Description:
The purpose of this study is to see if LOAd703 (an oncolytic adenovirus) can be safely given
to patients with pancreatic cancer. The study will also evaluate whether or not intratumoral
injection of LOAd703 will support current standard of care treatment to reduce the size of
the tumor and improve survival of the patients.
Adenoviruses are known as the "common cold" virus and most individuals have had multiple
infections during their lifetime. Oncolytic adenoviruses are adenoviruses that are modified
so they cannot multiply and spread (known as replicating) properly in normal (e.g. healthy)
cells, but instead, they infect and replicate very well in cancer cells. This strong
replication leads to the death of the cancer cell. Oncolytic viruses have been evaluated in
multiple clinical trials for cancer treatment during the past decade and been proven safe. It
is common to have a fever the first day or two after virus injection since the immune system
will react to the virus infection. The immune system can also kill cancer cells but to do so
it needs to be properly stimulated. Oncolytic viruses alone do not seem to be strong enough
to activate clinically relevant anti-cancer responses. However, it is thought that if
additional immune system stimulators are added to the oncolytic viruses they may be able to
result in clinical relevant antic-cancer responses.
LOAd703 is an oncolytic adenovirus that has been modified to include additional immune system
stimulators. Specifically, genes that stimulate the immune system have been added to the
oncolytic adenovirus. Once the oncolytic adenovirus infects the cancer cells, the genes will
be expressed, resulting in activation of the immune response so it can attack and kill cancer
cells.
In this study, LOAd703 will be given by intratumoral injections. It will be given in addition
to standard of care treatment with gemcitabine and nab-paclitaxel +/- the anti-PD-L1 antibody
atezolizumab. Because this is an experimental therapy, there will be extra visits for disease
monitoring and samples accordingly to the detailed information below. The LOAd703 is an
investigational agent not approved by the FDA.
Title
- Brief Title: LOAd703 Oncolytic Virus Therapy for Pancreatic Cancer
- Official Title: Phase I/IIa Trial Evaluating Safety of LOAd703, an Armed Oncolytic Adenovirus for Pancreatic Cancer
Clinical Trial IDs
- ORG STUDY ID:
LOKON001
- NCT ID:
NCT02705196
Conditions
Interventions
Drug | Synonyms | Arms |
---|
gemcitabine | Gemzar | Arm 1 Intratumoral LOAd703 |
nab-paclitaxel | Abraxane | Arm 1 Intratumoral LOAd703 |
atezolizumab | Tecentriq | Arm 2: Intratumoral LOAd703 + atezolizumab |
Purpose
The purpose of this study is to see if LOAd703 (an oncolytic adenovirus) can be safely given
to patients with pancreatic cancer. The study will also evaluate whether or not intratumoral
injection of LOAd703 will support current standard of care treatment to reduce the size of
the tumor and improve survival of the patients.
Adenoviruses are known as the "common cold" virus and most individuals have had multiple
infections during their lifetime. Oncolytic adenoviruses are adenoviruses that are modified
so they cannot multiply and spread (known as replicating) properly in normal (e.g. healthy)
cells, but instead, they infect and replicate very well in cancer cells. This strong
replication leads to the death of the cancer cell. Oncolytic viruses have been evaluated in
multiple clinical trials for cancer treatment during the past decade and been proven safe. It
is common to have a fever the first day or two after virus injection since the immune system
will react to the virus infection. The immune system can also kill cancer cells but to do so
it needs to be properly stimulated. Oncolytic viruses alone do not seem to be strong enough
to activate clinically relevant anti-cancer responses. However, it is thought that if
additional immune system stimulators are added to the oncolytic viruses they may be able to
result in clinical relevant antic-cancer responses.
LOAd703 is an oncolytic adenovirus that has been modified to include additional immune system
stimulators. Specifically, genes that stimulate the immune system have been added to the
oncolytic adenovirus. Once the oncolytic adenovirus infects the cancer cells, the genes will
be expressed, resulting in activation of the immune response so it can attack and kill cancer
cells.
In this study, LOAd703 will be given by intratumoral injections. It will be given in addition
to standard of care treatment with gemcitabine and nab-paclitaxel +/- the anti-PD-L1 antibody
atezolizumab. Because this is an experimental therapy, there will be extra visits for disease
monitoring and samples accordingly to the detailed information below. The LOAd703 is an
investigational agent not approved by the FDA.
Detailed Description
The research will be conducted at Baylor College of Medicine (BCM) and Baylor St. Luke's
Medical Center (BSLMC).
All patients will receive standard of care treatment for their pancreatic cancer. Standard of
care treatment will be gemcitabine in combination with nab-paclitaxel given on days 1, 8, and
15 of a 28 day cycle.
Arm 1: LOAd703 treatment will be initiated at day 15 of the first cycle and given every other
week for 6 doses. Depending on the location of the tumor the injection of LOAd703 can be
given in different ways. The most common route of injection is ultrasound-guided percutaneous
injection, but endoscopic ultrasound-guidance will be used for some patients as appropriate.
All patients will receive anti-anxiety drugs or sedation as needed for comfort during the
procedure. This study evaluates different doses of LOAd703. All patients will receive six
injections of LOAd703. If patients in either phase of the study are judged by the
investigator to be deriving clinical benefit from LOAd703 once all scheduled injections have
been administered, they will be eligible to receive up to 6 additional biweekly doses of
LOAd703.
Arm 2: the same procedures as arm 1 in regard to LOAd703. In addition, the arm 2 patients
will receive atezolizumab at a fixed dose, every chemotherapy cycle day 1. The treatments can
continue until the final follow-up visit.
Follow-up visits: Besides visits to receive treatments, patients will continue to visit
BCM/BSLMC or their local doctor for evaluation of health status and side effects. At some
visits blood samples will be obtained. Some of the blood samples being obtained are
considered standard of care to ensure patient safety for standard of care treatment and the
LOAd703 injection. However, some blood and biopsy samples (in applicable patients) will be
collected to be analyzed for the presence of LOAd703, atezolizumab tumor markers and
immunology markers. The extra blood will be 5-15 ml (3 teaspoonfuls) of blood collected at
the screening visit and at eight different time points both during treatment and after
treatments are completed. Imaging of the tumor to determine tumor size will be done every two
to three months, which is routine for the monitoring of patients with pancreatic cancer.
Patients will actively participate in the study for about 9 months when the final follow-up
visit will be scheduled (or 12 months if additional doses of LOAD703 are given). After their
active participation is completed patients will continue to receive routine care and will be
contacted by the study team every 3 months to provide follow up on the status of their
disease.
Trial Arms
Name | Type | Description | Interventions |
---|
Arm 1 Intratumoral LOAd703 | Experimental | Patients will receive gemcitabine intravenously at a dose of 1000mg/m2 + nab-paclitaxel 125 mg/m2 as per hospital standards. One cycle will be one dose of gemcitabine +nab-paclitaxel given on days 1, 8, and 15 of a 28 day cycle. LOAd703 will be given every other week for 6 doses starting on day 15 of the first cycle of chemotherapy. There is an option for an additional 6 doses if patients benefit from treatment.
The following LOAd703 doses will be evaluated:
Dose level 1: 5 X 10^10 viral particles per treatment Dose level 2: 1 X 10^11 viral particles per treatment Dose level 3: 5 X 10^11 viral particles per treatment | - gemcitabine
- nab-paclitaxel
|
Arm 2: Intratumoral LOAd703 + atezolizumab | Experimental | Patients will receive gemcitabine intravenously at a dose of 1000mg/m2 + nab-paclitaxel 125 mg/m2 as per hospital standards. One cycle will be one dose of gemcitabine +nab-paclitaxel given on days 1, 8, and 15 of a 28 day cycle. LOAd703 will be given every other week for 6 doses starting on day 15 of the first cycle of chemotherapy. There is an option for an additional 6 doses if patients benefit from treatment. A fixed dose of atezolizumab 1680 mg will be given every 4 weeks on day 1 of each chemotherapy cycle.
Patients will be assigned to the following LOAd703 doses:
Dose level 1: 1 X 10^11 viral particles per treatment Dose level 2: 5 X 10^11 viral particles per treatment | - gemcitabine
- nab-paclitaxel
- atezolizumab
|
Eligibility Criteria
Inclusion Criteria:
1. Diagnosis of ductal adenocarcinoma of the pancreas (PDAC).
2. Low tumor burden with at least one lesion that is suitable for image-guided
intratumoral injection and needle biopsy.
3. The patient is not eligible for a complete surgical resection of their disease as
evaluated by a radiologist and/or surgeon.
4. Patients who may receive the injections endoscopically should be eligible for
sedation.
5. The patient must be eligible for standard of care treatment with gemcitabine
+nab-paclitaxel.
6. Age ≥ 18 yrs of age
7. Females of childbearing potential must have a negative pregnancy test and agree to use
contraception during on-study protocol treatment.
8. Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2.
9. Absolute neutrophil count (ANC) ≥1.0 x 10^9/l, hemoglobin ≥9 g/dl, platelet count ≥
100 x 10^9/l, prothrombin (INR) <1.5.
10. Adequate hepatic function, with bilirubin < 1.5 x the ULN, and AST and ALT < 2.5 x ULN
11. Adequate renal function with serum creatinine <2 x the ULN or creatinine clearance >30
mL/min
12. The patient must provide informed consent.
Exclusion Criteria:
1. Any concurrent treatment that would compromise the study including but not limited to
continuous high dose corticosteroids (>10 mg/day of prednisone equivalence),
lymphodepleting antibodies or cytotoxic agents.
2. Treatment with high dose immune inhibitors including lymphotoxic monoclonal antibodies
such as alemtuzumab (Campath), or rapamycin/rapalogs or cytotoxic agents within 21
days of registration
3. Treatment with biologic therapy within 21 days of registration.
4. Use of any investigational agents within 21 days of registration.
5. The use of systemic immunostimulatory agents (including, but not limited to,
interferons and IL-2) are prohibited within 4 weeks or 5 half-lives of the drug
(whichever is longer) prior to initiation of study treatment and during study
treatment because these agents could potentially increase the risk for autoimmune
conditions when given in combination with atezolizumab
6. Pregnant or breastfeeding females.
7. Known active hepatitis B or C infection, HIV infection or tuberculosis.
8. Patients with active autoimmune disease or immune deficiency or previous
Guillain-Barre syndrome. Patients with eczema, psoriasis, lichen simplex chronicus or
vitiligo with dermatologic manifestations only (e.g. patients with psoriatic arthritis
are excluded) are eligible for the study provide all of the following conditions are
met:
- Rash must cover <10% of body surface area
- Disease is well controlled at baseline and requires only low-potency topical
corticosteroids
- No occurrence of acute exacerbations of the underlying condition requiring
psoralen plus ultraviolet A radiation, methotrexate, retinoids, biologic agents,
oral calcineurin inhibitors or high-potency or oral corticosteroids within the
previous 12 months
9. Uncontrolled intercurrent illness including but not limited to psychiatric
illness/social situations that in the opinion of the Investigator would compromise
compliance of study requirements or put the patient at unacceptable risk.
10. Other malignancies within the past 2 years (not including basal cell carcinoma of the
skin, prostate cancer or in situ cervix carcinoma).
11. Moderate to large volume ascites.
12. History of leptomeningeal disease.
13. Uncontrolled pleural effusion, pericardial effusion or ascites requiring recurrent
drainage procedures (once monthly or more frequently)
14. History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g. bronchiolitis
obliterans), drug-induced pneumonitis, or idiopathic pneumonitis or evidence of active
pneumonitis on screening chest computed tomography (CT) scan. However, history of
radiation pneumonitis in the radiation field (fibrosis) is permitted.
15. Unstable angina, uncontrolled cardiac arrhythmia, recent (within 3 months) history of
myocardial infarction or stroke or New York Class III/IV congestive heart failure
16. Major surgical procedure, other than for diagnosis, within 4 weeks prior to initiation
of study treatment or anticipation of need for a major surgical procedure during the
study.
17. Prior allogeneic stem cell or solid organ transplantation.
18. History of severe allergic anaphylactic reactions to chimeric human or humanized
antibodies or fusion proteins.
19. Known hypersensitivity to CHO cell products or any component of the atezolizumab
formulation.
20. Live attenuated vaccines (e.g. FluMist) are prohibited within 4 weeks prior to
initiation of study treatment, during atezolizumab treatment, and for 5 months after
the final dose of atezolizumab.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Number of patient with dose-limiting toxicities (DLTs) as evaluated accordingly to CTCAE 4.0 |
Time Frame: | 9 months |
Safety Issue: | |
Description: | Maximum tolerated dose of multiple (6x) image-guided intratumoral injections of LOAd703 at three dose levels in combination with standard of care therapy |
Secondary Outcome Measures
Measure: | Overall Response Rate |
Time Frame: | 9 months |
Safety Issue: | |
Description: | To determine the percentage of subjects achieving a partial response or better (according to RECIST 1.1) to repeat doses of LOAd703 (at the highest dose as determined in Phase I) combined with standard of care treatment with and without atezolizumab in pancreatic cancer. |
Measure: | Overall Survival |
Time Frame: | 6 months post last patient, last visit |
Safety Issue: | |
Description: | To determine the survival days post study initiation |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Lokon Pharma AB |
Trial Keywords
- oncolytic
- adenovirus
- pancreatic
- cancer
- LOKON
- LOAd703
Last Updated
March 24, 2021