Sponsor: Replimune Inc. (industry)
Phase: 3
Start date: July 11, 2024
Planned enrollment: 400
RP1 (vusolimogene oderparepvec-wtpg; brand name Tudriqev) is an oncolytic virus injected into tumors. Although it was developed as an investigational treatment, the U.S. FDA granted it accelerated approval on August 6, 2026, in combination with nivolumab for adults with unresectable advanced cutaneous melanoma that progressed after anti–PD-1 treatment. Confirmatory studies are required to verify clinical benefit. (fda.gov)
RP1 is a modified herpes simplex virus type 1 designed to replicate preferentially in tumors. It has deletions in the ICP34.5 and ICP47 genes and produces GM-CSF and a fusogenic protein intended to promote tumor-cell destruction and antitumor immune activity. Nivolumab blocks PD-1, an immune checkpoint. (frontiersin.org)
In IGNYTE, a single-arm trial of RP1 plus nivolumab in 140 patients whose melanoma had progressed on anti–PD-1 therapy, the published objective response rate was 32.9%, including 15.0% complete responses; median response duration was 33.7 months. For its approval assessment, the FDA reported a 24.2% response rate and 14.1-month median response duration in the subset of 91 patients with at least one tumor that was not injected. These figures reflect different analysis populations. Without a randomized comparison, the trial cannot establish how much RP1 contributed to the combination’s effect. (pmc.ncbi.nlm.nih.gov)
In the published IGNYTE analysis, treatment-related adverse events were grade 1–2 in 77.1%, grade 3 in 9.3%, and grade 4 in 3.6% of patients; no treatment-related grade 5 events were reported. Common adverse reactions included fatigue, fever, chills, nausea, diarrhea, and injection-site reactions. FDA warnings address herpetic infection or reactivation, injection complications, accidental exposure, and immune-mediated events. (pmc.ncbi.nlm.nih.gov)
Last updated: Sep 2026
Goal: Determine whether vusolimogene oderparepvec (VO) plus nivolumab improves survival compared with physician’s choice treatment in advanced cutaneous melanoma after checkpoint inhibitor therapy.
Patients: Patients aged 12 years or older with unresectable stage IIIB–IV cutaneous melanoma, at least one measurable injectable tumor, and progression after anti-PD-1 therapy and anti-CTLA-4 therapy, given together or sequentially. Patients who are not candidates for anti-CTLA-4 therapy may also enroll. Key restrictions include more than two prior systemic treatment lines, active CNS metastases, and LDH greater than twice the upper limit of normal.
Design: Randomized, multicenter, open-label, controlled trial comparing VO plus nivolumab with physician’s choice treatment.
Treatments: The experimental arm receives intratumoral VO plus nivolumab. VO is a modified herpes simplex virus type 1 designed to replicate in tumors and express GM-CSF and a fusogenic protein to promote tumor-cell destruction and antitumor immunity; nivolumab blocks PD-1. In the prior single-arm IGNYTE study of the combination after anti-PD-1 progression, the published objective response rate was 32.9%, but the study could not establish VO’s contribution to that response. The comparator is physician’s choice of nivolumab plus relatlimab, anti-PD-1 monotherapy with nivolumab or pembrolizumab, or single-agent chemotherapy.
Outcomes: The primary endpoint is overall survival from randomization. Secondary endpoints include RECIST v1.1 progression-free survival and objective response rate; assessments are planned through approximately January 2029.
Burden on patient: Likely moderate. The experimental arm requires visits for intratumoral injections as well as nivolumab administration, with imaging and safety monitoring expected in a melanoma trial. Injectable tumors may make travel and procedures more demanding than systemic treatment alone. The supplied information does not specify mandatory research biopsies, intensive pharmacokinetic sampling, or visit frequency, so the additional burden cannot be estimated precisely.
Last updated: Sep 2026
Caution: ClinicalTrials.gov appears to have newer eligibility criteria than the version saved here. Review the current criteria in ClinicalTrials.gov.
Key Inclusion Criteria:
* Male or female who is 12 years of age or older at the time of signed informed consent.
* Patients with histologically or cytologically confirmed unresectable or metastatic Stage IIIb through IV/M1a through M1d cutaneous melanoma.
* Confirmed disease progression (PD) on an approved anti-PD-1 and an anti-CTLA-4 treatment, administered either as a combination regimen (eg, nivolumab + ipilimumab) or in sequence.
1. Treatment with prior anti-PD-1 therapy must have continued for a minimum of 8 weeks
2. Patients who in the physician's judgement are not candidates for treatment with an anti-CTLA-4 antibody are eligible
* Has documented BRAF V600 mutation status. Patients with BRAF mutation should have received prior BRAF-directed therapy (with or without a MEK inhibitor) prior to enrollment in the study, unless deemed not clinically indicated at Investigator's discretion due to concurrent medical condition or prior toxicity.
* Has at least 1 measurable and injectable tumor of ≥1 cm in longest diameter (or shortest diameter for lymph nodes).
* Has adequate hematologic function.
* Has adequate hepatic function.
* Has adequate renal function.
* Prothrombin time (PT) ≤1.5 × ULN and partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) ≤1.5 × ULN
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 to 1 for patients 18 years and older or a Lansky performance score (PSc) ≥80 for patients 12 to 17 years of age.
* Life expectancy of at least 3 months.
* Female and male patients of reproductive potential must agree to avoid becoming pregnant or impregnating a partner and adhere to highly effective contraception requirements during the treatment period and for at least 6 months after the last dose of study treatment.
* Women of childbearing potential must have a negative serum beta-human chorionic gonadotropin (β-hCG) test within 72 hours before the first dose of study treatment.
Key Exclusion Criteria:
* Primary mucosal or uveal melanoma.
* More than 2 lines of systemic therapy for advanced melanoma.
* Known acute or chronic hepatitis.
* Known human immunodeficiency virus (HIV) infection.
* Active significant herpetic infections or prior complications of HSV-1 infection.
* Had systemic infection requiring IV antibiotics or other serious active infection requiring antimicrobial, antiviral, or antifungal treatment within 14 days prior to dosing.
* With active significant herpetic infections or prior complications of HSV-1 infection.
* Evidence of spinal cord compression or at high risk of spinal cord compression.
* Known active central nervous system (CNS) metastases and/or carcinomatous meningitis at time of screening.
* Serum lactate dehydrogenase (LDH) \>2 × ULN.
* Major surgery ≤2 weeks prior to starting study drug.
* Prior malignancy active within the previous 3 years, except for locally curable cancers that have apparently been cured
* History of significant cardiac disease including myocarditis or congestive heart.
* History of life-threatening toxicity related to prior immune.
* Active, known, or suspected autoimmune disease requiring systemic treatment.
* History of (noninfectious) pneumonitis that required steroids or has current pneumonitis.
* Prior oncolytic virus or other therapy given by intratumoral administration.
* Requires intermittent or chronic use of systemic (oral or IV) antivirals with known antiherpetic activity (eg, acyclovir).
* Has received a live vaccine within 28 days prior to the first dose of study treatment.
* Systemic anticancer therapies within 5 half-lives or 4 weeks of the first dose, whichever is shorter.
* Conditions requiring treatment with immunosuppressive doses (\>10 mg per day of prednisone or equivalent) of systemic corticosteroids other than for corticosteroid replacement therapy within 14 days after enrollment.
Nice, 06200, France
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Marseille, 13005, France
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Pierre-Bénite, 69495, France
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Paris, 75010, France
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Villejuif, 94800, France
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Berlin, 10117, Germany
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Erfurt, 99089, Germany
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Mainz, 55131, Germany
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Kiel, 24105, Germany
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Essen, 45147, Germany
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Heidelberg, 69120, Germany
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Hamburg, 20246, Germany
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Tübingen, 72076, Germany
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Warsaw, 02-781, Poland
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Gdansk, 80-214, Poland
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Madrid, 28027, Spain
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Pamplona, 31008, Spain
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Barcelona, 08036, Spain
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El Palmar, 30120, Spain
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Barcelona, 08035, Spain
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Madrid, 28041, Spain
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Liverpool, L7 8YA, United Kingdom
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London, SW3 6JJ, United Kingdom
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Gilbert, Arizona, 85234, United States
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San Francisco, California, 94115, United States
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Palo Alto, California, 94304, United States
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Sacramento, California, 95816, United States
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Los Angeles, California, 90025, United States
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Orange, California, 92868, United States
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La Jolla, California, 92037, United States
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Los Angeles, California, 90095, United States
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San Francisco, California, 94143, United States
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Los Angeles, California, 90033, United States
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Englewood, Colorado, 80113, United States
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Aurora, Colorado, 80045, United States
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Washington D.C., District of Columbia, 20010, United States
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Hollywood, Florida, 33021, United States
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Tampa, Florida, 33612, United States
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Atlanta, Georgia, 30322, United States
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Chicago, Illinois, 60611, United States
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Iowa City, Iowa, 52242, United States
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Westwood, Kansas, 66205, United States
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Louisville, Kentucky, 40202, United States
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Grand Rapids, Michigan, 49503, United States
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Detroit, Michigan, 48202, United States
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Minneapolis, Minnesota, 55455, United States
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Lebanon, New Hampshire, 03756, United States
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Hackensack, New Jersey, 07601, United States
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Camden, New Jersey, 08103, United States
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Morristown, New Jersey, 07960, United States
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The Bronx, New York, 10461, United States
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Lake Success, New York, 11042, United States
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Buffalo, New York, 14263, United States
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Stony Brook, New York, 11794, United States
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Durham, North Carolina, 27710, United States
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Chapel Hill, North Carolina, 27514, United States
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Columbus, Ohio, 43210, United States
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Philadelphia, Pennsylvania, 19111, United States
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Philadelphia, Pennsylvania, 19107, United States
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Pittsburgh, Pennsylvania, 15232, United States
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Providence, Rhode Island, 02903, United States
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Knoxville, Tennessee, 37920, United States
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Germantown, Tennessee, 38138, United States
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Dallas, Texas, 75246, United States
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Houston, Texas, 77030, United States
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Dallas, Texas, 75390, United States
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Salt Lake City, Utah, 84112, United States
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Murray, Utah, 84107, United States
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St. George, Utah, 84790, United States
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Burlington, Vermont, 05401, United States
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Morgantown, West Virginia, 26506, United States
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Park Ridge, Illinois, 60068, United States
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Status: Withdrawn