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Durvalumab and Olaparib in Metastatic or Recurrent Endometrial Cancer (DOMEC)

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ClinicalTrials.gov Identifier: NCT03951415
Recruitment Status : Recruiting
First Posted : May 15, 2019
Last Update Posted : July 11, 2019
Sponsor:
Collaborators:
Amsterdam University Medical Center
Erasmus Medical Center
Maastricht University Medical Center
The Netherlands Cancer Institute
Radboud University
University Medical Center Groningen
UMC Utrecht
AstraZeneca
Information provided by (Responsible Party):
J.R. Kroep, Leiden University Medical Center

Brief Summary:
The DOMEC trial is designed as a Dutch Gynecological Oncology Group (DGOG), prospective, multi-center, phase II study for 55 patients with advanced (recurrent, refractory or metastatic) endometrial cancer or carcinosarcoma of the uterus to investigate the efficacy of the combination therapy of olaparib tablets and durvalumab IV.

Condition or disease Intervention/treatment Phase
Endometrial Neoplasms Uterine Neoplasms Endometrium Cancer Drug: PARP inhibitor and Anti-PD-L1 Phase 2

Detailed Description:

The prognosis of recurrent or persistent endometrial carcinoma not amenable to local therapy is poor. First line therapy exists of platinum-based chemotherapy or hormonal therapy. No standard subsequent-line therapy has been described.The combination of Poly(ADP-ribose) polymerases (PARP) inhibition and Programmed death-ligand 1 (PD-L1) blocking has great potential in the treatment of recurrent endometrial cancer. The DOMEC trial is designed to investigate this treatment combination among all molecular subgroups.

The DOMEC trial is designed as a DGOG, prospective, multi-center, phase II study for 55 patients with advanced (recurrent, refractory or metastatic) endometrial cancer, including carcinosarcoma of the uterus. Patients must have had one prior platinum-based chemotherapeutic regimen or not be able/willing to get chemotherapy. The aim is to investigate the efficacy of the combination therapy of olaparib tablets 300mg twice daily orally and durvalumab 1500mg by IV infusion every 4 weeks in terms of progression free survival. Secondary objectives are to investigate objective response rate, overall survival, safety and predictive biomarkers.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 55 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Durvalumab and Olaparib in Metastatic or Recurrent Endometrial Cancer
Actual Study Start Date : July 8, 2019
Estimated Primary Completion Date : July 1, 2023
Estimated Study Completion Date : July 1, 2023

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: PARP inhibitor and Anti-PD-L1
olaparib tablets 300mg twice daily orally and durvalumab 1500mg by IV infusion every 4 weeks
Drug: PARP inhibitor and Anti-PD-L1
olaparib tablets 300mg twice daily orally and durvalumab 1500mg by IV infusion every 4 weeks
Other Names:
  • olaparib
  • durvalumab
  • PARP inhibitor
  • Anti-PD-L1 Monoclonal Antibody




Primary Outcome Measures :
  1. Progression free survival (PFS) [ Time Frame: 6 months ]
    PFS will be counted from the date of registration until the first observation of radiological progressive disease according to RECIST 1.1 criteria or death due to any cause, whichever occurred first.


Secondary Outcome Measures :
  1. Objective response rate (ORR) [ Time Frame: 12 weeks ]
    according to RECIST 1.1 criteria

  2. Overall survival (OS) [ Time Frame: Through study completion, up to 36 months ]
    OS will be determined from the date of registration until death from any cause.

  3. Adverse events [ Time Frame: Through study completion, up to 36 months ]
    Assessed by NCI Common Terminology Criteria for adverse Events (CTCAE) version 5.0

  4. Predictive biomarkers in tumor biopsy [ Time Frame: At baseline ]
    MMRd/POLE, HR status, quantification of CD3,CD4,CD8,CD103,CD161,PD-1,LAG3,CTLA-4,NKG2A,GOXp3 positieve T cells, NK cells, percentage PD-L1 on myeloid cells/tumorcells, quantification of myeloid cell infiltration (CD68,CD14,CD33,CD163) in tumor biopsies.


Other Outcome Measures:
  1. Functional HRD assay (optional) [ Time Frame: At baseline ]
    Extra biopsy

  2. Immunological effects of PARP-1 inhibition (optional) [ Time Frame: Change From Baseline to 6 weeks and 12 weeks ]
    Tests for T cell and APC functionality measured by the measurement of recall antigen responses and mixed lymphocyte cultures, respectively, the levels of regulatory T cells, activation markers on T cells and DC).

  3. Predictive biomarkers for PD-L1 blocking in blood (optional) [ Time Frame: Change From Baseline to 6 weeks and 12 weeks ]
    e.g. monocyticMDSC levels, DC levels, inhibitory marker expression, neutrophil-to-lymphocyte ratio, absolute lymphocyte count, T-cell reactivity during PD-L1 blocking, T-cell cytokine expression after SEB activation



Information from the National Library of Medicine

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

Inclusion criteria:

  • Written informed consent
  • Age > 18 years old
  • Histologically confirmed diagnosis of endometrial cancer or carcinosarcoma of the endometrium.
  • Metastatic disease or locally advanced tumor not amenable to local therapy.
  • Documented progressive disease before enrolment.
  • Measurable lesions outside irradiated field or progressive measurable lesions in irradiated area
  • Not eligible for hormonal therapy (because of negative hormone receptor/poor differentiation, or after failure of hormonal therapy).
  • Previous failure of chemotherapy, or refusal to undergo chemotherapy or chemo-naive patients not suitable for chemotherapy.
  • WHO performance 0-1
  • Adequate organ system function as measured within 28 days prior to administration of study treatment, as defined below:

    • Haemoglobin ≥ 10.0 g/dL, with no blood transfusion in the past 28 days.
    • Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
    • Platelet count ≥ 100 x 109/L
    • Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN) (not applicable to Gilbert's syndrome)
    • Aspartate aminotransferase (AST) (Serum Glutamic Oxaloacetic Transaminase (SGOT)) / Alanine aminotransferase (ALT) (Serum Glutamic Pyruvate Transaminase (SGPT)) ≤ 2.5 x ULN unless liver metastases are present in which case they must be ≤ 5x ULN
    • Patients must have creatinine clearance estimated of ≥51 mL/min estimated using the Cockcroft-Gault equation or 24 hr urine clearance.
  • Life expectancy of at least 16 weeks.
  • Measurable disease as defined by RECIST 1.1 criteria
  • Able to swallow and retain oral medication.
  • A female is eligible to enter and participate in this study if there is:

Exclusion criteria:

  • Participation in another clinical study with an investigational product during the last month or previous enrolment in the present study.
  • Any previous treatment with PARP inhibitor, including olaparib and/or any previous treatment with a PD1 or PD-L1 inhibitor
  • History of another primary malignancy except for malignancy treated with curative intent and with no known active disease ≥5 years before the first dose of investigational product and of low potential risk for recurrence or adequately treated non-melanoma skin cancer, lentigo maligna or carcinoma in situ.
  • History of leptomeningeal carcinomatosis, symptomatic uncontrolled brain metastases (≤2mg/ day corticosteroids started ≥4 weeks prior to treatment is accepted) and spinal cord compression (unless received definitive treatment and clinically stable for 28 days) .
  • Resting ECG with QTc > 470 msec on 2 or more time points within a 24 hour period or family history of long QT syndrome
  • Concomitant use of known strong or moderate CYP3A inhibitors and inducers.
  • Any unresolved toxicity NCI CTCAE Grade ≥2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria.
  • Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab (except intranasal and inhaled corticosteroids or systemic prednisone ≤ 10 mg/day)
  • Major surgery ≤2 weeks of starting study treatment
  • History of active primary immunodeficiency
  • Active or prior documented autoimmune or inflammatory disorders, with exception of: vitiligo or alopecia, hypothyroidism stable on hormone replacement, any chronic skin condition that does not require systemic therapy, celiac disease controlled by diet alone
  • Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the study medication.
  • Active infection including tuberculosis, hepatitis B/C and HIV
  • Patients with an expected or known hypersensitivity to olaparib or durvalumab or any of the excipients of the products.
  • Previous allogenic bone marrow transplant or double umbilical cord blood transplantation (dUCBT).
  • Receipt of live attenuated vaccine within 30 days prior to the first dose of IP.
  • Pregnancy or breastfeeding

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): NCT03951415


Contacts
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Contact: Judith Kroep, Dr. +31-71-5263464 J.R.Kroep@lumc.nl

Locations
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Netherlands
Amsterdam UMC, AMC Not yet recruiting
Amsterdam, Netherlands, 1105 AZ
Contact: A M Westermann, MD PhD         
Principal Investigator: A M Westermann, MD PhD         
NKI-AVL Not yet recruiting
Amsterdam, Netherlands
Contact: G S Sonke, MD PhD         
Universitair Medisch Centrum Groningen Not yet recruiting
Groningen, Netherlands
Contact: M Jalving, MD PhD         
Leiden University Medical Center Recruiting
Leiden, Netherlands, 2300RC
Contact: J R Kroep, MD PhD         
Principal Investigator: J R Kroep, MD PhD         
Academisch Ziekenhuis Maastricht Not yet recruiting
Maastricht, Netherlands
Contact: R I Lalisang, MD PhD         
RadboudMC Not yet recruiting
Nijmegen, Netherlands
Contact: P B Ottevanger, MD PhD         
Erasmus MC Not yet recruiting
Rotterdam, Netherlands
Contact: I A Boere, MD PhD         
Universitair Medisch Centrum Utrecht Not yet recruiting
Utrecht, Netherlands
Contact: P O Witteveen, MD PhD         
Sponsors and Collaborators
Leiden University Medical Center
Amsterdam University Medical Center
Erasmus Medical Center
Maastricht University Medical Center
The Netherlands Cancer Institute
Radboud University
University Medical Center Groningen
UMC Utrecht
AstraZeneca

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Responsible Party: J.R. Kroep, Principal Investigator, Leiden University Medical Center
ClinicalTrials.gov Identifier: NCT03951415     History of Changes
Other Study ID Numbers: DOMEC
First Posted: May 15, 2019    Key Record Dates
Last Update Posted: July 11, 2019
Last Verified: July 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by J.R. Kroep, Leiden University Medical Center:
Poly (ADP-ribose) Polymerase Inhibitors
Antibodies, Monoclonal
Checkpoint Inhibitors
olaparib
durvalumab
Anti-PD-L1
Additional relevant MeSH terms:
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Endometrial Neoplasms
Uterine Neoplasms
Neoplasms
Genital Neoplasms, Female
Urogenital Neoplasms
Neoplasms by Site
Uterine Diseases
Genital Diseases, Female
Durvalumab
Olaparib
Poly(ADP-ribose) Polymerase Inhibitors
Antibodies
Antibodies, Monoclonal
Immunologic Factors
Physiological Effects of Drugs
Antineoplastic Agents, Immunological
Antineoplastic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action