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RecruitingNCT07804056Updated Sep 21, 2026

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

A Phase 3 interventional study of Alpha1H and Transurethral Resection of Bladder Tumor (TURBT) in Urinary Bladder Neoplasms and Non-muscle Invasive Bladder Cancer (NMIBC), sponsored by Hamlet Pharma AB. Recruiting at 1 site in Czechia. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-21.

Primary conditionNon-Muscle Invasive Bladder NeoplasmsRegistry: Urinary Bladder NeoplasmsReclassifiedWhy we changed it
Registry
Urinary Bladder Neoplasms — the first condition term the registry derived for this study.
ClinicalTrials.gg
Non-Muscle Invasive Bladder Neoplasms
Why
  1. The study's listed conditions name Non-Muscle Invasive Bladder Neoplasms, a narrower term within Urinary Bladder Neoplasms.
Confidence
High: the new condition is named in the study's own listed conditions. Of 351 hand-checked studies reclassified this way, 68% were exactly right and 84% in the right disease family; the registry's first term was right for 5% (measured 2026-10-21). How we classify →
Wrong?
Tell us the study's main condition →

Sponsored by Hamlet Pharma AB · Phase 3, Interventional, and Treatment

From the registry’s dates

  • Started Sep 2026; still recruiting 1 month later.

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Phase
Phase 3
Study type
Interventional
Enrollment
194
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

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.
02

Conditions studied

  • Urinary Bladder Neoplasms
  • Non-muscle Invasive Bladder Cancer (NMIBC)

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Keywords

  • Non-Muscle Invasive Bladder Cancer
  • Papillary Bladder Carcinoma
  • Low-Grade Bladder Cancer
  • Low-Risk Bladder Cancer
  • Intermediate-Risk Bladder Cancer
  • Alpha1H
  • Neoadjuvant Therapy
  • Intravesical Instillation
03

In context

Non-Muscle Invasive Bladder Neoplasms Reclassified

294 studies on the registry are indexed under Non-Muscle Invasive Bladder Neoplasms; 126 are open to participants now.

This study's planned enrollment of 194 is above the median of 62 across 231 interventional studies indexed under Non-Muscle Invasive Bladder Neoplasms.

Browse Non-Muscle Invasive Bladder Neoplasms studies →

Lead sponsor

Hamlet Pharma AB is the lead sponsor of 2 studies on the registry; 1 is open to participants now.

Compared within Non-Muscle Invasive Bladder Neoplasms, this study's primary condition as ClinicalTrials.gg classifies it; the registry's first condition term is Urinary Bladder Neoplasms. The counts are of registry records indexed under each term, refreshed daily. How we classify →

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Signed and dated .
  • 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 .
  • Women of childbearing potential must agree to use highly effective 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

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.
  • of 3 or 4.
  • Any other agent or non-marketed product within one month prior to Visit 1 and during the trial.
  • Known active infection, defined as detectable HIV viral load at screening.
  • Active virus (HBV) infection, defined as hepatitis B surface antigen (HBsAg) positivity with detectable HBV DNA at screening.
  • Active 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.
Terms in these criteria, in plain language(8)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
194 participants (estimated)

Study arms

  • Experimental
    Alpha1H

    Participants receive 6 intravesical instillations of Alpha1H over approximately 1 month prior to transurethral resection of bladder tumor (TURBT).

    Drug: Alpha1H · Procedure: Transurethral Resection of Bladder Tumor (TURBT) · Drug: Intravesical Chemotherapy

  • Active comparator
    Standard of Care

    Participants receive standard of care consisting of transurethral resection of bladder tumor (TURBT) followed by a single early intravesical instillation of standard chemotherapy.

    Procedure: Transurethral Resection of Bladder Tumor (TURBT) · Drug: Intravesical Chemotherapy

Interventions

  • DrugAlpha1H

    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.

  • ProcedureTransurethral Resection of Bladder Tumor (TURBT)

    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.

  • DrugIntravesical Chemotherapy

    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.

06

What researchers measure

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)

    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.

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

  4. Tumor Gene Expression

    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.

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

  5. Urinary Biomarkers and Immune Response

    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.

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

  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

    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.

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

07

Study locations

1 of 1 sites recruiting
08

References and documents

Individual participant data

Plan to share: Undecided

No publications or documents are linked to this record.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Started Sep 2026 (actual). Primary completion is estimated for Jul 2029, 34 months after the start.

How these figures are worked out, and which studies are left out of them.

Registered
Aug 26, 2026
First posted
Sep 4, 2026
StartActual
Sep 17, 2026
Primary completionEst.
Jul 2029
CompletionEst.
Jul 2029
Last update
Sep 21, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Sep 21, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT07804056
Lead sponsor
Hamlet Pharma AB
Responsible party
Sponsor
First posted
Sep 4, 2026
Start date
Sep 17, 2026
Primary completion
Jul 2029 (estimated)
Completion
Jul 2029 (estimated)
Last update
Sep 21, 2026

Study contacts

Catharina Svanborg, MD, PhD.
Contact
catharina.svanborg@med.lu.se
+46709426549
Petr Bouska
Contact
pe.bouska@gmail.com
+420773076076

Oversight

FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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