1054PD - Phase I/II CANON study: oncolytic immunotherapy for the treatment of non-muscle invasive bladder (NMIBC) cancer using intravesical coxsackievirus A21

Date 10 October 2016
Event ESMO 2016 Congress
Session Immunotherapy of cancer
Topics Immunotherapy
Presenter Hardev Pandha
Citation Annals of Oncology (2016) 27 (6): 359-378. 10.1093/annonc/mdw378
Authors H.S. Pandha1, N. Annels2, M. Arif2, H. Mostafid2, S. Sandhu3, K. Harrington4, A. Melcher5, D. Mansfield4, G. Au6, M. Grose6, R. Karpathy6, D. Shafren6
  • 1Clinical And Experimental Medicine, University of Surrey, GU2 7WG - Guildford/GB
  • 2Clinical And Experimental Medicine, University of Surrey, Guildford/GB
  • 3Urology, Kingston Hospital, KT2 7QB - Kingston/GB
  • 4Targeted Therapy, Institute of Cancer Research ICR, London/GB
  • 5Oncology And Clinical Research, Leeds Institute of Cancer and Pathology, Leeds/GB
  • 6Viralytics, Viralytics Limited, Sydney/AU



CAVATAK® is a novel, bio-selected Intercellular Adhesion Molecule 1 (ICAM-1) targeted immunotherapeutic Coxsackievirus A21 (CVA21). Surface ICAM-1 is up-regulated on NMIBC. CVA21 displays potent oncolytic activity against in vitro cultures of NMIBC cancer cells and ex-vivo human bladder tumor. Combining CVA21 with mitocycin C (MMC) synergistically enhances viral replication by increasing expression levels of ICAM-1.


The CANON study investigated the tolerance of escalating intravesical (IV) doses of CVA21 in 16 first-line NMIBC cancer pts. Stage 1 Cohort 1 (n = 3) and Cohort 2 (n = 3), pts received a single CVA21 administration at 1 x 108 and 3 x 108 TCID50, respectively. In Cohort 3 (n = 3), pts received 2 doses of CVA21 at 3 x 108 TCID50. Stage 2: Cohort 1 (n = 3), pts received a single CVA21 dose of 3 x 108 TCID50 and Cohort 2 (n = 3) with 2 doses of CVA21 at 3 x 108 TCID50, both in combination with MMC (10mg). Cystoscopy photography was performed before and after treatment (tx). IV tx was followed by TURBT surgery after 8-11 days, with tissues analysed for CVA21 replication, apoptosis, evidence of viral-induced changes immune cell infiltrates (multi-spectral imaging) and immune checkpoint molecules.


Data indicate tolerance of IV CVA21 tx. Serial cystoscopy identified viral-induced surface haemorrhage and immune inflammation of the tumor micro-environment. Virus replication within tumor was highlighted by detection of secondary viral load peaks in the urine. TURBT tissue analysis displayed marked tumor specific viral replication and evidence of viral-induced apoptotic cell death. NanoString analysis identified widespread increases in interferon (IFN), viral RNA and immune-checkpoint genes in CVA21-treated tissues compared to untreated historical controls.


Clinical activity of CVA21 was demonstrated by evidence of complete tumor response, viral replication and notable signs of tumor inflammation. The observed up-regulation of IFN/immune checkpoint genes provides evidence for the generation of both strong local and systemic anti-tumor immune responses.

Clinical trial identification


Legal entity responsible for the study

Viralytics Ltd


Viralytics Ltd


All authors have declared no conflicts of interest.