An Open-Label, Multiple-Center, Phase IIa/IIb Clinical Trial to Evaluate the Efficacy, Safety and Tolerability of VG161 as Monotherapy and in Combination With Nivolumab for Treatment of Patients With Hepatocellular Carcinoma or Intrahepatic Cholangiocarcinoma

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Trial Details

Sponsor: Virogin Biotech Canada Ltd (industry)

Phase: 2

Start date: Jan. 24, 2024

Planned enrollment: 97

Trial ID: NCT05223816
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More trial details at ClinicalTrials.gov More info

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Investigational Drug AI Analysis

chevron Show for: VG161 (Recombinant Human IL12/15-PDL1B Oncolytic HSV-1 Injection)

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Goal: Evaluate the antitumor activity, safety, and tolerability of the oncolytic HSV-1 VG161 given intratumorally as monotherapy in advanced HCC and ICC, and explore the safety and preliminary efficacy of VG161 combined with nivolumab.

Patients: Adults ≥18 years with ECOG 0–1 and at least one measurable and one injectable lesion. Cohort 2: advanced/metastatic or unresectable HCC after at least two prior FDA‑approved systemic lines, including prior immunotherapy or anti‑angiogenic therapy first line and at least one second‑line regimen (TKI, anti‑angiogenic, or immunotherapy). Cohort 3: advanced/metastatic or unresectable ICC after first‑line chemotherapy, with required receipt of IDH1 inhibitor for IDH1‑mutant disease and PD‑1 inhibitor for MSI‑H disease. Cohorts 1 and 4 meet HCC or ICC criteria. Key exclusions include unsafe-to-inject lesions, active CNS disease (unless treated/stable), recent major surgery, significant infections including active HSV, use of recent antivirals or immunosuppression, therapeutic anticoagulation, and prior radiation to the target lesion without evidence of progression.

Design: Open-label, multicenter, nonrandomized phase IIa/IIb study with a safety run-in (Cohort 1) followed by Simon two-stage single-arm monotherapy cohorts in HCC (Cohort 2) and ICC (Cohort 3), and a combination cohort with nivolumab (Cohort 4). Planned enrollment approximately 97 patients. Stopping rules are embedded for early futility in the monotherapy cohorts based on ORR and short-term PFS thresholds.

Treatments: VG161 intratumoral injections at 1×10^8 PFU daily on Days 1–3 per cycle across cohorts. VG161 is a genetically engineered oncolytic HSV‑1 expressing IL‑12, an IL‑15/IL‑15Rα complex, and a PD‑1/PD‑L1–blocking peptide to couple direct oncolysis with local immune activation and checkpoint blockade. In a prior phase 1 study in heavily pretreated primary liver cancer, VG161 showed an objective response rate around 17% and disease control near 60–65%, with manageable safety and no dose‑limiting toxicities; fever and transient cytopenias were the most common events. The agent has FDA Fast Track designation for advanced HCC and CDE Breakthrough Therapy designation in China. Combination cohort: VG161 on the same schedule plus nivolumab 240 mg IV on Days 8 and 15 of cycle 1, with option to switch to 480 mg every 4 weeks thereafter per investigator discretion.

Outcomes: Primary endpoints: safety in the run-in cohort (AEs/SAEs per CTCAE v5.0); objective response rate in HCC and ICC monotherapy cohorts; 3‑month PFS in the HCC monotherapy cohort. Secondary endpoints include VG161 pharmacokinetics and biodistribution (blood levels, shedding), immunogenicity (anti–HSV‑1 antibodies, ADA/NAb), pharmacodynamics (PD‑L1 blocking peptide, IL‑12, IL‑15; lymphocyte subsets; cytokines; immune activation markers such as PD‑L1, PD‑1, CD69, CD8+Ki67high), ORR in the safety cohort, PFS and OS across cohorts, duration of response, and safety in Cohorts 2 and 3.

Burden on patient: Moderate to high. Patients undergo image-guided intratumoral injections on three consecutive days per cycle, requiring procedure visits and potential anesthesia or sedation depending on lesion location. The protocol includes frequent safety assessments, serial blood draws for PK, immunogenicity, cytokines, and immune phenotyping, as well as surveillance for viral shedding. Imaging per RECIST and potential biopsy or repeat injections add visit frequency and travel. Combination cohort adds additional infusion visits for nivolumab, particularly in cycle 1. The need for injectable, potentially deep lesions further increases procedural complexity and site visit burden compared with standard systemic therapy.

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Sites (3)

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Mayo Clinic

Phoenix, Arizona, 85054, United States

No email / No phone

Status: Recruiting

Mayo Clinic Florida

Jacksonville, Florida, 32224, United States

No email / No phone

Status: Recruiting

Mayo Clinic

Rochester, Minnesota, 55905, United States

No email / No phone

Status: Recruiting

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