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A Trial of Niraparib in BAP1 and Other DNA Damage Response (DDR) Deficient Neoplasms (UF-STO-ETI-001)

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ClinicalTrials.gov Identifier: NCT03207347
Recruitment Status : Recruiting
First Posted : July 2, 2017
Last Update Posted : May 2, 2019
Sponsor:
Collaborator:
Tesaro, Inc.
Information provided by (Responsible Party):
University of Florida

Brief Summary:
This open-label, non-randomized study will investigate the use of niraparib in patients with tumors known to have mutations in BAP1 and other select DNA damage response pathway genes.

Condition or disease Intervention/treatment Phase
Mesothelioma Uveal Melanoma Renal Cell Carcinoma Cholangiocarcinoma Drug: Niraparib Phase 2

Detailed Description:
BAP1 is an ubiquitin ligase that is critical in helping to regulate the cell cycle, cellular differentiation, and cell death. This protein is also intimately involved with DNA double-strand break repair. Germline mutations in the BAP1 gene are associated with a hereditary cancer syndrome that increases the risk of uveal melanoma, mesothelioma and renal cell carcinoma. PARP is another protein that is crucial in DNA repair and enables continued cell replication and survival. It is hypothesized that PARP inhibition with niraparib will result in significant cytoreduction in patient tumors with mutations in BAP1 and other components of the DNA damage response pathway through synthetic lethality. Synthetic lethality is the inhibition of a gene that a cell relies on to compensate for the loss of another gene, resulting in the cell's demise.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 57 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Patients in both cohorts will receive niraparib.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II Trial of the PARP Inhibitor, Niraparib, in BAP1 and Other DNA Damage Response (DDR) Pathway Deficient Neoplasms (UF-STO-ETI-001)
Actual Study Start Date : August 13, 2018
Estimated Primary Completion Date : December 2021
Estimated Study Completion Date : December 2022


Arm Intervention/treatment
Experimental: Cohort A
This cohort will enroll patients with mesothelioma, uveal melanoma, renal cell carcinoma (clear cell type), and cholangiocarcinoma.
Drug: Niraparib
Patients will take 300 mg of niraparib orally once daily each day of a 28 day cycle.
Other Name: Zejula

Experimental: Cohort B
This cohort will enroll patients whose tumors have a known DNA damage response mutation in any of the following genes: ARID1A, ATM, ATR, BACH1 (BRIP1), BAP1, BARD1, BLM, CHEK1, CHEK2, CDK2, CDK4, ERCC, FAM175A, FEN1, IDH1, IDH2, MRE11A, NBN (NBS1), PALB2, POLD1, PRKDC (DNA-PK) PTEN, RAD50, RAD51, RAD52, RAD54, RPA1, SLX4, WRN, or XRCC. This cohort is open to patients with any type of malignancy (except prostate).
Drug: Niraparib
Patients will take 300 mg of niraparib orally once daily each day of a 28 day cycle.
Other Name: Zejula




Primary Outcome Measures :
  1. Objective Response Rate [ Time Frame: 1 year ]
    Determine the objective response rate for patients with BAP1 and other DNA double- strand break repair pathway mutations


Secondary Outcome Measures :
  1. Progression Free Survival [ Time Frame: 1 year ]
    Determine the median progression free survival

  2. Progression Free Survival [ Time Frame: 3 months ]
    Determine the progression free survival at 3 months

  3. Progression Free Survival [ Time Frame: 6 months ]
    Determine the progression free survival at 6 months

  4. Overall Survival [ Time Frame: 2 years ]
    Estimate the median overall survival

  5. Number of participants with treatment-related adverse events, as assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.0 [ Time Frame: 1 year ]
    Determine the incidence, severity, and reversibility of the toxicities of niraparib using CTCAE v4.0


Other Outcome Measures:
  1. Number of DNA repair mechanism deficiencies [ Time Frame: 1 year ]
    Explore the impact that specific DNA repair mechanism deficiencies have on tumor PARP inhibition

  2. Biomarker identification [ Time Frame: 1 year ]
    Explore alternate biomarkers that predict response to PARP inhibition



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age ≥18 years
  • Histologically confirmed diagnosis of incurable cancer
  • Prior treatment with standard systemic therapy (must have exhausted or declined all known effective therapies)
  • Must be willing to provide blood/serum/plasma for toxicity monitoring and other research purposes
  • Must have formalin-fixed paraffin embedded (FFPE) tissue available for research purposes. Tissue must have been obtained within the last 3 years
  • Measurable disease by RECIST (v 1.1) criteria
  • Adequate organ function
  • ECOG Performance Status of 0-1
  • Life expectancy ≥ 12 weeks
  • Women of childbearing potential must have a negative serum pregnancy test within 7 days prior to the first dose
  • Confirmed diagnosis of uveal melanoma, mesothelioma, renal cell carcinoma (clear cell subtype), or cholangiocarcinoma (Cohort A only)
  • Known DNA damage repair mutation including any one of the following: ARID1A, ATM, ATR, BACH1 (BRIP1), BAP1, BARD1, BLM, CHEK1, CHEK2, CDK2, CDK4, ERCC, FAM175A, FEN1, IDH1, IDH2, MRE11A, NBN (NBS1), PALB2, POLD1, PRKDC (DNA-PK) PTEN, RAD50, RAD51, RAD52, RAD54, RPA1, SLX4, WRN, or XRCC. Only CLIA certified next generation sequencing (NGS) assays are acceptable. Variants of unknown significance (VUS) will be allowed to enroll on study (Cohort B only)
  • Subjects must agree to not donate blood during the study or for 90 days after the last dose of study treatment.
  • Subjects receiving corticosteroids may continue as long as their dose is stable for least 4 weeks prior to initiating protocol therapy.

Exclusion Criteria:

  • Prior exposure to PARP inhibitors
  • Known BRCA1 or BRCA2 mutation
  • Pathologic diagnosis of prostate cancer (cohort B only)
  • Simultaneous enrollment in any other interventional clinical trial
  • Major surgery ≤ 3 weeks of starting the study
  • Investigational therapy ≤ 4 weeks of first day of dosing of study drug
  • Radiotherapy to > 20% of the bone marrow within 4 weeks of the first dose of study drug
  • Known hypersensitivity to niraparib
  • Platelet or red blood cell transfusion ≤ 4 weeks of first dose of study drug
  • Colony-stimulating factors within 4 weeks prior to starting protocol therapy
  • Subjects must not have more than one active malignancy at the time of enrollment (Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen [as determined by the treatment physician and approved by the PI] may be included).
  • Known, active symptomatic brain or leptomeningeal metastases
  • Subject has had any known Grade 3 or 4 anemia, neutropenia or thrombocytopenia due to prior chemotherapy that persisted > 4 weeks and was related to the most recent treatment
  • Known history of myelodysplastic syndrome or acute myeloid leukemia
  • Females or males of childbearing potential who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for at least 180 days after the last dose of study drug.
  • Females who are pregnant or breastfeeding
  • History of any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of protocol therapy or that might affect the interpretation of the results of the study or that puts the subject at high risk for treatment complications, in the opinion of the treating physician or study PI.
  • Prisoners or subjects who are involuntarily incarcerated.
  • Subjects who are compulsorily detained for treatment of either a psychiatric or physical illness.
  • Inability to comply with the study and/or follow-up procedures

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): NCT03207347


Contacts
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Contact: Ashton Monismith, RN (352) 265-0680 ext 87657 amonismith@ufl.edu

Locations
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United States, Florida
University of Florida Recruiting
Gainesville, Florida, United States, 32610
Principal Investigator: Thomas George, MD, FACP         
Sponsors and Collaborators
University of Florida
Tesaro, Inc.
Investigators
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Principal Investigator: Thomas George, MD, FACP University of Florida

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Responsible Party: University of Florida
ClinicalTrials.gov Identifier: NCT03207347     History of Changes
Other Study ID Numbers: UF-STO-ETI-001
IRB201701827 -A ( Other Identifier: University of Florida )
OCR15732 ( Other Identifier: Universiy of Florida )
First Posted: July 2, 2017    Key Record Dates
Last Update Posted: May 2, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Keywords provided by University of Florida:
BAP1
niraparib
DNA repair
PARP inhibitor
homologous repair deficiency
renal cell carcinoma
cholangiocarcinoma
mesothelioma
uveal melanoma

Additional relevant MeSH terms:
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Neoplasms
Melanoma
Carcinoma, Renal Cell
Mesothelioma
Cholangiocarcinoma
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms, Nerve Tissue
Nevi and Melanomas
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Kidney Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Kidney Diseases
Urologic Diseases
Adenoma
Neoplasms, Mesothelial
Niraparib
Poly(ADP-ribose) Polymerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents