Safety Study of Intratumoral Injection of Clostridium Novyi-NT Spores to Treat Patients With Solid Tumors That Have Not Responded to Standard Therapies

Inclusion Criteria:

1. Diagnosis of an advanced solid tumor malignancy. There must be a target tumor which is
measureable, palpable or clearly identifiable under ultrasound or radiographic
guidance and amenable to percutaneous injection of C. novyi-NT spores. The targeted
lesion must have a longest diameter ≥ 1 cm and ≤ 12 cm and be measurable as defined by
RECIST 1.1 criteria. The target lesion must not be located in either the thoracic,
abdominal or pelvic cavities or in the brain. There must be no clinical, no
functional, and no radiographic evidence of bone involvement at the site of the target
lesion.

2. History of prior treatment with at least one line of systemic anticancer therapy, when
an approved systemic therapy is available, and no curative option is available for
continued treatment.

3. At least 4 weeks have elapsed since the completion of major surgery, and the patient
has fully recovered from this surgery and any post-surgical complications.

4. Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less.

5. Patient is at least 18 years of age.

6. Patient is capable of giving informed consent.

7. Patient of childbearing potential (defined by the clinical sites' standards) is using
adequate birth control measures (e.g., barrier method with spermicide; intrauterine
device; implantable or injectable hormonal contraceptives; surgical sterilization) for
the duration of the study and will continue to use such precautions for 12 months
after receiving treatment.

8. Patient has no significant valvular heart disease (trace or mild valvular stenosis or
regurgitation is allowed).

9. Patient is able to stay within 45 minutes driving time of an emergency room for 28
days after doing.

10. The patient has a caregiver for 28 days after dosing.

Exclusion Criteria:

1. Positive pregnancy test.

2. Serum creatinine level > 1.5 x the upper limit of normal (ULN), chronic renal failure
requiring hemodialysis or peritoneal dialysis.

3. Patient has any of the following hematologic parameters:

- Platelet count equal to or less than 100,000/mm3

- Hemoglobin less than 9.0 g/dL

- Absolute neutrophil count (ANC) less than 1,000 /mm3

4. Oxygen saturation (Sp02) of less than 95% on room air.

5. Mean arterial blood pressure (BP) of less than 70 mmHg.

6. Glasgow Coma Score (GCS) of less than 15.

7. Treatment with an investigational drug within the past 30 days or 5 half-lives of that
drug, whichever is shorter.

8. Documented primary brain malignancy or brain metastases.

9. Clinically significant ascites or clinical evidence or history of portosystemic
hypertension or cirrhosis.

10. Laboratory evidence of hepatic dysfunction indicated by any of the following:

- Bilirubin ≥ 1.5 x the ULN

- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) above 2.5X the
ULN

- Alkaline phosphatase above 2.5X the ULN

- International normalized ratio (INR) greater than 1.3

11. Patient has a foreign body which in the opinion of the treating investigator could be
difficult to manage in case of infection (e.g. prosthetic hip).

12. Clinically significant pleural effusion.

13. Clinically significant pericardial effusion, circumferential pericardial effusion, or
any effusion greater than 1.0 cm at any location around the heart.

14. Need for ongoing treatment with an immunosuppressive agent.

15. History of solid organ transplantation (with the exception of a corneal transplant > 3
months prior to screening).

16. History of an ischemic insult in the previous 12 months (myocardial infarction,
cerebral vascular accident, ischemic tissue from injury, transient ischemic attack.

17. History of a significant medical illness deemed by the PI or local investigators as
unsuitable for the trial. For example:

i. Symptomatic congestive heart failure ii. Psychiatric Illness/social situation that
may make study dangerous iii. Unstable angina pectoris

18. Asplenia.

19. Antibiotic allergies that would preclude treatment for a C. novyi-NT infection.

20. Treatment with antibiotics within 2 weeks (14 days) of dosing.

21. Active and clinically significant systemic or localized infection.