blessed: expanded access for dng64 for advanced pancreatic cancer, sarcoma and carcinoma of breast

Conditions: Pancreatic Cancer; Osteosarcoma; MPNST (Malignant Peripheral Nerve Sheath Tumor); Chondrosarcoma; Soft Tissue Sarcoma; Chordoma; Sarcoma; Carcinoma of Breast

Summary: forty patients with pancreatic cancer, sarcoma and carcinoma of breast will receive dng64 intravenously at a dose of 1-4 x 10e11 colony forming units (cfu) or equivalent 1.0-6.0 x 10e10 rv copies per dose one to three times a week. dng64 may be given alone or with one or more fda approved cancer therapies/immunotherapies. based on previous phase 1/2 us based clinical studies, dng64 does not suppress the bone marrow or cause organ dysfunction, and enhanced immune cell trafficking in tumors may cause the tumors to appear larger or new lesions to appear on ct, pet or mri. further, tumor stabilization/regression/remission may occur later during the treatment period. therefore, dng64 will be continued regardless of ct, pet or mri results if the patient has clinical benefit and does not have symptomatic disease progression.

dng64 is a targeted tumor agnostic gene therapy that displays a sig-binding peptide for binding to abnormal collagenous signature (sig) proteins in the tumor microenvironment and encoding a ccng1 inhibitor gene for killing cancer cells, its blood supply and stroma producing fibroblasts, thus reducing extracellular matrix production and augmenting drug entry and immune cell trafficking in tumor microenvironment. enhanced ccng1 expression has been found in all cancer types tested at the cancer center of southern california as of june 2023. hence, in july 2023, the usfda authorized the use of dng64 as platform therapy upon which one or more fda approved cancer drugs/ immunotherapies may be added. this would allow a personalized approach in the treatment of all cancer patients. forty patients with pancreatic cancer, sarcoma and carcinoma of breast will receive dng64 intravenously at a dose of 1-4 x 10e11 colony forming units (cfu) or equivalent 1.0-6.0 x 10e10 rv copies per dose one-three times a week. dng64 may be given alone or with an fda approved cancer therapy/immunotherapy on physician discretion. based on previous phase 1/2 us based clinical studies, dng64 does not suppress the bone marrow or cause serious organ dysfunction, and enhanced immune cell trafficking in tumors may cause the tumors to appear larger or new lesions to appear on ct, pet or mri. further, tumor stabilization/regression/remission may occur later during the treatment period. therefore, dng64 will be continued regardless of ct, pet or mri results if the patient has clinical benefit and does not have symptomatic disease progression. if the patient develops a treatment-related \>grade 3 adverse event, the dng64 infusions will be held and the patient will be monitored until the toxicity has resolved to \<grade 1, and the patient is stable, after which treatment may be resumed. if the adverse event does not resolve to \<grade 1 within 3 weeks, the dng64 treatment will be held until the data are discussed with the food and drug administration and a decision is made whether to continue or terminate the study.

Eligibility criteria:
inclusion criteria: * patient is ≥12 years of age, either male or female for patients with sarcoma; \>18 years of age, either male or female.with pancreatic cancer or carcinoma of breast. * patient has pancreatic cancer or sarcoma or carcinoma of breast confirmed by pathologic examination at diagnosis. * patients with advanced metastatic pancreatic cancer who have received systemic therapies such as folfirinox and gemcitabine + albumin-bound paclitaxel; patients with metastatic sarcoma who have disease progression after two or more lines of systemic treatments and not amenable to surgical resection or radiotherapy; specifically for osteosarcoma: have disease progression after high dose methotrexate, cisplatinum, doxorubicin and ifosfamide; for soft tissue sarcoma: have disease progression after doxorubicin + ifosfamide/mesna, gemcitabine, docetaxel, dacarbazine, trabectedin, pazopanib, eribulin; patients with metastatic carcinoma of breast who have disease progression with standard therapy (act), targeted therapies including aromatase inhibitors, trastuzumab, pertuzumab, enhertu, tyrosine kinase inhibitors, immune checkpoint inhibitors; patient who is intolerant to or declines available therapeutic options after documentation that patient has been informed of the available therapeutic options. * patient is able to understand or is willing to sign a written informed consent. * patient agrees to use barrier contraception during vector infusion period and for 6 weeks after infusion exclusion criteria: * patient is unwilling to provide formal informed consent. * patient is unwilling to use barrier contraception during vector infusion period and for 6 weeks after infusion

Keywords: tumor targeted gene therapy human cyclin g1 inhibitor cell cycle control ccng1 inhibitor