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Adenovirus Mediated Suicide Gene Therapy With Radiotherapy in Progressive Astrocytoma.

Primary Purpose

Malignant Glioma of Brain, Astrocytoma, Malignant Astrocytoma

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ad5-yCD/mutTKSR39rep-ADP adenovirus and fractionated stereotactic radiosurgery (fSRS)
Sponsored by
Henry Ford Health System
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Malignant Glioma of Brain

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Subjects with radiologic evidence of intracranial recurrence or progression of a previously diagnosed high-grade astrocytoma. To be eligible for this trial, the subjects must have: Histologically documented glioblastomas or anaplastic astrocytoma prior to the debulking surgery that is suspicious to have progressed on imaging. An interval of at least 3 months must have elapsed since the completion of the most recent course of radiation while at least 4 weeks must have elapsed since the completion of a non-nitrosourea containing chemotherapy regimen and at least 6 weeks since the completion of a nitrosourea containing chemotherapy regimen. Patients must be ≥ 18 years of age, able to provide informed consent and express a willingness to meet all the expected requirements of the protocol for the duration of the study. Must have recovered from toxicity (grade 2 or less) of prior therapy. Eligible for partial or total resection of the recurrent tumor No anticipated physical connection between post-resection tumor cavity and cerebral ventricle Karnofsky performance status (KPS) ≥ 60 at time of surgery No prior treatment of the tumor with gene or virus therapy, immunotherapy, brachytherapy, or implants of polymers containing chemotherapeutic agents (e.g. Gliadel Wafer) No immunosuppressive or immune disorder Baseline organ function testing intact Patients who are candidates for surgical debulking (re-resection) following recurrence of diseases based on multidisciplinary evaluation by neurosurgeons, radiation oncologists, neuro-radiologists, and neuro-oncologists. Subjects must have adequate baseline organ function, as assessed by the following laboratory values, within 30 days before initiating the study therapy: Adequate renal function with creatinine clearance ≥ 50 mL/min/m2 Platelet count ≥ 100,000/μL Absolute neutrophil count ≥ 1,000/μL Hemoglobin > 10.0 g/dL Bilirubin < 1.5 mg/dL; SGOT and SGPT < 2.5 times upper limit of normal (ULN). Women of child-bearing potential will be required to practice birth control for the duration of the treatment and for at least 90 days after surgery with intratumor virus inoculation. Men must use barrier protection for the duration of treatment and for at least 90 days after surgery with intratumor virus inoculation treatment. Exclusion Criteria: Acute infection. Acute infection is defined by any viral, bacterial, or fungal infection that has required active treatment and caused oral temperature >38.5oC and/or clinically significant leukocytosis Serum antibodies to human immunodeficiency virus (HIV) Previous history of liver disease including autoimmune or viral hepatitis Positive serologic test for Hepatitis B or C at baseline Immunosuppressive therapy except for corticosteroid use Serious medical or psychiatric illness or concomitant medication, which, in the judgment of the investigator, might interfere with the subject's ability to respond to or tolerate the treatment or complete the trial Impaired immunity or susceptibility to serious viral infections Pregnant or lactating females Allergy to any product used on the protocol Patient is not able to undergo a brain MRI. Patients who are not eligible for debulking surgery or resection of recurrent disease will be considered ineligible.

Sites / Locations

  • Henry Ford Health SystemRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ad5-yCD/mutTKSR39rep-ADP adenovirus and fSRS Arm

Arm Description

Subjects will receive a single intratumoral injection of the Ad5-yCD/mutTKSR39rep-ADP adenovirus at one of three dose levels beginning at 1 x 1011 vp and escalating in half-log (3-fold) increments to 1 x 1012 vp, along with the same dose of fractionated stereotactic radiosurgery until unacceptable toxicity, disease progression, or withdrawal of consent.

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose
The primary objective is to determine the maximum tolerated dose of injected of Ad5-yCD/mutTKSR39rep-ADP adenovirus into the resection cavity at the time of surgery.

Secondary Outcome Measures

1. Assessment of antitumor immune response
Assessment of antitumor immune response by serum levels of interferon-gamma (IFN-γ) measured by ELISA and will be described by pico-gram per milliliter (pg/mL).
2. Assessment of change in antitumor immune response by peripheral blood monoclonal cell (PBMC) counts
Assessment of change in antitumor immune response by peripheral blood monoclonal cell (PBMC) counts measured by flow cytometry
Assessment of antitumor immune response by using antibodies against surface markers
Assessment of antitumor immune response by using antibodies against surface markers (CD3, CD56, CD4, CD8, CD45, CD69).

Full Information

First Posted
November 16, 2022
Last Updated
January 9, 2023
Sponsor
Henry Ford Health System
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1. Study Identification

Unique Protocol Identification Number
NCT05686798
Brief Title
Adenovirus Mediated Suicide Gene Therapy With Radiotherapy in Progressive Astrocytoma.
Official Title
Phase I Study of Replication-Competent Adenovirus-Mediated Double Suicide Gene Therapy With Stereotactic Radiosurgery in Patients With Recurrent or Progressive High Grade Astrocytomas
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Recruiting
Study Start Date
November 29, 2022 (Actual)
Primary Completion Date
October 2023 (Anticipated)
Study Completion Date
October 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Henry Ford Health System

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
The primary goal of this Phase I study is to determine the maximum tolerated dose of oncolytic adenovirus mediated double suicide-gene therapy in combination with fractionated stereotactic radiosurgery in patients with recurrent high-grade astrocytoma undergoing resection.
Detailed Description
Detailed study description: Patients with recurrent glioblastoma (GBM) or progressive high grade astrocytoma who are scheduled to undergo repeat surgery are eligible. After the removal of as much tumor tissue as possible, a modified oncolytic adenovirus is injected into the wall of the resection cavity and any residual tumor tissue. The goal of this study is to determine the maximum tolerated dose (MTD) of the injected adenovirus. This treatment is combined with a combination of oral 5-fluorocytosine (5-FC) and valganciclovir (vGCV) prodrug therapy. Following the surgery, patients will be treated with fractionated radiosurgery (fSRS). Patients will be monitored for 30 days before they start on next line anti-cancer therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malignant Glioma of Brain, Astrocytoma, Malignant Astrocytoma, Brain Tumor, Glioma, Brain Cancer, Glioblastoma, Glioblastoma Multiforme, GBM

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
18 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Ad5-yCD/mutTKSR39rep-ADP adenovirus and fSRS Arm
Arm Type
Experimental
Arm Description
Subjects will receive a single intratumoral injection of the Ad5-yCD/mutTKSR39rep-ADP adenovirus at one of three dose levels beginning at 1 x 1011 vp and escalating in half-log (3-fold) increments to 1 x 1012 vp, along with the same dose of fractionated stereotactic radiosurgery until unacceptable toxicity, disease progression, or withdrawal of consent.
Intervention Type
Biological
Intervention Name(s)
Ad5-yCD/mutTKSR39rep-ADP adenovirus and fractionated stereotactic radiosurgery (fSRS)
Intervention Description
Ad5-yCD/mutTKSR39rep-ADP adenovirus will be injected intratumoral
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose
Description
The primary objective is to determine the maximum tolerated dose of injected of Ad5-yCD/mutTKSR39rep-ADP adenovirus into the resection cavity at the time of surgery.
Time Frame
30 days
Secondary Outcome Measure Information:
Title
1. Assessment of antitumor immune response
Description
Assessment of antitumor immune response by serum levels of interferon-gamma (IFN-γ) measured by ELISA and will be described by pico-gram per milliliter (pg/mL).
Time Frame
Pre-surgery (day 0), 3, 7, 14, 21, 30, 90 days.
Title
2. Assessment of change in antitumor immune response by peripheral blood monoclonal cell (PBMC) counts
Description
Assessment of change in antitumor immune response by peripheral blood monoclonal cell (PBMC) counts measured by flow cytometry
Time Frame
Pre-surgery (day 0), 3, 7, 14, 21, 30, 90 days.
Title
Assessment of antitumor immune response by using antibodies against surface markers
Description
Assessment of antitumor immune response by using antibodies against surface markers (CD3, CD56, CD4, CD8, CD45, CD69).
Time Frame
Pre-surgery (day 0), 3, 7, 14, 21, 30, 90 days.
Other Pre-specified Outcome Measures:
Title
Quality of life as assessed using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30
Description
Assessment of quality of life (QOL) by using the European Organization for Research and Treatment of Cancer (EORTC) tools consisting of the EORTC QLQ-C30
Time Frame
Pre-surgery (day 0), 30 days, 90 days
Title
Quality of life as assessed using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BN20
Description
Assessment of quality of life (QOL) by using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BN20
Time Frame
Pre-surgery (day 0), 30 days, 90 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects with radiologic evidence of intracranial recurrence or progression of a previously diagnosed high-grade astrocytoma. To be eligible for this trial, the subjects must have: Histologically documented glioblastomas or anaplastic astrocytoma prior to the debulking surgery that is suspicious to have progressed on imaging. An interval of at least 3 months must have elapsed since the completion of the most recent course of radiation while at least 4 weeks must have elapsed since the completion of a non-nitrosourea containing chemotherapy regimen and at least 6 weeks since the completion of a nitrosourea containing chemotherapy regimen. Patients must be ≥ 18 years of age, able to provide informed consent and express a willingness to meet all the expected requirements of the protocol for the duration of the study. Must have recovered from toxicity (grade 2 or less) of prior therapy. Eligible for partial or total resection of the recurrent tumor No anticipated physical connection between post-resection tumor cavity and cerebral ventricle Karnofsky performance status (KPS) ≥ 60 at time of surgery No prior treatment of the tumor with gene or virus therapy, immunotherapy, brachytherapy, or implants of polymers containing chemotherapeutic agents (e.g. Gliadel Wafer) No immunosuppressive or immune disorder Baseline organ function testing intact Patients who are candidates for surgical debulking (re-resection) following recurrence of diseases based on multidisciplinary evaluation by neurosurgeons, radiation oncologists, neuro-radiologists, and neuro-oncologists. Subjects must have adequate baseline organ function, as assessed by the following laboratory values, within 30 days before initiating the study therapy: Adequate renal function with creatinine clearance ≥ 50 mL/min/m2 Platelet count ≥ 100,000/μL Absolute neutrophil count ≥ 1,000/μL Hemoglobin > 10.0 g/dL Bilirubin < 1.5 mg/dL; SGOT and SGPT < 2.5 times upper limit of normal (ULN). Women of child-bearing potential will be required to practice birth control for the duration of the treatment and for at least 90 days after surgery with intratumor virus inoculation. Men must use barrier protection for the duration of treatment and for at least 90 days after surgery with intratumor virus inoculation treatment. Exclusion Criteria: Acute infection. Acute infection is defined by any viral, bacterial, or fungal infection that has required active treatment and caused oral temperature >38.5oC and/or clinically significant leukocytosis Serum antibodies to human immunodeficiency virus (HIV) Previous history of liver disease including autoimmune or viral hepatitis Positive serologic test for Hepatitis B or C at baseline Immunosuppressive therapy except for corticosteroid use Serious medical or psychiatric illness or concomitant medication, which, in the judgment of the investigator, might interfere with the subject's ability to respond to or tolerate the treatment or complete the trial Impaired immunity or susceptibility to serious viral infections Pregnant or lactating females Allergy to any product used on the protocol Patient is not able to undergo a brain MRI. Patients who are not eligible for debulking surgery or resection of recurrent disease will be considered ineligible.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Tobias Walbert, MD, PhD
Phone
3139162723
Email
twalber1@hfhs.org
First Name & Middle Initial & Last Name or Official Title & Degree
Nyati Shyam, PhD
Phone
734-272-1751
Email
snyati1@hfhs.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Tobias Walbert, MD, PhD
Organizational Affiliation
Henry Ford Health System
Official's Role
Principal Investigator
Facility Information:
Facility Name
Henry Ford Health System
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48202
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tobias Walbert, MD, PhD
Phone
313-916-2723
Email
twalber1@hfhs.org

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
33524949
Citation
Ene CI, Fueyo J, Lang FF. Delta-24 adenoviral therapy for glioblastoma: evolution from the bench to bedside and future considerations. Neurosurg Focus. 2021 Feb;50(2):E6. doi: 10.3171/2020.11.FOCUS20853.
Results Reference
background
PubMed Identifier
28387849
Citation
Mitchell LA, Lopez Espinoza F, Mendoza D, Kato Y, Inagaki A, Hiraoka K, Kasahara N, Gruber HE, Jolly DJ, Robbins JM. Toca 511 gene transfer and treatment with the prodrug, 5-fluorocytosine, promotes durable antitumor immunity in a mouse glioma model. Neuro Oncol. 2017 Jul 1;19(7):930-939. doi: 10.1093/neuonc/nox037.
Results Reference
background
PubMed Identifier
31750274
Citation
Kiyokawa J, Wakimoto H. Preclinical And Clinical Development Of Oncolytic Adenovirus For The Treatment Of Malignant Glioma. Oncolytic Virother. 2019 Oct 24;8:27-37. doi: 10.2147/OV.S196403. eCollection 2019.
Results Reference
background
PubMed Identifier
8384892
Citation
Oldfield EH, Ram Z, Culver KW, Blaese RM, DeVroom HL, Anderson WF. Gene therapy for the treatment of brain tumors using intra-tumoral transduction with the thymidine kinase gene and intravenous ganciclovir. Hum Gene Ther. 1993 Feb;4(1):39-69. doi: 10.1089/hum.1993.4.1-39.
Results Reference
background
PubMed Identifier
8159705
Citation
Chen SH, Shine HD, Goodman JC, Grossman RG, Woo SL. Gene therapy for brain tumors: regression of experimental gliomas by adenovirus-mediated gene transfer in vivo. Proc Natl Acad Sci U S A. 1994 Apr 12;91(8):3054-7. doi: 10.1073/pnas.91.8.3054.
Results Reference
background
PubMed Identifier
9650617
Citation
Freytag SO, Rogulski KR, Paielli DL, Gilbert JD, Kim JH. A novel three-pronged approach to kill cancer cells selectively: concomitant viral, double suicide gene, and radiotherapy. Hum Gene Ther. 1998 Jun 10;9(9):1323-33. doi: 10.1089/hum.1998.9.9-1323.
Results Reference
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Learn more about this trial

Adenovirus Mediated Suicide Gene Therapy With Radiotherapy in Progressive Astrocytoma.

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