Study of Nab-Paclitaxel and Gemcitabine and Plus/Minus VCN-01 in Patients With Metastatic Pancreatic Cancer

Study Overview
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Brief Summary
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A phase IIb, open-label, randomized study of Nab-Paclitaxel and Gemcitabine and plus/minus VCN-01 in Patients with Metastatic Pancreatic Cancer

Detailed Description
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Multi-center, open label, randomized, 2-parallel arm, phase IIb study of nab-paclitaxel and gemcitabine as SoC plus/minus VCN-01 in patients with metastatic pancreatic cancer. VCN-01 is a genetically modified adenovirus characterised by the presence of four independent genetic modifications on the backbone of the wild-type human adenovirus serotype 5 (HAd5) genome that confer tumor selective replication and antitumor activity. Approximately 92 patients in sites in North America and European Union (EU) will be recruited and randomized in a 1:1 ratio to one of two treatment arms (i.e., approximately 46 patients per treatment arm): Arm 1- (SoC): Nab-paclitaxel and gemcitabine as SoC (28-day cycles). Patients in this arm will not receive the IMP (VCN-01). Arm 2- (VCN-01+ SoC): A maximum of two (2) doses of VCN-01 administrated in combination with nab-paclitaxel and gemcitabine as SoC (28 day cycles with exception of the IMP dose cycles, which will be 35-day cycles). A Data Monitoring Committee (DMC) will be convened at regular intervals to assess safety and to look at OS to determine if the trial can continue.

Official Title
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A Phase IIb, Open-label, Randomized Study of Nab-Paclitaxel and Gemcitabine and Plus/Minus VCN-01 in Patients With Metastatic Pancreatic Cancer

Conditions
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Pancreatic Adenocarcinoma, Metastatic

Intervention / Treatment
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* Drug: Nab-paclitaxel
* Drug: Gemcitabine
* Genetic: VCN-01


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Written informed consent obtained prior to any study-specific procedures or assessments. Male/female patients aged 18 years or over. Patients with histologically or cytologically confirmed, first line metastatic pancreatic adenocarcinoma stage IV de novo, who never received previous systemic treatment for their pancreatic cancer for which the established therapy is nab-paclitaxel/gemcitabine (clinical SoC). All patients must have at least one measurable tumor lesion that can be imaged for assessments determined by RECIST 1.1. Patients willing to comply with the study treatment. Patients with a minimum life expectancy of 5 months. ECOG performance status of 0 or 1. Use of a reliable method of contraception in fertile men and women. Female patients of childbearing potential (i.e., female patients who are not postmenopausal or surgically sterile) must agree to use effective contraception. Male patients must agree to use effective contraception or be surgically sterile. Adequate baseline organ function (hematologic, liver, renal and nutritional) within 1 week of randomization: Hematology: Absolute neutrophil count ≥1.5xE9 /L Hemoglobin ≥9 g/dL Platelets ≥100x109/L Coagulation (*except in patients on anticoagulants): Prothrombin time or international normalized ratio ≤1x upper limit of normal (ULN) Activated partial thromboplastin time ≤1.2xULN Hepatic: Total bilirubin ≤1.5xULN ALT and AST ≤2.5xULN (if there are no liver metastases) ALT and AST <5xULN, and bilirubin <1.5xULN (if there are liver metastases) Renal: • Serum creatinine ≤1.5xULN, and if >1.5xULN: Estimated creatinine clearance >50 mL/min using Cockcroft and Gault formula Nutritional: • Serum Albumin ≥30 g/L Exclusion Criteria: Patients not willing to complete the study procedures for geographic, psychiatric, or social reasons. Active infection or other serious illness or autoimmune disease at the moment of randomization. Treatment with live attenuated vaccines in the last 3 weeks and with the adenovirus type-5 (Ad5)-based COVID-vaccine in the last 12 weeks before the administration of study treatment. Known chronic liver disease (liver cirrhosis, chronic hepatitis). If there is a suspect of hepatic fibrosis, a fibroscan must be performed; patients with a value ≥9.5 kPa will be excluded. Note: Transient elastography (Fibroscan) is a non-invasive method for the assessment of hepatic fibrosis. Treatment with another investigational agent within five of that treatment's half-lives prior to infusion of study treatment. Viral syndrome diagnosed during the 2 weeks before start of study treatment administration. Chronic immunosuppressive therapy, except inhaled corticosteroids, and oral or IV corticosteroids with a dose lower than 10 mg prednisone or equivalent/day (exception: dexamethasone 1 mg/day as maximum). Concurrent malignant hematologic or solid disease. Patients with a prior history of cancer can be allowed if complete remission for at least 3 years. Patients in close contact (e.g., living in same house) with immunosuppressed patients (i.e., patients with chronic immunosuppressive therapy including high dose of corticosteroids, patients with acquired immunodeficiency syndrome (AIDS), and other chronic immune system diseases). Patients with Li Fraumeni syndrome or with previously known retinoblastoma protein pathway germline deficiency. A female patient, who is pregnant or lactating. Patients receiving full-dose anticoagulant therapy or in whom these therapies cannot be withdrawn 2 days prior and 2 days after VCN-01 administration. Patients with uncontrolled coagulopathy should be excluded. Untreated brain metastases and/or leptomeningeal carcinomatosis with progressive symptoms despite corticosteroid coverage. Patients with brain metastases with stable symptoms can be included. Any other condition, disease, metabolic dysfunction (e.g., uncontrolled diabetes mellitus), active or uncontrolled infection/inflammation, physical examination finding, mental state or clinical laboratory finding that would contraindicate participation in the clinical study due to safety concerns or compliance with clinical study procedures. Patients with previous pneumonitis or interstitial lung disease. Patients with pre-existing sensory neuropathy >G1. Patients with known risk factors for bowel perforation, i.e., history of diverticulitis, intra-abdominal abscess, intestinal obstruction or abdominal carcinomatosis. Patients with QT interval corrected by Fridericia (QTcF) assessment >450 ms for men or >470 ms for women and left ventricular ejection fraction (LVEF) evaluation less than 50% measured by ECHO or multigated acquisition scan.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Arm 1-SoC<br>Nab-paclitaxel and gemcitabine as SoC. | Drug: Nab-paclitaxel<br>* Nab-paclitaxel administered as a 30- to 40-minute IV infusion at a rate of 125 mg/m2. Nab-paclitaxel is administered on Day 1, Day 8 and Day 15 of each 28-day cycles.<br>Drug: Gemcitabine<br>* Gemcitabine administered at a rate of 1,000 mg/m2 and infused through a 30-minute IV infusion immediately after the completion of nab-paclitaxel administration as part of SoC. Gemcitabine is administered on Day 1, Day 8 and Day 15 of each 28-day cycles.<br>|
| Experimental: Arm 2 -VCN-01 + SoC<br>A maximum of two (2) doses of VCN-01 administrated as a single IV infusion in combination with nab-paclitaxel and gemcitabine as SoC. | Drug: Nab-paclitaxel<br>* Nab-paclitaxel administered as a 30- to 40-minute IV infusion at a rate of 125 mg/m2. Nab-paclitaxel is administered on Day 1, Day 8 and Day 15 of each 28-day cycles.<br>Drug: Gemcitabine<br>* Gemcitabine administered at a rate of 1,000 mg/m2 and infused through a 30-minute IV infusion immediately after the completion of nab-paclitaxel administration as part of SoC. Gemcitabine is administered on Day 1, Day 8 and Day 15 of each 28-day cycles.<br>Genetic: VCN-01<br>* VCN-01 administrated as a single IV infusion at dose 1xE13 vp/patient, over a period of 10 minutes on Day 1 of the 1st cycle and then again on Day 1 of the 4th cycle (Day 92). On cycle 1 and cycle 4, nab-paclitaxel and gemcitabine administered on Day 8, Day 15 and Day 22.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Survival | Time from randomization until death in both arms | From randomization until death for any cause up to 3 years | 
| Incidence of Adverse Events after VCN-01 IV administration | Safety and tolerability of VCN-01, IV administered at Week 1 and Week 14 in Arm 2 measured as incidence of Adverse Events as assessed by CTCAE v4.0 | From randomization until disease progression assessed up to 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to progression (TTP) or Progression Free Survival (PFS) |  | From randomization until disease progression assessed up to 3 years | 
| Overall Response Rate (ORR) | Objective response rate (ORR) defined as the sum of patients who achieved partial response (PR) plus patients who achieved complete response (CR) using RECIST version 1.1 criteria. | From randomization until death for any cause up to 3 years | 
| Disease Control Rate (DCR) | Disease Control Rate (DCR) defined as: stable disease (SD) + partial response (PR) + complete response (CR) | From randomization until death for any cause up to 3 years | 
| 1-year survival |  | From randomization to 1-year landmark | 
| Progression Free Survival (PFS) at the 1-year landmark | Time from randomization to either progression or death from any cause. | From randomization to1-year landmark | 
| Duration of Response (DoR) | Time from the date of first documented response until date of documented disease progression or death in the absence of disease progression. | From randomization to disease progression assessed up to 3 years | 
| Changes in tumor marker Ca 19.9 | Tumor marker Ca 19.9 measured every 4 weeks while on study | From randomization until disease progression assessed up to 3 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cancer, Pancreatic adenocarcinoma, metastatic, oncolytic virus, VCN-01, Gemcitabine, Nab-Paclitaxel