Sponsor: Imunon (industry)
Phase: 3
Start date: July 9, 2025
Planned enrollment: 500
IMNN-001 (GEN-1) is an intraperitoneally administered, DNA-mediated interleukin-12 (IL‑12) immunotherapy being developed for newly diagnosed advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer in combination with standard neoadjuvant and adjuvant carboplatin/paclitaxel. A randomized phase 1/2 trial (OVATION-2) reported numerically longer overall survival (OS) and progression‑free survival (PFS) with IMNN‑001 plus chemotherapy versus chemotherapy alone; the dataset has been presented at scientific meetings and published in a peer‑reviewed journal. A global phase 3 trial (OVATION‑3; NCT06915025) is now enrolling. (pubmed.ncbi.nlm.nih.gov, investors.imunon.com)
IMNN‑001 consists of a plasmid encoding human IL‑12 formulated with a PEG‑PEI‑cholesterol lipopolymer (TheraPlas) to enhance cellular transfection after intraperitoneal delivery. Local IL‑12 expression in the peritoneal cavity induces downstream cytokines (e.g., interferon‑γ, TNF‑α), promotes CD8+ T‑cell and NK‑cell activity, and reduces immunosuppressive elements within the tumor microenvironment, with minimal systemic cytokine exposure observed in clinical samples. (pmc.ncbi.nlm.nih.gov, investors.imunon.com)
Earlier, nonrandomized phase Ib (OVATION I; n=18) showed radiographic responses prior to debulking (86% in evaluable patients) and encouraging time to treatment failure, alongside intraperitoneal increases in IL‑12 and interferon‑γ. (aacrjournals.org)
A phase 3, randomized, open‑label trial (OVATION‑3; NCT06915025) with OS as the primary endpoint is recruiting. (ichgcp.net)
Notes: OVATION‑2 was an exploratory phase 1/2 study and not powered for definitive survival statistics; confirmatory evidence will depend on the ongoing OVATION‑3 trial. (pubmed.ncbi.nlm.nih.gov, investors.imunon.com)
Last updated: Sep 2025
Goal: To determine whether adding intraperitoneal IMNN-001 to standard neoadjuvant and adjuvant carboplatin/paclitaxel improves overall survival versus chemotherapy alone in newly diagnosed advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer, with subsequent standard-of-care maintenance therapy allowed in both arms.
Patients: Adult women (≥18 years) with histologically confirmed high-grade, non-mucinous epithelial ovarian, fallopian tube, or primary peritoneal cancer, FIGO stage IIIB/C or IV, eligible for neoadjuvant chemotherapy and interval debulking surgery. ECOG 0–2 and adequate marrow, renal, hepatic, and neurologic function are required. Key exclusions include low-grade histology, clear cell and mucinous subtypes, prior therapy for the current disease, active bowel obstruction or GI fistula/perforation, need for systemic immunosuppression, active hepatitis or HIV with detectable viral load, planned bevacizumab use, and conditions preventing safe IP catheter placement.
Design: Randomized, adaptive, open-label, multicenter phase 3 study with 1:1 allocation to chemotherapy plus IMNN-001 versus chemotherapy alone. Stratification by homologous recombination deficiency status and disease stage. Independent data monitoring committee oversight. Planned enrollment of 500. Interval debulking after neoadjuvant therapy, with allowance for additional neoadjuvant cycles per investigator with medical monitor input. Standard-of-care maintenance therapy permitted in both arms.
Treatments: Control: Standard paclitaxel 175 mg/m2 IV over 3 hours plus carboplatin AUC 6 IV over 1 hour on Day 1 every 3 weeks for 6 cycles (3 neoadjuvant, 3 adjuvant) followed by SOC maintenance per local practice (e.g., PARP inhibitors such as olaparib or niraparib where appropriate). Experimental: Same chemotherapy plus intraperitoneal IMNN-001 100 mg/m2 on Days 8 and 15 of cycle 1, then Days 1, 8, and 15 of cycles 2–6 (total 17 IP doses), with IMNN-001 administered at least 30 minutes after carboplatin when on the same day. IMNN-001 is an intraperitoneal, DNA-mediated IL-12 immunotherapy (plasmid encoding human IL-12 formulated with a PEG-PEI-cholesterol lipopolymer) designed to drive local IL-12 expression within the peritoneal cavity, augmenting IFN-γ and NK/CD8+ T-cell activity and decreasing immunosuppression in the tumor microenvironment while minimizing systemic cytokine exposure. In a randomized phase 1/2 study (OVATION-2), IMNN-001 plus chemotherapy showed numerically longer PFS and OS and higher surgical response metrics versus chemotherapy alone; safety was manageable without cytokine release syndrome signals, though the study was not powered for definitive survival outcomes. A global phase 3 program is ongoing to confirm efficacy with OS as the primary endpoint.
Outcomes: Primary: Overall survival from randomization to death from any cause over approximately 48 months. Key secondary endpoints include chemotherapy response score at interval debulking (CRS1–3), surgical cytoreduction status at IDS (R0/R1/R2), time to second-line treatment or death, and objective response rate by RECIST v1.1 prior to IDS.
Burden on patient: Moderate. Patients receive standard IV carboplatin/paclitaxel for six 3-week cycles and undergo interval debulking surgery, consistent with usual care. The experimental arm adds frequent intraperitoneal administrations (17 total) requiring IP catheter placement and multiple clinic visits on Days 1, 8, and 15 across cycles, increasing procedural and visit burden and potential abdominal discomfort. Tumor tissue is required at pre-screening/screening for HRD status, but no intensive pharmacokinetic sampling is specified. Maintenance therapy and imaging schedules align with standard practice. Travel and time commitments are higher than SOC due to repeated IP dosing, while other assessments are similar to routine management.
Inclusion Criteria:
1. Participants must be female, ≥18 years of age, able to understand the study procedures, and agree to participate in the study by providing written informed consent.
2. Participants with a histologically confirmed diagnosis of high-grade non-mucinous epithelial ovarian (serous, endometrioid, carcinosarcoma, mixed epithelial pathologies), fallopian tube or peritoneal cancer that is Stage IIIB/C or IV according to the International Federation of Gynecology and Obstetrics (FIGO) or tumor, node and metastasis staging criteria.
3. Participants eligible to receive neoadjuvant chemotherapy.
4. Participants will provide a tumor tissue sample at pre-screening or screening, via laparoscopy or image guided core biopsy for determination of confirmed biomarker tumor status (HRD vs. HRP). See biomarker status definitions in the section below.
5. Participants of childbearing potential must have a negative serum pregnancy test (beta human chorionic gonadotropin) within 14 days prior to initiation of protocol therapy and be practicing an effective form of contraception. If applicable, participants must discontinue breastfeeding prior to study entry.
6. Participants must have adequate:
1. Bone marrow function: Absolute neutrophil count (ANC) greater than or equal to 1,500/µl. Exceptions may be made in patients with benign ethnic neutropenia \>800/ul with approval of a medical monitor. This ANC cannot have been induced or supported by granulocyte colony stimulating factors. Platelets greater than or equal to 100,000/µl.
2. Renal function: eGFR \> 60 ml/min/1.73m2
3. Hepatic function: Bilirubin ≤ 1.5 x ULN. SGOT (AST) and SGPT (ALT) ≤ 3.0 x ULN and alkaline phosphatase ≤ 2.5 x ULN. Exceptions due to hepatic metastases can be considered in consultation with medical monitor.
4. Neurologic function: Neuropathy (sensory and motor) less than or equal to Grade 1 as defined by CTCAE version 5.0.
7. Participants must have an ECOG score of 0, 1 or 2.
8. Participants should be free of active infection requiring parenteral antibiotics or a serious uncontrolled medical illness or disorder within 4 weeks of study entry.
9. Any hormonal therapy directed at the malignant tumor must be discontinued at least one week prior to the first treatment. Continuation of hormone replacement therapy is permitted.
Exclusion Criteria:
1. Participant who has received prior treatment with IMNN-001.
2. Participant who has received oral or parenteral corticosteroids (\>10 mg prednisone) within 2 weeks of first dose of IMNN-001 (if applicable) or who have a clinical requirement for ongoing systemic immunosuppressive therapy such as chronic steroid use not related to chemotherapy administration.
3. Participant has mucinous, germ cell, transitional cell, clear cell, undifferentiated, or non-epithelial ovarian cancer.
4. Participant has low-grade or Grade 1 epithelial ovarian cancer.
5. Participant of childbearing potential, not practicing adequate contraception, participant who is pregnant, or participant who is breastfeeding are not eligible for this trial.
6. Participant has a bowel obstruction by clinical symptoms or computed tomography (CT) scan, sub-occlusive mesenteric disease, abdominal or gastrointestinal fistula, gastrointestinal perforation, or intra-abdominal abscess.
7. Participant has been diagnosed and/or treated with any therapy for invasive cancer \<3 years from study enrollment, completed adjuvant chemotherapy and/or targeted therapy at least 3 years from enrollment, or completed adjuvant hormonal therapy less than 4 weeks from enrollment.
8. Participant with definitively treated non-invasive malignancies such as cervical carcinoma in situ, ductal carcinoma in situ, grade 1 or 2 Stage IA endometrioid endometrial cancer, or non-melanomatous skin cancer are allowed.
9. Participant with concurrent severe medical problems unrelated to the malignancy that would significantly limit full compliance with the study or expose the participant to extreme risk or decreased life expectancy.
10. Participant has known active hepatitis or HIV with detectable viral load.
11. Participant has a known contraindication or uncontrolled hypersensitivity to the components of paclitaxel, carboplatin, IMNN-001, or their excipients.
12. Prior treatment for high-grade non-mucinous epithelial ovarian, fallopian tube, or peritoneal cancer (e.g., immunotherapy, anticancer therapy, surgery, radiation therapy).
13. Participant is receiving treatment for active autoimmune disease. "Active" refers to any condition currently requiring therapy. Examples of autoimmune disease include systemic lupus erythematosus, multiple sclerosis, inflammatory bowel disease and rheumatoid arthritis.
14. Participant who has received prior radiotherapy to any portion of the abdominal cavity or pelvis is excluded. Prior radiation for localized cancer of the breast, head and neck, or skin is permitted, if it was completed at least 3 years prior to registration, and the participant remains free of recurrent or metastatic disease.
15. Participant who has received prior chemotherapy for any abdominal or pelvic tumor is excluded. Participant may have received prior adjuvant chemotherapy for localized breast cancer, if it was completed at least three years prior to registration, and that the participant remains free of recurrent or metastatic disease.
16. Participant with history or evidence upon physical examination of CNS disease, including primary brain tumor, seizures not controlled with standard medical therapy, any brain metastases, or history of cerebrovascular accident (CVA, stroke), transient ischemic attack (TIA) or subarachnoid hemorrhage within six months of the first date of treatment on this study.
17. Participant who will receive bevacizumab with the neoadjuvant or adjuvant treatment, or as maintenance will be excluded.
18. Participant with any condition/anomaly that would interfere with the appropriate placement of the IP catheter for study drug administration including abdominal surgery within 4 weeks of study entry (for reason other than IP port placement or laparoscopic diagnosis of epithelial ovarian cancer), intestinal dysfunction as defined in #6 above.
St Louis, Missouri, 63110, United States
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Status: Recruiting
Portland, Oregon, 97213, United States
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Status: Recruiting
Chattanooga, Tennessee, 37403, United States
[email protected] / No phone
Status: Recruiting
Spokane, Washington, 99204, United States
[email protected] / No phone
Status: Recruiting