Intervention: Sirolimus
Trial phase: Phase 1 | Phase 2
ATC code: L01EG04 | L04AA10 | S01XA23
SMILES: COC1CC2CCC(C)C(O)(O2)C(=O)C(=O)N2CCCCC2C(=O)OC(C(C)CC2CCC(O)C(OC)C2)CC(=O)C(C)C=C(C)C(O)C(OC)C(=O)C(C)CC(C)C=CC=CC=C1C
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 1
Group description: Phase 1, Cohort 2b: ABI-009 injectable suspension, 100 mg in 80 mL 0.9% saline, administered intravesically and retained for 2 hours, twice per week (total dose 200 mg per week) for 6 weeks
Eligibility criteria:
Inclusion Criteria:

Patients must have a diagnosis of transitional cell carcinoma (TCC) of the urinary bladder confirmed at the study institution. The patient must have demonstrated nonmuscle-invasive bladder cancer refractory or recurrent to standard intravesical therapy. Refractory disease is defined as failure to achieve tumor-free status by 6 months of initiation of adequate BCG therapy. Recurrent disease is defined as reappearance of disease after achieving a tumor-free status by 6 months of initiation of adequate BCG therapy. Adequate BCG therapy includes at least 6 weeks induction plus 3 additional doses of either induction or maintenance. Patients with a history of other intravesical agents (except nab-rapamycin or gemcitabine) in addition to standard BCG will also be allowed to enroll. All grossly visible disease must be fully resected and pathologic stage will be confirmed at the institution where the patient is enrolled. This will include stage Ta, T1, Tis and exclude all patients with muscle invasion (T2).

For phase 1, patients with multifocal low-grade Ta histology will be eligible for participation
For phase 2, individuals with Ta disease only must have documentation of high-grade histology
For phase 2, prior intravesical treatment with nab-rapamycin or gemcitabine is not allowed
Age >18 and must be able to read, understand, and sign informed consent
Performance Status: ECOG 0, 1, and 2 (See Appendix III)

Hematologic inclusion within 2 weeks of start of treatment

Absolute neutrophil count >1,500/mm3
Hemoglobin >9.0 g/dl
Platelet count >100,000/mm3

Hepatic inclusion within 2 weeks of entry

Total bilirubin must be within normal limits.
Adequate renal function with serum creatinine ≤2.5 mg/dL
Aspartate transaminase (AST) and alanine transaminase (ALT) ≤2.5 x ULN for the institution, alkaline phosphatase ≤ 2.5 x ULN for the institution, unless bone metastasis is present in the absence of liver metastasis
Women of childbearing potential must have a negative pregnancy test.
All patients of childbearing potential must be willing to consent to using effective contraception, ie, intrauterine device, birth control pills, depo-provera, and condoms while on treatment and for 3 months after their participation in the study ends.

Exclusion Criteria:

Any other malignancy diagnosed within 1 year of study entry (except basal or squamous cell skin cancers or noninvasive cancer of the cervix) is excluded
Concurrent treatment with any chemotherapeutic agent
Women who are pregnant or lactating
History of vesicoureteral reflux or an indwelling urinary stent
Participation in any other research protocol involving administration of an investigational agent within 1 month prior to study entry
History of radiation to the pelvis
History of interstitial lung disease and/or pneumonitis
Evidence of metastatic disease