Evaluation of Pressurized Intraperitoneal Aerosol Chemotherapy With VRT106 Versus PIPAC in Patients With Advanced Gastric Cancer and PeritonealMetastasis: A Prospective, Multicenter, Open-Label, Randomized Controlled Trial

This study is a prospective, multicenter, open-label, randomized controlled clinical trial, planned to enroll 30 patients with advanced gastric cancer and peritoneal metastasis. It aims to evaluate the safety and efficacy of systemic therapy plus Pressurized Intra-Peritoneal Aerosol Virus (PIPAV) with VRT106 compared to systemic therapy plus Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC).

Study Overview

• Status: Not yet recruiting
• Conditions: Advanced Gastric Cancer
• Intervention / Treatment: Drug: Doxorubicin (Adriamycin); Drug: VRT106

Detailed Description

To evaluate the efficacy and quality of life in different treatment cohorts for patients with advanced gastric cancer and peritoneal metastasis.

To evaluate the biodistribution and biological effects of PIPAV（Pressurized Intra-Peritoneal Aerosol Virus） treatment in patients with advanced gastric cancer and peritoneal metastasis, including viral distribution and shedding characteristics, as well as immunogenicity.

To explore the relationship between pharmacodynamics, biomarkers, and therapeutic efficacy.

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Yong Li MD; Phone Number: +86 13798191490; Email: liyong@gdph.org.cn

Study Locations

• China
  • Guangdong
    • Guangzhou, Guangdong, China
      • No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou
      • Contact: Yong Li MD; Phone Number: +8613822177479; Email: liyong@gdph.org.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Aged 18 to 75 years, inclusive, regardless of gender.
2. Histologically or pathologically confirmed gastric adenocarcinoma with peritoneal metastasis (confirmed by imaging findings, previous surgical pathology, or positive cytology from ascites/peritoneal fluid), and assessed by the investigator as having unresectable peritoneal lesions with a PCI score > 6.
3. Subjects with no contraindications for laparoscopic surgery.
4. ECOG performance status ≤ 1.
5. Expected survival time ≥ 6 months.

6. No blood transfusion or treatment with hematopoietic stimulating factors within 14 days before screening, and meeting the following criteria:

   • Hematology: Absolute neutrophil count (ANC) ≥ 1.5 × 10⁹/L, platelet count (PLT) ≥ 100 × 10⁹/L, hemoglobin (Hb) ≥ 90 g/L.
   • Blood biochemistry: Total bilirubin (TBIL) ≤ 1.5 × upper limit of normal (ULN) (≤ 3.0 × ULN for subjects with Gilbert syndrome); alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ≤ 3.0 × ULN; albumin ≥ 2.8 g/dL; creatinine ≤ 1.5 × ULN; or creatinine clearance (Ccr) ≥ 50 mL/min (calculated using the Cockcroft-Gault formula, only required if creatinine > 1.5 × ULN).
   • Coagulation function: Activated partial thromboplastin time (APTT), international normalized ratio (INR), or prothrombin time (PT) ≤ 1.5 × ULN.
7. Female subjects of childbearing potential or male subjects with partners of childbearing potential must use effective contraception throughout the treatment period and for 3 months after the last dose.
8. Voluntary participation in the clinical study, with full understanding and signed informed consent form (ICF); willingness and ability to comply with all trial procedures.

Exclusion Criteria:

• 1. Subjects with gastrointestinal obstruction; 2. Subjects completely dependent on parenteral nutrition; 3. Subjects with decompensated ascites; 4. Subjects with severe abdominal infection (manifesting as peritonitis); 5. Subjects with extensive abdominal adhesions; 6. Subjects undergoing simultaneous cytoreductive surgery and gastrointestinal resection and reconstruction; 7. Subjects with concurrent portal vein thrombosis; 8. Known allergy to any component of the VRT106 formulation (mannitol, human albumin, trehalose, etc.) or to chemotherapy drugs; 9. Use of live attenuated vaccines within 4 weeks prior to the first dose of the study drug, including but not limited to: measles, mumps, rubella, varicella/zoster, yellow fever, rabies, BCG, and typhoid vaccines. Seasonal influenza vaccines for injection are inactivated virus vaccines and are allowed; intranasal influenza vaccines are live attenuated and are not allowed; 10. Use of systemic glucocorticoids (prednisone > 10 mg/day or equivalent dose of similar drugs) or other immunosuppressive therapy within 1 week prior to the first dose of the study drug, except for the following:
• Use of topical, ocular, intra-articular, intranasal, and inhaled corticosteroids;
• Use of corticosteroids for prophylactic treatment (e.g., prevention of contrast agent allergy); 11. Use of immunomodulatory drugs, including but not limited to thymosin, interleukin-2, interferon, etc., within 14 days prior to the first dose of the study drug; 12. Subjects with active autoimmune disease or a history of autoimmune disease that may recur. However, subjects with the following diseases are not excluded and may be further screened: a. Type 1 diabetes; b. Hypothyroidism (if controlled by hormone replacement therapy alone); c. Controlled celiac disease; d. Skin diseases not requiring systemic treatment (e.g., vitiligo, psoriasis, alopecia); e. Any other disease not expected to recur in the absence of an external trigger; 13. History of splenectomy; 14. Adverse reactions from prior anti-tumor therapy have not recovered to ≤ Grade 1 per NCI-CTCAE v5.0 (excluding alopecia, chemotherapy-induced Grade 2 neurotoxicity, and other toxicities deemed by the investigator to pose no safety risk); 15. History of severe cardiovascular disease, including but not limited to:
• Severe cardiac rhythm or conduction abnormalities, such as ventricular arrhythmias requiring clinical intervention, second- or third-degree atrioventricular block, QT interval corrected using Fridericia's formula (QTcF) ≥ 480 ms, etc.;
• Occurrence of acute coronary syndrome, acute myocardial infarction, congestive heart failure, stroke, or other Grade 3 or higher cardiovascular events within 6 months prior to the first dose of the study drug;
• New York Heart Association (NYHA) functional class ≥ II, or left ventricular ejection fraction (LVEF) < 50%;
• Poorly controlled hypertension per investigator judgment (hypertension not controlled despite standard treatment: systolic blood pressure ≥ 160 mmHg and/or diastolic blood pressure ≥ 100 mmHg); 16. Uncontrolled active infection requiring systemic therapy; 17. Presence of other invasive malignancies besides the study disease. Exceptions include: cured basal cell or squamous cell carcinoma of the skin, carcinoma in situ (e.g., breast cancer, cervical carcinoma in situ), superficial bladder cancer, or malignancies with no recurrence and no treatment for the past 2 years; 18. Pregnant or breastfeeding women; 19. Subjects deemed by the investigator to have other serious systemic diseases or other reasons making them unsuitable for participation in this clinical trial; 20. Subjects who have received other unmarketed investigational drugs/device therapies within 4 weeks prior to the first dose of the study drug; 21. Concurrent enrollment in another clinical study, except for observational (non-interventional) clinical studies or the follow-up phase of an interventional study (must be judged by the investigator as not impacting the efficacy and safety evaluation of this study).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PIPAV + PIPAC; Based on systemic anti-tumor therapy, on Day 1 (D1) of each treatment cycle, intraperitoneal nebulization therapy is administered with 9×10⁸ CCID₅₀ (3 vials) diluted in 150 mL of 0.9% normal saline. Following the completion of VRT106 perfusion, chemotherapy drugs are continuously perfused after a 15-minute interval. The chemotherapeutic agents include doxorubicin (1.5 mg/m²) diluted in 50 mL of 0.9% normal saline for pressurized intra-peritoneal aerosol chemotherapy, immediately followed by cisplatin (7.5 mg/m²) diluted in 150 mL of 0.9% normal saline. This regimen is administered for three consecutive treatment cycles.	Drug: Doxorubicin (Adriamycin); Doxorubicin (Adriamycin); Drug: VRT106; VRT106
Active Comparator: PIPAV; Based on systemic anti-tumor therapy, on Day 1 (D1) of each treatment cycle, intraperitoneal nebulization therapy is administered with 9×10⁸ CCID₅₀ (3 vials) diluted in 150 mL of 0.9% normal saline. This regimen is administered for three consecutive treatment cycles.	Drug: VRT106; VRT106
Active Comparator: PIPAC; Based on systemic anti-tumor therapy, pressurized intra-peritoneal aerosol chemotherapy is administered using doxorubicin (1.5 mg/m²) diluted in 50 mL of 0.9% normal saline, immediately followed by cisplatin (7.5 mg/m²) diluted in 150 mL of 0.9% normal saline for pressurized intra-peritoneal aerosol chemotherapy. This regimen is administered for three consecutive treatment cycles.	Drug: Doxorubicin (Adriamycin); Doxorubicin (Adriamycin)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of adverse events	Incidence of adverse events	From the screening period to 28 days after the last intraperitoneal perfusion treatment during the follow-up period
Incidence of serious adverse events	Incidence of serious adverse events	From the screening period to 28 days after the last intraperitoneal perfusion treatment during the follow-up period
Eastern Cooperative Oncology Group Performance status	0 - Fully active, able to carry on all pre-disease performance without restriction.; - Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work.; - Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours.; - Capable of only limited self-care; confined to bed or chair more than 50% of waking hours.; - Completely disabled; cannot carry on any self-care; totally confined to bed or chair.; - Dead.	From the screening period to 28 days after the last intraperitoneal perfusion treatment during the follow-up period
Surgical complications	Surgical complications	From the screening period to 28 days after the last intraperitoneal perfusion treatment during the follow-up period
Postoperative pain score (Visual Analogue Scale/VAS score)	Scores of 1-3 are defined as "mild pain (sleep unaffected)"; 4-6 as "moderate pain (sleep affected)"; 7-10 as "severe pain (sleep severely affected)	At the beginning of Cycle 1 (each cycle lasting 28 days), at the beginning of Cycle 2 (each cycle lasting 28 days), and at the beginning of Cycle 3 (each cycle lasting 28 days)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Peritoneal cancer index，PCI	0: No peritoneal metastasis; 1-2: Mild peritoneal metastasis; 3-4: Moderate peritoneal metastasis; 5-6: Severe peritoneal metastasis	At the beginning of Cycle 1 (each cycle lasting 28 days), at the beginning of Cycle 2 (each cycle lasting 28 days), and at the beginning of Cycle 3 (each cycle lasting 28 days)
Peritoneal regression grading score，PRGS	PRGS 1 - Complete Response No residual tumor cells Extensive fibrosis / gelatinous mucin pools / infarct-like necrosis PRGS 2 - Major Changes Predominantly regressive changes in tumor cells Fibrosis / gelatinous mucin pools / Tumor cells predominantly with infarct-like necrosis PRGS 3 - Minor Changes Tumor cells predominate, significantly more than regressive changes Tumor cells clearly dominate, more than fibrosis / gelatinous mucin pools / infarct-like necrosis PRGS 4 - No Changes Steady growth of tumor cells (visible at lowest magnification) No regressive changes	At the beginning of Cycle 1 (each cycle lasting 28 days), at the beginning of Cycle 2 (each cycle lasting 28 days), and at the beginning of Cycle 3 (each cycle lasting 28 days).
Quality of life score	Quality of life score	At the beginning of Cycle 1 (each cycle lasting 28 days), at the beginning of Cycle 2 (each cycle lasting 28 days), and at the beginning of Cycle 3 (each cycle lasting 28 days).

Collaborators and Investigators

• Sponsor: Guangdong Provincial People's Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2026
• Primary Completion (Estimated): March 1, 2028
• Study Completion (Estimated): June 1, 2029

Study Registration Dates

• First Submitted: March 2, 2026
• First Submitted That Met QC Criteria: March 17, 2026
• First Posted (Actual): March 20, 2026

Study Record Updates

• Last Update Posted (Actual): March 20, 2026
• Last Update Submitted That Met QC Criteria: March 17, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: VRT106; Pressurized Intra-Peritoneal Aerosol; advanced gastric cancer with peritoneal metastasis
• Additional Relevant MeSH Terms: Organic Chemicals; Hydrocarbons; Hydrocarbons, Cyclic; Carbohydrates; Polycyclic Aromatic Hydrocarbons; Hydrocarbons, Aromatic; Polycyclic Compounds; Glycosides; Anthracyclines; Naphthacenes; Aminoglycosides; Daunorubicin; Doxorubicin
• Other Study ID Numbers: HOPE-02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No