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TVEC and Preop Radiation for Sarcoma (8 ml Dose)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT04599062
Recruitment Status : Recruiting
First Posted : October 22, 2020
Last Update Posted : May 6, 2022
Information provided by (Responsible Party):
Varun Monga, MD, University of Iowa

Brief Summary:

The purpose of this research study is to determine the safety and tolerability of talimogene laherparepvec when combined with radiation therapy.

Approximately 46 people will take part in this study conducted by investigators at the University of Iowa.

Condition or disease Intervention/treatment Phase
Soft Tissue Sarcoma Drug: Talimogene Laherparepvec Radiation: Radiotherapy Phase 1 Phase 2

Detailed Description:
This is a single-arm open-label phase Ib and phase II clinical study assessing the safety and relative efficacy of concurrent talimogene laherparepvec in combination with radiotherapy in patients with soft tissue sarcomas. Patients will be treated with neoadjuvant radiation and weekly intratumoral injections of talimogene laherparepvec. Weekly injections of talimogene laherparepvec will be continued until surgery. Surgery will be performed 4-6 weeks from the end of radiation therapy to allow for resolution of acute toxicities per current standard of care.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 46 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Neoadjuvant Intralesional Injection of Talimogene Laherparepvec With Concurrent Preoperative Radiation in Patients With Locally Advanced Soft Tissue Sarcomas
Actual Study Start Date : September 10, 2020
Estimated Primary Completion Date : April 30, 2023
Estimated Study Completion Date : June 30, 2024

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Treatment

Talimogene Laherparepvec in combination with radiotherapy

Talimogene Laherparepvec Dose Levels:

Dose 0 = talimogene laherparepvec up to 8.0 mL of 108 PFU/mL dosed weekly

Dose -1 = talimogene laherparepvec up to 8.0 mL of 108 PFU/mL dosed every 2 weeks

Drug: Talimogene Laherparepvec
Talimogene Laherparepvec

Radiation: Radiotherapy
Concurrent Preoperative Radiation. External Beam Radiation Therapy (EBRT) will be given at the standard dose for resectable soft tissue sarcomas. according to the NCCN sarcoma guidelines.

Primary Outcome Measures :
  1. Phase 1b: Number of Participants With Dose Limiting Toxicities (DLTs) [ Time Frame: 14 weeks ]
    A DLT is defined as any of the following talimogene laherparepvec-related toxicity or related to the combination of talimogene laherparepvec and radiation therapy during treatment and up to 4 weeks after the last talimogene laherparepvec injection: Grade 3 or greater immune-mediated adverse events, Grade 3 or greater allergic reactions, any grade plasmacytoma, any other unexpected grade 3 or greater hematologic or non-hematologic toxicity, with the exceptions of: any grade of alopecia, expected radiation related skin toxicity of any grade, Grade 3 arthralgia or myalgia, brief (< 1 week) grade 3 fatigue, Grade 3 fever, Grade 3 diarrhea or vomiting responding to supportive case.

  2. Phase 2: Number of Subjects With Pathologic Tumor Necrosis ≥ 90% Following Concurrent Radiation Therapy and Talimogene Laherparepvec. [ Time Frame: 14 weeks ]
    At the end of the neoadjuvant therapy, patients will undergo resection of the treated tumor. The percentage of post treatment tumor necrosis must be documented. The primary end point for this study is pathologic complete response (pCR), and is defined as ≥ 90% tumor necrosis following concurrent radiation therapy and talimogene laherparepvec.

Secondary Outcome Measures :
  1. Overall Response Rate (ORR) as Measured by RECIST [ Time Frame: 24 months ]
    Overall response rate (ORR) as measured by RECIST 1.1. Complete response is the disappearance of all target lesions.Partial response is a 30% decrease in the sum of the longest dimensions of the target lesions, relative to baseline. Progressive disease is an increase of 20% or more in the sum of the longest dimension of target lesions. Stable disease is a decrease in the tumor size of < 30% or an increase of < 20%..

  2. Time to Disease Progression (TTP) [ Time Frame: 24 months ]
    TTP is defined as the time from enrollment until objective tumor progression

  3. Overall Survival Rate (OS) at 5 Years [ Time Frame: 5 years ]
    Subjects will be followed for overall survival rate (OS) at 5 years from the last enrollment

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Subject has provided informed consent.
  • Histologically confirmed diagnosis of locally advanced STS that is unresectable with clear wide margins, for which preoperative radiotherapy is considered appropriate.


  • Resectable stage IIB, III, and IV disease that are not suitable for surgically resection alone due to inability to achieve clear margins.
  • Including metastatic (stage IV) disease for which radiotherapy and surgical resection are indicated.
  • Except certain histologic subtypes: GIST, Desmoid, Ewing sarcoma, Kaposi sarcoma, bone sarcomas and myxoid liposarcomas (Grade 1).
  • Previous treatment: prior systemic anti-cancer treatment consisting of chemotherapy, immunotherapy, or targeted therapy are allowed provided therapy completed at least 1 year prior to enrollment.
  • No prior Talimogene laherparepvec or tumor vaccines allowed.
  • No prior radiation to the same tumor bed allowed.

    • Age ≥18 years.
    • Both men and women of all races and ethnic groups are eligible for this trial.
    • ECOG performance status ≤1.
    • Patient must have measurable disease:
  • Tumor size at least ≥ 5 cm in the longest diameter as measured by CT scan or MRI for which radiation is feasible.

    • Patient must have injectable disease (direct injection or ultrasound guided).

Exclusion Criteria:

  • Certain histologic subtypes: GIST, Desmoid, Ewing sarcoma, Kaposi sarcoma bone sarcomas and low grade myxoid liposarcomas ( Grade 1).
  • History or evidence of sarcoma associated with immunodeficiency states (e.g.: Hereditary immune deficiency, HIV, organ transplant or leukemia).
  • Subjects with retroperitoneal and visceral sarcoma.
  • History or evidence of gastrointestinal inflammatory bowel disease (ulcerative colitis or Crohn's disease) or other symptomatic autoimmune disease including, inflammatory bowel disease, or history of any poorly controlled or severe systemic autoimmune disease (i.e., rheumatoid arthritis, systemic lupus erythematosus, scleroderma, type I diabetes, or autoimmune vasculitis).
  • History of other malignancy within the past 3 years except treated with curative intent and no known active disease present and has not received chemotherapy for ≥ 1 year before enrollment/randomization and low risk for recurrence.
  • History of prior or current autoimmune disease.
  • History of prior or current splenectomy or splenic irradiation.
  • Active herpetic skin lesions
  • Require intermittent or chronic treatment with an anti-herpetic drug (e.g., acyclovir), other than intermittent topical use.
  • Any non-oncology vaccine therapies used for the prevention of infectious disease within 28 days prior to enrollment and during treatment period.
  • Concomitant treatment with therapeutic anticoagulants such as warfarin. Patients on therapeutic low molecular weight heparin may be allowed provided the dose can be safely held as per the treating investigator on the morning of scheduled intratumoral injection and can be resumed 12 hours after the procedure
  • Known human immunodeficiency virus (HIV) disease (requires negative test for clinically suspected HIV infection).
  • Acute or chronic hepatitis B or hepatitis C infection (requires negative test for clinically suspected hepatitis B or hepatitis C infection).
  • Evidence of hepatitis B -

    1. Positive HBV surface antigen (indicative for chronic hepatitis B or recent acute hepatitis B).
    2. Negative HBV surface antigen but positive HBV total core antibody (indicative for resolved hepatitis B infection or occult hepatitis B) and detectable copies of HBV DNA by PCR (detectable HBV DNA copies suggest occult hepatitis B).
  • Evidence of hepatitis C -

    1. Positive HCV antibody and positive HCV RNA by PCR (undetectable RNA copies suggest past and resolved hepatitis C infection).

  • Female subjects who are pregnant or breast-feeding, or planning to become pregnant during study treatment and through 3 months after the last dose of study treatment.
  • Female subjects of childbearing potential or male subjects who are unwilling to use 2 highly effective methods of contraception during study treatment and through 3 months after the last dose of study treatment. See Section 7.5 for more details.
  • Currently receiving treatment in another investigational device or drug study, or less than 30 days since ending treatment on another investigational device or drug study(s).
  • Other investigational procedures while participating in this study that could affect the primary objective of the study as determined by the PI are excluded.
  • Subject previously has entered this study.
  • Patients who are receiving any other investigational agents.
  • Evidence of CNS metastases.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to talimogene laherparepvec.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Patients on or requiring immunosuppressive therapies.
  • Any of the following laboratory abnormalities:

    • Hemoglobin < 9.0 g/dL
    • Absolute neutrophil count (ANC) < 1500 per mm3
    • Platelet count < 100,000 per mm3
    • Total bilirubin > 1.5 × ULN
    • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 2.5 × ULN
    • Alkaline phosphatase > 2.5 × ULN
    • PT (or INR) and PTT (or aPTT) > 1.5 × ULN
    • Creatinine > 2.0 × ULN

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT04599062

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Contact: Varun Monga, MD 319-384-9497

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United States, Iowa
University of Iowa Hospitals and Clinics Recruiting
Iowa City, Iowa, United States, 52242
Contact: Varun Monga, MD    319-384-9497   
Principal Investigator: Varun Monga, MD         
Sponsors and Collaborators
Varun Monga, MD
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Principal Investigator: Varun Monga, MD University of Iowa Holden Comprehensive Cancer Center
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Responsible Party: Varun Monga, MD, Clinical Assistant Professor, University of Iowa Identifier: NCT04599062    
Other Study ID Numbers: 201504731 (8 milliliter dose)
First Posted: October 22, 2020    Key Record Dates
Last Update Posted: May 6, 2022
Last Verified: May 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Neoplasms, Connective and Soft Tissue
Neoplasms by Histologic Type
Talimogene laherparepvec
Antineoplastic Agents, Immunological
Antineoplastic Agents