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    Clinical Trial Results:
    A Phase I/II Trial Investigating LOAd703 in Combination with Atezolizumab in Malignant Melanoma

    Summary
    EudraCT number
    2019-003300-12
    Trial protocol
    SE  
    Global end of trial date
    18 Jul 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    05 Jul 2024
    First version publication date
    05 Jul 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    LOKON003
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04123470
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Lokon Pharma AB
    Sponsor organisation address
    Bredgrand 14, Uppsala, Sweden, 75320
    Public contact
    Angelica Loskog, Lokon Pharma AB, angelica.loskog@lokonpharma.com
    Scientific contact
    Angelica Loskog, Lokon Pharma AB, angelica.loskog@lokonpharma.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    18 Jul 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    18 Jul 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    18 Jul 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective is to determine the tolerability of LOAd703 administered by intratumoral injections in combination with intravenous atezolizumab.
    Protection of trial subjects
    The study was conducted in accordance to the protocol, applicable regulatory requirements, GCP and ethical principals of the latest version of the Declaration of Helsinki. The principal investigators were responsible for ensuring the protocol is followed. Safeguards to protect clinical research volunteers include Institutional Review Boards/Independent Ethics Committee, informed consent and cohort review safety meetings.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    30 Sep 2020
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Sweden: 17
    Country: Number of subjects enrolled
    United States: 7
    Worldwide total number of subjects
    24
    EEA total number of subjects
    17
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    12
    From 65 to 84 years
    12
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Overall, a total of 26 subjects were enrolled in the study, 2 out of 26 subjects were screening failures and 24 out of 26 subjects were registered in the study. The study enrollment was stopped after obtaining sufficient safety data, and subjects were followed until the End of Study was reached as per protocol.

    Pre-assignment
    Screening details
    Adult patients (≥18 years of age) with a pathological confirmation of locally advanced or metastatic melanoma who had received at least 1 prior line of checkpoint blockade antibody therapy (monotherapy or combination) as adjuvant or treatment for systemic disease were eligible for the study.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    Not applicable

    Arms
    Arm title
    Treatment arm
    Arm description
    LOAD703 (Delolimogene mupadenorepvec) at two dose levels 1x10e11 VP and 5x10e11 VP in combination with atezolizumab (fixed dose 1200mg). Treatments of LOAd703 (up to 12 times) were delivered by intratumoral injection concurrent with intravenous atezolizumab treatment (up to 19 times) every 3 weeks
    Arm type
    Experimental

    Investigational medicinal product name
    LOAd703
    Investigational medicinal product code
    Other name
    delolimogene mupadenorepvec
    Pharmaceutical forms
    Solution for injection in vial
    Routes of administration
    Intratumoral use
    Dosage and administration details
    Modified adenovirus serotype 5/35 containing a CMV promoter-driven transgene cassette with human transgenes encoding membrane-bound CD40 ligand (TMZ-CD40L) and full-length 4-1BBL. LOAd703 was tested at two dose levels: 1x10e11VP and 5x10e11 VP. LOAd703 is delivered frozen in vials containing 650 µl of virus in suspension. The frozen vial is thawed at the clinic on wet ice or in a refrigerator +4°C (±2°C) according to the Sponsor’s instructions. The thawed LOAd703 virus is used directly or is diluted with physiological saline (0.9% NaCl)prior use depending on the patient dose and number of lesions to be injected. The Investigator and the radiologist assess together which lesion(s) are suitable for direct or image guided injection. The prescribed virus dose in suspension is administered by i.t. injections into ≤3 lesions per treatment occasion.

    Investigational medicinal product name
    Atezolizumab
    Investigational medicinal product code
    Other name
    Tecentriq
    Pharmaceutical forms
    Concentrate for solution for injection/infusion, Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Humanized monoclonal antibody based on a human IgG1 framework containing heavy chain VHIII and light chain VκI subgroup sequences. For IV administration, atezolizumab (1200mg per vial) is administered in 250 mL IV infusion bags containing 0.9% NaCl and infusion lines equipped with 0.2 or 0.22 um in-line filters. Administration of atezolizumab will be performed in a monitored setting where there is immediate access to trained personnel and adequate equipment and medicine to manage potentially serious reactions. No premedication is permitted prior to the first infusion. However, if the patient experienced an infusion-related reaction with any previous infusion, premedication with antihistamines, antipyretics, and/or analgesics may be administered for subsequent doses at the discretion of the Investigator. Atezolizumab will be administrated IV using a fixed dose (1200 mg/infusion).

    Number of subjects in period 1
    Treatment arm
    Started
    24
    Completed
    11
    Not completed
    13
         Consent withdrawn by subject
    1
         Death (progressive disease)
    11
         Lost to follow-up
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    24 24
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    64.0 (51.5 to 72.0) -
    Gender categorical
    Units: Subjects
        Female
    11 11
        Male
    13 13
    Race
    Units: Subjects
        American Indian or Alaska Native
    0 0
        Asian
    0 0
        Black or African American
    1 1
        Native Hawaiian or Other Pacific Islander
    0 0
        White
    21 21
        Other
    0 0
        Not reported
    2 2
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    1 1
        Not Hispanic or Latino
    19 19
        Not reported
    4 4
    Disease stage at initial diagnosis
    Units: Subjects
        stage 0
    1 1
        stage I
    5 5
        stage II
    2 2
        stage III
    12 12
        stage IV
    3 3
        Unknown
    1 1
    Disease stage at study entry
    Units: Subjects
        stage III
    0 0
        stage IV
    24 24
        Unknown
    0 0
    Time from initial diagnosis
    Units: months
        arithmetic mean (standard deviation)
    87.82 ( 98.990 ) -
    Subject analysis sets

    Subject analysis set title
    LOAd703 dose 1x10e11 VP
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    LOAd703 dose is 1x10e11 VP in combination with atezolizumab at fixed dose 1200mg

    Subject analysis set title
    LOAd703 dose 5x10e11 VP
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    LOAd703 dose 5x10e11VP in combination with fixed atezolizumab 1200 mg

    Subject analysis sets values
    LOAd703 dose 1x10e11 VP LOAd703 dose 5x10e11 VP
    Number of subjects
    7
    17
    Age categorical
    Units: Subjects
        In utero
        Preterm newborn infants (gestational age < 37 wks)
        Newborns (0-27 days)
        Infants and toddlers (28 days-23 months)
        Children (2-11 years)
        Adolescents (12-17 years)
        Adults (18-64 years)
        From 65-84 years
        85 years and over
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    70.0 (53.0 to 74.0)
    63.0 (46.0 to 70.0)
    Gender categorical
    Units: Subjects
        Female
    2
    9
        Male
    5
    8
    Race
    Units: Subjects
        American Indian or Alaska Native
    0
    0
        Asian
    0
    0
        Black or African American
    0
    1
        Native Hawaiian or Other Pacific Islander
    0
    0
        White
    7
    14
        Other
    0
    0
        Not reported
    0
    2
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    0
    1
        Not Hispanic or Latino
    7
    12
        Not reported
    0
    4
    Disease stage at initial diagnosis
    Units: Subjects
        stage 0
    0
    1
        stage I
    2
    3
        stage II
    0
    2
        stage III
    4
    8
        stage IV
    1
    2
        Unknown
    0
    1
    Disease stage at study entry
    Units: Subjects
        stage III
    0
    0
        stage IV
    7
    17
        Unknown
    0
    0
    Time from initial diagnosis
    Units: months
        arithmetic mean (standard deviation)
    104.85 ( 143.310 )
    80.81 ( 78.774 )

    End points

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    End points reporting groups
    Reporting group title
    Treatment arm
    Reporting group description
    LOAD703 (Delolimogene mupadenorepvec) at two dose levels 1x10e11 VP and 5x10e11 VP in combination with atezolizumab (fixed dose 1200mg). Treatments of LOAd703 (up to 12 times) were delivered by intratumoral injection concurrent with intravenous atezolizumab treatment (up to 19 times) every 3 weeks

    Subject analysis set title
    LOAd703 dose 1x10e11 VP
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    LOAd703 dose is 1x10e11 VP in combination with atezolizumab at fixed dose 1200mg

    Subject analysis set title
    LOAd703 dose 5x10e11 VP
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    LOAd703 dose 5x10e11VP in combination with fixed atezolizumab 1200 mg

    Primary: Safety determined by the NCI-CTCAE v5.0

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    End point title
    Safety determined by the NCI-CTCAE v5.0 [1]
    End point description
    End point type
    Primary
    End point timeframe
    57 weeks
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No formal statistical analysis was performed to compare dose groups. Results are presented with descriptive statistics, are tabulated by dose group and reviewed to evaluate the study endpoints.
    End point values
    LOAd703 dose 1x10e11 VP LOAd703 dose 5x10e11 VP
    Number of subjects analysed
    7 [2]
    17 [3]
    Units: Number of events
        All Adverse events (AE)
    52
    130
        All Serious adverse events (SAEs)
    6
    11
        SARs related to LOAd703
    0
    2
        SARs related to atezolizumab
    0
    1
        AE leading to withdrawal from the study
    0
    0
        AE leading to LOAd703 discontinuation
    4
    4
        AE leading to atezolizumab discontinuation
    6
    4
        AE leading to death
    1
    0
        AE related to LOAd703
    28
    64
        AE related to atezolizumab
    20
    41
        AE related to LOAd703 and/or atezolizumab
    30
    72
        AE related to LOAd703 grade 1
    17
    40
        AE related to LOAd703 grade 2
    11
    22
        AE related to LOAd703 grade 3
    0
    2
        AE related to LOAd703 grade 4
    0
    0
        AE related to LOAd703 grade 5
    0
    0
        AE related to atezolizumab grade 1
    10
    26
        AE related to atezolizumab grade 2
    10
    14
        AE related to atezolizumab grade 3
    0
    1
        AE related to atezolizumab grade 4
    0
    0
        AE related to atezolizumab grade 5
    0
    0
        AE not related to LOAd703 or atezolizumab grade 1
    7
    32
        AE not related to LOAd703 or atezolizumab grade 2
    7
    13
        AE not related to LOAd703 or atezolizumab grade 3
    7
    11
        AE not related to LOAd703 or atezolizumab grade 4
    0
    2
        AE not related to LOAd703 or atezolizumab grade 5
    1
    0
    Notes
    [2] - Number of subjects based on safety evaluable population
    [3] - Number of subjects based on safety evaluable population
    No statistical analyses for this end point

    Secondary: Best overall tumor response according to RECIST 1.1

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    End point title
    Best overall tumor response according to RECIST 1.1
    End point description
    Overall Response Rate is defined as proportion of subjects with the best overall response of complete response (CR) or partial response (PR). Clinical Benefit Rate is defined as proportion of subjects with the best overall response of complete response (CR) or partial response (PR) or stable disease (SD).
    End point type
    Secondary
    End point timeframe
    57 weeks
    End point values
    LOAd703 dose 1x10e11 VP LOAd703 dose 5x10e11 VP
    Number of subjects analysed
    6 [4]
    15 [5]
    Units: Number of subjects
        Complete response
    0
    0
        Partial response
    1
    3
        Stable disease
    3
    6
        Progressive disease
    2
    6
        Not evaluable
    0
    0
        Overall response rate (CR or PR)
    1
    3
        Clinical benefit rate (CR, PR or SD)
    4
    9
    Notes
    [4] - Number of subjects based on efficacy evaluable population
    [5] - Number of subjects based on efficacy evaluable population
    No statistical analyses for this end point

    Other pre-specified: Overall survival

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    End point title
    Overall survival
    End point description
    Overall survival is defined as the time from the first dose of study treatment (LOAd703 and/or atezolizumab) until death. In the LOAd703 1 x 10e11 VP + atezolizumab group, the median OS estimate was 26.05 months (95% CI: 2.10, not estimated). In the LOAd703 5 x 10e11 VP + atezolizumab group, the median OS estimate was not reached at the End of Study (25th percentile was 4.40 months [95% CI: 2.56, 12.22]).
    End point type
    Other pre-specified
    End point timeframe
    up till 48 months
    End point values
    LOAd703 dose 1x10e11 VP LOAd703 dose 5x10e11 VP
    Number of subjects analysed
    6 [6]
    15 [7]
    Units: number of subjects
        Number of subjects with event
    3
    7
        Number of subjects censored
    3
    8
    Notes
    [6] - Number of subjects based on efficacy evaluable population
    [7] - Number of subjects based on efficacy evaluable population
    No statistical analyses for this end point

    Other pre-specified: Progression-free survival

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    End point title
    Progression-free survival
    End point description
    Progression free survival is defined as the time from the first dose of study treatment until progression according to RECIST1.1 or death (whichever occurred first). In the 1x10e11 VP LOAd703 + atezolizumab group, the median PFS estimate was 11.19 months (95% CI: 1.84, not estimated); the estimated survival distribution and number of subjects at risk decreased over time (range: 0.6667 to 0, 4 subjects to 0). In the 5x10e11 VP LOAd703 + atezolizumab group, the median PFS estimate was 3.25 months (95% CI: 1.91,6.24); the estimated survival distribution and number of subjects at risk decreased over time (range: 0.5333 to 0.1600, 8 subjects to 2).
    End point type
    Other pre-specified
    End point timeframe
    up to 48 months
    End point values
    LOAd703 dose 1x10e11 VP LOAd703 dose 5x10e11 VP
    Number of subjects analysed
    6 [8]
    15 [9]
    Units: Number of subjects
        Number of subjects with event
    5
    12
        Number of subjects censored
    1
    3
    Notes
    [8] - Number of subjects based on efficacy evaluable population
    [9] - Number of subjects based on efficacy evaluable population
    No statistical analyses for this end point

    Other pre-specified: Time to progression

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    End point title
    Time to progression
    End point description
    Time to progression (TTP) defined as the time from first dose of study treatment until progression according to RECIST v1.1. In the 1 x 10e11 VP LOAd703+atezolizumab group, the median TTP was 11.19 months (95% CI: 1.84, not estimated); the estimated survival distribution and number of subjects at risk decreased over time (range: 0.6667 to 0, 4 subjects to 0). In the 5 x 10e11 VP LOAd703+atezolizumab group, the median TTP was 3.25 months (95% CI: 1.91, 6.24); the estimated survival distribution and number of subjects at risk decreased over time (range: 0.5333 to 0.1600, 8 subjects to 2).
    End point type
    Other pre-specified
    End point timeframe
    57 weeks
    End point values
    LOAd703 dose 1x10e11 VP LOAd703 dose 5x10e11 VP
    Number of subjects analysed
    6 [10]
    15 [11]
    Units: Number of subjects
        Number of subjects with event
    5
    12
        Number of subjects censored
    1
    3
    Notes
    [10] - Number of subjects based on efficacy evaluable population
    [11] - Number of subjects based on efficacy evaluable population
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    57 weeks
    Adverse event reporting additional description
    The AE reporting period for this study begins upon recieving the first LOAd703 and/or atezolizumab treatment and continues until final visit at week 57. If a patient experiences an AE after signing the informed consent but before the first treatment, the event may be recorded as medical condition.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.0
    Reporting groups
    Reporting group title
    LOAd703 dose 1x10e11VP
    Reporting group description
    -

    Reporting group title
    LOAd703 dose 5x10e11VP
    Reporting group description
    -

    Serious adverse events
    LOAd703 dose 1x10e11VP LOAd703 dose 5x10e11VP
    Total subjects affected by serious adverse events
         subjects affected / exposed
    2 / 7 (28.57%)
    5 / 17 (29.41%)
         number of deaths (all causes)
    4
    7
         number of deaths resulting from adverse events
    1
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Infected neoplasm
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tumour pain
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Medication error
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Deep vein thrombosis
    Additional description: Three events reported in 1 subject: deep venous thrombosis left lower extremity (grade 3); deep venous thrombosis right lower extremity (grade 3), worsening DVT L Leg (grade 3)
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lymphoedema
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac failure
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    General physical health deterioration
    Additional description: SAE of general physical health deterioration (2 events; 1 event Grade 3 that worsened to Grade 5), unrelated to study treatment, led to discontinuation of LOAd703 and atezolizumab in 1 subject. Subject died of disease progression.
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Non-cardiac chest pain
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Immune system disorders
    Cytokine release syndrome
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Abdominal abscess
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Salmonellosis
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    LOAd703 dose 1x10e11VP LOAd703 dose 5x10e11VP
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    7 / 7 (100.00%)
    17 / 17 (100.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Cancer pain
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Tumour pain
         subjects affected / exposed
    0 / 7 (0.00%)
    2 / 17 (11.76%)
         occurrences all number
    0
    2
    Vascular disorders
    Embolism
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Hypertension
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Hypotension
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Thrombosis
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Deep vein thrombosis
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    2
    0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    4 / 7 (57.14%)
    10 / 17 (58.82%)
         occurrences all number
    5
    18
    Fatigue
         subjects affected / exposed
    1 / 7 (14.29%)
    5 / 17 (29.41%)
         occurrences all number
    1
    5
    Chills
         subjects affected / exposed
    2 / 7 (28.57%)
    3 / 17 (17.65%)
         occurrences all number
    3
    4
    Injection site pain
         subjects affected / exposed
    0 / 7 (0.00%)
    2 / 17 (11.76%)
         occurrences all number
    0
    2
    Inflammation
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Injection site reaction
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Pain
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Oedema peripheral
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Immune system disorders
    Cytokine release syndrome
         subjects affected / exposed
    1 / 7 (14.29%)
    2 / 17 (11.76%)
         occurrences all number
    1
    2
    Reproductive system and breast disorders
    Vaginal haemorrhage
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Hiccups
         subjects affected / exposed
    1 / 7 (14.29%)
    1 / 17 (5.88%)
         occurrences all number
    1
    1
    Nasal congestion
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Cough
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Dysphonia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Dyspnoea
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Haemoptysis
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Hypoxia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Blood creatine increased
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Activated partial thromboplastin time prolonged
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Blood albumin decreased
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Borrelia test positive
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Lymphocyte count decreased
         subjects affected / exposed
    0 / 7 (0.00%)
    2 / 17 (11.76%)
         occurrences all number
    0
    2
    Neutrophil count decreased
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Troponin I increased
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    White blood cell count decreased
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    2
    Injury, poisoning and procedural complications
    Infusion related reaction
         subjects affected / exposed
    0 / 7 (0.00%)
    5 / 17 (29.41%)
         occurrences all number
    0
    8
    Contusion
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Rib fracture
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    1 / 7 (14.29%)
    1 / 17 (5.88%)
         occurrences all number
    2
    1
    Angina pectoris
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Sinus tachycardia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Nervous system disorders
    Headache
         subjects affected / exposed
    1 / 7 (14.29%)
    4 / 17 (23.53%)
         occurrences all number
    1
    8
    Dizziness
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Dysgeusia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Neuropathy peripheral
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Paraesthesia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Blood and lymphatic system disorders
    Leukocytosis
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Anaemia
         subjects affected / exposed
    1 / 7 (14.29%)
    2 / 17 (11.76%)
         occurrences all number
    1
    5
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    3 / 7 (42.86%)
    5 / 17 (29.41%)
         occurrences all number
    6
    5
    Vomiting
         subjects affected / exposed
    2 / 7 (28.57%)
    5 / 17 (29.41%)
         occurrences all number
    2
    5
    Diarrhoea
         subjects affected / exposed
    0 / 7 (0.00%)
    4 / 17 (23.53%)
         occurrences all number
    0
    4
    Abdominal pain
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    2 / 7 (28.57%)
    1 / 17 (5.88%)
         occurrences all number
    2
    1
    Pruritus
         subjects affected / exposed
    1 / 7 (14.29%)
    1 / 17 (5.88%)
         occurrences all number
    1
    1
    Erythema
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Skin disorder
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Renal and urinary disorders
    Haematuria
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Proteinuria
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Endocrine disorders
    Adrenal insufficiency
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Musculoskeletal and connective tissue disorders
    Myalgia
         subjects affected / exposed
    0 / 7 (0.00%)
    3 / 17 (17.65%)
         occurrences all number
    0
    3
    Pain in extremity
         subjects affected / exposed
    2 / 7 (28.57%)
    1 / 17 (5.88%)
         occurrences all number
    2
    1
    Groin pain
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Muscular weakness
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Back pain
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Muscle spasms
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    2 / 7 (28.57%)
    1 / 17 (5.88%)
         occurrences all number
    2
    1
    Pneumonia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Tooth abscess
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    1 / 7 (14.29%)
    1 / 17 (5.88%)
         occurrences all number
    1
    1
    Hypercalcaemia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Hyperglycaemia
         subjects affected / exposed
    0 / 7 (0.00%)
    2 / 17 (11.76%)
         occurrences all number
    0
    3
    Hypocalcaemia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Hypoglycaemia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Hyponatraemia
         subjects affected / exposed
    0 / 7 (0.00%)
    2 / 17 (11.76%)
         occurrences all number
    0
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    02 Dec 2019
    Secondary objectives and endpoints (sections synopsis, 3.1, 3.2) • The language is changed to better define what is being evaluated using the objective and endpoints stated. Exclusion criteria (sections synopsis, 4.2): • Criteria 6-12: it is clarified that registration is regarded when the first dose of LOAd703 and atezolizumab is given. • Criteria 18: it is clarified that the contraceptive method must be regarded highly effective, and that abstinence from heterosexual intercourse is a choice of contraceptive method as well depending on the lifestyle of the subject. • Criteria 19: it is clarified that men that has a partner of childbearing potential who refuse highly effective contraceptives are excluded. • Criteria 24: it is added that patients with tested reduced functional respiratory capacity are excluded. Dose limiting toxicity • We added information about the DLT evaluation during dose escalation. • 5.6.1, 5.6.5: we removed the use of Ringer’s acetate infusion solution so that all LOAd703 dilutions will be diluted in formulation buffer or physiological saline. • 5.6.3, 5.6.5: we changed that an unopened vial should be used within 24 hours from thawing. Administrative changes
    09 Jan 2020
    Administrative changes (EU version 2.1, dated 2020-01-09, was issued to include administrative changes added to the submitted IND version 2.0)
    26 Mar 2020
    • Exclusion criteria 15 was clarified to relate to monotherapy with a single PD-1/PD-L1 antibody. Administrative changes: • Section 1.4: The dept of Oncology in Uppsala has a new address. • Section 5.6.3: Temporarily storage of LOAd 703 in -20°C for up to 3 months, has been removed. • Section 5.6.5: the preparation instructions for LOAd703 has been clarified, to clearly state that the maximum dose, injected in 1 lesion, will not be diluted. • Section 5.6.6 was clarified in regards to selection of lesion and that subcutaneous lesions, visible to the eye, may be photographed. • Table I: Overview of ongoing clinical trials was updated. • Section 9.4 Immunological AEs and Handling Plan has been updated to refer to the atezolizumab IB. • Table 3 was removed, which affect the numbering of the 2 subsequent tables.
    20 Apr 2020
    • Exclusion criteria 1 was modified so that patients with acral melanoma will not longer be excluded. Administrative change: • A clarification was made in section 2.6.1 so that it is clear that NSAID or steroid treatment can be used.
    21 Sep 2020
    Synopsis and section 4.1 Inclusion criteria: • A new criterion was added: A life expectancy of at least 3 months as per the investigator: this is a common inclusion criterion for this type of patients • Patients with locally advanced melanoma or metastatic melanoma can be included, regardless of patient’s eligibility for complete tumor resection. • Prior treatment with tyrosine kinase inhibitor(s) is optional; patients that have not yet received treatment with tyrosine kinase inhibitor(s) can be included in the study • Cut-point for serum albumin levels was changed to ≥ 2.5 mg/dL as well as requirement for AST and ALT was changed to ≤ 5 times the ULN if liver metastases are present • Lactate dehydrogenase parameter was removed Synopsis and section 4.2 Exclusion criteria: • Exclusion criteria no 1 was modified so that patients with mucosal melanoma will no longer be excluded. • Exclusion of patients with progressive disease within 8 weeks after checkpoint inhibitor therapy and patients who have had more than 3 lines of treatment; were deemed to be to narrow and was replaced by a criterion excluding patients with rapid progression rate as assessed by the investigator • Exclusion criterion describing number and site of metastases was updated: patients with central nervous system involvement (cerebral metastases) will be excluded, but not patients with bone metastases • Washout period between cytotoxic and radiation therapy and protocol therapy (LOAd703/atezolizumab) was shortened to 14 days • Washout period between immunostimulatory therapy and protocol therapy (LOAd703/atezolizumab) was shortened to 21 days • Patients on warfarin continue to be excluded, but clarification was made that low molecular heparin is permitted Administrative changes
    11 Nov 2020
    Changes made in EU version only Synopsis and section 4.1 Inclusion criteria: • Valid for Swedish patients: Patients not eligible for complete resection with locally advanced melanoma or metastatic melanoma can be included. Valid for US patients: Patients with locally advanced melanoma or metastatic melanoma can be included, regardless of patient’s eligibility for complete tumor resection. • Valid for Swedish patients: Patients with B-Raf mutations must have received appropriate therapy with tyrosine kinase inhibitors(s) or MEK inhibitor (no changes from version 4.0) Valid for US patients: Prior treatment with tyrosine kinase inhibitor(s) is optional; patients that have not yet received treatment with tyrosine kinase inhibitor(s) can be included in the study
    15 Feb 2021
    Changes made in EU version only Substantial change, section 7.2.10: Blood Chemistry and 7.2.11: Hematology: • If samples are taken for routine analysis <7 days prior to screening, the results can be used for eligibility evaluation at the discretion of the investigator, without need of subject the patients for new sampling.
    25 Apr 2022
    • Number of patients needed to be enrolled to achieve at least 25 evaluable patients at MTD has been changed to up to 50 throughout the document (synopsis, section 3.3 Summary of Trial Design) • The expected duration of the study has been updated (synopsis, section 3.5 End of Study, 5.0 Treatment of Patients). • An additional site has been added (section 1.0 General Information) • New exclusion criteria no. 32: Adenovirus-based vaccines (e.g Vaxzevria, known as COVID-19 vaccine Astra Zeneca, J&J Covid-19 vaccine) are prohibited 3 months prior to initiation of study treatment, during treatment and 6 months after the final dose of LOAd703 (synopsis, section 4.2, concomitant medication section 5.8). • In section 5.8 Approved and Non-approved concomitant treatment it has been added that palliative surgery and local radiotherapy will be allowed. • The time points for vital signs measurements have been updated in section 5.1 Treatment Overview and 7.2.6 Vital signs. • Addition for US only, as already approved for Sweden. In section 5.1 Treatment Overview and 6.2 Screening, 7.2.10 Blood Chemistry and 7.2.11 Hematology it has been clarified that “If samples are taken for routine analysis <7 days prior to screening, the results can be used for eligibility evaluation at the discretion of the Investigator, without need of subject the patients for new sampling”. • Addition for Sweden only. In section 7.3.1 Anti-Adenoviral Antibodies addition of “Valid for Swedish patients: patients enrolled at Uppsala site, Sweden will be asked to provide additional blood samples for research purposes to identify and isolate B-cells producing anti-adenoviral antibodies. Blood samples will be collected at 2-3 occasions (up to 42 ml in total) during the LOAd703 treatment period (starting from week 6 until week 33)” have been made. Administrative changes
    09 Jun 2023
    • Definition for the End of study has been modified under section Definition and Terms and in the section 3.5 End of Study and section 13.4 Study Report • The expected duration of the study has been updated to reflect change of the End of Study definition (synopsis, 3.4 Duration of Study, 5.1 Treatment overview) • Contact details for the new Site Principal Investigator at Baylor College of Medicine has been updated. Administrative changes

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Exploratory analysis for shedding, anti-adenovirus immunity, PK atezolizumab, immunity to atezolizumab, immune and protein profile was done. Results are summarized per individual subjects or over time without statistical analysis. Data not submitted.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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