Recombinant Oncolytic Poliovirus PVS-RIPO in Treating Patients with Recurrent Grade IV Malignant Glioma

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Basic Trial Information

PhaseTypeAgeTrial IDs
Phase IBiomarker/Laboratory analysis, Treatment18 and overPro00031169
NCI-2013-01899, NS20023, NCT01491893

Trial Description

Summary

This phase I trial studies the side effects and best dose of recombinant oncolytic poliovirus PVS-RIPO in treating patients with grade IV malignant glioma that has come back. Vaccines made from a gene-modified virus may help the body build an effective immune response to kill tumor cells.

Further Study Information

PRIMARY OBJECTIVES:

I. To determine the maximally tolerated dose (MTD) or optimal dose of PVSRIPO (recombinant oncolytic poliovirus PVS-RIPO) when delivered intracerebrally by convection-enhanced delivery.

SECONDARY OBJECTIVES:

I. To obtain correlative mechanistic evidence for PVSRIPO’s effects on infected World Health Organization (WHO) grade IV malignant glioma tumors and to estimate progression free survival (PFS) and overall survival (OS) in recurrent WHO grade IV malignant glioma patients.

II. To obtain information about clinical response rates to intratumoral inoculation of PVSRIPO.

III. To estimate the efficacy of PVSRIPO administered at the optimal dose.

OUTLINE: This is a dose-escalation study.

Patients receive recombinant oncolytic poliovirus PVS-RIPO intratumorally over approximately 6.5 hours in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 2, 4, 8, 16, 24, 32, 40 and 48 weeks.

Eligibility Criteria

Inclusion Criteria:

A signed informed consent form approved by the Duke University Institutional Review Board (IRB) will be required for patient enrollment into the study; patients must be able to read and understand the informed consent document and must sign the informed consent indicating that they are aware of the investigational nature of this study

At the time of biopsy, prior to administration of virus, the presence of recurrent tumor must be confirmed by histopathological analysis of frozen sections

The patient must have received a boost immunization with trivalent inactivated IPOL™ (poliovirus vaccine inactivated) (Sanofi-Pasteur) at least 2 weeks prior to administration of the study agent

Hemoglobin >= 9

Neutrophil count >= 1000

Alkaline phosphatase =< 2.5 x normal

Serum glutamic oxaloacetic transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT) =< 2.5 x normal

Total bilirubin =< 2.5 x normal

Positive serum anti-poliovirus titer

Prothrombin and partial thromboplastin times =< 1.2 x normal

Platelet count >= 125,000/ul

The patient must have a Karnofsky performance score (KPS) of >= 70% at the time of entry

Patients may be included in the study independent of the regimen of previous surgical, radiation, or chemotherapy treatments administered; however, the exclusions listed below must be followed

Patients must have a recurrent supratentorial WHO grade IV malignant glioma based on imaging studies with measurable disease (>= 1 cm and =< 5.5 cm of contrast-enhancing tumor); prior histopathology consistent with a World Health Organization (WHO) grade IV malignant glioma confirmed by the study pathologist, Roger McLendon, or his designate

Creatinine =< 1.2 x normal

Exclusion Criteria:

Patients with prior, unrelated malignancy requiring current active treatment with the exception of cervical carcinoma in situ and adequately treated basal cell or squamous cell carcinoma of the skin

Patients with worsening steroid myopathy (history of gradual progression of bilateral proximal muscle weakness, and atrophy of proximal muscle groups)

Patients on greater than 4 mg per day of dexamethasone within the 2 weeks prior to PVSRIPO infusion

Patients must not have diagnosis of agammaglobulinemia; patients with the following will be excluded:

Immunoglobulin G (IgG) levels < 400 mg/dL (4 g/L)

Undetectable anti-tetanus toxoid IgG

Known history of agammaglobulinemia

Patients with neoplastic lesions in the brainstem, cerebellum or spinal cord, radiological evidence of multifocal disease, or leptomeningeal disease; patients with evidence of diffuse subependymal disease or tumor in the brainstem, cerebellum, spinal cord, or cerebrospinal fluid (CSF) will be excluded

Patients with radiological evidence of active (growing) multifocal disease, tumors extending into or crossing the corpus callosum or leptomeningeal disease, will be excluded

Patients who have not recovered from the toxic effects of prior chemotherapy and/or radiation therapy will be excluded; guidelines for this recovery period are dependent upon the specific therapeutic agent being used:

Patients may not have received chemotherapy or bevacizumab =< 4 weeks (except for nitrosourea [6 weeks] or metronomic dosed chemotherapy such as daily etoposide or cyclophosphamide [1 week]) prior to starting the study drug unless patients have recovered from side effects of such therapy

Patients may not have received immunotherapy =< 4 weeks prior to starting the study drug unless patients have recovered from side effects of such therapy

Patients may not have received investigational drugs =< 4 weeks prior to starting the study drug unless patients have recovered from side effects of such therapy

Patients must have completed all standard of care treatments including resection and concurrent chemo-radiation prior to participating in this trial

A history of neurological complications due to poliovirus infection

Patients with an impending, life-threatening cerebral herniation syndrome, based on the assessment of the study neurosurgeons, Allan Friedman or John Sampson, or their designate, will be excluded

Females who are pregnant or breast-feeding during the study period will be excluded; adults of reproductive potential not employing an effective method of birth control will be excluded; sexually active women of child bearing potential, whose partner is male, must use two forms of IRB approved birth control; one method must be a barrier method

Sexually active men, whose partner is a female of child bearing potential, must use a barrier method of contraception and either have had a vasectomy or use spermicide

If patients meet any of the following they will be excluded:

Active infection requiring treatment or having an unexplained febrile illness (temperature maximum [Tmax] > 99.5 Fahrenheit [F]/37.5 Celsius [C])

Known immunosuppressive disease or known human immunodeficiency virus infection

Unstable or severe intercurrent medical conditions such as severe heart (New York Heart Association class 3 or 4) or lung (forced expiratory volume in 1 second [FEV1] < 50%) disease, uncontrolled diabetes mellitus

Albumin allergy; patients with a known allergy will be excluded

Gadolinium allergy

Trial Contact Information

Trial Lead Organizations / Sponsors / Collaborators

Duke University Medical Center

  • National Cancer Institute
Allan Howard Friedman, Principal Investigator

Trial Sites

U.S.A.

North Carolina
Durham

Duke University Medical Center

Allan Howard Friedman
Ph: 919-681-6421
Email: fried010@mc.duke.edu

Allan Howard Friedman
Principal Investigator

Link to the current ClinicalTrials.gov record.
NLM Identifer NCT01491893

Note: Information about participating sites on pharmaceutical industry trials may be incomplete. Please visit the ClinicalTrials.gov record via the link above for more information about participating sites.