Pexastimogene devacirepvec

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JX-594 is an oncolytic virus is designed to target and destroy cancer cells. [1] It is also known as Pexa-Vec, [2] INN pexastimogene devacirepvec [3] ) and was constructed in Dr. Edmund Lattime's lab at Thomas Jefferson University, tested in clinical trials on melanoma patients, and licensed and further developed by SillaJen.

Contents

JX-594 is a modified Copenhagen [4] strain (or Wyeth strain [3] ) vaccinia poxvirus engineered by addition of the GM-CSF gene and deletion of the thymidine kinase gene which limits viral replication to cells with high levels of thymidine kinase, typically seen in cancer cells with a mutated RAS or p53 gene. [5] The virus also has the LacZ gene insertion under control of the p7.5 promoter. [3] The virus kills the infected/cancer cells by lysis and also expresses GM-CSF which may help initiate an anti-tumour immune response. [6] [7] [8]

It has orphan drug designation from US Food and Drug Administration and EUMA[ clarification needed ] for the treatment of hepatocellular carcinoma (liver cancer). [2]

In clinical trials doses have been administered by intratumoral or intravenous injection. [3]

Technology

Pexa-Vec (JX-594) is the most advanced product candidate from SillaJen's proprietary SOLVE™ (Selective Oncolytic Vaccinia Engineering) platform. [9] [ non-primary source needed ] SOLVE [9] is used to optimize virus targeting to specific cancer types, to select transgenes to include into the viral genome, and to optimize viral infection and/or replication selectively through targeted mutations.

Oncolytic viruses could have 3-prolonged attack on cancer: direct cell lysis with replication and spread, immune activation, and antivascular [10] [11] [12] [13]

JX-900 (VVDD): [15] VVDD Platform: Next-gen enhanced oncolytic immunotherapy. [16]

Clinical trials

A phase 3 randomized, open-label, clinical trial of Pexa-Vec plus sorafenib versus sorafenib is being conducted on patients with advanced hepatocellular carcinoma who have not previously received any systemic therapy. The study is being done to determine and compare overall survival for patients in the two treatment arms. [17] [ non-primary source needed ] The study is Sponsored by SillaJen, Inc. [18]

Mechanism of Action of Pexa-Vec (Jx-594)

The experimental therapy, Pexa-Vec, is an attenuated vaccinia virus engineered to stimulate anti-tumor immunity and directly lyse tumor cells. Pexa-Vec has cancer selectivity through the deactivation of its thymidine kinase gene, and it has been engineered to express the granulocyte-macrophage colony-stimulating factor gene to stimulate a systemic anti-tumor immune response. Researchers believe that Pexa-Vec may be a systemic treatment of hepatocellular carcinoma by inducing tumor necrosis and shrinkage of both injected and non-injected tumors after direct intratumoral delivery. Final data from a randomized dose-ranging phase 2 study of Pexa-Vec [19] in mainly sorafenib naïve patients with advanced hepatocellular carcinoma demonstrated that the risk of death for patients who received Pexa-Vec at the high dose was markedly reduced (by nearly 60 percent; hazard ratio = 0.41) when compared to patients randomized to a low dose control (one-tenth of the high dose). The median overall survival for high and low dose groups was 14.1 months versus 6.7 months, respectively (p = 0.020 for superiority of the high dose). Pexa-Vec was well tolerated, with patients experiencing transient flu-like symptoms that generally resolved within 24 hours. [17]

As of June 2018,[update] these are the clinical trials investigating Pexa-Vec. [20] [21] [22] [23] [ needs update ]

Clinical trials investigating Pexa-Vec (as of June 2018)
IndicationPhaseStatusNotesSponsorRef
Hepatocellular carcinomaIIIRecruitingCombined with sorafenib SillaJenNCT02562755
Solid TumorsIIRecruitingCombined with metronomic cyclophosphamide InvestigatorNCT02630368
Renal Cell Carcinoma 2LIRecruitingCombined with REGN2810 SillaJenNCT03294083
Colorectal Cancer 2L/3LIRecruitingCombined with PD-L1 and CTLA4 Investigator
Liver CancerIRecruitingCombined with Nivolumab Transgene NCT03071094
Solid TumorsIRecruitingCombined with Ipilimumab InvestigatorNCT02977156

Study Design

Participants will be randomly assigned to one of two treatment arms, having an equal chance of receiving either Pexa-Vec followed by sorafenib, or sorafenib alone.[ citation needed ]

Arm A: Pexa-Vec followed by sorafenib

  • Participants will visit the study center approximately 14 times over 18 weeks. [17]
  • All Pexa-Vec treatments (3) will be given by intratumoral injections into liver tumors.
  • Following Pexa-Vec injection series completion, patients will receive sorafenib starting at week 6 of the study

Arm B: sorafenib

  • Participants will visit the study center approximately 12 times over 18 weeks and receive sorafenib as per standard of care. [17]

Pipeline candidates

JX-Next Generation

Novel oncolytic viruses in SillaJen pipeline are engineered through the Selective Oncolytic Vaccinia Engineering (SOLVE) platform. [24]

JX-929

JX-929 is derived from Western Reserve strain vaccinia virus. JX-929's tumor selectivity has been optimized through deletion of thymidine kinase and vaccinia growth factor. JX-929 has been administered as a monotherapy to patients with breast, colorectal, and pancreatic cancer via intratumoral & intravenous injections in a Phase 1, dose escalation clinical trial. This Phase 1 study showed delivery to and replication within tumors [25] both IT [26] and IV. [27] [ clarification needed ]

JX-970

JX-970 is also derived from a Western Reserve strain vaccinia virus and utilizes the same tumor selectivity mechanisms as JX-929. In addition, it expresses granulocyte-macrophage colony-stimulating factor to stimulate immune responses. In nonclinical studies, the JX-970 backbone exerted a tumor debulking effect and at the same time demonstrated a selective preference for tumor tissues. [26] The precursor of JX-970 is JX-963 which demonstrated efficacy in pre-clinical studies.[ citation needed ]

Related Research Articles

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Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults and is currently the most common cause of death in people with cirrhosis. HCC is the third leading cause of cancer-related deaths worldwide.

<span class="mw-page-title-main">Cancer immunotherapy</span> Artificial stimulation of the immune system to treat cancer

Cancer immunotherapy (immuno-oncotherapy) is the stimulation of the immune system to treat cancer, improving the immune system's natural ability to fight the disease. It is an application of the fundamental research of cancer immunology (immuno-oncology) and a growing subspecialty of oncology.

An oncolytic virus is a virus that preferentially infects and kills cancer cells. As the infected cancer cells are destroyed by oncolysis, they release new infectious virus particles or virions to help destroy the remaining tumour. Oncolytic viruses are thought not only to cause direct destruction of the tumour cells, but also to stimulate host anti-tumour immune system responses. Oncolytic viruses also have the ability to affect the tumor micro-environment in multiple ways.

Virotherapy is a treatment using biotechnology to convert viruses into therapeutic agents by reprogramming viruses to treat diseases. There are three main branches of virotherapy: anti-cancer oncolytic viruses, viral vectors for gene therapy and viral immunotherapy. These branches use three different types of treatment methods: gene overexpression, gene knockout, and suicide gene delivery. Gene overexpression adds genetic sequences that compensate for low to zero levels of needed gene expression. Gene knockout uses RNA methods to silence or reduce expression of disease-causing genes. Suicide gene delivery introduces genetic sequences that induce an apoptotic response in cells, usually to kill cancerous growths. In a slightly different context, virotherapy can also refer more broadly to the use of viruses to treat certain medical conditions by killing pathogens.

<span class="mw-page-title-main">Sorafenib</span> Chemical compound

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<span class="mw-page-title-main">Selective internal radiation therapy</span>

Selective internal radiation therapy (SIRT), also known as transarterial radioembolization (TARE), radioembolization or intra-arterial microbrachytherapy is a form of radionuclide therapy used in interventional radiology to treat cancer. It is generally for selected patients with surgically unresectable cancers, especially hepatocellular carcinoma or metastasis to the liver. The treatment involves injecting tiny microspheres of radioactive material into the arteries that supply the tumor, where the spheres lodge in the small vessels of the tumor. Because this treatment combines radiotherapy with embolization, it is also called radioembolization. The chemotherapeutic analogue is called chemoembolization, of which transcatheter arterial chemoembolization (TACE) is the usual form.

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Jennerex Biotherapeutics, Inc. was an American private biopharmaceutical company that developed the oncolytic viruses JX-594 and JX-929 among others. By creating oncolytic viruses that can (1) kill tumor cells directly through lysis, (2) activate the immune system by delivering genes that encode immunostimulants and by overcoming tumor cell-induced immunological tolerance, and (3) reduce tumor nutrient supply through the destruction of blood vessels, Jennerex aimed to create a novel approach to treating and possibly curing cancer.

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References

  1. ↑ Un virus contre le cancer 25 March 2012, Radio Canada (in French)
  2. 1 2 Jennerex Granted FDA Orphan Drug Designation for Pexa-Vec in Hepatocellular Carcinoma (HCC)
  3. 1 2 3 4 Phase 1 Study of Intratumoral Pexa-Vec (JX-594), an Oncolytic and Immunotherapeutic Vaccinia Virus, in Pediatric Cancer Patients
  4. ↑ Transgene Presents Data on Improved Cytotoxic Activity of Oncolytic Viruses Expressing Intrabodies in Resistant Tumor Cell Lines. October 2016
  5. ↑ Bos, JL (September 1, 1989). "ras oncogenes in human cancer: a review". Cancer Research. 49 (17): 4682–9. PMID   2547513.
  6. ↑ "NCI Drug Dictionary". National Cancer Institute. 2011-02-02. Retrieved 25 March 2013.
  7. ↑ "Novel Cancer-Targeting Virus Therapy Shows Efficacy in Early-Stage Trial". 31 August 2011.
  8. ↑ Breitbach at al. (2011). "Intravenous delivery of a multi-mechanistic cancer-targeted oncolytic poxvirus in humans". Nature. 477 (7362): 99–102. Bibcode:2011Natur.477...99B. doi:10.1038/nature10358. PMID   21886163. S2CID   4365604.
  9. 1 2 "SOLVE > Technology > Sillajen". www.sillajen.com (in Korean). Retrieved 2018-06-17.
  10. ↑ Breitbach, Caroline J.; Burke, James; Jonker, Derek; Stephenson, Joe; Haas, Andrew R.; Chow, Laura Q. M.; Nieva, Jorge; Hwang, Tae-Ho; Moon, Anne (2011-08-31). "Intravenous delivery of a multi-mechanistic cancer-targeted oncolytic poxvirus in humans". Nature. 477 (7362): 99–102. Bibcode:2011Natur.477...99B. doi:10.1038/nature10358. ISSN   1476-4687. PMID   21886163. S2CID   4365604.
  11. ↑ Kirn, David H.; Thorne, Steve H. (January 2009). "Targeted and armed oncolytic poxviruses: a novel multi-mechanistic therapeutic class for cancer". Nature Reviews. Cancer. 9 (1): 64–71. doi:10.1038/nrc2545. ISSN   1474-1768. PMID   19104515. S2CID   20344137.
  12. ↑ Breitbach, Caroline J.; Arulanandam, Rozanne; De Silva, Naomi; Thorne, Steve H.; Patt, Richard; Daneshmand, Manijeh; Moon, Anne; Ilkow, Carolina; Burke, James (2013-02-15). "Oncolytic vaccinia virus disrupts tumor-associated vasculature in humans". Cancer Research. 73 (4): 1265–1275. doi: 10.1158/0008-5472.CAN-12-2687 . ISSN   1538-7445. PMID   23393196.
  13. ↑ Parker, Charles Thomas; Garrity, George M (2003-01-01). Parker, Charles Thomas; Garrity, George M (eds.). "Exemplar Abstract for Mycobacterium yongonense Kim et al. 2013 and Mycobacterium intracellulare yongonense (Kim et al. 2013) Castejon et al. 2018". doi:10.1601/ex.23701.{{cite journal}}: Cite journal requires |journal= (help)
  14. 1 2 3 "SOLVE > Technology > Sillajen". www.sillajen.com (in Korean). Retrieved 2018-06-16.
  15. 1 2 "JX-900 Series > Pipeline > Sillajen". www.sillajen.com (in Korean). Retrieved 2018-06-17.
  16. 1 2 Zeh, Herbert J; Downs-Canner, Stephanie; McCart, J Andrea; Guo, Zong Sheng; Rao, Uma N M; Ramalingam, Lekshmi; Thorne, Stephen H; Jones, Heather L; Kalinski, Pawel (January 2015). "First-in-man Study of Western Reserve Strain Oncolytic Vaccinia Virus: Safety, Systemic Spread, and Antitumor Activity". Molecular Therapy. 23 (1): 202–214. doi:10.1038/mt.2014.194. ISSN   1525-0016. PMC   4426804 . PMID   25292189.
  17. 1 2 3 4 "General Information | PHOCUS". SillaJen. Retrieved 2018-06-27.
  18. ↑ "Hepatocellular Carcinoma Study Comparing Vaccinia Virus Based Immunotherapy Plus Sorafenib vs Sorafenib Alone". ClinicalTrials.gov. Retrieved 2018-06-27.
  19. ↑ Heo, Jeong; Breitbach, Caroline; Cho, Mong; Hwang, Tae-Ho; Kim, Chang Won; Jeon, Ung Bae; Woo, Hyun Young; Yoon, Ki Tae; Lee, Jun Woo; Burke, James; Hickman, Theresa; Longpre, Lara; Patt, Richard H.; Kirn, David H. (2013-05-20). "Phase II trial of Pexa-Vec (pexastimogene devacirepvec; JX-594), an oncolytic and immunotherapeutic vaccinia virus, followed by sorafenib in patients with advanced hepatocellular carcinoma". Journal of Clinical Oncology. 31 (15_suppl): 4122. doi:10.1200/jco.2013.31.15_suppl.4122.
  20. ↑ "Hepatocellular Carcinoma Study Comparing Vaccinia Virus Based Immunotherapy Plus Sorafenib vs Sorafenib Alone - Full Text View - ClinicalTrials.gov" . Retrieved 2018-06-16.
  21. ↑ "A Study of Metronomic CP and JX-594 in Patients With Advanced Breast Cancer and Advanced Soft-tissue Sarcoma (METROmaJX) - Full Text View - ClinicalTrials.gov" . Retrieved 2018-06-16.
  22. ↑ "A Trial to Evaluate the Safety and Efficacy of the Combination of the Oncolytic Immunotherapy Pexa-Vec With the PD-1 Receptor Blocking Antibody Nivolumab in the First-line Treatment of Advanced Hepatocellular Carcinoma". ClinicalTrials.gov. Retrieved 2018-06-16.
  23. ↑ "Immunization Strategy With Intra-tumoral Injections of Pexa-Vec With Ipilimumab in Metastatic / Advanced Solid Tumors". ClinicalTrials.gov. Retrieved 2018-06-16.
  24. ↑ "JX-900 Series > Pipeline > Sillajen". www.sillajen.com (in Korean). Retrieved 2018-06-16.
  25. ↑ Thorne, R. M.; Horne, R. B. (December 2007). "Comment onKhazanov et al.[2002] andKhazanov et al.[2006]". Journal of Geophysical Research: Space Physics. 112 (A12): n/a. Bibcode:2007JGRA..11212214T. doi: 10.1029/2007ja012268 . ISSN   0148-0227.
  26. 1 2 Zeh, Herbert J.; Downs-Canner, Stephanie; McCart, J. Andrea; Guo, Zong Sheng; Rao, Uma N. M.; Ramalingam, Lekshmi; Thorne, Stephen H.; Jones, Heather L.; Kalinski, Pawel (January 2015). "First-in-man study of western reserve strain oncolytic vaccinia virus: safety, systemic spread, and antitumor activity". Molecular Therapy. 23 (1): 202–214. doi:10.1038/mt.2014.194. ISSN   1525-0024. PMC   4426804 . PMID   25292189.
  27. ↑ Downs-Canner, Stephanie; Guo, Zong Sheng; Ravindranathan, Roshni; Breitbach, Caroline J; O'Malley, Mark E; Jones, Heather L; Moon, Anne; McCart, Judith Andrea; Shuai, Yongli (August 2016). "Phase 1 Study of Intravenous Oncolytic Poxvirus (vvDD) in Patients With Advanced Solid Cancers". Molecular Therapy. 24 (8): 1492–1501. doi:10.1038/mt.2016.101. ISSN   1525-0016. PMC   5023393 . PMID   27203445.
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