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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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 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

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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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