Sponsor: Virogin Biotech Canada Ltd (industry)
Phase: 2
Start date: Jan. 24, 2024
Planned enrollment: 97
VG161 (Recombinant Human IL12/15‑PDL1B Oncolytic HSV‑1 Injection) is an intratumorally administered, genetically engineered herpes simplex virus type‑1 (HSV‑1) being developed for solid tumors, with a clinical focus on hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). In a multicenter phase 1 trial in advanced, treatment‑refractory primary liver cancer (predominantly HCC; NCT04806464), results were presented at the 2024 ASCO Annual Meeting and subsequently published in Nature on March 19, 2025. These reports describe encouraging antitumor activity with a manageable safety profile and no dose‑limiting toxicities observed. (ascopubs.org, pubmed.ncbi.nlm.nih.gov)
Regulatory notes: the FDA granted Fast Track designation for advanced HCC (July 13, 2023), and China’s CDE granted Breakthrough Therapy Designation (September 6, 2024). (virogin.com)
Phase 1, single‑arm, intratumoral VG161 (NCT04806464; dose‑escalation and expansion in advanced primary liver cancer after ≥2 prior systemic lines):
A phase 2 study in HCC and ICC (Mayo Clinic) is listed; site status currently shows closed to enrollment at Mayo locations. (mayo.edu)
Notes: All efficacy data to date are from early‑phase, single‑arm studies in heavily pretreated populations; randomized data are not yet available in the public domain as of September 2, 2025. (pubmed.ncbi.nlm.nih.gov, ascopubs.org)
Last updated: Sep 2025
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.
Inclusion Criteria:
1. Signed written informed consent.
2. Males or females aged 18 years and older.
3. Performance status: Eastern Cooperative Oncology Group (ECOG) 0 or 1.
4. For subject in Cohort 2: cytologically confirmed advanced/metastatic or surgically unresectable HCC, with documented disease progression after at least two lines of FDA approved systemic therapy, including immunotherapy or anti-angiogenesis therapy as the first line treatment and at least one regimen of the following agents as the second line: anti-angiogenesis agents, tyrosine kinase inhibitors or immunotherapy.
5. For subject in Cohort 3: Histologically or cytologically confirmed advanced/metastatic or surgically unresectable ICC, with documented disease progression after chemotherapy as the first line systemic therapy. For patients with known IDH1 mutation, they must receive the appropriate targeted therapy with a IDH1 inhibitor and for patients with MSI-H tumors, they must receive immunotherapy with PD-1 inhibitors.
6. For subjects in Cohort 1 and Cohort 4: should fulfill either inclusion criteria 4) or 5).
7. Liver function: Child-Pugh A-B for cohort 1 and 2.
8. At least one measurable lesion per RECIST 1.1
9. At least 1 injectable lesion; ≥15 mm in longest diameter and deemed injectable as per Investigator's discretion. Subjects with deep or visceral lesions (such as hepatic or intraperitoneal lymph nodes) that can be safely injected under guided imaging can be considered for intratumoral injection of VG161..
Exclusion Criteria:
1. Participation in any trial of any other investigational agent within the last 4 weeks prior to dosing. Wash out periods to be reviewed on a case by case basis with Medical Monitor, as required.
2. Tumors to be injected lying in mucosal regions or close to an airway, major blood vessel or spinal cord that, in the opinion of the Investigators, could cause occlusion or compression in the case of tumor swelling or erosion into a major vessel in the case of necrosis.
3. Subjects with any primary Central Nervous System (CNS) malignancy including glioma and current, active, progressing CNS malignancy, including carcinomatosis meningitis are excluded. Subjects with treated brain metastases are eligible if there is no evidence of progression for at least 4 weeks after CNS-directed treatment, as ascertained by clinical examination and brain imaging (magnetic resonance imaging \[MRI\] or computed tomography \[CT\] scan) during the screening period and off steroids (for at least 2 weeks prior to first dose of IP).
4. Major surgery within 14 days prior to dosing.
5. Intercurrent serious infections within 28 days prior to Screening or treated systematically with antibiotics within 14 days prior to signing ICF.
6. Life-threatening illness unrelated to cancer.
7. Active Herpes infection.
8. Treatment with antiviral agents within 14 days prior to dosing.
9. Uncontrolled congestive heart failure.
10. Known to test positive for human immunodeficiency virus (HIV) or syphilis.
11. Active infection including hepatitis B (HBV) or hepatitis C (HCV) that currently under anti-virus treatment which can affect study drug treatment as per investigator's decision.
12. Use of ganciclovir or acyclovir within 14 days prior to dosing.
13. Subjects with a condition requiring systemic treatment with either corticosteroids (\>10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days prior to dosing. Inhaled or topical steroids, and adrenal replacement steroid doses ≤10 mg daily prednisone equivalent, are permitted in the absence of active autoimmune disease.
14. Subjects who have been on systemic anticoagulants within 14 days prior to dosing and/or with International Normalized Ratio (INR) \> 1.5 x the upper limit of the reference range are excluded from this study.
15. Subjects with prior radiation therapy to the tumor lesion to be injected are excluded from the study, unless there is evidence of tumor progression in the most recent imaging, following completion of radiotherapy.
Phoenix, Arizona, 85054, United States
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Status: Recruiting
Jacksonville, Florida, 32224, United States
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Status: Recruiting
Rochester, Minnesota, 55905, United States
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Status: Recruiting