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OLAParib COmbinations (OLAPCO)

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ClinicalTrials.gov Identifier: NCT02576444
Recruitment Status : Recruiting
First Posted : October 15, 2015
Last Update Posted : April 10, 2018
Sponsor:
Collaborators:
Dana-Farber Cancer Institute
Vanderbilt-Ingram Cancer Center
Information provided by (Responsible Party):
Joseph Paul Eder, Yale University

Brief Summary:
The primary objective of this phase II trial is to determine tumor overall response rate (ORR) in molecularly selected patients with measurable disease as assessed by the Response Evaluation Criteria in Solid Tumors (RECIST), before versus after 16 weeks of treatment across tumor types in each arm of the study.

Condition or disease Intervention/treatment Phase
Cancer Drug: AZD2281 Drug: AZD5363 Drug: AZD1775 Drug: AZD6738 Phase 2

Detailed Description:

This is a phase II signal-searching study in a range of tumor types with the potential to identify novel tumor indications for combination therapy with olaparib that can subsequently be explored in dedicated studies. Patients will be enrolled in this study based on molecular markers from genetic profiling performed on their tumors prior to study entry (outside of protocol). The trial will also identify genetic determinants of response and resistance.

Patients with tumors harboring mutations in DNA damage repair genes will be treated with olaparib. Patients with tumors harboring either TP53 or KRAS mutations or mutations in KRAS and TP53 will be treated with AZD1775 plus olaparib. Patients with tumors harboring PIK3CA, AKT, or ARID1A mutations or other molecular aberrations leading to dysregulation of the PI3K/AKT pathway will be treated with AZD5363 plus olaparib. Patients with tumors harboring mutations such as TORC1/2 or TSC1/2 or LKB1 mutations or are PTEN-deficient (determined either by genetic mutation or by IHC) will be treated with AZD2014 plus olaparib.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 64 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II Study of the PARP Inhibitor Olaparib (AZD2281) Alone and in Combination With AZD1775, AZD5363, or AZD6738 in Advanced Solid Tumors
Study Start Date : November 2015
Estimated Primary Completion Date : September 2018
Estimated Study Completion Date : September 2018

Resource links provided by the National Library of Medicine

Drug Information available for: Olaparib

Arm Intervention/treatment
Experimental: Group 1
Patients with cholangiocarcinoma harboring IDH 1/2 tumors will be treated with olaparib. Patients with tumors harboring mutation in HDR genes will be treated with olaparib.
Drug: AZD2281
Patients will be administered olaparib orally twice daily (bid) at 300 mg. Two (2) x 150 mg olaparib tablets should be taken at the same times each morning and evening of each day, approximately 12 hours apart with approximately 240 mL of water.
Other Name: Olaparib

Experimental: Group 2
Patients with tumors harboring PTEN, PIK3CA, AKT, or ARID1A mutations or other molecular aberrations leading to dysregulation of the PI3K/AKT pathway will be treated with AZD5363 plus olaparib.
Drug: AZD2281
Patients will be administered olaparib orally twice daily (bid) at 300 mg. Two (2) x 150 mg olaparib tablets should be taken at the same times each morning and evening of each day, approximately 12 hours apart with approximately 240 mL of water.
Other Name: Olaparib

Drug: AZD5363
Patients will be administered AZD5363 at 640 mg twice daily for two days on/five days off (2/7) schedule. Two (2) 200 mg tablets and three (3) 80 mg tablets should be taken twice daily.

Experimental: Group 3
Patients with tumors harboring either TP53 or KRAS mutations or mutations in KRAS and TP53 will be treated with AZD1775 plus olaparib. TP53 mutations must be found on the TP53 mutation eligibility list.
Drug: AZD2281
Patients will be administered olaparib orally twice daily (bid) at 300 mg. Two (2) x 150 mg olaparib tablets should be taken at the same times each morning and evening of each day, approximately 12 hours apart with approximately 240 mL of water.
Other Name: Olaparib

Drug: AZD1775
The recommended dose will be available no earlier than March 2016.

Experimental: Group 4
Patients with tumors harboring mutations in HDR genes, including ATM, CHK2, APOBEC, MRE11 complex, will be treated with AZD6738 and olaparib.
Drug: AZD2281
Patients will be administered olaparib orally twice daily (bid) at 300 mg. Two (2) x 150 mg olaparib tablets should be taken at the same times each morning and evening of each day, approximately 12 hours apart with approximately 240 mL of water.
Other Name: Olaparib

Drug: AZD6738
Patients will be administered AZD6738 at 160 mg daily for days 1-7 of a 28-day cycle (7/28) schedule. AZD6738 is available as 100, 20, and 10 mg tablets. Tablets should be taken daily.




Primary Outcome Measures :
  1. Overall Response Rate [ Time Frame: Change from baseline to 16 weeks ]
    tumor overall response rate (ORR) in molecularly selected patients with measurable disease as assessed by the Response Evaluation Criteria in Solid Tumors (RECIST), before versus after 16 weeks of treatment across tumor types in each arm of the study (Note: there will be no formal comparison between arms)



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Histologically documented metastatic cancer (solid tumors, not including hematologic malignancies)
  • Patients who have received standard first-line therapy for metastatic cancer (except for the tumors for which no first-line therapy exists) and in whom a trial of targeted therapy is considered the best available treatment option. Eligible patients should not have available therapies that will convey clinical benefit.
  • Progressive cancer at the time of study entry
  • Measurable disease by RECIST v1.1
  • Age ≥ 18 years
  • Life expectancy ≥ 16 weeks
  • Eastern Cooperative Oncology Group Performance Status (ECOG PS) score of 0 or 1 (APPENDIX A: Performance Status Criteria)
  • Able to understand the nature of this trial and provide written informed consent
  • Patient is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up.
  • Molecular testing or appropriate IHC results from CLIA-certified laboratories used for patient eligibility should be obtained from the most recent tumor biopsy (baseline tumor biopsies and on-progression tumor biopsies are optional)
  • Prior treatment with olaparib monotherapy when treated in one of the combination arms in the study is allowed.
  • Prior radiation therapy is allowed. Patients must not have received radiation therapy within 21 days prior to the initiation of study treatment.
  • Other therapies: Prior experimental (non-FDA approved) therapies and immunotherapies are allowed. Patients must not have received these therapies for 21 days or five half-lives of the drug (whichever is less) prior to the initiation of study treatment and must have full recovery from any acute clinically significant effects of these therapies.
  • Adequate hematologic function defined as:

    • Absolute neutrophil count (ANC) ≥ 1500/μL
    • White blood cells (WBC) > 3x109/L
    • Hemoglobin (Hgb) ≥ 10 g/dL (may be achieved with erythropoietin agents; no blood transfusions in the 28 days prior to entry)
    • Platelets ≥ 100,000/μL
    • No features suggestive of MDS/AML on peripheral blood smear
  • Adequate renal and liver function defined as:

    • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 × the upper limit of normal (ULN) (≤ 5 × ULN if considered due to primary or metastatic liver involvement)
    • Total bilirubin ≤ 1.5 ×ULN
    • Alkaline phosphatase ≤ 2× ULN (≤ 5 × ULN if considered due to tumor)
    • Serum creatinine ≤ 1.5 ULN
  • At least one lesion, not previously irradiated, that can be accurately measured at baseline as ≥ 10 mm in the longest diameter (except lymph nodes which must have short axis ≥ 15 mm) with computed tomography (CT) or magnetic resonance imaging (MRI) or ≥ 10 mm with calipers by clinical exam OR At least one lesion (measurable and/or non-measurable) that can be accurately assessed by CT/MRI/plain x-ray/clinical exam at baseline and follow up visits.
  • Women of child-bearing potential must have a negative pregnancy test (urine or serum) within 28 days prior to starting the study drug. Both males and females must agree to adequate birth control if conception is possible during the study and for 6 months after the last dose. Female patients are considered to not be of child-bearing potential if they have a history of tubal ligation or hysterectomy or are post-menopausal with a minimum of 1 year without menses.

Exclusion Criteria:

  • Patients with known germline BRCA mutations in breast or ovarian cancers will be excluded from the study, however testing is not required for inclusion in the study.
  • Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site)
  • Prior standard of care cancer chemotherapy, immunotherapy, or radiotherapy <21 days prior to first dose of study agent(s)
  • Patients with hematologic malignancies (includes patients with myelodysplastic syndrome/acute myeloid leukemia).
  • Patients with primary CNS malignancies
  • Patients must not have received allogeneic stem cell transplant
  • Concurrent administration of any other anti-cancer therapy

    • Bisphosphonates and Denosumab for bone metastases are allowed if started at least 4 weeks prior to treatment with study agent(s).
    • Octreotide is allowed if dose is stable for >3 months with no worsening of carcinoid syndrome
    • Hormonal therapy with luteinizing hormone-releasing hormone (LHRH) analogues for medical castration in patients with castrate-resistant prostate cancer is permitted
  • Patients who have not demonstrated stable recover (28 days or greater) from ≤ CTCAE grade 2 non-hematological toxicities related to prior therapy such as peripheral neuropathy or alopecia, or incomplete recovery from previous surgery, unless agreed by the Principal Investigator (PI) and documented are not eligible to participate in this study.
  • Active or untreated brain metastases or spinal cord compression

    • A scan to confirm the absence of brain metastases is not required.
    • Patients with treated brain metastases or spinal cord compression are eligible if they have minimal neurologic symptoms and evidence of stable disease (for at least 1 month) or response on follow-up scan. The patient can receive a stable dose of corticosteroids before and during the study if started at least 28 days prior to initiating the study agent(s)..
  • History of carcinomatous meningitis
  • Patients with second primary cancer, except: adequately treated non-melanoma skin cancer, curatively treated stage I cancers (cervix, breast, colon, lung, or prostate as examples) or other advanced (> Stage I)solid tumors curatively treated with no evidence of disease for ≥ 5 years.
  • Patient must not have a co-morbid condition(s) that, in the opinion of the investigator, prevent safe treatment.
  • Immunocompromised patients, e.g., patients who are known to be serologically positive for human immunodeficiency virus (HIV) and are receiving antiviral therapy (testing is not part of the protocol).

    - Patients with known (testing is not part of the protocol) active hepatic disease (i.e., Hepatitis B or C) due to risk of drug interactions with anti-viral therapy.

  • Any of the following cardiovascular events within 6 months prior to study entry: myocardial infarction, malignant hypertension, severe/unstable angina, symptomatic congestive heart failure, cerebral vascular accident, or transient ischemic attack
  • History or presence of clinically significant ventricular or atrial dysrhythmia > Grade 2 (NCI CTCAE v4.0)

    − Patients with chronic, rate-controlled atrial arrhythmias who do not have other cardiac abnormalities are eligible.

  • Major surgery within 3 weeks prior to first dose of study treatment, and patients must have recovered from the effects of surgery
  • Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the study medication
  • Refractory nausea and vomiting, chronic gastrointestinal diseases (e.g. inflammatory bowel disease) or significant bowel resection that would preclude adequate absorption
  • Patients with uncontrolled seizures
  • Inadequate bone marrow reserve within past 28 days prior to study treatment as demonstrated by:

    • Absolute neutrophil count (ANC) < 1500/μl,
    • WBC ≤ 3x109/L
    • Platelet count (PLT) < 100,000/μl, or
    • Hemoglobin (Hgb) < 10 g/dL
  • Blood (packed red blood cells, platelets) transfusions within 1 month prior to study start
  • Whole blood transfusion in the last 120 days prior to entry to the study
  • Patients with concomitant use of drugs, herbal supplements and/or ingestion of foods known to strongly modulate CYP3A4 enzyme activity as specified in the drug specific appendix.
  • Women who are pregnant or lactating (breastfeeding)
  • Patients with a known hypersensitivity to olaparib or any of the excipients of the product.
  • Patients with a known hypersensitivity to the combination/comparator agent
  • Any other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or may interfere with the interpretation of study results

    − Patients considered a poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease or active, uncontrolled infection. Examples include, but are not limited to, uncontrolled ventricular arrhythmia, superior vena cava syndrome, extensive bilateral lung disease on HRCT scan or any psychiatric disorder that prohibits obtaining informed consent

  • Psychological, familial, sociological, or geographical conditions that do not permit compliance with the protocol

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02576444


Contacts
Contact: Manuel Avedissian 203-737-3669 manuel.avedissian@yale.edu

Locations
United States, Connecticut
Yale Cancer Center Recruiting
New Haven, Connecticut, United States, 06520-8028
Contact: Alexandra Minnella    203-737-3446    alexandra.minnella@yale.edu   
Principal Investigator: Joseph P Eder, MD         
United States, Massachusetts
Dana-Farber Cancer Institute Recruiting
Boston, Massachusetts, United States, 02215
Contact: Brian Beardslee    617-632-5638    brian_beardslee@dfci.harvard.edu   
Principal Investigator: Geoffrey Shapiro, MD         
United States, Tennessee
Vanderbilt-Ingram Cancer Center Recruiting
Nashville, Tennessee, United States, 37232
Contact: Michael McGill    615-936-0602    michael.g.mcgill@vanderbilt.edu   
Principal Investigator: Vicki L Keedy, MD         
Sponsors and Collaborators
Joseph Paul Eder
Dana-Farber Cancer Institute
Vanderbilt-Ingram Cancer Center
Investigators
Principal Investigator: Joseph P Eder, MD Yale University Cancer Center

Responsible Party: Joseph Paul Eder, Professor of Medicine; Clinical Director, Early Drug Development Program, Yale University
ClinicalTrials.gov Identifier: NCT02576444     History of Changes
Other Study ID Numbers: 1508016363
First Posted: October 15, 2015    Key Record Dates
Last Update Posted: April 10, 2018
Last Verified: April 2018

Additional relevant MeSH terms:
Olaparib
Poly(ADP-ribose) Polymerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents