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History of Changes for Study: NCT03152318
A Study of the Treatment of Recurrent Malignant Glioma With rQNestin34.5v.2
Latest version (submitted August 7, 2023) on ClinicalTrials.gov
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Study Record Versions
Version A B Submitted Date Changes
1 May 12, 2017 None (earliest Version on record)
2 July 18, 2017 Recruitment Status, Study Status and Contacts/Locations
3 March 15, 2018 Study Status
4 April 9, 2018 Arms and Interventions, Conditions, Study Description, Study Status, Eligibility, Study Design and Study Identification
5 July 18, 2018 Study Status and Sponsor/Collaborators
6 August 11, 2019 Study Status and Eligibility
7 January 31, 2020 Study Status
8 December 7, 2020 Study Status
9 August 9, 2021 Study Status, Eligibility and Study Design
10 August 3, 2022 Recruitment Status, Study Status, Contacts/Locations and Study Design
11 October 6, 2022 Study Status
12 October 19, 2022 Arms and Interventions, Conditions and Study Status
13 October 24, 2022 Recruitment Status, Contacts/Locations, Study Design, Study Status, Arms and Interventions and Eligibility
14 January 10, 2023 Study Status and Sponsor/Collaborators
15 August 7, 2023 Contacts/Locations and Study Status
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Study NCT03152318
Submitted Date:  May 12, 2017 (v1)

Open or close this module Study Identification
Unique Protocol ID: 16-557
Brief Title: A Study of the Treatment of Recurrent Malignant Glioma With rQNestin34.5v.2
Official Title: A Phase I Study of the Treatment of Recurrent Malignant Glioma With rQNestin34.5v.2, a Genetically Engineered HSV-1 Virus, and Immunomodulation With Cyclophosphamide
Secondary IDs:
Open or close this module Study Status
Record Verification: May 2017
Overall Status: Not yet recruiting
Study Start: June 1, 2017
Primary Completion: April 1, 2020 [Anticipated]
Study Completion: August 1, 2023 [Anticipated]
First Submitted: May 9, 2017
First Submitted that
Met QC Criteria:
May 12, 2017
First Posted: May 15, 2017 [Actual]
Last Update Submitted that
Met QC Criteria:
May 12, 2017
Last Update Posted: May 15, 2017 [Actual]
Open or close this module Sponsor/Collaborators
Sponsor: Dana-Farber Cancer Institute
Responsible Party: Principal Investigator
Investigator: E. Antonio Chiocca
Official Title: Principal Investigator
Affiliation: Dana-Farber Cancer Institute
Collaborators: National Institutes of Health (NIH)
Open or close this module Oversight
U.S. FDA-regulated Drug: Yes
U.S. FDA-regulated Device: No
Data Monitoring: Yes
Open or close this module Study Description
Brief Summary: This research study is evaluating an investigational drug called rQNestin34.5v.2. This research study is a Phase I clinical trial, which tests the safety of an investigational drug and also tries to define the appropriate dose of the investigational drug as a possible treatment for this diagnosis of recurrent or progressive brain tumor.
Detailed Description:

This research study is a Phase I clinical trial, which tests the safety of an investigational drug and also tries to define the appropriate dose of the investigational drug as a possible treatment for this diagnosis. "Investigational" means that the intervention is being studied.

The FDA (the U.S. Food and Drug Administration) has not approved rQNestin34.5v.2 as a treatment for any disease. This is the first time that rQnestin34.5v.2 will be given to humans.

The research drug, rQNestin34.5v.2, is made from the herpes simplex virus type 1 (HSV1). The large majority of humans already have regular HSV1 in their nervous system. Normally, this virus can cause cold sores in areas like the lips, fingers and genitals in humans by making copies of itself in normal healthy cells. In some cases, HSV1 can cause severe infection of the brain and liver and/or death. However, scientists have removed or changed parts of the rQNestin virus being used on this study so it can only make copies of itself in glioma cells and not normal healthy cells.

If it is effective, the rQNestin34.5v.2 drug will spread to a glioma cell, kill it, and then make a copy of itself and spread again. This should be repeated over and over until all glioma cells are reached. If rQNestin34.5v.2 moves into a normal brain cell, it should not grow and make copies, and therefore should not spread to other normal brain cells.

The purpose of this research study is to test if rQnestin34.5v.2 is safe to use in humans, and if it is effective in treating malignant glioma. This study is also looking for the highest dose of rQNestin34.5v.2 that can be given safely to people with malignant brain tumors.

Open or close this module Conditions
Conditions: Malignant Glioma of Brain
Astrocytoma
Malignant Astrocytoma
Oligodendroglioma
Anaplastic Oligodendroglioma of Brain (Diagnosis)
Mixed Oligo-Astrocytoma
Ependymoma
Ganglioglioma
Pylocytic/Pylomyxoid Astrocytoma
Keywords: Malignant Glioma
Open or close this module Study Design
Study Type: Interventional
Primary Purpose: Treatment
Study Phase: Phase 1
Interventional Study Model: Sequential Assignment
phase I, open-label, single center, dose-escalation, double arm clinical trial.
Number of Arms: 2
Masking: None (Open Label)
Allocation: Non-Randomized
Enrollment: 108 [Anticipated]
Open or close this module Arms and Interventions
Arms Assigned Interventions
Experimental: Arm A- rQNestin

Arm A is rQNestin34.5v.2 treatment This study follows a standard 3+3 dose escalation design. Participants will not enroll to Arm B until the MTD or HTD has been met for Arm A.

  • Subjects with presumed radiologic evidence of recurrent malignant glioma will undergo stereotactic biopsy under monitored general or local anesthesia. Evidence of recurrent high grade or malignant must be found on frozen section for the person to receive administration of the agent.
  • rQNestin34.5v.2 Indicated dose as per cohort, Intratumor administration during surgery, single dose
Drug: rQNestin34.5v.2
Intratumor administration over 5 minutes, Indicated dose as per cohort, Single dose on day of surgery (day 0).
Procedure: Stereotactic biopsy
In both arms, subjects will go to the intraoperative MRI operating room. The stereotactic needle will be placed stereotactically into the tumor bed using intraoperative MRI guidance
Experimental: Arm B- rQNestin+CPA

Arm B is rQNestin34.5v.2 treatment with Cyclophosphamide (CPA) pre-treatment This study follows a standard 3+3 dose escalation design. Participants will not enroll to Arm B until the MTD or HTD has been met for Arm A.

  • Cyclophosphamide one intravenous injection 2 days prior to procedure.
  • Subjects with presumed radiologic evidence of recurrent malignant glioma will undergo stereotactic biopsy under monitored general or local anesthesia. Evidence of recurrent high grade or malignant must be found on frozen section for the person to receive administration of the agent.
  • rQNestin34.5v.2 Indicated dose as per cohort, Intratumor administration during surgery, single dose
Drug: rQNestin34.5v.2
Intratumor administration over 5 minutes, Indicated dose as per cohort, Single dose on day of surgery (day 0).
Drug: Cyclophosphamide
Single dose 2 days (+/- 6 hrs) before administration of rQNestin34.5v.2
Other Names:
  • Cytoxan®
  • Neosar®
Procedure: Stereotactic biopsy
In both arms, subjects will go to the intraoperative MRI operating room. The stereotactic needle will be placed stereotactically into the tumor bed using intraoperative MRI guidance
Open or close this module Outcome Measures
Primary Outcome Measures:
1. Maximum Tolerated Dose
[ Time Frame: Minimum of 21 Days ]

The primary objective is to determine the maximum tolerated dose of rQNestin34.5v.2 injected into recurrent malignant gliomas, with or without previous immunomodulation with cyclophosphamide.
Secondary Outcome Measures:
1. MRI Changes in Permeability
[ Time Frame: Evaluated every 2 months for 1 year ]

Determine MRI alterations of permeability in injected sites using standard perfusion sequences.
2. MRI Changes in Volume
[ Time Frame: Evaluated every 2 months for 1 year ]

Determine MRI alterations of cerebral blood volume in injected sites using standard sequences.
3. MRI Changes in Flow
[ Time Frame: Evaluated every 2 months for 1 year ]

Determine MRI alterations of cerebral blood flow in injected sites using standard sequences.
4. Viral Shedding in Saliva
[ Time Frame: Evaluated up to day 56 for each subject ]

Assess the shedding of rQNestin34.5v.2 in the saliva of subjects treated with rQNestin34.5v.2
5. HSV1 Viremia
[ Time Frame: Evaluated up to day 56 for each subject ]

Assess the degree of HSV-1 viremia post rQNestin34.5v.2 administration
6. HSV1 Antibody Response
[ Time Frame: Evaluated up to day 56 for each subject ]

Identify changes in HSV1 antibody response
Open or close this module Eligibility
Minimum Age: 18 Years
Maximum Age:
Sex: All
Gender Based:
Accepts Healthy Volunteers: No
Criteria:

Inclusion Criteria:

  • At the time of surgery, frozen biopsy confirmation of high grade or malignant glioma by neuropathologist. To be confirmed at time of surgery, after registration in OnCore.
  • Participants must have prior diagnosis of glioma (astrocytoma, malignant astrocytoma, oligodendroglioma, anaplastic oligodendroglioma, mixed oligo-astrocytoma), exclusive of ependymoma, ganglioglioma, pylocytic/pylomyxoid astrocytoma as confirmed by a neuropathologist or by a previous local pathology report.
  • Prior history of external beam radiotherapy ≥ 5,000 cGy delivered to the tumor at least 4 weeks prior to QACT registration;
  • Prior history of temozolomide chemotherapy provided concurrent to external beam radiotherapy and after as per current standard of care. At least 8 weeks must have passed from the last dose of temozolomide and first dose of cyclophosphamide and/or rQNestin34.5v.2;
  • If participant was treated with bevacizumab, at least 4 weeks must elapse before treatment with either agent (Cyclophosphamide or rQNestin34.5v.2);
  • Recurrent lesion must be ≥ 1.0 cm in diameter as determined by MRI;
  • Normal hematological, renal and liver function as defined below: Leukocytes ≥3,000/mcL; Absolute lymphocyte count > 800/ mcL; Absolute neutrophil count ≥1,500/mcL; platelets ≥100,000/mcL; PT or PTT <1.5 x institutional upper limit; Hemoglobin >10.0 g/dL; Total serum bilirubin within normal institutional limits; AST(SGOT)/ALT(SGPT) ≤2.5 × institutional upper limit of normal; Serum creatinine within normal institutional limits OR Creatinine clearance ≥60 mL/min/1.73 m2 for participants with creatinine levels above institutional normal;
  • Karnofsky Performance Score ≥70.
  • Age≥ 18 years;
  • Ability to understand and the willingness to sign a written informed consent document;
  • The effects of rQNestin34.5v.2 and cyclophosphamide on the developing human fetus are unknown. For this reason and because cytotoxic & immunomodulating agents as well as other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation including 3 months following the study. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study and for the duration of study participation including 3 months following the study. Women of child-bearing potential must have a negative serum pregnancy test within 48 hours of study registration.
  • Steroid regimen stable or decreasing for at least 7 days prior to inoculation;
  • Ability to undergo MRI scanning with contrast;
  • Subjects with any recurrence (first, second, third, etc recurrence) will be able to be enrolled.

Exclusion Criteria:

Participants who exhibit any of the following conditions prior to initiating study treatment will not be eligible for this study:

  • Participants with significant renal or liver disease
  • Participants with progressive systemic malignancy.
  • Known chronic infections with HIV, hepatitis B or C; participants with a history of resolved Hepatitis A may be included in the trial.
  • Participants with active viral, bacterial or fungal infection requiring concurrent antiviral or antibiotics.
  • Subjects with active HSV1 infection on current valacyclovir, acyclovir or ganciclovir therapy must be off treatment with any of these agents at least 7 days prior to surgery.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to cyclophosphamide (only for arm B).
  • Active, known, or suspected immunosuppressive disorders, such as acquired or congenital immune deficiency syndromes and autoimmune diseases
  • Unacceptable anesthesia risk
  • Serious cardiopulmonary medical condition
  • Pregnant or lactating females
  • Recurrent glioma where injection in either arm A or B of the biologic agent would require access and/or considerable spillage into the ventricular system.
  • Prior participant in another protocol using an investigational agent or device within 6 weeks of the first dose of rQNestin34.5v.2.
  • Known HIV seropositivity.
  • Concurrent therapy with drugs active against HSV (acyclovir, valaciclovir, penciclovir, famciclovir, ganciclovir, foscarnet, cidofovir). Participants must be off treatment with these agents for at least 7 days prior to surgery.
  • Active oral or genital herpes lesions.
  • Participants who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier.
  • Participants who are receiving any other investigational agents.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Participants with tumor ≤ 1 cm proximity to the ventricles will be excluded. This criterion is only applicable for the initial 6 subjects enrolled to study. After 6 subjects have been successfully enrolled, participants with tumor ≤ 1 cm proximity to the ventricles will be allowed to enroll however the study agent (rQNestin34.5v.2) may not be injected in any area that is within 1 cm of the ventricle regardless of where the tumor is located.
Open or close this module Contacts/Locations
Central Contact Person: E. Antonio Chiooca, MD, PhD
Telephone: 617-732-6939
Email: echiocca@partners.org
Study Officials: E. Antonio Chiocca, MD, PhD
Principal Investigator
Brigham and Women's Hospital
Locations: United States, Massachusetts
Dana Farber Cancer Institute
Boston, Massachusetts, United States, 02115
Contact:Principal Investigator: E.Antonio Chiocca, MD, PhD
Brigham and Women's Hospital
Boston, Massachusetts, United States, 02215
Contact:Contact: E. Antonio Chiocca, MD, PhD 617-732-6939 echiocca@partners.org
Contact:Principal Investigator: E. Antonio Chiocca, MD, PhD
Open or close this module IPDSharing
Plan to Share IPD: No
Open or close this module References
Links:
Available IPD/Information:

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