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The primary objectives are to:
The secondary objective is to:
1) Evaluate the efficacy of intralesional ASN-002 in non-target tumours when administered in combination with oral vismodegib in patients with BCCs.
The exploratory objective is to:
1) Evaluate immunological biomarkers during the course of treatment.
Methodology:
This study will evaluate ASN-002 (in the dose range 0.5 to 1.5x10(11) vp/mL) with the Hh inhibitor vismodegib (Erivedge®). The study will initially evaluate two Arms receiving 1.0 x 10(11) vp/injection, and following a safety review, may implement further arms in an adaptive study design.
Following screening and baseline biopsies for target and non-target tumours, eligible subjects will be enrolled in the study.
Cycle 1: Treatment with vismodegib (daily dose of 150 mg) for 4 weeks and ASN-002 for 3 weeks (i.e., three ASN-002 injections in total):
Clinical response will be assessed at Week 17, following which, the investigator may where clinically indicated, initiate Cycle 2.
Cycle 2: Treatment with vismodegib (daily dose of 150 mg) for 4 weeks, and one further injection with ASN-002:
Surgical excision for all patients will occur between Week 25 and Week 33 at the investigators discretion, and dependent on when patient completed study treatment (1 or 2 treatment cycles). Up to 10 BCCs to be excised including 3 target tumours. Excisions can be conducted over 2 visits as per Investigator's discretion.
The Investigator may enrol eligible patients parallel into either Arm 1 or Arm 2, based on the number of tumours present. Up to 10 study BCC tumours (up to 3 target and up to 7 non-target) will be selected per patient.
Following review of at least Week 5 data for N=6 patients in Arm 1 and Arm 2, further Arms with varying doses of ASN-002 (in the dose range 0.5x10(11) vp or 1.5x10(11) vp) may be explored at the discretion of the Safety Review Committee (SRC). Vismodegib or ASN-002 may be evaluated as monotherapies to provide control groups to allow comparison of treatment Arms.
Safety and clinical assessments will be performed at Weeks 1, 3, 4, 5, 7, 17, 25 to 33.
Histological response will be evaluated in all study tumours via excision between Week 25 and Week 33 (as per investigator's discretion).
Six patients will be recruited to each Arm of the study, each Arm may be expanded to 12 patients at the discretion of the SRC.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Arm 1, Patients with 1 Tumour | Experimental | Participants with 1 Target Tumour will receive 3 x ASN-002 1.0x10(11) Injections + VISMODEGIB (150 mg) daily for 4 weeks. |
|
| Arm 2, Patients with 3 or more Tumours | Experimental | Participants with 3 or more Target Tumours will receive 3 x ASN-002 1.0x10(11) Injections (per tumour) + VISMODEGIB (150 mg) daily for 4 weeks. |
|
| Arm 6 Patients with 3 or more Tumours | Experimental | Participants with 3 or more Target Tumours will receive 3 x ASN-002 1.5x10(11) Injections (per tumour) + VISMODEGIB (150 mg) daily for 4 weeks |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ASN-002 | Biological | ASN-002 has been designed for clinical applications, especially for intratumoral administration in the treatment of various cancers. This rAd vector delivers the gene of interest, in the case of ASN-002 the human IFNγ gene, into target cells. The rAd vector in ASN-002 is replication deficient and although it infects cells, it is not able to replicate in the tumor or in normal human cells. The infected cells are able to transcribe and translate the IFNγ DNA leading to a sustained local concentration of IFNγ in the tumor mass that is designed to avoid high levels of systemic IFNγ that may be lead to unacceptable toxicity. |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of ASN-002 related Adverse Events in patients with previously untreated nBCC | Incidence of Adverse Adverse events will be monitored | Participants will be followed up to 6 months |
| Microscopic clearance of the injected Target basal cell carcinoma. | Histological clearance (HC) will be defined as the absence of detectable evidence of BCC tumor cell nests in serial histological samples as determined by central pathology review. | Microscopic examinations of sample collected at weeks 25-33 after the first dose. |
| Measure | Description | Time Frame |
|---|---|---|
| Microscopic clearance of the injected Non-Target basal cell carcinoma. | Histological clearance (HC) will be defined as the absence of detectable evidence of BCC tumor cell nests in serial histological samples as determined by central pathology review. | Microscopic examinations of sample collected at weeks 25-33 after the first dose. |
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Inclusion Criteria:
Histologically confirmed previously untreated, BCC (nodular and superficial), 5-20 mm in maximum diameter, per the selection criteria for study BCC tumours. A punch biopsy (refer to study procedure manual for biopsy size selection) from the thickest part of all the target tumours is required for histological confirmation of BCC and to exclude BCC non-eligible subtypes.
Note: If a patient has mix of nodular and superficial BCC tumours, at least one target tumour should be a nodular BCC.
Removal of < 25% of the area of each biopsied tumour by initial biopsy performed 1-12 weeks before Day 1. If the initial biopsy was performed >8 weeks prior to screening, the investigator may re-biopsy the tumour, provided not > 25% of the area of the original tumour is removed. Non-study tumours may be resected or treated at the discretion of the Investigator prior to study entry or if they develop during the study.
Hedgehog pathway inhibitor treatment naïve.
Acceptable general health as determined by the investigator, i.e. no serious or active medical or psychiatric illness or recreational or therapeutic drug or alcohol use that, in the opinion of the Investigator, would interfere with treatment, assessment or compliance with the protocol, ability to provide informed consent, or patient safety.
18 years of age or older.
Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2.
Screening laboratory values as follows:
Female patients who are documented infertile, postmenopausal for at least 1 year, surgically sterile or using acceptable and highly effective birth control for the duration of the study and for at least 3 months after last administration of the study treatments.
Male patients with female partners of child bearing potential, agreement to use two adequate contraception methods while being on vismodegib and for 3 months of completion. agreement not to donate semen for 3 months after completion of vismodegib.
Written informed consent prior to initiation of study-specified procedures.
Able and willing to comply with all study requirements, including surgical removal of tumour/tumour site at completion of study.
Baseline tissue sample adequate for determination of histological or other biomarkers.
Exclusion Criteria
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| Name | Affiliation | Role |
|---|---|---|
| Clement Leong, Ph.D | Ascend Biopharmaceuticals Ltd | Study Chair |
| Gregory Siller | Central Brisbane Dermatology | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Central Brisbane Dermatology | Brisbane | Queensland | 4000 | Australia | ||
| Princess Alexandra Hospital |
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| ID | Term |
|---|---|
| D002280 | Carcinoma, Basal Cell |
| D001478 | Basal Cell Nevus Syndrome |
| ID | Term |
|---|---|
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
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| ID | Term |
|---|---|
| C000707471 | gusacitinib |
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|
| Brisbane |
| Queensland |
| 4102 |
| Australia |
| Veracity Clinical Research | Brisbane | Queensland | 4102 | Australia |
| Sunshine Coast University Hospital | Sunshine Coast | Queensland | Australia |
| Sinclair Dermatology | Melbourne | Victoria | 3000 | Australia |
| Royal Melbourne Hospital | Melbourne | Victoria | 3050 | Australia |
| Burswood Dermatology | Perth | Western Australia | 6100 | Australia |
| D018295 |
| Neoplasms, Basal Cell |
| D009807 | Odontogenic Cysts |
| D007570 | Jaw Cysts |
| D001845 | Bone Cysts |
| D003560 | Cysts |
| D009386 | Neoplastic Syndromes, Hereditary |
| D001848 | Bone Diseases, Developmental |
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |
| D007571 | Jaw Diseases |
| D009057 | Stomatognathic Diseases |
| D000015 | Abnormalities, Multiple |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D030342 | Genetic Diseases, Inborn |