Study to Evaluate Safety and MTD of Epidural Resiniferatoxin Injection for Treatment of Intractable Cancer Pain

Inclusion Criteria:

• Histologically confirmed advanced cancer or metastasis, which has not responded tostandard therapy, producing intractable chronic pain in any area below themid-thoracic level.

• Male or female subjects must be at least 18 years of age.

• Must have a worst pain score ≥6 on the NPRS at Screening visit.

• Subjects not seeking or receiving potentially curative therapies for cancer.Palliative therapy is acceptable if the therapy started and is stable prior to IPadministration.

• Sexually active female subjects of childbearing potential and male subjects capable offathering a child must be willing to use an effective method of contraception to avoidpregnancies.

• Must be willing and capable of understanding and cooperating with the requirements ofthe study.

• Must be able to understand and complete study-related forms and adequately communicatewith the investigator and/or site staff.

• Must have provided written informed consent prior to participating in anystudy-related activity.

• Subjects able to complete the study duration.

Exclusion Criteria:

• Subjects with leptomeningeal metastases in lumbar area.

• Undergoing or have plans to undergo changes to current cancer treatment during thestudy through the Day15 assessment.

• Had prior lumbar spine surgical procedures that could impair the ability to performthe injection.

• Evidence of brain pathology or increase intracranial pressure.

• Presence of an IT shunt.

• Has evidence or a coagulopathy or hemostasis problem.

• Subjects with a total neutrophil count <1500 cells/mm3.

• Subjects with serum creatinine ≥1.5 mg/dL.

• Is febrile or has other evidence of an infection within 7 days of planned injection.

• Has an allergy or hypersensitivity to chili peppers, capsaicin, or radiographiccontrast agents.

• Female subjects who are pregnant, are planning on becoming pregnant, or are currentlybreastfeeding.

• Subjects with any medical condition that could adversely impact study participation orassessments.

• Subjects who have received new anti-cancer treatments and there is less than one weekor four half-lives of the investigational drug, whichever is greater, between the lastdose of the new drug and the planned day of IP administration; or had a change in thedose or schedule of the anti-cancer treatments within one week or four half-lives,whichever is greater, between the last dose of the anti-cancer treatment and theplanned day of IP administration; or are scheduled to receive a new anti-cancertherapy or investigational product prior to completion of the Day 15 visit.

• Subjects with additional loci of pain above the mid-thoracic level or other paindisorder due to non-cancer etiology, unless both the investigator and the subject areclearly able to distinguish the additional pain from the target pain due to cancer.

• Liver cirrhosis or severe hepatic impairment, with liver function test 3 times aboveULN.

• Sensory/peripheral neuropathy of CTCAE Grade 2 or higher.

• Nonstudy related minor surgical procedure ≤5 days or major surgical procedure ≤21 daysprior to Screening visit.

• Subjects who have not completely recovered from any toxicities from previouschemotherapy, hormone therapy, immunotherapy, or radiotherapies that are CTCAE Grade 3or higher.

• Arterial thrombi (including stroke), myocardial infarction, admission for unstableangina, cardiac angioplasty, or stenting within 3 months prior to Screening visit.

• Corrected QT using Fridericia's formula (QTcF) prolongation.

• Evidence or history of bleeding disorder within 4 weeks prior to IP administration.

• Known HIV or acquired immunodeficiency syndrome-related illness, acute or history ofchronic hepatitis B or C.