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.
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.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Thymidine kinase-inactivated vaccinia virus expressing human GM-CSF
University of California, Los Angeles
Los Angeles, California, United States
Billings Clinic
Billings, Montana, United States
Cancer Centers of the Carolinas
Greenville, South Carolina, United States
Number of Participants With Objective Response in Injected Tumor(s)
Response was evaluated at the participant level based on the sum of the longest diameters of the injected target tumors. Tumor assessments were performed using RECIST criteria. Complete response (CR): all lesions disappear; Partial response (PR): maximum diameter decrease of \> 30% of the longest diameter (LD) of target lesions using the baseline LD; Progressive disease (PD): increase of \>20% in the sum of LD target lesions using the smallest sum LD recorded since treatment started; Stable disease (SD): unable to categorize as PR or PD using as reference the lobe with the smallest diameter at baseline.
Time frame: Initial response assessment after six weeks (Day 43)
Incidence of Treatment-related Adverse Events (AEs) and Serious Adverse Events (SAEs)
Safety was determined by the incidence of treatment-related adverse events (AEs), treatment-related serious adverse events (SAEs), and clinically-significant changes from baseline in routine laboratory parameters. Severity was determined by NCI-CTCAE version 3.0.
Time frame: Up to Day 64
Best Overall Response for Entire Disease Burden (RECIST Criteria)
Overall response was defined as the best response recorded from the start of the treatment until disease progression or recurrence across the entire disease burden (both injected and non-injected tumors), evaluated using RECIST criteria (Complete Response \[CR\], Partial Response \[PR\], Stable Disease \[SD\], or Progressive Disease \[PD\]).
Time frame: Initial response assessment after six weeks (Day 43)
Progression-free Survival
Progression-free survival was defined as the time from the first study treatment until objective evidence of disease progression or death.
Time frame: From first study treatment until objective evidence of disease progression or death, up to 20.5 months
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Number of Participants With Objective Response in Non-injected Tumor(s)
Response was evaluated at the participant level for non-injected tumors.Response rate was evaluated specifically in non-injected tumors to assess systemic anti-tumoral efficacy, evaluated using RECIST criteria (Complete Response \[CR\], Partial Response \[PR\], Stable Disease \[SD\], or Progressive Disease \[PD\]).
Time frame: Initial response assessment after six weeks (Day 43)