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 intratumoral, replication‑competent HSV‑1–based oncolytic virus engineered to express IL‑12, IL‑15 complexed with IL‑15Rα, and a secreted PD‑L1–blocking peptide. It is being investigated across multiple solid tumors, with the most mature data in refractory hepatocellular carcinoma (HCC). A multicenter phase 1 trial in advanced primary liver cancer reported no dose‑limiting toxicities and signs of antitumor activity; these results were presented at ASCO 2024 and subsequently published in Nature (epub March 19, 2025). (ascopubs.org)
Hepatocellular carcinoma (intratumoral VG161 monotherapy)
- Phase 1 (China; NCT04806464): In 40 HCC patients dosed (35 evaluable after ≥2 prior lines), ORR 17.14% (6/35) and DCR 60.00% by RECIST/mRECIST; median PFS 2.90 months and median OS 9.40 months. A subgroup with ≥3 months of prior checkpoint inhibitor exposure (n=22) showed longer OS versus ≤3 months (17.30 vs 7.40 months; HR 0.32). (ascopubs.org)
- Peer‑reviewed publication (Nature, 2025): Confirms a multicenter phase 1 experience in refractory HCC, reporting VG161 was well tolerated and associated with “promising efficacy,” including remodeling of the tumor immune microenvironment and a gene‑expression model predicting benefit; clinical trial registration NCT04806464. (Quantitative response details are in the ASCO abstract above.) (pubmed.ncbi.nlm.nih.gov)
Combination therapy (HCC)
- Phase Ib/IIa (VG161 + camrelizumab; NCT06124001): As of 31 Dec 2024, 16 patients enrolled; among 11 evaluable, ORR 18.2% (2 PR) and 8 SD; median PFS 6.3 months; 6‑month OS rate 87.5%. RP2D identified as VG161 3×10^8 PFU plus camrelizumab 3 mg/kg per cycle. Early, single‑arm data; follow‑up ongoing. (ovid.com)
Other tumor types
- Pancreatic cancer (planned/ongoing): A phase 1/2 study is evaluating VG161 combined with nivolumab in advanced pancreatic cancer (NCT05162118). Preclinical pancreatic cancer models showed enhanced systemic antitumor immunity and synergy with anti‑PD‑1. (cdek.pharmacy.purdue.edu)
Notes and context: Clinical data are early and come primarily from single‑arm studies in heavily pretreated HCC; randomized data are not yet available as of October 7, 2025. (pubmed.ncbi.nlm.nih.gov)
Last updated: Oct 2025
Goal: Evaluate the antitumor activity, safety, and tolerability of intratumoral VG161 as monotherapy in refractory hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC), and assess VG161 combined with nivolumab in HCC/ICC. A safety run-in characterizes acute safety, biodistribution, shedding, and immunogenicity.
Patients: Adults ≥18 years with ECOG 0–1 and at least one measurable and at least one image-guidable injectable lesion (≥15 mm). Cohort 2: advanced/metastatic or unresectable HCC with progression after at least two prior systemic lines including an immunotherapy or anti-angiogenic first line and at least one of TKI/anti-angiogenic/CPI as second line; Child-Pugh A–B permitted for safety run-in and HCC monotherapy cohorts. Cohort 3: advanced/metastatic or unresectable ICC post first-line chemotherapy; if IDH1-mutant, must have received IDH1 inhibitor; if MSI-H, must have received PD-1 inhibitor. Combination cohort includes eligible HCC or ICC. Key exclusions include unsafe-to-inject lesions (near mucosa/airway/major vessel/spinal cord), active CNS disease, major recent surgery, significant infections including active HSV, recent antivirals or immunosuppression, uncontrolled heart failure, active HBV/HCV on antivirals compromising study therapy, therapeutic anticoagulation, and prior radiation to the index injectable lesion without clear progression.
Design: Open-label, multicenter, nonrandomized phase IIa/IIb study with four cohorts. Cohort 1 safety run-in (n=10). Two-stage Simon-like designs for monotherapy efficacy in HCC (Cohort 2; n≈39) and ICC (Cohort 3; n≈33) with early stopping for futility based on ORR and short-term PFS. A combination cohort (Cohort 4; up to 12) evaluates VG161 plus nivolumab. Planned total enrollment 97.
Treatments: VG161 intratumoral injection at 1.0×10^8 PFU daily on Days 1–3 of each treatment cycle. VG161 is a recombinant oncolytic HSV-1 engineered to delete ICP34.5 and express IL-12, an IL-15/IL-15Rα complex, and a localized PD-1/PD-L1–blocking fusion peptide to couple direct oncolysis with stimulation of Th1/NK/CD8+ T-cell responses and local checkpoint blockade. In a prior phase 1 study in heavily pretreated primary liver cancer, VG161 showed an ORR around 17% and disease control near 60–65% with manageable safety and no dose-limiting toxicities; fever and transient cytopenias were common, and median OS approximated 9–10 months. Regulatory agencies have recognized VG161 with expedited designations in advanced HCC, reflecting unmet need and early activity signals. Combination cohort: VG161 as above plus nivolumab 240 mg IV on Days 8 and 15 of each cycle; dosing may transition to 480 mg IV every 4 weeks after cycle 1 at investigator discretion.
Outcomes: Primary: safety in the run-in cohort (AEs/SAEs by CTCAE v5.0), ORR in HCC (Cohort 2) and ICC (Cohort 3), and 3-month PFS in HCC (Cohort 2). Secondary: pharmacokinetics/biodistribution and immunology in Cohort 1 (blood VG161 levels, PD-L1 blocking peptide, IL-12, IL-15, serum antibodies, VG161 DNA shedding, ADA/NAb), ORR in Cohort 1, PFS, OS, and DOR across cohorts, detailed safety in Cohorts 2 and 3, and immune monitoring (lymphocyte subsets, plasma cytokines including IL-15/IL-6/TNF-α/IFN-γ, and markers such as PD-L1, PD-1, CD69, CD8+Ki67high, anti–HSV-1 antibodies).
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 safety run-in includes intensive blood sampling for viral kinetics, cytokines, immunogenicity, and shedding assessments, increasing visit frequency and phlebotomy. All cohorts require serial imaging for RECIST assessments and frequent safety labs; combination therapy adds infusion visits on Days 8 and 15 of cycle 1 and potentially every 4 weeks thereafter. Travel burden is higher for those with deep visceral lesions requiring interventional radiology and for sites with limited geographic availability.
Last updated: Oct 2025
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