A Trial Evaluating Concurrent Whole Brain Radiotherapy and Iniparib in Multiple Non Operable Brain Metastases (RAPIBE)

• Rate of adverse events [ Time Frame: Until 6 month follow-up ] [ Designated as safety issue: Yes ]
  To evaluate toxicity later than 12 weeks after the end of radiotherapy and iniparib
• Quality of life [ Time Frame: At baseline, Week 1, Week 4, Week 6, Week 12 and Month 6 ] [ Designated as safety issue: No ]
  Quality of life will be assessed according to the EORTC QLQ-C30 and QLQ-BN20 questionnaires
• Cognitive functions [ Time Frame: At baseline, Week 1, Week 4, Week 6, Week 12 and Month 6 ] [ Designated as safety issue: No ]
  Cognitive functions will be assessed according to the MMS (Mini Mental State) questionnaire
• Objective response rate [ Time Frame: At 6 and 12 weeks after the end of radiotherapy ] [ Designated as safety issue: No ]
  Objective response rates (complete and partial response) will be evaluated by MRI according to the RECIST criteria (v1.1)
• Time to local progression [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Time to local progression will be measured from the start of treatment until the first date of objectively documented local progression.
• Local progression-free survival [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Local progression-free-survival will be measured from the start of treatment until the first date of objectively documented local progression or death.

Recent pre-clinical and clinical data have indicated that BSI-201 does not possess characteristics typical of the PARP inhibitor class. Based on the results from in vitro and in vivo studies, this trial aims to evaluate the combination of BSI-201 concomitantly with radiotherapy in patients who present with multiple non operable brain metastases. As radiotherapy is a local treatment targeting only the tumor, and because the molecule BSI-201 has shown no major toxicity against tissues without DNA alterations, the proposed combination is expected to provide tumor-selective therapy and leading to a clinical benefit improvement.

Primary objective is to determine the recommended phase II dose (RP2D) and evaluate acute toxicity (CTC-AE v4.0 grading scale) of concurrent administration of whole brain radiotherapy (WBR) and a small molecule BSI-201 in non operable brain metastases.

Inclusion Criteria:

• Non operable brain metastases from any type of cancer (≥ 2)
• At least one measured brain target available ≥ 1 cm (T1-weighted sequences with contrast application MRI)
• No stereotaxie indication
• Any anterior treatments for systemic disease (any chemotherapy at any line) are accepted but have to be interrupted at least 15 days before and up to 30 days after the present protocol
• No extra-brain disease or stabilized since at least 1 month
• Aged ≥ 18 years old
• KPS > 70 (RPS class I or II)
• Adequate bone marrow function: WBC ≥ 3.5 x 109/L, ANC ≥ 1.5 x 109/L, Platelets ≥ LLN, Hb > 10g/dL,
• Adequate renal function: serum creatinine ≤ 1.5 × ULN and blood urea nitrogen ≤ 25 mg/dL
• Male or female patient using adequate contraceptive method
• Women of childbearing potential must have a negative serum or urine pregnancy test within 3 days prior to the start of treatment
• Informed and signed consent
• Able to be followed according to the terms of the protocol
• Affiliated to the French National social security

Exclusion Criteria:

• Anterior treatment for brain metastases (surgery, radiosurgery, stereotaxie)
• Leptomeningeal metastases
• Inclusion in another protocol within 30 days
• Brain metastases with severe intracranial hypertension clinical signs
• Other cancer except the known primary tumor or in situ cervix cancer or basocellular carcinoma