Safety and Efficacy of NRG-103 Injection in the Treatment of Recurrent Glioblastoma Patients

The annual incidence rate of malignant brain tumors in China is 4.2/100000, and GBM accounts for 50.9%. GBM is highly invasive and malignant. After undergoing anti-tumor treatments such as surgery, radiotherapy, and chemotherapy, the short-term recurrence rate is extremely high. The median survival time after recurrence is only 9 months, and the 1-year survival rate is 30%. It is urgent to explore new therapy strategy.

Transgenic oncolytic virus therapy for GBM is an emerging anti-tumor therapy. The genetically engineered oncolytic virus has improved selectivity towards tumor cells, replicating and lysing only within infected tumor cells, while activating the body's immune system to launch a more extensive attack on tumors. At present, various genetically modified oncolytic viruses targeting GBM have entered the clinical trial stage both domestically and internationally. For example, G47Δ, with superior anti-tumor activity and good safety in early clinical trials, has been conditionally approved for marketing in Japan for the treatment of malignant gliomas. DNX-2401, JL15003, and others are also in the early stages of clinical research. NRG-103 is an innovative gene therapy drug developed based on the in situ trans-differentiation technology. Through multiple mutation modifications of the adenovirus genome, it can enhance the specific recognition and killing effect of oncolytic virus on GBM tumor cells without being limited by tumor gene phenotype, and regulate the immune microenvironment to induce stronger anti-tumor immune response. In addition, the two transcription factors expressed on NRG-103 can efficiently transdifferentiate residual GBM tumor cells into non tumor like neuronal cells, in order to achieve the goal of delaying tumor recurrence and long-term survival. NRG-103 exhibits significant anti-tumor activity and clear in situ trans-differentiation effects in preclinical models, providing scientific evidence for the potential clinical efficacy of NRG-103.

Inclusion criteria

• Age≥18 years.
• Patients must have histologically or cytologically confirmed glioblastoma(WHO 2021).
• Patients have experienced recurrence (RANO 2.0) after previous anti-tumor treatments, including the recurrent tumor has been surgically removed and an Ommaya reservoir has been placed inside the tumor cavity.
• The relevant adverse reactions from the previous treatment have been restored to ≤1 level(NCI-CTCAE v5.0).
• Karnofsky Performance Score≥70.
• Stable doses of dexamethasone during the week prior to inclusion.
• Adequate bone marrow reserve: White blood cell count>2.0 × 109/L, neutrophil count>1.0 × 109/L, platelet count>100 × 109/L, international normalized ratio ≤1.5 times ULN, and activated partial thromboplastin time≤1.5 times ULN.
• Normal heart, renal and liver function.
• Effective method of contraception for patients and their partners.
• Written informed consent.

Exclusion criteria

• Allergy to the components of the test drug and contrast agent.
• Unable to undergo imaging examinations required for the research.
• A history of cell therapy, gene therapy, or oncolytic virus therapy.
• Undergoing other clinical trials.
• A history of anti-tumor vaccines or other immunomodulatory drugs with 4 weeks.
• A history of other type of malignant tumors.
• Unexplained fever.
• A history of autoimmune disease.
• A history of immunodeficiency, or other acquired or congenital immunodeficiency diseases, or history of organ transplantation.
• Active hepatitis B, or hepatitis C.
• Severe heart disease (NYHA III or IV), or poorly controlled diabetes.
• Two or more GBM lesions.
• GBM lesion located in the brainstem, cerebellum, posterior fossa, or spinal cord, as well as leptomeningeal diseases.
• A history of diffuse subarachnoid and subarachnoid diseases.
• GBM lesion invades the ventricular wall or tumor cavity communicates with the ventricle after surgery.
• A history of encephalitis, multiple sclerosis, or other central nervous system infections.
• Cerebral herniation syndrome.
• Pregnant and lactating women.
• Other situations that the researcher deems unsuitable for entry into the study.