This is a Phase I Study to Evaluate the Safety, Tolerability, and Efficacy of VCN-01 in Combination With Durvalumab (MEDI4736) in Subjects With Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck. VCN-01 is a genetically modified oncolytic adenovirus characterized by the presence of four independent genetic modifications on the backbone of the wild-type HAd5 adenovirus genome, encoding human PH20, that confer tumor selectivity and anti-tumor activity. Durvalumab is a human monoclonal antibody (mAb) of the immunoglobulin G (IgG) 1 kappa subclass that inhibits binding of PD-L1. The proposed mechanism of action (MOA) for durvalumab is interference in the interaction of PD-L1 with PD-1 and CD80 (B7.1). Blockade of PD-L1/PD-1 and PD-L1/CD80 interactions releases the inhibition of immune responses, including those that may result in tumor elimination.
* Research Hypothesis The presence of VCN-01 into the tumor after systemic administration will help to overcome the observed resistance to durvalumab and other PD1/PD-L1 checkpoint inhibitors. * Primary objectives To evaluate the safety and tolerability of a single intravenous injection of VCN-01 combined with durvalumab in two administration regimens (concomitant or durvalumab starting two weeks later "sequential schedule"), and to determine the recommended phase II dose (RP2D) of the combination. * Study design This is a phase I trial, multicenter, open label, and dose escalation study. Patients will be entered at each dose level, according to a planned dose escalation schedule. Absence of unacceptable toxicity at the previous dose is required for entering a patient in the subsequent level. * Number of Centers: up to 3 * Number of Patients: 15-20 patients * Study Population: Patients with metastatic squamous cell carcinoma of the head and neck who have progressed during or after treatment with immune-checkpoint inhibitors.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Dose level 1: 3.3x10\^12 viral particles/patient and Dose level 2: 1x10\^13 viral particles/patient
Dose: 1500 mg Q4W
Institut Català D'Oncologia
L'Hospitalet de Llobregat, Barcelona, Spain
Hospital Universitari Vall D'Hebron
Barcelona, Spain
Safety by means of Adverse Events (AEs)
Incidence of Adverse Events as assessed by CTCAE v4.0
Time frame: through study completion, an average of 2 years
Objective response rate (ORR)
Proportion of patients with reduction in tumor burden of a predefined amount assessed by CT or MRI
Time frame: On Cycle 3 (+/- 3 days, each cycle is 28 days), and then every 2 cycles (± 7 days) until disease progression or withdrawal (an average of 2 years)
Progression Free Survival (PFS)
Time from study enrollment until disease progression or death assessed by CT or MRI
Time frame: On Cycle 3 (+/- 3 days, each cycle is 28 days), and then every 2 cycles (± 7 days) until disease progression or withdrawal (an average of 2 years)
Maximum Plasma Concentration (Cmax ) of VCN-01
The maximum (or peak) concentration that VCN-01 achieves in plasma after its administration.
Time frame: For both arms: On day 1 pre-dose (within 15 minutes prior to VCN-01 infusion) and then 30 minutes, 1, 2, 4, 6, 24 and 48 hours post VCN-01 administration.
Tmax of VCN-01
Time to Maximum Plasma Concentration of VCN-01
Time frame: VCN-01 and Durvalumab concomitant arm: On day 1 pre-dose (within 15 minutes prior to VCN-01 infusion) and then 30 minutes, 1 hours, 2 hours, 4 hours, 6 hours, 24 hours and 48 hours post VCN-01 administration. VCN-01 and Durvalumab sequential: On day 1
AUC of VCN-01
The definite integral in a plot of drug concentration in blood plasma vs. time.
Time frame: VCN-01 and Durvalumab concomitant arm: On day 1 pre-dose (within 15 minutes prior to VCN-01 infusion) and then 30 minutes, 1 hours, 2 hours, 4 hours, 6 hours, 24 hours and 48 hours post VCN-01 administration. VCN-01 and Durvalumab sequential: On day 1
Apparent Half-Life (t1/2) of VCN-01
The time it takes for half to be removed
Time frame: VCN-01 and Durvalumab concomitant arm: On day 1 pre-dose (within 15 minutes prior to VCN-01 infusion) and then 30 minutes, 1 hours, 2 hours, 4 hours, 6 hours, 24 hours and 48 hours post VCN-01 administration. VCN-01 and Durvalumab sequential: On day 1
Elimination rate constant of VCN-01
The rate at which VCN-01 is removed from the body.
Time frame: VCN-01 and Durvalumab concomitant arm: On day 1 pre-dose (within 15 minutes prior to VCN-01 infusion) and then 30 minutes, 1 hours, 2 hours, 4 hours, 6 hours, 24 hours and 48 hours post VCN-01 administration. VCN-01 and Durvalumab sequential: On day 1
VCN-01 viral shedding in blood
Determination of VCN-01 levels in peripheral blood samples
Time frame: VCN-01 and Durvalumab concomitant arm: On day 1: pre-dose and then, 4 hours, 24 hours and 48 hours post dose, on day 8, day 15, day 22 of cycle 1 (each cycle is 28 days), then on day1 of subsequent durvalumab cycles and at the final visit. Arm II: On day
anti-VCN-01 antibodies
Assessment of Blood levels of neutralizing anti-VCN-01 antibodies
Time frame: At screening, on day 1 pre-dose (within 15 minutes prior to VCN-01 ) in both arms. In concomitant arm: at day1 of subsequent durvalumab cycles (each cycle is 28 days), and at the final visit. In sequential arm: at day15 on cycle 1, at day1 of subsequent
VCN-01 viral shedding in stool and sputum
Determination of VCN-01 levels in stool and sputum
Time frame: VCN-01 and Durvalumab concomitant arm: at day 1, 8, 15 and 22 on cycle 1 (each cycle is 28 days) And at day1 of subsequent durvalumab cycles. VCN-01 and Durvalumab sequential: at day -14, -7, 1, 8, 15 on cycle 1 and at day 1 of subsequent durvalumab
Immunological changes induced by the combination of VCN-01 and durvalumab.
Study of the Immunological changes induced by the combination of VCN-01 and durvalumab by assessment of blood levels of circulating Interleukin 6 and Interleukin 10
Time frame: VCN-01 and Durvalumab concomitant arm: On day 1: pre-dose, at 30 minutes, 6 hours, 24 hours, 48 hours, at day 8 on cycle 1 (each cycle is 28 days), at day 1of cycle 2 and at the final visit. VCN-01 and Durvalumab sequential: On day 1, 15 minutes before
Changes in Microbiome in stool (VCN-01 and Durvalumab concomitant arm)
Analyse the microbiome in stool, prior and after VCN-01 administration
Time frame: On day 1: pre-dose and 1st deposition after-dose (the first deposition occurred from day 1 to day 7), day 8, day 15, day 22 on cycle 1 (each cycle is 28 days).
Changes in Microbiome in stool (VCN-01 and Durvalumab sequential)
Analyse the microbiome in stool, prior and after VCN-01 administration
Time frame: On day -14 (pre-dose and 1st deposition after-dose), day -7, Day 1, day 8 and day15 on cycle 1 (each cycle is 28 days).
Circulating free DNA (cfDNA) in plasma analysis (VCN-01 and Durvalumab concomitant arm)
To analyse the circulating free DNA (cfDNA) in plasma obtained from samples collected prior and post VCN-01 treatment.
Time frame: Pre-dose on day 1 (within 15min prior to VCN-01 infusion) and at day 8 on cycle 1, at day 1 on cycle 2, at day 1 on cycle 3 and at day 1 on cycle 4 (within 15min prior durvalumab administration) (each cycle is 28 days).
Circulating free DNA (cfDNA) in plasma analysis (VCN-01 and Durvalumab sequential)
To analyse the circulating free DNA (cfDNA) in plasma obtained from samples collected prior and post VCN-01 treatment.
Time frame: On day -14 pre-dose and 1st deposition after-dose(the first deposition occurred from day -14 to day -8), day -7, day 1, day 8 and day15 on cycle 1 (each cycle is 28 days).
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