Description:
This study is a clinical trial to assess the efficacy and confirm the safety of intratumoral
inoculation of G207 (an experimental virus therapy) combined with a single 5 Gy dose of
radiation in recurrent/progressive pediatric high-grade gliomas
Title
- Brief Title: HSV G207 With a Single Radiation Dose in Children With Recurrent High-Grade Glioma
- Official Title: Phase II Clinical Trial of HSV G207 With a Single 5 Gy Radiation Dose in Children With Recurrent High-Grade Glioma
Clinical Trial IDs
- ORG STUDY ID:
XUAB 2045
- NCT ID:
NCT04482933
Conditions
- Neoplasms
- High Grade Glioma
- Glioblastoma Multiforme
- Malignant Glioma of Brain
- Anaplastic Astrocytoma of Brain
- High-grade Glioma
- Anaplastic Glioma
- Giant Cell Glioblastoma
Interventions
Drug | Synonyms | Arms |
---|
Biological G207 | Experimental: HSV G207 | Experimental: HSV G207 |
Purpose
This study is a clinical trial to assess the efficacy and confirm the safety of intratumoral
inoculation of G207 (an experimental virus therapy) combined with a single 5 Gy dose of
radiation in recurrent/progressive pediatric high-grade gliomas
Detailed Description
Outcomes for children with recurrent or progressive high-grade glioma (brain tumor) are very
poor, and there are a lack of effective salvage therapies once a patient fails standard
treatments. Novel innovative treatments are greatly needed.
G207 is an oncolytic herpes simplex virus-1 (HSV) that has been successfully engineered to
introduce mutations in the virus that enable it to selectively replicate in and kill cancer
cells, but not normal cells. Replication of G207 in the tumor not only kills the infected
tumor cells, but causes the tumor cell to act as a factory to produce new virus. These virus
particles are released as the tumor cell dies, and can then proceed to infect other tumor
cells in the vicinity, and continue the process of tumor kill. In addition to this direct
oncolytic activity, the virus engenders an anti-tumor immune response; the virus is
immunogenic and produces a debris field which exposes cancer cell antigens to immune cells,
which can target other cancer cells. Thus, the oncolytic effect of the virus and the immune
response that the virus stimulates provide a dual attack against cancer cells. In preclinical
studies, a single 5 Gy dose of radiation within 24 hours of virus inoculation to the tumor
increased virus replication and tumor cell killing. Radiation may also enhance the immune
response against the tumor.
The University of Alabama at Birmingham has conducted three phase I trials of G207 injected
into the recurrent tumor alone or combined with a single dose of radiation in adults with
recurrent high-grade gliomas. In these trials, high doses (up to 3 x 10^9 plaque-forming
units) of virus were safely injected directly into the tumor or surrounding brain tissue
without serious toxicities. Radiographic and neuropathologic evidence of an antitumor
response was seen in some patients. Preclinical laboratory studies have demonstrated that a
variety of aggressive pediatric brain tumor types are sensitive to G207.
A Phase I study of intratumoral G207 alone or combined with a 5 Gy dose of radiation in
children ages 3-18 with biopsy-confirmed recurrent/progressive supratentorial brain tumors
recently completed the highest planned dose level (UAB1472; NCT02457845). The study used a 3
+ 3 design with 4 dose cohorts.12 Patients underwent stereotactic placement of up to 4
intratumoral catheters. The following day they received a single controlled-rate infusion of
G207 (1 x 10^7 or 1 x 10^8 pfu) over 6 hours. Cohorts 3 and 4 received a 5 Gy radiation
fraction to the gross tumor volume within 24 hours of G207. Twelve subjects with progressive
high-grade glioma received G207. Twenty adverse events, all grade 1, were attributed to G207.
G207 was determined to be safe and tolerable in children and a recommended Phase 2 was
established (1 x10^8 followed by 5 Gy radiation to the tumor).
This study is a phase II, open-label, single arm clinical trial of G207 alone or combined
with a single low dose of radiation in children with recurrent or progressive high grade
glioma. The primary objective is to assess the efficacy. The secondary objective is to
confirm the safety and tolerability of G207 and to survey for virologic shedding following
G207.
Subjects will receive G207 at 1 x 10^8 plaque-forming units (pfu), intratumorally via
controlled rate infusion through up to 4 silastic catheters over a 6 hour period. The subject
will then receive a single 5 Gy dose of radiation to the tumor within 24 hours of virus
inoculation.
Trial Arms
Name | Type | Description | Interventions |
---|
Experimental: HSV G207 | Experimental | All subjects will receive G207 at 1 x 10^8 plaque-forming units (pfu), intratumorally via controlled rate infusion through up to 4 silastic catheters over a 6 hour period. The subject will then receive a single 5 Gy dose of radiation to the tumor within 24 hours of virus inoculation. | |
Eligibility Criteria
Inclusion Criteria:
Patients meeting the following inclusion criteria will be eligible for the study:
- Age ≥ 3 years of age and ≤ 21 years of age at the time of study enrollment
- Patients must have a pathologically proven malignant high-grade glioma (including
glioblastoma multiforme, giant cell glioblastoma, anaplastic astrocytoma, midline
diffuse glioma) which is progressive or recurrent despite standard care including
surgery, radiotherapy, and/or chemotherapy
- Lesion must be ≥ 1.0 cm and ≤ 4.0 cm in longest dimension and surgically accessible as
determined by MRI. Larger tumors may be surgically debulked and treated if ≤ 4.0 cm
after debulking
- Multifocal disease on the unilateral side is eligible if at least one catheter can be
placed in all multifocal areas
- Performance score ≥ 60% (Karnofsky for children ≥16 years old; modified Lansky for
children < 16 years old)
- Patients with neurological deficits should have deficits that are stable for ≥ 1 week
prior to enrollment. A baseline detailed neurological exam should clearly document the
neurological status of the patient at the time of enrollment on the study
- Prior therapy: patients must have recovered from acute treatment related toxicities of
all prior surgery, chemotherapy, immunotherapy, radiotherapy, differentiation therapy,
biologic therapy, or virotherapy prior to entering this study
- Myelosuppressive chemotherapy: patients must have received their last dose at least 3
weeks prior and demonstrated count recovery as defined below
- Investigational/Biologic agents: patients must have recovered from any acute
toxicities potentially related to the agent and received the last dose ≥ 7 days prior
to entering this study (this period must be extended beyond the time during which
adverse events are known to occur for agents with known adverse events ≥ 7 days). For
viral therapy or cellular therapy, patients must have received therapy ≥ 3 months
prior to study entry and have recovered from all acute toxicities potentially related
to the agent.
- Monoclonal antibodies: patient must have received last dose ≥ 28 days prior
- Radiation: Patients must have received their last fraction of radiation (≥ 54 Gy) ≥ 3
months prior to study entry. Patients must have received local palliative radiation ≥
28 days prior to study entry
- Patient must have adequate organ and marrow function as defined by the following:
Hemoglobin ≥8 g/dL (may receive blood transfusions); absolute neutrophil count ≥ 1.0 x
10^9 cells/L; platelet count ≥ 100 x 10^9 cells/L (transfusion independent defined as
not receiving platelets transfusions ≥ 7 days prior to enrollment); alanine
aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 times the
institutional upper limit of normal for age; creatinine within normal institutional
limits OR creatinine clearance > 60 mL/min/1.73 m^2 for patients with creatinine
levels above institutional normal
- Written informed consent in accordance with institutional and FDA guidelines must be
obtained from patient or legal guardian
Exclusion Criteria:
Patients with the following conditions will be excluded from participation in the study:
- Primary cerebellar, brainstem or spinal tumors
- Metastatic disease or gliomatosis cerebri
- Acute infection or medical condition precluding surgery
- Pregnant or lactating
- Diagnosis of encephalitis or central nervous system (CNS) infection < 3 months prior,
or receiving ongoing treatment for encephalitis, CNS infection or multiple sclerosis
- Tumor involvement which would require ventricular, cerebellar or brainstem inoculation
or would require access through a ventricle in order to deliver treatment
- Required steroid increase within 1 week prior to G207 inoculation or patients
requiring >4 mg of dexamethasone daily
- Known HIV seropositivity
- Concurrent therapy with any drug active against HSV (acyclovir, valacyclovir,
penciclovir, famciclovir, ganciclovir, foscarnet, cidofovir) or any immunosuppressive
drug therapy (except dexamethasone or prednisone).
- Other current malignancy
- Concurrent anticancer or investigational drug
Maximum Eligible Age: | 21 Years |
Minimum Eligible Age: | 3 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Efficacy (overall survival) |
Time Frame: | Baseline to 24 months |
Safety Issue: | |
Description: | The overall survival for each patient receiving G207 will be calculated by estimating the 1-year and 2-year overall survival. |
Secondary Outcome Measures
Measure: | Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] |
Time Frame: | Baseline to 15 years |
Safety Issue: | |
Description: | All events with a Grade 3 or above toxicity (defined by the CTCAE v5.0) will be tabulated by event and by relationship to G207. |
Measure: | Virologic Shedding |
Time Frame: | Baseline to 15 years |
Safety Issue: | |
Description: | Virologic shedding will be assessed from saliva, conjunctiva and blood by polymerase chain reaction (PCR) |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Not yet recruiting |
Lead Sponsor: | University of Alabama at Birmingham |
Trial Keywords
- Brain Tumor, Recurrent
- glioma
- oncolytic virotherapy
- immunotherapy
- immunovirotherapy
- neoplasm
- progressive
- virus
- HSV
- herpes virus
- herpes simplex virus
- oncolytic virus
Last Updated
July 8, 2021