G207 Followed by Radiation Therapy in Malignant Glioma

Study Overview
=================
Brief Summary
-----------------
This is an open-label, single site study to evaluate the safety and tolerability of intratumoral administration of G207 followed by treatment with radiation therapy in patients with recurrent/progressive malignant glioma. This study is a two stage phase 1 study, in which a de-escalating dosing scheme will be used, i.e. the first patients will receive the higher dose and if excessive toxicity occurs, the dose will be reduced for the following patients. The purpose of the dose de-escalation phase is to find the best safe dose of G207. In the first stage of the study, treatment with G207 will be followed by focal radiation therapy on the following day, and in the second stage treatment with G207 will be followed by gamma knife surgery also on the following day. All patients will return to the clinic 28 days and 3, 6, 9 and 12 months after G207 administration at which time clinical assessments will be performed, and will be followed for safety and survival at clinic visits or by telephone every 3 months for up to 2 additional years and annually thereafter.

Official Title
-----------------
A Staged Phase 1 Study of the Treatment of Malignant Glioma With G207, a Genetically Engineered HSV-1, Followed by Radiation Therapy

Conditions
-----------------
Malignant Glioma

Intervention / Treatment
-----------------
* Drug: G207


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Pathologically proven residual/recurrent glioblastoma multiforme, gliosarcoma or anaplastic astrocytoma which is progressive despite radiotherapy or chemotherapy Failed external beam radiotherapy > 5,000 CGy at least 4 weeks prior to enrollment Residual/recurrent lesion must be ≥ 1.0 cm and (for Stage 2 only) ≤ 4 cm in diameter as determined by magnetic resonance imaging (MRI) Normal hematological, renal and liver function Absolute neutrophil count > 1500/mm3 Platelets > 100,000/mm3 Prothrombin time (PT) or partial thromboplastin time (PTT) < 1.3 x control Creatinine < 1.7 mg/dl Total bilirubin < 1.5 mg/dl Transaminases < 4 times above the upper limits of the institutional norm Karnofsky Performance Status score ≥ 70 Age > 19 years-old Capable of giving informed consent Must be willing to practice an effective barrier method of birth control for 2 months post G207 inoculation, whether male or female Females of childbearing potential: negative pregnancy test within 24 hours prior to G207 administration Exclusion Criteria: Surgical resection within 4 weeks of enrolment Acute infection, granulocytopenia or medical condition precluding surgery Pregnant or lactating females History of encephalitis, multiple sclerosis, or other central nervous system (CNS) infection Tumor involvement which would require ventricular, brainstem, basal ganglia, or posterior fossa inoculation or would require access through a ventricle in order to deliver treatment or tumor involving both hemispheres or with subependymal/cerebral spinal fluid (CSF) dissemination Tumor position that could, in the Investigator's opinion, pose the risk of penetration of the cerebral ventricular system during inoculation with the study drug (Note: If penetration of the ventricular system is suspected or confirmed, G207 administration must be aborted.) Tumor locations that would expose the patient to unacceptable risk with radiation therapy Prior participant in experimental viral therapy (e.g., adenovirus, retrovirus or herpesvirus protocol) Prior participant in chemotherapy, cytotoxic therapy, immunotherapy or gene therapy protocol within 6 weeks of enrolment Required steroid increase within 2 weeks prior to injection HIV seropositive Concurrent therapy with any drug active against herpes simplex virus (HSV) (acyclovir, valaciclovir, penciclovir, famciclovir, ganciclovir, foscavir, cidofovir) Active oral or genital herpes lesion Any contraindication for undergoing MRI such as pacemakers, infusion pumps, ferromagnetic aneurysm clips, metal prostheses, etc. Radiation treatment volume of greater than 4 cm maximum diameter (Stage 2 only)

Ages Eligible for Study
-----------------
Minimum Age: 19 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: G207|1 x 10E9 plaque forming units, administered by stereotactic injections into the tumor (single administration)|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse events |  | from 1st dose to end of study visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Radiographic response |  | Withdrawal or death of last patient | 
| Performance scale |  | Last patient out | 
| Overall survival |  | Withdrawal or death of last patient | 
| Immune response |  | Last patient out | 
| Presence of G207 in blood and saliva |  | Last patient out | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Malignant glioma, Glioblastoma multiforme, GBM, Gliosarcoma, Anaplastic astrocytoma, Brain cancer, Brain tumor, Glioma, recurrent/progressive malignant glioma