A Study of Recombinant Vaccinia Virus to Treat Malignant Melanoma
Primary Purpose
Melanoma
Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
JX-594
Sponsored by

About this trial
This is an interventional treatment trial for Melanoma focused on measuring Melanoma, Oncolytic virus, Pexa-Vec
Eligibility Criteria
Inclusion Criteria:
- Histologically-confirmed, Stage 3 or Stage 4 malignant melanoma
- At least one tumor mass measurable by CT/MRI and/or physical examination that can be injected by direct visualization or by ultrasound-guidance
- Anticipated survival of at least 16 weeks
- Cancer is not surgically resectable for cure
- KPS score of ≥ 70 (refer to APPENDIX E: KARNOFSKY PERFORMANCE STATUS (KPS))
- Age ≥18 years
- Men and women of reproductive potential must be willing to follow accepted birth control methods during treatment and for 3 months after the last treatment with JX-594
- The ability to understand and willingness to sign an Institutional Review Board (IRB)/Independent Ethics Committee (IEC)-approved written informed consent form
- Able to comply with study procedures and follow-up examinations
- Adequate liver function: Total bilirubin ≤ 2.0 x ULN; AST, ALT ≤ 2.0 x ULN
- Adequate bone marrow function: WBC > 3,500 cells/mm3 and < 50,000 cells/mm3; ANC > 1,500 cells/mm3; Hemoglobin > 10 g/dL; Platelet count > 125,000 plts/mm3
- Acceptable coagulation status: INR < (ULN + 10%)
- Acceptable kidney function: Serum creatinine < 2.0 mg/dL
Exclusion Criteria:
- Target tumor(s) adherent to and/or invading a major vascular structure (e.g. carotid artery)
- Pregnant or nursing an infant
- Known infection with HIV
- Systemic corticosteroid or other immunosuppressive medication use within 4 weeks of first treatment with JX-594
- Clinically significant active infection or uncontrolled medical condition (e.g. pulmonary, neurological, cardiovascular, gastrointestinal, genitourinary) considered high risk for investigational new drug treatment Significant immunodeficiency due to underlying illness and/or medication (e.g. systemic corticosteroids)
- History of eczema that at some stage has required systemic therapy
- Clinically significant and/or rapidly accumulating ascites, peri-cardial and/or pleural effusions (e.g. requiring drainage for symptom control)
- Severe or unstable cardiac disease which includes, but is not limited to, any of the following within 6 months prior to screening: myocardial infarct, unstable angina, congestive heart failure, myocarditis, arrhythmias diagnosed and requiring medication, or any clinically-significant change in cardiac status
- Treatment of the target tumor(s) with radiotherapy, chemotherapy, surgery, or an investigational drug within 4 weeks of screening (6 weeks in case of mitomycin C or nitrosoureas)
- Experienced a severe reaction or side-effect as a result of a previous smallpox vaccination
- Inability or unwillingness to give informed consent or comply with the procedures required in this protocol
- Patients with household contacts who are pregnant or nursing an infant, children < 5 years old, have history of eczema that at some stage has required systemic therapy, or have a significant immunodeficiency due to underlying illness (e.g. HIV) and/or medication (e.g. systemic corticosteroids) will be excluded unless alternate living arrangements can be made during the patient's active dosing period and for three weeks following the last dose of study medication.
Sites / Locations
- UCLA
- Billings Clinic
- Cancer Center of the Carolinas
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Single Arm
Arm Description
Intratumoral injection(s) of Recombinant Vaccinia GM-CSF, JX-594
Outcomes
Primary Outcome Measures
Response rate for injected tumor(s)
Secondary Outcome Measures
Safety, as determined by incidence of treatment-related adverse events, serious adverse events (SAEs), and clinically-significant changes from baseline in routine laboratory parameters
Best overall response for entire disease burden (RECIST criteria)
Progression-free survival (PFS)
Response rate of non-injected tumor(s)
Full Information
NCT ID
NCT00429312
First Posted
January 29, 2007
Last Updated
January 13, 2015
Sponsor
Jennerex Biotherapeutics
1. Study Identification
Unique Protocol Identification Number
NCT00429312
Brief Title
A Study of Recombinant Vaccinia Virus to Treat Malignant Melanoma
Official Title
A Phase I/II, Open-Label Study of JX-594 (Thymidine Kinase-deleted Vaccinia Virus Plus GM-CSF) Administered by Intratumoral Injection in Patients With Unresectable Stage 3 or Stage 4 Malignant Melanoma
Study Type
Interventional
2. Study Status
Record Verification Date
March 2010
Overall Recruitment Status
Completed
Study Start Date
March 2007 (undefined)
Primary Completion Date
February 2008 (Actual)
Study Completion Date
December 2009 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Jennerex Biotherapeutics
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this research study is to find out whether JX-594 (Pexa-Vec) is safe and effective for treating surgically unresectable malignant melanoma.
Detailed Description
Cancer of the skin is the most common of all cancers, probably accounting for more than 50% of all cancers. Melanoma accounts for about 4% of skin cancer cases but causes a large majority of skin cancer deaths. The American Cancer Society estimates that about 62,190 new melanomas will be diagnosed in the United States during 2006.
DTIC is the only chemotherapy drug approved by the FDA for the treatment of metastatic melanoma. The reported response rates are 5-20% without any evidence of prolonged survival in randomized clinical trials versus best supportive care. The median overall survival for melanoma patients treated with DTIC alone is approximately 8 months; PFS and TTP following treatment with DTIC is approximately 7 weeks, and the objective response rate for DTIC alone (CR+PR) is less than 10% (Millward, 2004). Other chemotherapy agents including cisplatin and carboplatin, BCNU, vindesine, paclitaxel, docetaxel, and vinorelbine have also been tested but none have improved upon the very modest activity of DTIC.
Melanoma may be the optimal target for JX-594 immunotherapy because of the relatively high rate of accessible disease for injection, the positive response of melanoma seen with IL-2 immunotherapy, and the lack of effective, tolerable therapy for patient with metastatic melanoma. Furthermore, it is speculated that JX-594 replication targets the EGFR pathway, which is highly expressed in melanocytes.
Results from an initial Phase I/II study suggest that intratumoral injection of JX-594 is safe and effective in treating both injected and distant disease in patients with surgically incurable metastatic melanoma. Response of both injected tumors (in 5 of 7 patients) and response of at least one non-injected tumor (in 4 of 7 patients) was demonstrated, including two patients who achieved a partial response (6 + months) and a complete response (4 + months) to JX-594 treatment. Particularly noteworthy is that efficacy and gene expression occurred despite pre-treatment vaccination (and, therefore, pre-existing anti-vaccinia immunity) in all patients.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Melanoma
Keywords
Melanoma, Oncolytic virus, Pexa-Vec
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
10 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Single Arm
Arm Type
Experimental
Arm Description
Intratumoral injection(s) of Recombinant Vaccinia GM-CSF, JX-594
Intervention Type
Biological
Intervention Name(s)
JX-594
Other Intervention Name(s)
JX594
Intervention Description
Thymidine kinase-deleted vaccinia virus plus GM-CSF
Primary Outcome Measure Information:
Title
Response rate for injected tumor(s)
Time Frame
Initial response assessment at 6 weeks
Secondary Outcome Measure Information:
Title
Safety, as determined by incidence of treatment-related adverse events, serious adverse events (SAEs), and clinically-significant changes from baseline in routine laboratory parameters
Time Frame
Safety evaluation throughout study period
Title
Best overall response for entire disease burden (RECIST criteria)
Time Frame
Initial response assessment after six weeks
Title
Progression-free survival (PFS)
Time Frame
Follow-up every three weeks until new therapy or disease progression
Title
Response rate of non-injected tumor(s)
Time Frame
Initial response assessment at six weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Histologically-confirmed, Stage 3 or Stage 4 malignant melanoma
At least one tumor mass measurable by CT/MRI and/or physical examination that can be injected by direct visualization or by ultrasound-guidance
Anticipated survival of at least 16 weeks
Cancer is not surgically resectable for cure
KPS score of ≥ 70 (refer to APPENDIX E: KARNOFSKY PERFORMANCE STATUS (KPS))
Age ≥18 years
Men and women of reproductive potential must be willing to follow accepted birth control methods during treatment and for 3 months after the last treatment with JX-594
The ability to understand and willingness to sign an Institutional Review Board (IRB)/Independent Ethics Committee (IEC)-approved written informed consent form
Able to comply with study procedures and follow-up examinations
Adequate liver function: Total bilirubin ≤ 2.0 x ULN; AST, ALT ≤ 2.0 x ULN
Adequate bone marrow function: WBC > 3,500 cells/mm3 and < 50,000 cells/mm3; ANC > 1,500 cells/mm3; Hemoglobin > 10 g/dL; Platelet count > 125,000 plts/mm3
Acceptable coagulation status: INR < (ULN + 10%)
Acceptable kidney function: Serum creatinine < 2.0 mg/dL
Exclusion Criteria:
Target tumor(s) adherent to and/or invading a major vascular structure (e.g. carotid artery)
Pregnant or nursing an infant
Known infection with HIV
Systemic corticosteroid or other immunosuppressive medication use within 4 weeks of first treatment with JX-594
Clinically significant active infection or uncontrolled medical condition (e.g. pulmonary, neurological, cardiovascular, gastrointestinal, genitourinary) considered high risk for investigational new drug treatment Significant immunodeficiency due to underlying illness and/or medication (e.g. systemic corticosteroids)
History of eczema that at some stage has required systemic therapy
Clinically significant and/or rapidly accumulating ascites, peri-cardial and/or pleural effusions (e.g. requiring drainage for symptom control)
Severe or unstable cardiac disease which includes, but is not limited to, any of the following within 6 months prior to screening: myocardial infarct, unstable angina, congestive heart failure, myocarditis, arrhythmias diagnosed and requiring medication, or any clinically-significant change in cardiac status
Treatment of the target tumor(s) with radiotherapy, chemotherapy, surgery, or an investigational drug within 4 weeks of screening (6 weeks in case of mitomycin C or nitrosoureas)
Experienced a severe reaction or side-effect as a result of a previous smallpox vaccination
Inability or unwillingness to give informed consent or comply with the procedures required in this protocol
Patients with household contacts who are pregnant or nursing an infant, children < 5 years old, have history of eczema that at some stage has required systemic therapy, or have a significant immunodeficiency due to underlying illness (e.g. HIV) and/or medication (e.g. systemic corticosteroids) will be excluded unless alternate living arrangements can be made during the patient's active dosing period and for three weeks following the last dose of study medication.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James Burke, M.D.
Organizational Affiliation
Billings Clinic
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
David H Kirn, M.D.
Organizational Affiliation
Jennerex Biotherapeutics
Official's Role
Study Director
Facility Information:
Facility Name
UCLA
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
Facility Name
Billings Clinic
City
Billings
State/Province
Montana
ZIP/Postal Code
59101
Country
United States
Facility Name
Cancer Center of the Carolinas
City
Greenville
State/Province
South Carolina
ZIP/Postal Code
29605
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
10505851
Citation
Mastrangelo MJ, Maguire HC Jr, Eisenlohr LC, Laughlin CE, Monken CE, McCue PA, Kovatich AJ, Lattime EC. Intratumoral recombinant GM-CSF-encoding virus as gene therapy in patients with cutaneous melanoma. Cancer Gene Ther. 1999 Sep-Oct;6(5):409-22. doi: 10.1038/sj.cgt.7700066.
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A Study of Recombinant Vaccinia Virus to Treat Malignant Melanoma
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