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Phase 1, non-randomized, open label dose escalation clinical trial evaluating the safety of GEN2 in participants with primary & metastatic liver tumors.
This clinical trial will be divided into two phases: Phase IA in which the dose, route, and schedule of the GEN2 administration is determined and Phase IB which is designed to explore the activity of GEN2 in patients of a defined or several defined tumor types and stages based on the Phase IA data of GEN2.
Phase IA is divided into three routes of administration: (a) Phase 1A.1 which explores peripheral IV infusion; (b) Phase IA.2 which investigates hepatic arterial infusion and (c) Phase IA.3 which examines intratumoral delivery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Phase 1A.1: Peripheral IV | Experimental | GEN2 is administered in repeating three week cycles. On week one, GEN2 is given intravenously on three consecutive days and the presence of the HSV-TK-m2 expression is monitored by [18F]FHBG PET scanning after 3 to 8 days. Valganciclovir dosing is initiated on day 7 to 9 for 5 days. An approximately one week drug holiday follows. |
|
| Phase IA.2: Hepatic Artery Infusion | Experimental | GEN2 is administered in repeating three week cycles. On week one, GEN2 is given as a single hepatic artery infusion (HAI) on two successive days and the presence of the HSV-TK-m2 expression is monitored by [18F]FHBG PET scanning after 3 to 8 days. Valganciclovir dosing is initiated on day 7 to 9 for 5 days. An approximately one week drug holiday follows. |
|
| Phase IA.3: Intratumoral Injection | Experimental | GEN2 is administered in repeating three week cycles. On week one, GEN2 is given via injection directly into the tumor lesions on one day and the presence of the HSV-TK-m2 expression is monitored by [18F]FHBG PET scanning after 3 to 8 days. Valganciclovir dosing is initiated on day 7 to 9 for 5 days. An approximately one week drug holiday follows. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| GEN2 (HSV-Thymidine Kinase-m2 and hGM-CSF Genes) | Drug | GEN2 is an investigational drug combining cytotoxic and immunotherapy. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Maximum Tolerated Dose (MTD) | The MTD is the defined as the highest dose level at which, at most, one patient experiences a DLT. | First 3 weeks of GEN2 Administration |
| Dose Limiting Toxicity (DLT) |
| First 3 weeks of GEN2 Administration |
| Recommended Phase 2 Dose (RP2D) | The RP2D will be administered for Phase 1B. It is determined when the accelerated phase ends for Phase IA and the dose assignment for a new patient in the standard dose escalation will follow a modified Fibonacci scheme. If a modified Fibonacci has already been used, the RP2D will be explored from the remaining intervals between the dose which had no DLTs and the Maximum Administered Dose (MAD). | First 3 weeks of GEN2 Administration |
| Number of participants with treatment-related adverse events as assessed by CTCAE v4.0 | Each Adverse Event is to be classified by the Investigator as serious or non-serious. The classification of the gravity of the event determines the reporting procedures to be followed. | Treatment Initiation until 30 days after last dose of GEN2 |
| Measure | Description | Time Frame |
|---|---|---|
| Plasma pharmacokinetics of GEN2 | GEN2 PK Cmax is dose proportional. | During Week 1 of Cycle 1, Cycle 2 & Cycle 6 (each cycle is 28 days) |
| HSV-TK-m2 protein expression from GEN2 via serial [18F]FHBG PET and/or SPECT imaging |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Priscilla B Caguioa, MD | St. Luke's Medical Center - Quezon City | Principal Investigator |
| Maria Belen E Tamayo, MD | Makati Medical Center | Principal Investigator |
| John P Querol, MD | The Medical City | Principal Investigator |
| Necy S Juat, MD | National Kidney and Transplant Institute | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Makati Medical Center | Makati City | 1229 | Philippines | |||
| The Medical City |
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| ID | Term |
|---|---|
| D006528 | Carcinoma, Hepatocellular |
| D009362 | Neoplasm Metastasis |
| D008113 | Liver Neoplasms |
| ID | Term |
|---|---|
| D000230 | Adenocarcinoma |
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
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Dose Escalation Trial
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Identify number of participants with positive [18F] FHBG scan
| Day 3-8 of GEN2 Treatment |
| Preliminary Evidence of anti-tumor activity of GEN2 | Measure of anti-tumor efficacy based on objective tumor assessments made according to the irRECIST 1.1 | Week 9 and every 6 weeks thereafter through study completion, an average of 8 months. |
| Clinical research testing for antibodies to retrovector gp70 env, replication-competent retrovirus in peripheral blood lymphocytes (PBLs); vector integration into genomic DNA of PBLs, and circulating hGM-CSF protein | No replication-competent retrovirus. No vector integration into genomic DNA of PBLS. No GM-CSF detectable in patients after GEN2 administration | Cycle 1, Cycle 2, Cycle 6, after 6th month on treatment, annually thereafter |
| Pasig |
| Philippines |
| National Kidney and Transplant Institute | Quezon City | 1101 | Philippines |
| St. Luke's Medical Center | Quezon City | 1112 | Philippines |
| D009369 | Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D004066 | Digestive System Diseases |
| D008107 | Liver Diseases |
| D009385 | Neoplastic Processes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |