ 12 weeks. After the main study, the subjects may continue in an optional extended 24‐months follow‐up period.