This Phase I/II trial evaluates LOAd703 in patients with cancer (pancreatic, biliary, colorectal or ovarian) together with their standard of care chemotherapy or using gemcitabine immune-conditioning. LOAd703 is administered by intratumoral image-guided injections. Maximum 50 patients can be enrolled. LOAd703 is an immunostimulatory gene therapy using an selection replication competent adenovirus as a gene vehicle. The virus is derived from serotype 5 adenovirus with the fiber from serotype 35. It expresses the transgenes trimerized membrane-bound isoleucine zipper (TMZ) TMZ-CD40L and 41BBL under control of a cytomegalovirus (CMV) promoter.
The trial is a Phase I/II trial evaluating the effect of LOAd703 in patients with pancreatic cancer, biliary cancer, ovarian cancer and colorectal cancer. LOAd703 is an oncolytic adenovirus serotype 5/35 encoding immunostimulatory transgenes: TMZ-CD40L and 41BBL. In Phase I, three doses (total viral load - 1x10e11, 5x10e11, 1x10e12 viral particles (VP)) of LOAd703 will be tested as add-on to standard of care or immune-conditioning gemcitabine chemotherapy. 8 treatments of LOAd703 will be delivered by image-guided intratumoral injection at the same time of chemotherapy. In Phase II stage of the study, patients will be treated at maximum tolerated dose/maximum tolerated study dose as defined in the Phase I stage. In both phases: tumor biopsies, blood samples and radiological imaging will be performed to evaluate safety, effect and mechanisms of action. Further, patients will be subjected to oral and rectal swabs, and urine sampling to determine virus shedding. The patients will be monitored for time to progression, progression free survival and overall survival.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
47
Oncolytic adenovirus serotype 5/35 encoding TMZ-CD40L and 4-1BBL
Karolinska University Hospital, Huddinge
Stockholm, Sweden
Uppsala University Hospital
Uppsala, Sweden
Safety: Toxicity Symptoms Graded According to CTCAE v4.03.
The toxicity symptoms were graded according to CTCAE v4.03.
Time frame: Up to 50 weeks
Immune Reactions to LOAd703 Virus as Assessed by Anti-adenovirus Ig ELISA
Fold change between baseline and evaluation visit for anti-adenovirus antibodies (LOAd703). The baseline is the last available measurement taken before the first LOAd703 treatment. Evaluation is a measurement taken from subjects receiving at least 3 LOAd703 treatments.
Time frame: Up to 50 weeks
Response on Tumor Size by Dose and Cancer Diagnosis
Local and distant anti-tumoral size changes assessed by appropriate imaging accordingly to RECIST 1.1. Complete Response (CR), complete macroscopic disappearance of all tumors; Partial Response (PR), a reduction of at least 30% in the sum of all tumor diameters from baseline; one/more lesions fulfilling the criteria for PR and other/others for progressive disease (PD); Stable disease (SD), Neither PR nor PD; Progressive disease (PD), at least 20% increase in the sum of all tumor diameters from the smallest tumor size and/or the appearance of new tumor lesion/s; Overall response rate (ORR) = CR + PR; Clinical benefit rate (CBR) = CR + PR + SD.
Time frame: Up to 50 weeks
Overall Survival
Months of overall survival (OS) from registration by dose and cancer diagnosis
Time frame: From registration date to date of death, assessed up to 40 months
Time to Progression
Time to progression from registration by dose and cancer diagnosis
Time frame: From registration date to date of progression, assessed up to 40 months
Progression Free Survival
Months of progression free survival (PFS) from registration by dose and cancer diagnosis
Time frame: From registration date to date of progression, or date of death, which ever came first, assessed up to 40 months
Systemic Immune Activation
Percentage of participants with upregulated immune marker in blood at evaluation as compared to baseline. The baseline is the last available measurement taken before the first LOAd703 treatment. Evaluation is a measurement taken from subjects receiving at least 3 LOAd703 treatments.
Time frame: Up to 50 weeks
Immune Cell Activation
Fold change between baseline and evaluation visit for CD8+ CD3+ T cells activation evaluated by flow cytometry. The baseline is the last available measurement taken before the first LOAd703 treatment. Evaluation is a measurement taken from subjects receiving at least 3 LOAd703 treatments.
Time frame: Up to 50 weeks
Presence of LOAd703 Virus in Blood
Percentage of PK samples analyzed that were positive for viral DNA/ml in serum.
Time frame: Up to 50 weeks
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