Randomized dose-finding clinical trial of oncolytic immunotherapeutic vaccinia JX-594 in liver cancer

Jeong Heo; Tony Reid; Leyo Ruo; Caroline J. Breitbach; Steven Rose; Mark Bloomston; Mong Cho; Ho Yeong Lim; Hyun Cheol Chung; Chang Won Kim; James Burke; Riccardo Lencioni; Theresa Hickman; Anne Moon; Yeon Sook Lee; Mi Kyeong Kim; Manijeh Daneshmand; Kara Dubois; Lara Longpre; Minhtran Ngo; Cliona Rooney; John C. Bell; Byung Geon Rhee; Richard Patt; Tae Ho Hwang; David H. Kirn

doi:10.1038/nm.3089

Randomized dose-finding clinical trial of oncolytic immunotherapeutic vaccinia JX-594 in liver cancer

Jeong Heo, Tony Reid, Leyo Ruo, Caroline J. Breitbach, Steven Rose, Mark Bloomston, Mong Cho, Ho Yeong Lim, Hyun Cheol Chung, Chang Won Kim, James Burke, Riccardo Lencioni, Theresa Hickman, Anne Moon, Yeon Sook Lee, Mi Kyeong Kim, Manijeh Daneshmand, Kara Dubois, Lara Longpre, Minhtran NgoCliona Rooney, John C. Bell, Byung Geon Rhee, Richard Patt, Tae Ho Hwang, David H. Kirn

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

445 Citations (Scopus)

Abstract

Oncolytic viruses and active immunotherapeutics have complementary mechanisms of action (MOA) that are both self amplifying in tumors, yet the impact of dose on subject outcome is unclear. JX-594 (Pexa-Vec) is an oncolytic and immunotherapeutic vaccinia virus. To determine the optimal JX-594 dose in subjects with advanced hepatocellular carcinoma (HCC), we conducted a randomized phase 2 dose-finding trial (n = 30). Radiologists infused low- or high-dose JX-594 into liver tumors (days 1, 15 and 29); infusions resulted in acute detectable intravascular JX-594 genomes. Objective intrahepatic Modified Response Evaluation Criteria in Solid Tumors (mRECIST) (15%) and Choi (62%) response rates and intrahepatic disease control (50%) were equivalent in injected and distant noninjected tumors at both doses. JX-594 replication and granulocyte-macrophage colony-stimulating factor (GM-CSF) expression preceded the induction of anticancer immunity. In contrast to tumor response rate and immune endpoints, subject survival duration was significantly related to dose (median survival of 14.1 months compared to 6.7 months on the high and low dose, respectively; hazard ratio 0.39; P = 0.020). JX-594 demonstrated oncolytic and immunotherapy MOA, tumor responses and dose-related survival in individuals with HCC.

Original language	English
Pages (from-to)	329-336
Number of pages	8
Journal	Nature Medicine
Volume	19
Issue number	3
DOIs	https://doi.org/10.1038/nm.3089
Publication status	Published - 2013 Mar

Bibliographical note

Funding Information:
J.-M. Limacher, M. Homerin, B.M. Bastien and M. Lusky (all from Transgene SA) gave insightful comments on the manuscript. T.-H.H. and M.K.K. were supported by a grant of the Korea Healthcare technology Research and Development Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A091047). C.R. was supported by a pilot grant from the Dan Duncan Cancer Center. M.N. was supported by the Robert and Janice McNair Foundation and Baylor Research Advocates for Student Scientists Fund. J.C.B. is supported by the Ontario Institute for Cancer Research and the Terry Fox Foundation. Funding was provided by Jennerex, Transgene SA (Illkirch, France) and the Green Cross Corporation; grants to T.-H.H. from Korea Healthcare technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea; to J.C.B. from the Terry Fox Foundation and the Canadian Institute for Health Research (CIHR); and a pilot grant to C.R. from the Dan Duncan Cancer Center. This trial was registered with ClinicalTrials.gov, number NCT00554372.

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Biochemistry, Genetics and Molecular Biology(all)

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Heo, J., Reid, T., Ruo, L., Breitbach, C. J., Rose, S., Bloomston, M., Cho, M., Lim, H. Y., Chung, H. C., Kim, C. W., Burke, J., Lencioni, R., Hickman, T., Moon, A., Lee, Y. S., Kim, M. K., Daneshmand, M., Dubois, K., Longpre, L., ... Kirn, D. H. (2013). Randomized dose-finding clinical trial of oncolytic immunotherapeutic vaccinia JX-594 in liver cancer. Nature Medicine, 19(3), 329-336. https://doi.org/10.1038/nm.3089

Heo, Jeong ; Reid, Tony ; Ruo, Leyo ; Breitbach, Caroline J. ; Rose, Steven ; Bloomston, Mark ; Cho, Mong ; Lim, Ho Yeong ; Chung, Hyun Cheol ; Kim, Chang Won ; Burke, James ; Lencioni, Riccardo ; Hickman, Theresa ; Moon, Anne ; Lee, Yeon Sook ; Kim, Mi Kyeong ; Daneshmand, Manijeh ; Dubois, Kara ; Longpre, Lara ; Ngo, Minhtran ; Rooney, Cliona ; Bell, John C. ; Rhee, Byung Geon ; Patt, Richard ; Hwang, Tae Ho ; Kirn, David H. / Randomized dose-finding clinical trial of oncolytic immunotherapeutic vaccinia JX-594 in liver cancer. In: Nature Medicine. 2013 ; Vol. 19, No. 3. pp. 329-336.

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title = "Randomized dose-finding clinical trial of oncolytic immunotherapeutic vaccinia JX-594 in liver cancer",

abstract = "Oncolytic viruses and active immunotherapeutics have complementary mechanisms of action (MOA) that are both self amplifying in tumors, yet the impact of dose on subject outcome is unclear. JX-594 (Pexa-Vec) is an oncolytic and immunotherapeutic vaccinia virus. To determine the optimal JX-594 dose in subjects with advanced hepatocellular carcinoma (HCC), we conducted a randomized phase 2 dose-finding trial (n = 30). Radiologists infused low- or high-dose JX-594 into liver tumors (days 1, 15 and 29); infusions resulted in acute detectable intravascular JX-594 genomes. Objective intrahepatic Modified Response Evaluation Criteria in Solid Tumors (mRECIST) (15%) and Choi (62%) response rates and intrahepatic disease control (50%) were equivalent in injected and distant noninjected tumors at both doses. JX-594 replication and granulocyte-macrophage colony-stimulating factor (GM-CSF) expression preceded the induction of anticancer immunity. In contrast to tumor response rate and immune endpoints, subject survival duration was significantly related to dose (median survival of 14.1 months compared to 6.7 months on the high and low dose, respectively; hazard ratio 0.39; P = 0.020). JX-594 demonstrated oncolytic and immunotherapy MOA, tumor responses and dose-related survival in individuals with HCC.",

author = "Jeong Heo and Tony Reid and Leyo Ruo and Breitbach, {Caroline J.} and Steven Rose and Mark Bloomston and Mong Cho and Lim, {Ho Yeong} and Chung, {Hyun Cheol} and Kim, {Chang Won} and James Burke and Riccardo Lencioni and Theresa Hickman and Anne Moon and Lee, {Yeon Sook} and Kim, {Mi Kyeong} and Manijeh Daneshmand and Kara Dubois and Lara Longpre and Minhtran Ngo and Cliona Rooney and Bell, {John C.} and Rhee, {Byung Geon} and Richard Patt and Hwang, {Tae Ho} and Kirn, {David H.}",

note = "Funding Information: J.-M. Limacher, M. Homerin, B.M. Bastien and M. Lusky (all from Transgene SA) gave insightful comments on the manuscript. T.-H.H. and M.K.K. were supported by a grant of the Korea Healthcare technology Research and Development Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A091047). C.R. was supported by a pilot grant from the Dan Duncan Cancer Center. M.N. was supported by the Robert and Janice McNair Foundation and Baylor Research Advocates for Student Scientists Fund. J.C.B. is supported by the Ontario Institute for Cancer Research and the Terry Fox Foundation. Funding was provided by Jennerex, Transgene SA (Illkirch, France) and the Green Cross Corporation; grants to T.-H.H. from Korea Healthcare technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea; to J.C.B. from the Terry Fox Foundation and the Canadian Institute for Health Research (CIHR); and a pilot grant to C.R. from the Dan Duncan Cancer Center. This trial was registered with ClinicalTrials.gov, number NCT00554372.",

year = "2013",

month = mar,

doi = "10.1038/nm.3089",

language = "English",

volume = "19",

pages = "329--336",

journal = "Nature Medicine",

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Heo, J, Reid, T, Ruo, L, Breitbach, CJ, Rose, S, Bloomston, M, Cho, M, Lim, HY, Chung, HC, Kim, CW, Burke, J, Lencioni, R, Hickman, T, Moon, A, Lee, YS, Kim, MK, Daneshmand, M, Dubois, K, Longpre, L, Ngo, M, Rooney, C, Bell, JC, Rhee, BG, Patt, R, Hwang, TH & Kirn, DH 2013, 'Randomized dose-finding clinical trial of oncolytic immunotherapeutic vaccinia JX-594 in liver cancer', Nature Medicine, vol. 19, no. 3, pp. 329-336. https://doi.org/10.1038/nm.3089

Randomized dose-finding clinical trial of oncolytic immunotherapeutic vaccinia JX-594 in liver cancer. / Heo, Jeong; Reid, Tony; Ruo, Leyo; Breitbach, Caroline J.; Rose, Steven; Bloomston, Mark; Cho, Mong; Lim, Ho Yeong; Chung, Hyun Cheol; Kim, Chang Won; Burke, James; Lencioni, Riccardo; Hickman, Theresa; Moon, Anne; Lee, Yeon Sook; Kim, Mi Kyeong; Daneshmand, Manijeh; Dubois, Kara; Longpre, Lara; Ngo, Minhtran; Rooney, Cliona; Bell, John C.; Rhee, Byung Geon; Patt, Richard; Hwang, Tae Ho; Kirn, David H.

In: Nature Medicine, Vol. 19, No. 3, 03.2013, p. 329-336.

Research output: Contribution to journal › Article › peer-review

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AU - Reid, Tony

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AU - Bloomston, Mark

AU - Cho, Mong

AU - Lim, Ho Yeong

AU - Chung, Hyun Cheol

AU - Kim, Chang Won

AU - Burke, James

AU - Lencioni, Riccardo

AU - Hickman, Theresa

AU - Moon, Anne

AU - Lee, Yeon Sook

AU - Kim, Mi Kyeong

AU - Daneshmand, Manijeh

AU - Dubois, Kara

AU - Longpre, Lara

AU - Ngo, Minhtran

AU - Rooney, Cliona

AU - Bell, John C.

AU - Rhee, Byung Geon

AU - Patt, Richard

AU - Hwang, Tae Ho

AU - Kirn, David H.

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PY - 2013/3

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AB - Oncolytic viruses and active immunotherapeutics have complementary mechanisms of action (MOA) that are both self amplifying in tumors, yet the impact of dose on subject outcome is unclear. JX-594 (Pexa-Vec) is an oncolytic and immunotherapeutic vaccinia virus. To determine the optimal JX-594 dose in subjects with advanced hepatocellular carcinoma (HCC), we conducted a randomized phase 2 dose-finding trial (n = 30). Radiologists infused low- or high-dose JX-594 into liver tumors (days 1, 15 and 29); infusions resulted in acute detectable intravascular JX-594 genomes. Objective intrahepatic Modified Response Evaluation Criteria in Solid Tumors (mRECIST) (15%) and Choi (62%) response rates and intrahepatic disease control (50%) were equivalent in injected and distant noninjected tumors at both doses. JX-594 replication and granulocyte-macrophage colony-stimulating factor (GM-CSF) expression preceded the induction of anticancer immunity. In contrast to tumor response rate and immune endpoints, subject survival duration was significantly related to dose (median survival of 14.1 months compared to 6.7 months on the high and low dose, respectively; hazard ratio 0.39; P = 0.020). JX-594 demonstrated oncolytic and immunotherapy MOA, tumor responses and dose-related survival in individuals with HCC.

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Randomized dose-finding clinical trial of oncolytic immunotherapeutic vaccinia JX-594 in liver cancer

Abstract

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