Purpose of the study is to evaluate the safety, tolerability and pharmacokinetic parameters of the drug based on double recombinant vaccinia virus VV-GMCSF-Lact, in patients with recurrent/refractory metastatic breast cancer in successive cohorts with dose escalation with single and multiple administration. The study provides: determination of the maximum tolerated dose of the drug and the frequency, nature, intensity and duration of adverse events connected with the use of the study drug in escalating doses; detection of dose-limiting toxicity, its severity, duration and reversibility; determination of the profile of virus pharmacokinetics and antivirus antibodies; assessment of the objective response to the treatment. Stage 1,: The virus drug is administered intratumorally once according to a "3+3" design in the dosage from 1\*107 PFU to 10\*107 PFU. The frequency of dose-limiting toxicity (DLT) will be evaluated (non-hematological toxicity III degree and above; development of febrile neutropenia and body temperature \> 38.3°C more than two days after drug administration; thrombocytopenia III degree and above and/or hemorrhagic complications; repeated increase in ALT and/or AST activity is more than 4 times higher than the normal upper limit). Escalation to the next level occurs if there is no DLT in the entire cohort under study. The study stops if the incidence of DLT in a cohort of 3 patients is 2 or 3. The maximum tolerated dose (MTD) will be considered the studied dose that is lower than the dose which DLT was determined. Stage 1 assumes randomization of no more than 36 patients. Stage 2, multiple administration: According to Stage 1 the study will move to the second stage if there will be possibility to study at least one dosage regimen based on the previously studied dose. At Stage 2 two doses in ascending order below the MTD and MTD are planned to be used. Escalation to the next level occurs if no DLT is observed during dosing of the first three patients. If DLT develops and drug administration is discontinued, the patient is not excluded from the study, her drug administration visits are skipped, and she goes through all follow-up visits. The drug will be administered intratumorally 1 time per week for 4 weeks in 3 dosages: MTD and 2 lower dosages. Each cohort will include up to 6 patients in a "3+3" design. It is expected to include up to 24 patients, taking into account the possible inclusion of patients to replace those who left.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
34
Intratumoral injections: 1\*107 PFU (calculated at minimal ED on mice); 2\*107 PFU; 4\*107 PFU; 6\*107 PFU; 8\*107 PFU; 10\*107 PFU;
N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation
Moscow, Russia, Russia
National Medical Research Radiological Centre (NMRRC) of the Ministry of Health of the Russian Federation
Obninsk, Russia, Russia
N.N. Petrov National Medical Research Center of Oncology
Saint Petersburg, Russia, Russia
Oncology Research Center, LLC
Saint Petersburg, Russia, Russia
Safety Parameters
Number of participants with: AEs, SAEs, lethal outcomes, AEs of grade 3 and higher severity, AEs leading to withdrawal, AEs related to IP administration, and Dose Limiting Toxicity. The severity of adverse events was assessed according to CTCAE (Common Terminology Criteria for Adverse Events) Version 5.0. National Cancer Institute. 2017.
Time frame: 90 days from the data of the last treatment (for Stage 1 up to 107 days from participation in the study; for Stage 2 up to 129 days from participation in the study
Number of Participants With Dose-limiting Toxicity
Dose-limiting toxicity is defined as the occurrence of at least one of the following events following administration of the investigational drug: 1. Grade 3 non-hematologic toxicity according to the CTCAE (excluding alopecia); 2. development of febrile neutropenia (neutrophils \<1.0 × 10⁹/L with a single; 3. rise in body temperature \>38.3°C or a sustained body temperature \>=38°C for more than one hour), or development of a clinically significant systemic infection (a local infection at the site of drug administration or at the biopsy site will not be considered clinically significant); (3) Grade III thrombocytopenia or higher and/or hemorrhagic complications; (4) recurrent or persistent elevation of ALT and/or AST levels to more than 4 times the upper limit of normal.
Time frame: plus 3 days to the day of the last treatment for single dose, plus 14 days to the day of the last treatment for multiple doses
Determination of Virus Concentrations in Blood
Determination of maximum virus concentrations in blood.
Time frame: up to 216 hours since the last treatment
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