ClinicalTrials.gg
RecruitingNCT07658196TIPCUpdated Oct 1, 2026

TLR9 Immunotherapy for Peritoneal Carcinomatosis

A Phase 1 interventional study of ACM-CpG in Malignant Ascites, Colorectal Adenocarcinoma and Peritoneal (Metastatic) Cancer, sponsored by Brown University. Recruiting at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-10-01.

Sponsored by Brown University · Phase 1, Interventional, and Treatment

From the registry’s dates

  • Started Aug 2026; still recruiting 2 months later.
Updated Oct 1, 2026Study contact changedGo to Updates ↓
Phase
Phase 1
Study type
Interventional
Enrollment
24
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

The goal of this clinical trial is to determine the safety and efficacy of of ACM-CpG for inoperable peritoneal metastases or malignant ascites. The main questions it aims to answer are:

  • To determine the safety and maximum tolerated dose (MTD) or optimal biologic dose (OBD) of intraperitoneal injection(s) of ACM-CpG for inoperable peritoneal metastases or malignant ascites? Researchers will assign treatment levels using escalating doses of ACM-CpG Therapy.

Participants will:

  • Will receive at least one dose of ACM-CpG therapy on Day 1 of a 28-day treatment cycle.
  • May receive up to 2 additional injections if they have clinically stable or responsive disease.
  • Must visit the clinic on Days 1, 4, 7, 10, 14, 21, and 28 for checkups and tests.
  • Will have a CT scan or MRI performed every 8 weeks for 3 scans and then continue to receive scans every 12 weeks to monitor their disease.
Read the detailed description

Escalating doses of ACM-CpG Therapy will use a standard 3+3 design.

02

Conditions studied

  • Malignant Ascites
  • Colorectal Adenocarcinoma
  • Peritoneal (Metastatic) Cancer
  • Appendiceal Adenocarcinoma

Keywords

  • Metastatic disease must be primarily located in the peritoneal cavity
  • ACM-CpG
  • TLR9
  • Malignant Ascites
  • Peritoneal Carcinomatosis,
  • Appendiceal Adenocarcinoma
  • CRC
03

In context

Neoplasm Metastasis

4,040 studies on the registry are indexed under Neoplasm Metastasis; 886 are open to participants now.

This study's planned enrollment of 24 is below the median of 50 across 3,268 interventional studies indexed under Neoplasm Metastasis.

Browse Neoplasm Metastasis studies →

Lead sponsor

Brown University is the lead sponsor of 290 studies on the registry; 40 are open to participants now.

Of its 26 completed or terminated interventional studies of FDA-regulated products, 19 (73%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Patients eligible for inclusion in this study must meet all of the following criteria:

    1. Male or female patients age ≥ 18 years of age at the time of
    2. Must be able to provide written informed consent, stating an understanding of the procedures and nature of the study treatment, and willingness to comply with study requirements
    3. Must have documented CRC or appendiceal adenocarcinoma peritoneal carcinomatosis or malignant ascites. Primary tumor may be intact and limited liver and/or lung disease is permitted
    4. Must have evaluable disease by physical examination, serum tumor markers, radiologic assessment, or laparoscopic visual assessment
    5. Must have a of ≥ 12 weeks as estimated by the investigator
    6. Must have an status of ≤ 2
    7. Patients with acceptable laboratory values defined as:

      • Estimated (calculated using Cockcroft-Gault formula, or measured) ≥ 60 mL/min, not dialysis dependent
      • Total ≤ 1.5 mg/dl, unless elevated bilirubin is clearly related to Gilbert syndrome (and total bilirubin \< 6.0 mg/dl)
      • (ALT) ≤ 3.5 x (ULN)
      • Aspartate aminotransferase (AST) ≤ 3.5 x ULN
      • > 1.0 x 109/L (must be independent of blood product administration)
      • count > 100 x 109/L (must be independent of blood product administration)
      • ≥ 8 g/dL (must be independent of blood product administration)
    8. Surgically sterile patients or patients of (CBP) who agree to use highly effective methods of during study dosing and for 6 months after last dose of study drug
    9. All other relevant medical conditions must be well-managed and stable, in the opinion of the investigator, for at least 28 days prior to administration of study drug

Exclusion criteria

Exclusion Criteria:

  1. Has received prior TLR9 therapy
  2. Has received chemotherapy, radiotherapy, or biological cancer therapy within 21 days or 5 half-lives (whichever is shorter) of the start of treatment
  3. Has received an agent within 28 days of the start of treatment
  4. Has received a commercial vaccine (flu, COVID, etc.) within 2 weeks of C1D1
  5. Has any unresolved toxicity ≥ Grade 2 from previous anti-cancer therapy, except for stable chronic toxicities (≤ Grade 3) that are not expected to resolve
  6. Has a history of confirmed outside of the peritoneal cavity, liver, or lungs
  7. Has high volume liver or lung metastases, defined as > 50% replacement of the liver volume by metastatic disease or > 5 lung lesions greater than 1 cm in size
  8. Tumor causing biliary obstruction not amenable to stenting or percutaneous drainage
  9. Ongoing or untreated intra-abdominal infection or bowel obstruction
  10. Has known, clinically active Virus (HBV), Virus (HCV), or (HIV) (Note: Testing is not required)
  11. Receiving continuous systemic therapy (≥ 10 mg/day of prednisolone or equivalent)
  12. cardiac disease or impaired cardiac function, including any of the following:

    • A history of newly diagnosed transmural myocardial infarction, cerebral infarction, or pulmonary embolism within 6 months, except those approved by the medical monitor
    • A history of newly diagnosed deep vein thrombosis (DVT) within 3 months
    • (LVEF) \< 50%
    • >480 msec
  13. Active bacterial, viral, or fungal infection: patients with ongoing use of prophylactic antibiotics, antiviral agents, or antifungal agents remain eligible as long as there is no evidence of active infection
  14. Other active within 2 years excluding cutaneous squamous or basal cell carcinomas
  15. Any medical condition that would, in the investigator's judgment, prevent the patient's participation in the clinical study due to safety concerns, compliance with clinical study procedures or interpretation of study results
  16. History of to TLR9 agonists
  17. Pregnant, likely to become pregnant, or lactating women (where pregnancy is defined as the state of a female after conception and until the termination of gestation)
Terms in these criteria, in plain language(24)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Life expectancy

The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Histologically or cytologically confirmed

The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).

Your pathology report is the document that shows this.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

QT and QTc

On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.

The study may name a correction formula and a limit in milliseconds, often around 450–480.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

05

Study design

Phase
Phase 1
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Sequential assignment
Masking
None (open label)
Enrollment
24 participants (estimated)

Study arms

  • Experimental
    ACM-CpG

    Drug: ACM-CpG

Interventions

  • DrugACM-CpG

    The dose of ACM-CpG therapy to be infused by intraperitoneal injection will be dependent upon the dose level being delivered at the time of patient enrollment. Dose Levels C1D1 ACM-CpG Dose -1a (step down dose) 0.1 mg 1. (starting dose) 0.25 mg 2. 0.5 mg 3. 1.0 mg 4. 2.0 mg 5. 4.0 mg 6. 8.0 mg 7. (optional) 10.0 mg

06

What researchers measure

Primary outcomes

  1. Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]

    includes dose limiting toxicities (DLTs), Serious adverse events (SAEs), hospitalizations, CRS, neurotoxicity, and clinically significant laboratory abnormalities

    Time frame: From enrollment to 30 days post the last dose of ACM-CpG

Secondary outcomes

  1. Progression Free Survival (PFS)

    Time frame: From enrollment to disease progression up to 6 months post end of treatment

  2. Disease control rate (DCR)

    The percentage of patients who have achieved complete response, partial response and stable disease

    Time frame: From enrollment to End of follow-up (up to 6 months post end of treatment)

  3. Overall Survival (OS)

    Time frame: From enrollment to End of follow-up (up to 6 months post end of treatment)

  4. Quality of life composite index

    Time frame: From enrollment to 30 days post the last dose of ACM-CpG

07

Study locations

1 of 1 sites recruiting
08

Timeline

1 registry update since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started Aug 2026 (actual). Primary completion is estimated for Jul 2028, 23 months after the start.

Of 210 non-industry phase 1 interventional studies under Neoplasm Metastasis, half reached primary completion within 61 months of starting (the median), counting those still running; a quarter within 40 and three quarters within 98. This study's planned 23 months is below that.

Counting every sponsor, half of 496 studies reached it within 54 months; a quarter within 33 and three quarters within 83.

How these figures are worked out, and which studies are left out of them.

Registered
May 6, 2026
First posted
Jun 18, 2026
StartActual
Aug 25, 2026
Primary completionEst.
Jul 2028
CompletionEst.
Jul 2030
Last update
Oct 1, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
Contact
Study contact changed: added •••3234. See the current contact
Oct 1, 2026
Show all 1 update
  1. Oct 1, 2026
    Contact Study contact changed: added •••3234. See the current contact
    + 1 other change: verification date

From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗

09

Registry details

Key details

Study ID
NCT07658196
Lead sponsor
Brown University
Responsible party
Sponsor
First posted
Jun 18, 2026
Start date
Aug 25, 2026
Primary completion
Jul 2028 (estimated)
Completion
Jul 2030 (estimated)
Last update
Oct 1, 2026

Study contacts

Roxanne Wood
Contact
roxanne_wood@brown.edu
401-863-3000
Eligibility Screening
Contact
401-444-3234.
Khaldoun Almhanna, MD
principal investigator · Brown University Health

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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