Clinical trial NCT06995677: Efficacy and Safety of TYRA-300 in Participants With FGFR3 Altered Low Grade, Intermediate Risk Non-Muscle Invasive Bladder Cancer
Official title: A Phase 2 Multicenter, Open-Label Study Evaluating the Efficacy and Safety of TYRA-300 in Participants With FGFR3 Altered Low Grade, Intermediate Risk Non-Muscle Invasive Bladder Cancer (SURF302)
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
Conditions: Low-grade NMIBC
FGFR Gene Amplification
FGFR Gene Alterations
FGFR3 Gene Alteration
FGFR3 Gene Mutation
FGFR3 Gene Fusions
Keywords: FGFR3 gene alterations
FGFR3 gene mutations
FGFR3 gene fusions
FGFR3
Non-Muscle Invasive Bladder Cancer
Lead sponsor: Tyra Biosciences, Inc
Sponsor class: INDUSTRY
First posted: 2025-05-29
Enrollment: 90
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Cohort A will test a TYRA-300 dose of 60mg QD. In addition, Dose Cohort B will test, in parallel, a slightly reduced dose of TYRA-300 50 mg QD. Dose Cohort C of TYRA-300 will only open if another dose needs to be explored based on the safety and efficacy results from Cohorts A and B.
Primary purpose: TREATMENT

Brief summary: Phase 2 Study of TYRA-300 in FGFR3 Altered Low Grade, Intermediate Risk NMIBC

Detailed description: A Phase 2 Multicenter, Open-Label Study Evaluating the Efficacy and Safety of TYRA-300 in Participants with FGFR3 Altered Low Grade, Intermediate Risk Non-Muscle Invasive Bladder Cancer

Eligibility criteria: Inclusion Criteria:

* Participants age 18 and over of informed consent and willing and able to comply with all requires study procedures
* Able to understand and given written informed consent
* Participants with histologically confirmed low-grade NMIBC within 6 weeks prior to randomization with prior diagnostic biopsy/TURBT to confirm stage and grade and with at least 3 mm and no more than 12 mm total (1/2 a resectoscope loop to 2 loops, refer to Section 8.1.5) residual visible tumor as a marker lesion(s) left behind:

  1. Ta low grade
  2. T1 low grade
* Participants must have intermediate risk NMIBC, defined as having any of the following characteristics (AUA Guidelines, 2024)

  1. Recurrence within 1 year, LG Ta
  2. Solitary LG Ta \>3cm
  3. LG Ta, multifocal
  4. LG T1
* Documented activating FGFR3 mutation or fusion (Appendix 4)
* Have undergone bladder mapping and identification of visible marker lesion(s) within 6 weeks prior to randomization (refer to Inclusion Criterion #3)
* No evidence of urothelial carcinoma of the upper urinary tract (confirmed by imaging) or prostatic urethra within 6 months of randomization
* No prior BCG administration within 1 year of date of consent.
* No intravesical chemotherapy within 8 weeks prior to C1D1.
* ECOG 0-1
* Pathology consistent with pure urothelial carcinoma; if mixed histology, ensure that at least 80% of the sample is urothelial
* Adequate bone marrow, liver, and renal function:

  b. Bone marrow function: i. Absolute neutrophil count (ANC) \> or = 1,500/mm3 ii. Platelet count \> or = 75,000/mm3 iii. /hemoglobin \> or = 10.0 g/dL e. Liver function: i.Total bilirubin \< or = ULN ii. Alanine aminotransferase (ALT) \< or = ULN iii. Aspartate aminotransferase (AST) \< or = ULN f. Renal function: i. estimated glomerular filtration rate \>60 mL/min calculated using the modification of diet in renal disease equation or CKD-EPI formula ii. Serum Phosphate level \< or = ULN prior to starting treatment g. Coagulation i. International normalized ratio (INR) \< or = 1.5 x ULN
* Ability to swallow tablets
* Participants (male and female) of child-bearing potential (including females who are post-menopausal for less than 1 year) must be willing to practice effective contraception while on treatment and be willing and able to continue contraception for 3 months (males) and 6 months (females) after the last dose of study treatment. Potential male participants should consider the potential impact of TYRA-300 on their ability to father a child and discuss options with the site study staff.
* Potential participants who are positive for human immunodeficiency virus (HIV) must have a viral load below the limits of detection and on stable antiretroviral therapy for at least 3 months prior to C1D1. NOTE: some of the compounds in antiretroviral therapy may be on the prohibited medications list. Allowances will be made to ensure the participant's HIV treatment continues uninterrupted following a discussion with the Sponsor's medical monitor. A discussion of the impact of the antiretroviral therapy on TYRA- 300 needs to be discussed with the potential participant prior to C1D1.
* Potential participants with chronic hepatitis B virus (HBV) infection with active disease should be on a suppressive antiviral therapy prior to C1D1.
* Potential participants patients with a history of hepatitis C virus (HCV) infection should have completed curative antiviral treatment and must have a HCV viral load below the limit of quantification.
* Potential participants with a history of HCV infection and on current treatment must have a HCV viral load below the limit of quantification

Exclusion Criteria:

* Presence of tumor in ureter or prostatic urethra:
* Current or previous history of muscle invasive bladder cancer
* Current or previous history of lymph node positive and/or metastatic bladder cancer
* Evidence of pure squamous cell carcinoma, pure adenocarcinoma or pure undifferentiated carcinoma of the bladder
* Currently receiving systemic cancer therapy (cytotoxic, immunotherapy, targeted)
* Currently receiving treatment with a prohibited therapy (refer to Section 6.7.1)
* Current or prior history of pelvic external beam radiotherapy
* Current or history of receiving a prior FGFR inhibitor
* Systemic immunotherapy within 6 months prior to randomization
* Treatment with an investigational agent within 30 days or 5 half-lives from randomization, whichever is shorter; compounds with an unknown half-life will default to the 30 days.
* Prior treatment with an intravesical agent within 8 weeks prior to C1D1
* Current ongoing toxicity from previous therapy
* Had major surgery within 4 weeks prior to C1D1
* Any reason that in the view of the investigator, would substantially impair the ability of the participant to comply with study procedures and/or risk to the participant (i.e., uncontrolled diabetes)
* Females who are pregnant, breastfeeding or planning to become pregnant within 6 months after the last dose of TYRA-300 and males who plan to father a child while enrolled in this study or within 3 months after the last dose of TYRA-300
* Has impaired wound healing capacity
* Serum phosphate levels above the upper limit of normal during screening
* Any ocular condition likely to increase the risk of eye toxicity
* Current evidence of central serous retinopathy or retinal pigmented epithelial detachment of any grade at time of baseline examination.
* History of or current uncontrolled cardiovascular disease
* Gastrointestinal disorders that will affect oral administration or absorption of TYRA-300
* Known history of HIV infection, or active hepatitis B or C
* History of a second primary malignancy within 3 years of signing ICF, except for nonmelanoma skin cancer and cured and active surveillance malignancies (i.e., prostate, breast) .
* Known allergy to TYRA-300 or any excipients of the formulated product
* Participants taking strong inhibitors and/or inducers of CYP3A4 enzyme
* History of prolonged QT syndrome or baseline heart rate-corrected QT interval using Fridericia formula (QTcF) interval \>470 ms

Primary outcomes:
measure: To assess the efficacy of TYRA-300 in LG IR-NMIBC participants
timeFrame: at 3 months
Secondary outcomes:
measure: Duration of response (responders only)
timeFrame: time from initial response to confirmed recurrence of disease or death, up to 24 months
measure: Time to recurrence (responders only)
timeFrame: time from start of response to confirmed recurrence of disease, up to 24 months
measure: Recurrence-free survival rate (responders only)
timeFrame: at 12 months and 24 months
measure: Progression-free survival (all participants)
timeFrame: time from randomization to the progression of disease or death from any cause, whichever occurs first, up to 24 months
measure: Incidence and severity of adverse events
timeFrame: Up to 2 years
measure: To assess the safety and tolerability of TYRA-300 in LG IR-NMIBC participants
timeFrame: From initiation of treatment to 2 years
Other outcomes:
Locations:
city: Nashville
country: United States
facility: Urology Associates PC
state: Tennessee
Study officials:
affiliation: Tyra Biosciences, Inc
name: Doug Warner, MD
role: STUDY_CHAIR
References: