Ctim-13. phase i clinical trial of oncolytic hsv-1 m032, a second-generation virus armed to expressed il-12, for the treatment of adult patients with recurrent or progressive malignant glioma

Abstract BACKGROUND Effective treatment options are limited for patients diagnosed with malignant glioma, and outcomes remain very poor. Recurrence and progression rates are universal. Preclinical data showed that a second-generation oncolytic herpes virus (oHSV) with selective replication and armed to induce IL-12 expression was a more effective anti-glioma agent than the first-generation oHSV. METHODS We conducted an open-label, dose-escalating phase I trial designed to determine the safety and tolerability of intratumoral injection of the M032 virus in patients with recurrent or progressive MG. Patients underwent stereotactic placement of intratumoral catheters. The following day, M032 was infused over a period of 6 hours. Primary endpoint was to determine safety and maximum tolerated dose (maximal planned dose of 109 PFU). Dose elevations were made using a modified Continual Reassessment Method. RESULTS Twenty-one patients with recurrent MG ages 19 to 71 received M032 (16 Males, 5 Females). Fourteen patients had IDH wild-type tumors, and eighteen patients had unmethylated MGMT status. Four grade 1, two grade 2, two grade 3, and two grade 4 adverse events were identified as possibly related to M032. Both grade 3 and grade 4 adverse events possibly related to M032 occurred in a single patient on the 108 PFU cohort. No serious adverse events at the maximal plan dose were attributed to M032. Median post-treatment survival was 9.38 months (95% CI, 7.57 to 12.95). 2 participants were still alive following treatment. CONCLUSIONS Intratumoral M032 had an acceptable adverse-event profile. We observed two grade 3 and two grade 4 adverse events in a patient with a large tumor prompting an amendment to tumor size inclusion criteria. No dose-limiting toxicity occurred at the maximum dose. Preliminary evidence suggests favorable response in some patients with recurrent or progressive MG. Careful selection of patients is needed when considering treatment with M032 (ClinicalTrials.gov number, NCT02062827).