Open-Label Proof of Concept Study of VP-315 in Basal Cell Carcinoma

• ClinicalTrials.gov Identifier: NCT05188729
• Recruitment Status: Recruiting
• First Posted: January 12, 2022
• Last Update Posted: August 1, 2023
• Sponsor: Verrica Pharmaceuticals Inc.
• Collaborators: Instat Clinical Research; HeartcoR Solutions; Myonex; Vial Health Technology, Inc
• Information provided by (Responsible Party): Verrica Pharmaceuticals Inc.

Study Description

Brief Summary:

This is a 2-part, open-label, multicenter, dose-escalation, proof-of-concept study with a safety run-in designed to assess the safety, tolerability, MTD, and objective antitumor efficacy of ascending dose strengths of VP-315 when administered intratumorally to adults with biopsy proven basal cell carcinoma (BCC).

The study is expected to enroll approximately 80 subjects with a histological diagnosis of BCC in at least 1 eligible target lesion (confirmed by punch or shave biopsy).

Condition or disease	Intervention/treatment	Phase
Basal Cell Carcinoma; Skin Cancer; Cancer of the Skin, Basal Cell; Cancer of the Skin; Carcinoma	Drug: LTX-315 Part 1; Drug: VP-315 Part 2	Phase 2

Detailed Description:

This is a 2-part, open-label, multicenter, dose-escalation, proof-of-concept study with a safety run-in designed to assess the safety, tolerability, maximum tolerated dose (MTD), and objective antitumor efficacy of ascending dose strengths of VP-315 when administered intratumorally to adults with biopsy proven BCC.

The study is expected to enroll approximately 80 subjects with a histological diagnosis of BCC in at least 1 eligible target lesion (confirmed by punch or shave biopsy).

All enrolled subjects will receive VP-315 intradermal injection on an outpatient basis into up to 2 target lesions. In all Parts of the study (1 or 2, as below), each 7-day treatment week comprises up to 3 consecutive treatment days followed by a no-treatment period of at least 4 days. Dosing will commence in a single target lesion. Once a lesion is observed to be fully necrotic (Part 1, Part 2; Cohorts 1-2 only), treatment of that lesion stops, and treatment of subsequent target lesions (up to 2 total) may continue on Day 1 of the following week. In Part 2, Cohorts 4 and 5, treatment of a second target lesion begins on W2D1 (not based on status of necrosis of target lesion 1).

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 80 participants
• Allocation: Non-Randomized
• Intervention Model: Sequential Assignment
• Intervention Model Description: This is an open-label, multicenter, dose-escalating study. Eligible subjects will be enrolled sequentially.
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 2, Multicenter, Open-label, Proof-of-concept Study With Safety Run-in to Evaluate the Safety, Pharmacokinetics, and Efficacy of VP-315 in Adult Subjects With Basal Cell Carcinoma
• Actual Study Start Date: February 1, 2022
• Estimated Primary Completion Date: June 30, 2024
• Estimated Study Completion Date: June 30, 2024

Arms and Interventions

Arm	Intervention/treatment
Experimental: Part 1 LTX-315 Safety Run-in; Part 1: Starting total daily dose of LTX-315 will be 2 mg for the first subject. Subjects will receive ascending once daily doses increasing in 1 mg increments for up to 3 days in a 7-day treatment week until the first lesion is necrosed or a DLT occurs	Drug: LTX-315 Part 1; LTX-315 once-daily dosing; starting total daily dose of 2 mg for the first subject. Ascending once-daily 1 mg dosing increments (eg, 2 mg on Day 1, 3 mg on Day 2). Subjects may be treated for a maximum of 2 weeks and a maximum total daily dose of 8 mg in Part 1. The starting dose will be escalated between subject cohorts in 1-mg increments after the previous cohort has completed Week 1 dosing (the DLT observation period).; Other Name: VP-315
Experimental: Part 2 VP-315 Regimen Finding; Part 2: VP-315 once-daily dosing; total daily dose of 8 mg in up to 5 cohorts; Cohort 1: VP-315 once-daily dosing of 8 mg with half the target dose of 8 mg only on W1D1; all remaining doses will be the full target dose; Cohort 2: VP-315 once-daily dosing of 8 mg on all treatment days for up to 3 consecutive daily doses/week.; Cohort 3: has been removed, advance from Cohort 2 to 4 and 5. Cohorts 4 and 5, the total daily dose of VP-315 (8.0 mg) will be divided into a split dose; the first dose is not to exceed 2.4 mg (30% of 8 mg dose), and the remaining dose will not exceed 5.6 mg (70% of 8 mg dose) and administered 15 minutes apart (not to exceed 30 minutes).; Cohort 4: (Two times weekly dosing) VP-315 once-daily dosing of 8 mg, administered on 2 consecutive days in one week.; Cohort 5: (Three times weekly dosing) VP-315 once-daily dosing of 8 mg, administered on 3 consecutive days in one week. PK data will be collected in the Cohorts 4 and 5 expansion groups.	Drug: VP-315 Part 2; VP-315 once-daily dosing; Part 2 will be initiated upon completion of Part 1 to determine the optimal dosing regimen of VP-315. There were no DLTs observed in Part 1 of the study and the maximum dose of 8 mg was achieved. Therefore, the dose to be evaluated in Part 2 will be a total daily dose of 8 mg in 4 Cohorts.; Other Name: LTX-315

Outcome Measures

Primary Outcome Measures :

1. Part 1: Percentage of subjects with discontinuations due to adverse events [ Time Frame: Up to 9 weeks ]
   Subjects who discontinued the study due to adverse event
2. Part 1: Percentage of subjects with dose-limiting toxicities (DLTs) [ Time Frame: Day 4 (Safety Assessment) ]
   Subjects with pre-determined dose-limiting toxicities such as hypotension (specific criteria); significant elevation of serum tryptase; Grade 2 or higher adverse event (with specific criteria)
3. Part 1: Percentage of subjects with Cutaneous Reaction by severity [ Time Frame: Up to 9 weeks ]
   Evaluation of the tissue condition at the treatment site for the presence and severity of each of the following cutaneous reactions; Erythema, Induration, Swelling, Blister Formation, Desquamation, Erosion, Ulceration, Necrosis by a scale of None; Mild; Moderate; Severe.
4. Part 2: Percent of subjects with adverse events [ Time Frame: Up to 15 weeks ]
   Subjects with adverse events
5. Part 2: Percentage of subjects with discontinuations due to adverse events [ Time Frame: Up to 15 weeks ]
   Subjects that discontinued study due to adverse events
6. Part 2: Percent of subjects with Treatment Related Adverse Events of Special Interest (TRAEs SI) [ Time Frame: Treatment Week 1 Day 1 ]
   Subjects with pre-determined TRAEs of SI such as hypotension (specific criteria); significant elevation of serum tryptase; Grade 2 or higher adverse event (with specific criteria)
7. Part 2: Percent of subjects with Treatment Related Adverse Events of Special Interest (TRAEs SI) [ Time Frame: Treatment Week 1 Day 2 ]
   Subjects with pre-determined TRAEs of SI such as hypotension (specific criteria); significant elevation of serum tryptase; Grade 2 or higher adverse event (with specific criteria)
8. Part 2: Percent of subjects with Treatment Related Adverse Events of Special Interest (TRAEs SI) [ Time Frame: Treatment Week 1 Day 3 ]
   Subjects with pre-determined TRAEs of SI such as hypotension (specific criteria); significant elevation of serum tryptase; Grade 2 or higher adverse event (with specific criteria)
9. Part 2: Percent of subjects with Treatment Related Adverse Events of Special Interest (TRAEs SI) [ Time Frame: Treatment Week 2 Day 1 ]
   Subjects with pre-determined TRAEs of SI such as hypotension (specific criteria); significant elevation of serum tryptase; Grade 2 or higher adverse event (with specific criteria)
10. Part 2: Percent of subjects with Treatment Related Adverse Events of Special Interest (TRAEs SI) [ Time Frame: Treatment Week 2 Day 2 ]
    Subjects with pre-determined TRAEs of SI such as hypotension (specific criteria); significant elevation of serum tryptase; Grade 2 or higher adverse event (with specific criteria)
11. Part 2: Percent of subjects with Treatment Related Adverse Events of Special Interest (TRAEs SI) [ Time Frame: Treatment Week 2 Day 3 ]
    Subjects with pre-determined TRAEs of SI such as hypotension (specific criteria); significant elevation of serum tryptase; Grade 2 or higher adverse event (with specific criteria)
12. Part 2: Percentage of subjects with Cutaneous Reaction by severity [ Time Frame: Up to 105 days ]
    Evaluation of the tissue condition at the treatment site for the presence and severity of each of the following cutaneous reactions; Erythema, Induration, Swelling, Blister Formation, Desquamation, Erosion, Ulceration, Necrosis by a scale of None; Mild; Moderate; Severe.

Secondary Outcome Measures :

1. Part 2: Percentage of subjects with clinical clearance of treated lesion(s) at excision [ Time Frame: Day 84-91 ]
   Clinical clearance of treated lesion at excision as determined by visual assessment (no residual tumor seen on visual inspection)
2. Part 2: Percentage of subjects with histological clearance of treated lesion(s) at excision [ Time Frame: Day 84-91 ]
   Subjects with histological clearance of treated lesion(s) at excision
3. Part 2: Percentage of subjects with abscopal effect at excision [ Time Frame: Day 84-91 ]
   Abscopal effect as determined by clinical and histological clearance of nontreated lesions at excision
4. Part 2: Mean estimated remaining tumor volume at excision [ Time Frame: Day 84-91 ]
   Estimate of remaining tumor volume (necrotic cells:tumor cells) at excision
5. Part 2: Percent of subjects with Physician's Global Assessment by scale [ Time Frame: Up to 105 days ]
   Physician's global assessment of improvement per lesion as measured by the following scale: 100% improvement, no visible tumor; 75% to <100% improvement; 50% to <75% improvement; 25% to <50% improvement; up to 25% improvement; no change; worse
6. Part 2 (Cohorts 4 and 5 expansion groups): Plasma concentrations of VP-315 [ Time Frame: Day 1-2 ]
   Pharmacokinetics (PK) of an 8 mg dose of VP-315 administered with the optimal dosing regimen

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Adults ≥18 years of age
2. Clinically suspected BCC with at least 1 and up to 5 eligible lesion(s) suitable for biopsy and excision
3. Willing to refrain from using nonapproved topical agents on, or within 2 cm of, the target BCC lesions and surrounding areas during the treatment period. Subjects should use topical agents that are gentle (eg, Aquaphor, CeraVe) and will not irritate the skin in these areas.
4. Willing to refrain from exposure to direct sunlight or ultraviolet light and to avoid the use of tanning parlors for the duration of the study
5. Written informed consent obtained, including consent for tissue to be examined by the central dermatopathologist and stored by the Sponsor or designee
6. Willing to undergo BCC surgical excision procedure of target and nontarget BCC lesions after study treatment
7. Willing to delay surgical excision of target and nontarget BCC lesions until the end of treatment (EOT) visit
8. Provides written consent to allow photographs of the target and nontarget BCC lesion to be used as part of the study data
9. Willing to practice a highly effective method of birth control while on study and until 4 weeks after the last treatment. Highly effective birth control includes sexual abstinence, vasectomy, bilateral tubal ligation/occlusion, or a condom with spermicide (men) combined with hormonal birth control or intrauterine device in women.

BCC Lesion Inclusion Criterion

1. For punch biopsies: the size of the lesion(s) must be ≥0.5 cm and </=2 cm in the longest diameter prior to punch biopsy.
2. Histological diagnosis of nodular, micronodular, or superficial BCC, as confirmed by punch or shave biopsy performed within 28 days of W1D1. (NOTE: HISTORICAL punch or shave biopsies are acceptable, provided that the biopsy was performed according to clinical standard of care and was collected within the 28 days prior to Screening.)

Exclusion Criteria:

1. Presence of known or suspected systemic cancer
2. Treatment with systemic chemotherapeutic agents within the 6 months prior to the screening visit
3. Treatment with systemic immunotherapy, immunomodulators or immunosuppressants within the 12 weeks prior to the screening period
4. Genetic or nevoid conditions (eg, Gorlin / basal cell nevus syndrome, xeroderma pigmentosum)

5. Clinically significant laboratory values, as assessed by the investigator, for the tests listed in the Schedule of Assessments, including:

   1. serum creatinine >1.5× the upper limits of normal and
   2. serum tryptase concentration >11.4 ng/mL

6. Chronic medical condition that in the judgment of the investigator(s) would interfere with the performance of the study or would place the subject at undue risk, such as, but not limited to:

   1. Uncontrolled infection or infection requiring antibiotics
   2. Uncontrolled cardiac failure: Classification III or IV New York Heart Association
   3. History of cerebrovascular or cardiac disorders, or subjects at particular risk of sequelae following a short hypotensive episode, including subjects with systolic BP <110 mmHg and/or diastolic BP <70 mmHg at screening or Day 1
   4. Uncontrolled systemic or gastrointestinal inflammatory conditions
   5. Known bone marrow dysplasia
   6. History of positive tests for human immunodeficiency virus/acquired immunodeficiency syndrome or active hepatitis B or C
   7. History of systemic autoimmune disease requiring anti-inflammatory or immunosuppressive therapy within 3 months prior to Day 1, with the following exceptions:

   i. Subjects with a history of autoimmune thyroiditis are eligible provided the subject requires only thyroid hormone replacement therapy and disease has been stable for ≥1 year

   ii. Subjects with well-controlled type I diabetes (in the opinion of the investigator) are eligible

   h. Known mast cell activation syndrome, mastocytosis, or chronic idiopathic urticaria

7. Known sensitivity to any of the ingredients in the study medication
8. Elective surgery within 4 weeks prior to the screening visit, during the study, or 4 weeks after the treatment period
9. Evidence of current chronic alcohol or drug abuse
10. Current enrollment in an investigational drug or device study or participation in such a study within 4 weeks of the screening visit
11. In the investigator's opinion, evidence of unwillingness, or inability to follow the restrictions of the protocol and complete the study
12. Females who are pregnant or breastfeeding

BCC Lesion Exclusion Criteria

1. Recurrent or previously treated lesions
2. Lesions within 1 cm of the eyelids or lips, or on the hands, feet, ears, nose, and genitalia
3. Histological evidence of any other tumor in the biopsy specimen
4. Histological evidence of infiltrative, desmoplastic, sclerosing, or morpheaform BCC subtypes in the biopsy specimen

5. Medium- and high-risk basal cell carcinomas as defined by the National Comprehensive Cancer Network (NCCN) or Mohs Appropriate Use Criteria (ie, BCCs eligible for Mohs surgery).

   TARGET LESION EXCLUSION ONLY:

6. For subjects with severe stasis dermatitis, target BCC lesions may not be on the lower extremities

7. Within 2 cm of the target BCC lesion(s):

   1. Treatment with the following topical agents within the 12 weeks prior to the screening visit: aminolevulinic acid, 5-fluorouracil, corticosteroids, diclofenac, imiquimod, ingenol mebutate
   2. Treatment with surgical excision, or curettage within the 2 weeks prior to the screening visit
   3. Evidence of dermatological disease or confounding skin condition that may interfere with clinical evaluation (ie, psoriasis, atopic dermatitis, eczema, propensity to form keloids or hypertrophic scarring)
   4. Use of topical immunomodulators during study
8. Within 5 cm of the target BCC lesion(s): history of any skin cancer, except for other currently identified target and nontarget BCC lesions
9. Target BCC lesion is in the area of prior resurfacing procedure with CO2 laser or any photodynamic and phototherapy treatment within the 3 months prior to the screening visit

Contacts and Locations

Contacts

Contact: Wendy Pinson; (504)732-4588; Wendy@vial.com

Locations

United States, California

Therapeutics Clinical Research; Recruiting

San Diego, California, United States, 92123

Contact 858-571-6800

Principal Investigator: Neal D Bhatia, MD

United States, Florida

Florida Center for Dermatology; Recruiting

Saint Augustine, Florida, United States, 32080

Contact research@fcderm.com

Principal Investigator: Jonathan Kantor, MD

United States, Georgia

Gwinnett Dermatology; Recruiting

Snellville, Georgia, United States, 30078

Principal Investigator: Jonathan S Weiss, MD

United States, Maryland

Lawrence J Green, MD LLC; Active, not recruiting

Rockville, Maryland, United States, 20850

United States, Texas

Austin Institute of Clinical Research - Dripping Springs; Recruiting

Dripping Springs, Texas, United States, 78620

Principal Investigator: Daniel Carrasco, MD

Austin Institute of Clinical Research - Pflugerville; Recruiting

Pflugerville, Texas, United States, 78660

Principal Investigator: Edward Lain, MD

Sponsors and Collaborators

Verrica Pharmaceuticals Inc.

Instat Clinical Research

HeartcoR Solutions

Myonex

Vial Health Technology, Inc

Investigators

• Principal Investigator: Neal Bhatia, MD; Therapeutics Clinical Research

More Information

• Responsible Party: Verrica Pharmaceuticals Inc.
• ClinicalTrials.gov Identifier: NCT05188729
• Other Study ID Numbers: VP-315-201
• First Posted: January 12, 2022
• Last Update Posted: August 1, 2023
• Last Verified: July 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Verrica Pharmaceuticals Inc.:

Skin Cancer; BCC; Neoplasm; Epithelial

Additional relevant MeSH terms:

Carcinoma; Carcinoma, Basal Cell; Skin Neoplasms; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Neoplasms, Basal Cell; Neoplasms by Site; Skin Diseases