Combination Adenovirus + Pembrolizumab to Trigger Immune Virus Effects

In the initial phase of the study, up to 12 evaluable subjects will be enrolled in 3 dose cohorts to determine the best dose of DNX-2401, as follows:

* Cohort 1: Single dose DNX-2401 (5e8 vp) delivered intratumorally by cannula, followed by intravenous pembrolizumab every 3 weeks (Q3W)
* Cohort 2: Single dose DNX-2401(5e9 vp) delivered intratumorally by cannula, followed by intravenous pembrolizumab every 3 weeks (Q3W)
* Cohort 3: Single dose DNX-2401 (5e10 vp) delivered intratumorally by cannula, followed by intravenous pembrolizumab every 3 weeks (Q3W)

Following the initial phase, up to 36 additional subjects diagnosed with recurrent glioblastoma or gliosarcoma will be enrolled to receive a single of DNX-2401 determined in the initial phase administered intratumorally followed by intravenous pembrolizumab every 3 weeks.

All subjects will return to the clinic for study follow-up visits at regular intervals for safety monitoring, MRI scans and other assessments, for up to 2 years or until disease progression. All subjects will be followed closely for safety and survival.

• DNX-2401 (Biological), also known as Oncolytic virus, Genetically-modified adenovirus, Delta-24, Delta-24-RGD: On Day 0, following brain tumor biopsy and confirmation of recurrent tumor, a single injection of DNX-2401 is administered directly into the brain tumor.
• pembrolizumab (Biological), also known as KEYTRUDA, lambrolizumab, MK-3475, SCH 900475, Checkpoint inhibitor, monoclonal antibody, anti-PD1/PD-L1: Sequential intravenous administration every three weeks beginning 7-9 days after Day 0/DNX-2401

Primary outcomes

• Objective response rate (ORR) [3.5 years]: Interval tumor size reduction as measured from periodic MRI

Secondary outcomes

• Overall survival (OS) [3.5 years]: Months alive following treatment as measured during periodic study visits
• Time to tumor response [3.5 years]: Months to response following treatment as measured during periodic MRIs
• Duration of response [3.5 years]: Months of sustained response as measured during periodic study visits

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* A single glioblastoma or gliosarcoma tumor with histopathological confirmation for first or presenting second recurrence of glioblastoma or gliosarcoma at the time of consent
* Gross total or partial tumor resection is not possible or not planned
* A single measurable tumor that is at least 10.0 mm longest diameter (LDi) X 10.0 mm shortest diameter (SDi) and this tumor does not exceed 40.0 mm in LDi or SDi on Screening MRI
* Tumor recurrence or progression documented after previously failing surgical resection, chemotherapy or radiation
* Karnofsky performance status ≥ 70 %
* Prior anti-tumor therapies must have been completed within time periods specified in the protocol prior to DNX-2401 injection and toxic side effects must be mild, if present
* Demonstrate adequate organ function via specified laboratory test results

Exclusion Criteria:

* Multiple (≥ 2) separate enhancing tumors
* Tumor location on both sides of the brain and/or involvement that would present the risk of injecting DNX-2401 into the ventricles of the brain
* Tumor location in the brain stem
* Requires or, based upon history, may require treatment with high-dose systemic corticosteroids within 2 weeks of the start of intravenous pembrolizumab infusions and within 2 weeks following the first infusion of pembrolizumab
* Uncontrolled blood-sugar levels defined as HbA1c > 7%
* Previous treatment with any checkpoint inhibitor such as anti-PD1 or PD-L1 agents including pembrolizumab (KEYTRUDA) or any other checkpoint inhibitor(s) (e.g., ipilimumab, nivolumab, etc.)
* History of (non-infectious) or current active pneumonitis that required steroids and/or a history of interstitial lung disease
* Prior gene transfer therapy or prior therapy with a cytolytic virus of any type
* Brain tumor that is not measurable on MRI or persons who are unable to have MRIs
* Pregnant or nursing females

Note: Other protocol-defined inclusion and exclusion criteria may apply as outlined in the relevant protocol version

• Results publication: Nassiri F, Patil V, Yefet LS, Singh O, Liu J, Dang RMA, Yamaguchi TN, Daras M, Cloughesy TF, Colman H, Kumthekar PU, Chen CC, Aiken R, Groves MD, Ong SS, Ramakrishna R, Vogelbaum MA, Khagi S, Kaley T, Melear JM, Peereboom DM, Rodriguez A, Yankelevich M, Nair SG, Puduvalli VK, Aldape K, Gao A, Lopez-Janeiro A, de Andrea CE, Alonso MM, Boutros P, Robbins J, Mason WP, Sonabend AM, Stupp R, Fueyo J, Gomez-Manzano C, Lang FF, Zadeh G. Oncolytic DNX-2401 virotherapy plus pembrolizumab in recurrent glioblastoma: a phase 1/2 trial. Nat Med. 2023 Jun;29(6):1370-1378. doi: 10.1038/s41591-023-02347-y. Epub 2023 May 15. PMID 37188783

• Nancy Gady, BS, Study director, DNAtrix, Inc.