A Study of Recombinant Vaccinia Virus to Treat Unresectable Primary Hepatocellular Carcinoma

This study has been completed.
Information provided by (Responsible Party):
Jennerex Biotherapeutics
ClinicalTrials.gov Identifier:
First received: November 2, 2007
Last updated: April 9, 2013
Last verified: October 2011

The purpose of this research study is to determine whether JX-594 (Pexa-Vec) has significant anti-tumoral activity and tolerability in primary hepatocellular carcinoma and to determine the dose to be used in further testing.

Condition Intervention Phase
Carcinoma, Hepatocellular
Genetic: JX-594: Recombinant vaccinia virus (TK-deletion plus GM-CSF)
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II-a, Open-Label, Randomized Study of JX-594 (Thymidine Kinase-deleted Vaccinia Virus Plus GM-CSF) Administered by Intratumoral Injection in Patients With Unresectable Primary Hepatocellular Carcinoma

Resource links provided by NLM:

Further study details as provided by Jennerex Biotherapeutics:

Primary Outcome Measures:
  • To assess whether one of two dose levels of JX-594 is superior in preventing tumor progression in patients with unresectable primary hepatocellular carcinoma [ Time Frame: Initial progression status and response assessment at 8 weeks from first dose ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Safety and tolerability of JX-594 administered at two dose levels [ Time Frame: Safety evaluation throughout study participation ] [ Designated as safety issue: Yes ]
  • Time-to-tumor progression (TTP) [ Time Frame: Throughout study participation ] [ Designated as safety issue: No ]
  • Best radiographic response (based on modified RECIST and modified Choi) [ Time Frame: Periodically throughout study participation ] [ Designated as safety issue: No ]
  • Progression Free Survival (PFS) [ Time Frame: Ongoing ] [ Designated as safety issue: No ]

Enrollment: 30
Study Start Date: August 2008
Study Completion Date: February 2013
Primary Completion Date: December 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
1e8 pfu (plaque forming units) total dose of JX-594 (recombinant vaccinia virus) on each of three (3) treatment days (2 weeks apart)
Genetic: JX-594: Recombinant vaccinia virus (TK-deletion plus GM-CSF)
Patients will be randomized 1:1 to one of two total doses (1e8 or 1e9 pfu)and injected intratumorally in 1-5 intrahepatic tumors on Days 1, 15, and 29.
Experimental: 2
1e9 pfu (plaque-forming units) total dose of JX-594 (recombinant vaccinia virus) on each of three (3) treatment days (2 weeks apart)
Genetic: JX-594: Recombinant vaccinia virus (TK-deletion plus GM-CSF)
Patients will be randomized 1:1 to one of two total doses (1e8 or 1e9 pfu)and injected intratumorally in 1-5 intrahepatic tumors on Days 1, 15, and 29.

Detailed Description:

Hepatocellular carcinoma (HCC) is estimated to be the third most common cause of cancer-related deaths world-wide, and the fifth most common cancer diagnosis. According to the National Cancer Institute (NCI), approximately 17,000 new cases of HCC are diagnosed annually in the U.S. In Canada, the predicted incidence for 2007 is 1,350 new cases. In addition, approximately 10,000 new cases are diagnosed per year in S. Korea, 35,000 in the E.U. and 45,000 in Japan.

The five-year survival rate is estimated to be <10% for all HCC patients. Given the poor prognosis of these patients there is a desperate need for new therapies.

Surgical resection and liver transplant are the only curative treatment for HCC. Small HCC tumor(s) (less than 3 cm in diameter) can be resected by hepatectomy, the most effective treatment. Surgery was associated with a reported 50-60% five-year survival rate, but unfortunately was possible in only 10-15% of cases. Liver transplant is considered for patients with tumors that are unresectable but that are still limited exclusively to the liver, have no extracapsular or vascular invasion within the liver, and for whom there are no medical contraindications to transplantation. Patients with unresectable HCC that cannot receive liver transplantation, and who do not require systemic therapy, may be administered percutaneous ethanol injection therapy (PEIT), radiofrequency ablation (RFA), transarterial chemoembolization (TACE), and/or radioembolization, depending on the size of the intrahepatic tumors and the underlying liver function.

HCC may be a good target for IT injection with JX-594 because of the relatively high rate of accessible tumors for injection, the positive response seen in a patient with HCC in a recently completed Phase I study of JX-594 intratumoral injection within the liver, excellent tumor responses in multiple preclinical cancer models, and the lack of effective, tolerable therapy for most patients with HCC who cannot receive curative surgery or immediate liver transplantation. Furthermore, it is speculated that JX-594 replication targets the EGFR pathway, and that it's spread within and between tumors is dependent upon the intratumoral vasculature; HCC has highly activated angiogenesis and EGFR pathways in the majority of cases.


Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria

  • Histological confirmation or clinical/laboratory diagnosis of primary hepatocellular carcinoma (HCC)
  • Cancer is not surgically resectable for cure
  • Child Pugh A or B
  • Tumor progression during or after at least one prior HCC treatment regimen (Note: If standard HCC therapies are either medically contraindicated or patient has refused those treatments, the patient may be eligible for this study)
  • Performance Score: KPS score of ≥ 70
  • Anticipated survival of at least 16 weeks
  • Total bilirubin ≤ 2.5 x ULN
  • AST, ALT < 5.0 x ULN
  • WBC > 2,500 cells/mm3 and < 50,000 cells/mm3 (GCSF treatment allowed)
  • ANC > 1,250 cells/mm3 (GCSF treatment allowed)
  • Hemoglobin ≥ 9 g/dL (RBC transfusion allowed)
  • Platelet count ≥ 50,000 plts/mm3
  • Acceptable coagulation status: INR ≤ 1.5 x ULN
  • Acceptable kidney function: Serum creatinine < 2.0 mg/dL
  • If patients are diabetic or have a screening random glucose > 160 mg/dL, a fasting glucose must be done and patients must be WNL or Grade 1 in order to be eligible for the study
  • For patients who are sexually active: able and willing to abstain from sex during treatment period and for 3 weeks following treatment, and use an acceptable method of birth control for 3 months after last injection with JX-594
  • Able/willing to sign an IRB/IEC/REB-approved written consent form
  • Able and willing to comply with study procedures and follow-up examinations, including compliance with the "Infection Control Guidelines for Patients" (in written consent form)

Exclusion Criteria:

  • Current, known extra-hepatic tumors that, in the investigator's medical opinion, are likely to result in significant morbidity or mortality within the next 16 weeks.
  • Pregnant or nursing an infant
  • Known infection with HIV
  • Clinically significant active infection or uncontrolled medical condition considered high risk for investigational new drug treatment
  • Significant immunodeficiency due to underlying illness (e.g. hematological malignancies, congenital immunodeficiencies and/or HIV infection/AIDS) and/or medication (e.g. high-dose systemic corticosteroids)
  • History of exfoliative skin condition (e.g. severe eczema, ectopic dermatitis, or similar skin disorder) that at some stage has required systemic therapy
  • Clinically significant and/or rapidly accumulating ascites, peri-cardial and/or pleural effusions
  • Liver tumors in a location that would potentially result in significant clinical adverse effects if post-treatment tumor swelling were to occur (e.g. tumors impinging on the biliary tract that could affect drainage)
  • Severe or unstable cardiac disease
  • Current, known CNS malignancy
  • Anti-cancer therapy (e.g. RFA, TACE, PEIT, radioembolization, chemotherapy, surgery, or an investigational drug, etc.) within 4 weeks prior to first treatment
  • Absolute contraindication to undergoing MRI scanning
  • Experienced a severe systemic reaction or side-effect as a result of a previous smallpox vaccination
  • Use of anti-platelet or anti-coagulation medication
  • Use of the following anti-viral agents: ribavirin, adefovir, cidofovir (within 7 days prior to the first treatment), and PEG-IFN (within 14 days prior to the first treatment).
  • Inability or unwillingness to give informed consent or comply with the procedures required in the protocol
  • Patients with household contacts who meet any of these criteria unless alternate living arrangements can be made during the patient's active dosing period and for 7 days following the last dose of study medication:
  • Pregnant or nursing an infant
  • Children < 12 months old
  • History of exfoliative skin condition that at some stage has required systemic therapy
  • Significant immunodeficiency due to underlying illness (e.g. HIV/AIDS) and/or medication
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00554372

United States, California
Moores UCSD Cancer Center
La Jolla, California, United States, 92093
United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905
United States, Montana
Billings Clinic Cancer Center
Billings, Montana, United States, 59101
United States, Ohio
The Ohio State University
Columbus, Ohio, United States, 43210
United States, Pennsylvania
University of Pittsburgh Medical Center - Liver Cancer Center
Pittsburgh, Pennsylvania, United States, 15213
Canada, Ontario
McMaster University Medical Centre
Hamilton, Ontario, Canada, L8N 1Y3
Korea, Republic of
Pusan National University Hospital
Busan, Korea, Republic of
Samsung Medical Center
Seoul, Korea, Republic of
Shin Chon Severance Hospital / Yonsei University Medical Center
Seoul, Korea, Republic of
Sponsors and Collaborators
Jennerex Biotherapeutics
Study Director: David Kirn, MD Jennerex Biotherapeutics
  More Information

Additional Information:
No publications provided by Jennerex Biotherapeutics

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Jennerex Biotherapeutics
ClinicalTrials.gov Identifier: NCT00554372     History of Changes
Other Study ID Numbers: JX594-IT-HEP007
Study First Received: November 2, 2007
Last Updated: April 9, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by Jennerex Biotherapeutics:
unresectable primary hepatocellular carcinoma
hepatocellular carcinoma
liver cancer
Phase 2
oncolytic virus

Additional relevant MeSH terms:
Carcinoma, Hepatocellular
DNA Virus Infections
Digestive System Diseases
Digestive System Neoplasms
Liver Diseases
Liver Neoplasms
Neoplasms by Histologic Type
Neoplasms by Site
Neoplasms, Glandular and Epithelial
Poxviridae Infections
Virus Diseases

ClinicalTrials.gov processed this record on July 30, 2015