This early-phase study will examine Vusolimogene Oderparepvec, a genetically modified oncolytic viral strain of the herpes simplex type 1 (HSV-1) virus, with potential oncolytic, immunostimulating and antineoplastic activities. Upon administration, vusolimogene oderparepvec specifically targets, infects and replicates in tumor cells and does not infect healthy cells. This results in tumor cell lysis and the release of virus particles which infect and replicate within nearby tumor cells, resulting in tumor cel death. The immune system is activated by the released tumor-associated antigens (TAAs) from the tumor cells creating an anti-tumor immune response against the tumor cells, thereby further killing the tumor cells. The virus itself also elicits a tumor-specific systemic immune and cytotoxic T-lymphocyte (CTL) response, thereby killing nearby non-infected tumor cells.
The majority of the almost 80,000 patients newly diagnosed with melanoma each year in the U.S. present with localized early-stage melanoma (i.e., clinical stage I/II). Per the standard of care (SOC), these patients are treated with a curative intent, including wide local excision (WLE), with additional sentinel lymph node (SLN) biopsy (SLNB) for patients with Breslow ≥ 0.8 mm or \< 0.8 mm with ulceration or a positive deep margin. The incidence of SLN metastases significantly increases with the Breslow thickness of the tumor and the presence of ulceration. For T3b (Breslow \> 2 mm, with ulceration), the incidence of SLN metastases is 23-42%. For T4b disease (Breslow \> 4 mm), this increases up to 63%. As the tumor draining lymph node (TDLN), the SLN is where naïve T cells are first primed. However, this is also the site where melanoma cells initiate tumor mediated immune suppression and form the pre-metastatic niche. Thus, the SLN is a key potential target for local immune therapeutic intervention in early-stage melanoma patients, whereby tumor-mediated immune suppression can be counteracted, and the antitumor immune response can be boosted. As SLN positivity is the single most important prognostic factor in early-stage melanoma, intervention at the SLN may prevent disease recurrence. Almost all patients diagnosed with melanoma will have already undergone a diagnostic biopsy by the time they are seen by medical oncology. The majority undergo shave biopsy by dermatology or their primary care physician, and a smaller proportion have undergone punch or excisional biopsy. Replimune is developing vusolimogene oderparepvec (RP1), an oncolytic immunotherapy. RP1 is a selectively replicating competent herpes simplex virus 1 (HSV-1) that expresses exogenous genes and is administered by intratumoral injection. Local delivery of RP1 following initial biopsy of primary melanoma, prior to SLNB, provides a unique setting to clinically assess the role of the TDLN in the biological efficacy of RP1.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
25
Vusolimogene Oderparepvec is a genetically modified oncolytic viral strain of the herpes simplex type 1 (HSV-1) virus, with potential oncolytic, immunostimulating and antineoplastic activities.
UPMC Hillman Cancer Center
Pittsburgh, Pennsylvania, United States
RECRUITINGRate of Sentinel Lymph Node (SLN) Positivity
Proportion of patients with sentinel lymph node lymph node positivity (disease present in lymph node per pathologic assessment).
Time frame: Up to 2 years (cohort)
Incidence of all treatment-emergent adverse events (TEAEs)
Distinct number of patients that experience treatment-emergent adverse events (TEAEs) by highest grade per CTCAE v5.0.
Time frame: Up to 2 years
Incidence of ≥ Grade 3 Treatment Emergent Adverse Events (TEAEs)
Distinct number of patients that experience ≥ Grade 3 treatment-emergent adverse events (TEAEs) by highest grade per CTCAE v5.0.
Time frame: Up to 2 years
Incidence of Serious Adverse Events (SAEs)
Distinct number of distinct patients that experience Serious Adverse Events (SAEs) by highest grade per CTCAE v5.0.
Time frame: Up to 2 years
Incidence of fatal Adverse Events (AEs)
Distinct number of patients that experience fatal Adverse Events (AEs) by highest grade per CTCAE v5.0.
Time frame: Up to 2 years
Incidence of all treatment-emergent adverse events (TEAEs) requiring withdrawal from RP1
Distinct number of patients that experience treatment-emergent adverse events (TEAEs) requiring withdrawal from RP1 by highest grade per CTCAE v5.0.
Time frame: Up to 2 years
Recurrence Free Survival (RFS)
Median number of months from start of treatment to recurrence of disease or death from any cause. Recurrence of disease is defined as
Time frame: Up to 3 years
Overall Survival (OS)
Median number of months from start of treatment until death from any cause.
Time frame: Up to 3 years
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