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The purpose of this study is to explore a treatment that potentially enhances the delivery of chemotherapy to tumors in participants with superficial bladder cancer. The investigational medication to be studied is an enzyme called ChemophaseTM (recombinant human hyaluronidase, rHuPH20). Chemophase is being specifically developed for use with other anticancer drug to increase the local penetration of the anticancer drug for the treatment of superficial bladder cancer. In this study, Chemophase will be given in combination with mitomycin C directly into the bladder. Mitomycin C is an anti-tumor drug that is commonly used to treat superficial bladder cancer. It is envisioned that Chemophase with mitomycin C may potentially increase the local penetration of mitomycin C into remaining cancer cells following surgery to treat superficial bladder cancer.
The primary objectives of this study are to:
The secondary objectives of this study are to:
Study participants will receive six weekly study treatments administered intravesically (at Weeks 1 through 6) followed by post-treatment evaluations, at Weeks 8 and 12. The 12 participants treated at MTD will continue to receive combination therapy every three months until the end of Year 2 or until the time of documented tumor recurrence, whichever occurs first. For other participants, long-term follow-up after Week 12 will consist of disease monitoring of participants by telephone and will be performed every three months beginning three months after last study treatment for two years and then every six months thereafter, until bladder tumor recurrence.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cohort 1: MMC plus Chemophase 20,000 U | Experimental | Participants will receive 40 milligrams (mg) MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 20,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
|
| Cohort 2: MMC plus Chemophase 60,000 U | Experimental | Participants will receive 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 60,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
|
| Cohort 3: MMC plus Chemophase 200,000 U | Experimental | Participants will receive 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 200,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
|
| Cohort 4: MMC plus Chemophase 400,000 U | Experimental | Participants will receive 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 400,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
|
| Cohort 5: MMC plus Chemophase 800,000 U |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mitomycin C | Drug | intravesical administration |
|
| Measure | Description | Time Frame |
|---|---|---|
| Maximum Tolerated Dose (MTD) of Chemophase in Combination With MMC | The MTD was defined as the maximum dose level at which no more than two of six participants experienced dose-limiting toxicities (DLT). DLT was defined as any of the following:
| 5 weeks (Week 2 to Week 6) |
| Number of Participants With Dose Limiting Toxicities (DLTs) | DLT was defined as any of the following:
| 5 weeks (Week 2 to Week 6) |
| Recommended Dose of Chemophase With MMC For Future Studies | 5 weeks (Week 2 to Week 6) |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With a Quantifiable MMC Plasma Concentration Value | A quantifiable MMC plasma concentration value was a value that was not below the quantifiable limit (BQL) of <10.0 nanogram/milliliter (ng/mL). | 0 (predose), 1, 2, and 3 hours postdose at Weeks 1, 2, 5, and 6 |
| Number of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| BCG Oncology | Phoenix | Arizona | 85032 | United States | ||
| MedResearch |
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| Label | URL |
|---|---|
| Sponsor's website | View source |
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| ID | Title | Description |
|---|---|---|
| FG000 | Cohort 1: MMC Plus Chemophase 20,000 U | Participants received 40 milligrams (mg) mitomycin C (MMC) intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 20,000 Units (U) Chemophase intravesically once weekly from Weeks 2 through 6. |
| FG001 | Cohort 2: MMC Plus Chemophase 60,000 U |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Feb 26, 2009 | Sep 27, 2021 |
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Participants will receive 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 800,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
|
| Chemophase | Drug | intravesical administration |
|
TEAEs were defined as any AE that occurred after the first administration of the study drug and until the end of the study. AEs were defined as any untoward medical occurrence in a participant administered study drug and that did not necessarily have a causal relationship with the study drug. SAEs were defined as any AE that, in the view of either the Investigator or Sponsor, resulted in any of the following outcomes as fatal, life-threatening, required in-participant hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, a congenital anomaly/birth defect, an important medical event. A summary of all SAEs and Other AEs (nonserious) regardless of causality is located in 'Reported Adverse Events' Section. |
| Baseline up to 2 years |
| Number of Participants Who Remained Tumor Free at the End of the Study | Baseline up to 2 years |
| La Mesa |
| California |
| 91942 |
| United States |
| Malcolm Randall Veterans Administration Urology Section (112-C) | Gainesville | Florida | 32608 | United States |
| Advanced Research Institute | New Port Richey | Florida | 34652 | United States |
| James A. Haley Veterans Hospital | Tampa | Florida | 33612 | United States |
Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 60,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| FG002 | Cohort 3: MMC Plus Chemophase 200,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 200,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| FG003 | Cohort 4: MMC Plus Chemophase 400,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 400,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| FG004 | Cohort 5: MMC Plus Chemophase 800,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 800,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| Received at Least 1 Dose of Study Drug |
|
| COMPLETED |
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| NOT COMPLETED |
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|
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| ID | Title | Description |
|---|---|---|
| BG000 | Cohort 1: MMC Plus Chemophase 20,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 20,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| BG001 | Cohort 2: MMC Plus Chemophase 60,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 60,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| BG002 | Cohort 3: MMC Plus Chemophase 200,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 200,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| BG003 | Cohort 4: MMC Plus Chemophase 400,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 400,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| BG004 | Cohort 5: MMC Plus Chemophase 800,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 800,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| BG005 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Maximum Tolerated Dose (MTD) of Chemophase in Combination With MMC | The MTD was defined as the maximum dose level at which no more than two of six participants experienced dose-limiting toxicities (DLT). DLT was defined as any of the following:
| The Intent-To-Treat (ITT) Set included all participants who received one or more doses of Chemophase with MMC. | Posted | Number | Units | 5 weeks (Week 2 to Week 6) |
|
|
| ||||||||||||||||||||||||||
| Primary | Number of Participants With Dose Limiting Toxicities (DLTs) | DLT was defined as any of the following:
| ITT Set included all participants who received one or more doses of Chemophase with MMC. | Posted | Count of Participants | Participants | 5 weeks (Week 2 to Week 6) |
| ||||||||||||||||||||||||||||
| Primary | Recommended Dose of Chemophase With MMC For Future Studies | ITT Set included all participants who received one or more doses of Chemophase with MMC. | Posted | Number | Units | 5 weeks (Week 2 to Week 6) |
|
| ||||||||||||||||||||||||||||
| Secondary | Number of Participants With a Quantifiable MMC Plasma Concentration Value | A quantifiable MMC plasma concentration value was a value that was not below the quantifiable limit (BQL) of <10.0 nanogram/milliliter (ng/mL). | ITT Set included all participants who received one or more doses of Chemophase with MMC. | Posted | Count of Participants | Participants | 0 (predose), 1, 2, and 3 hours postdose at Weeks 1, 2, 5, and 6 |
| ||||||||||||||||||||||||||||
| Secondary | Number of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | TEAEs were defined as any AE that occurred after the first administration of the study drug and until the end of the study. AEs were defined as any untoward medical occurrence in a participant administered study drug and that did not necessarily have a causal relationship with the study drug. SAEs were defined as any AE that, in the view of either the Investigator or Sponsor, resulted in any of the following outcomes as fatal, life-threatening, required in-participant hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, a congenital anomaly/birth defect, an important medical event. A summary of all SAEs and Other AEs (nonserious) regardless of causality is located in 'Reported Adverse Events' Section. | The Safety Set included all participants who received one or more doses of Chemophase. | Posted | Count of Participants | Participants | Baseline up to 2 years |
| ||||||||||||||||||||||||||||
| Secondary | Number of Participants Who Remained Tumor Free at the End of the Study | ITT Set included all participants who received one or more doses of Chemophase with MMC. | Posted | Count of Participants | Participants | Baseline up to 2 years |
|
Baseline up to 2 years
The Safety Set included all participants who received one or more doses of Chemophase.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Cohort 1: MMC Plus Chemophase 20,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 20,000 U Chemophase intravesically once weekly from Weeks 2 through 6. | 1 | 3 | 0 | 3 | ||
| EG001 | Cohort 2: MMC Plus Chemophase 60,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 60,000 U Chemophase intravesically once weekly from Weeks 2 through 6. | 0 | 3 | 1 | 3 | ||
| EG002 | Cohort 3: MMC Plus Chemophase 200,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 200,000 U Chemophase intravesically once weekly from Weeks 2 through 6. | 2 | 6 | 4 | 6 | ||
| EG003 | Cohort 4: MMC Plus Chemophase 400,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 400,000 U Chemophase intravesically once weekly from Weeks 2 through 6. | 0 | 3 | 2 | 3 | ||
| EG004 | Cohort 5: MMC Plus Chemophase 800,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 800,000 U Chemophase intravesically once weekly from Weeks 2 through 6. | 2 | 12 | 10 | 12 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Pneumonia | Infections and infestations | MedDRA v8.0 | Systematic Assessment |
| |
| Metastases to bone | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA v8.0 | Systematic Assessment |
| |
| Neoplasm | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA v8.0 | Systematic Assessment |
| |
| Small cell lung cancer stage unspecified | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA v8.0 | Systematic Assessment |
| |
| Syncope | Nervous system disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Acute myocardial infarction | Cardiac disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Angina unstable | Cardiac disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Gastrointestinal haemorrhage | Gastrointestinal disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Chest pain | General disorders | MedDRA v8.0 | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Urinary tract infection | Infections and infestations | MedDRA v8.0 | Systematic Assessment |
| |
| Asymptomatic bacteriuria | Infections and infestations | MedDRA v8.0 | Systematic Assessment |
| |
| Cellulitis | Infections and infestations | MedDRA v8.0 | Systematic Assessment |
| |
| Folliculitis | Infections and infestations | MedDRA v8.0 | Systematic Assessment |
| |
| Helicobacter infection | Infections and infestations | MedDRA v8.0 | Systematic Assessment |
| |
| Influenza | Infections and infestations | MedDRA v8.0 | Systematic Assessment |
| |
| Nasopharyngitis | Infections and infestations | MedDRA v8.0 | Systematic Assessment |
| |
| Onychomycosis | Infections and infestations | MedDRA v8.0 | Systematic Assessment |
| |
| Basal cell carcinoma | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA v8.0 | Systematic Assessment |
| |
| Iron deficiency anaemia | Blood and lymphatic system disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Cerebral ischaemia | Nervous system disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Headache | Nervous system disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Diabetic retinopathy | Eye disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Dry eye | Eye disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Eye pain | Eye disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Acute myocardial infarction | Cardiac disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Cardiac failure congestive | Cardiac disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Coronary artery disease | Cardiac disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Dyspnoea | Respiratory, thoracic and mediastinal disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Cough | Respiratory, thoracic and mediastinal disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Nasal congestion | Respiratory, thoracic and mediastinal disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Abdominal pain | Gastrointestinal disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Diarrhoea | Gastrointestinal disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Diverticulum | Gastrointestinal disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Arthralgia | Musculoskeletal and connective tissue disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Plantar fasciitis | Musculoskeletal and connective tissue disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Dysuria | Renal and urinary disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Pollakiuria | Renal and urinary disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Bladder spasm | Renal and urinary disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Calculus urethral | Renal and urinary disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Haematuria | Renal and urinary disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Micturition urgency | Renal and urinary disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Nocturia | Renal and urinary disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Urethral disorder | Renal and urinary disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Urtheral haemorrhage | Renal and urinary disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Genital rash | Reproductive system and breast disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Balanitis | Reproductive system and breast disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Prostatitis | Reproductive system and breast disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Chest pain | General disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Malaise | General disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Suprapubic pain | General disorders | MedDRA v8.0 | Systematic Assessment |
| |
| Blood creatine phosphokinase increased | Investigations | MedDRA v8.0 | Systematic Assessment |
| |
| Red blood cells urine positive | Investigations | MedDRA v8.0 | Systematic Assessment |
| |
| White blood cells urine positive | Investigations | MedDRA v8.0 | Systematic Assessment |
| |
| Alanine aminotransferase increased | Investigations | MedDRA v8.0 | Systematic Assessment |
| |
| Aspartate aminotransferase increased | Investigations | MedDRA v8.0 | Systematic Assessment |
| |
| Blood urine present | Investigations | MedDRA v8.0 | Systematic Assessment |
| |
| False positive laboratory result | Investigations | MedDRA v8.0 | Systematic Assessment |
| |
| Haemoglobin decreased | Investigations | MedDRA v8.0 | Systematic Assessment |
| |
| Liver function test abnormal | Investigations | MedDRA v8.0 | Systematic Assessment |
| |
| White blood cells urine | Investigations | MedDRA v8.0 | Systematic Assessment |
|
The PI must submit a copy of the proposed publication to the Sponsor 40 days prior to date of submission for publication. They can request a delay of up to 45 days if it is determined there is any patentable subject matter or confidential Information. Sponsor can make changes to the communication to remove sponsor's confidential information from it prior to publication.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Chief Medical Officer | Halozyme Therapeutics | 855-495-3639 | halozyme@EVERSANA.com |
| Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Jan 11, 2008 | Sep 27, 2021 | SAP_001.pdf |
| ID | Term |
|---|---|
| D001749 | Urinary Bladder Neoplasms |
| D000093284 | Non-Muscle Invasive Bladder Neoplasms |
| ID | Term |
|---|---|
| D014571 | Urologic Neoplasms |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D001745 | Urinary Bladder Diseases |
| D014570 | Urologic Diseases |
| D052801 | Male Urogenital Diseases |
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
Not provided
Not provided
| ID | Term |
|---|---|
| D016685 | Mitomycin |
| ID | Term |
|---|---|
| D008937 | Mitomycins |
| D045563 | Indolequinones |
| D011809 | Quinones |
| D009930 | Organic Chemicals |
| D001389 | Azirines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D007211 | Indoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
Not provided
Not provided
| Male |
|
| OG003 |
| Cohort 4: MMC Plus Chemophase 400,000 U |
Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 400,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| OG004 | Cohort 5: MMC Plus Chemophase 800,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 800,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
|
|
| Title | Denominators | Categories |
|---|
|
| OG003 |
| Cohort 4: MMC Plus Chemophase 400,000 U |
Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 400,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| OG004 | Cohort 5: MMC Plus Chemophase 800,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 800,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
|
|
| OG002 | Cohort 3: MMC Plus Chemophase 200,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 200,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| OG003 | Cohort 4: MMC Plus Chemophase 400,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 400,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
| OG004 | Cohort 5: MMC Plus Chemophase 800,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 800,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
|
|
| OG004 | Cohort 5: MMC Plus Chemophase 800,000 U | Participants received 40 mg MMC intravesically on Day 1 of Week 1 followed by a combination of 40 mg MMC and 800,000 U Chemophase intravesically once weekly from Weeks 2 through 6. |
|
|