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Phase I Study of AZD5363 + Olaparib + Durvalumab in Patients With Advanced or Metastatic Solid Tumor Malignancies (MEDIPAC)

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ClinicalTrials.gov Identifier: NCT03772561
Recruitment Status : Recruiting
First Posted : December 11, 2018
Last Update Posted : December 24, 2018
Sponsor:
Information provided by (Responsible Party):
National University Hospital, Singapore

Brief Summary:

This is a Phase 1 dose-escalation study to evaluate the safety and tolerability of combination treatment of AZD5363 + Olaparib + Durvalumab and to determine the RP2D in patients with advanced or metastatic solid tumor malignancies.

The purpose of this trial is to determine if combination treatment of drugs, Olaparib, AZD5363 and Durvalumab has beneficial effects in advanced or metastatic cancers and to determine the effects it has on patients and their cancer.

Primary Objectives

• To evaluate the safety and tolerability of combination treatment AZD5363 + Olaparib + Durvalumab and determine the Maximum Tolerated Dose (MTD), Dose-Limiting Toxicities (DLTs), and Recommended Phase 2 Dose (RP2D) for patients with advanced or metastatic solid tumor malignancies.

Secondary Objectives

  • To determine the pharmacodynamics (PDn) of combination treatment AZD5363 + Olaparib + Durvalumab in patients with advanced or metastatic solid tumor malignancies
  • To describe anti-tumor response using immune RECIST of combination treatment AZD5363 + Olaparib + Durvalumab in patients with advanced or metastatic solid tumor malignancies

Exploratory Objectives

  • To evaluate anti-tumour response using RECIST v1.1 for combination treatment AZD5363 + Olaparib + Durvalumab in patients with advanced or metastatic solid tumor malignancies
  • To explore molecular correlates of the relationship between mutations in Akt/ PIK3CA/PTEN pathway and response to AZD5363 +Olaparib+ Durvalumab
  • To understand the role of tumour microenvironment in regulation of intratumoral immune regulators (i.e. T-regulatory cells) in improving response to Durvalumab
  • To understand the role of AZD5363 as an immunomodulator
  • To evaluate the role of PD-1 and PDL-1 immunohistochemical and tumour MMR status in predicting response to immune check point inhibitors.

Condition or disease Intervention/treatment Phase
Solid Tumor, Adult Drug: AZD5363+Olaparib+Durvalumab Phase 1

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: An Investigator Sponsored Phase I Study of the Safety, Tolerability and Pharmacodynamics of Escalating Doses of Combination Treatment of AZD5363 + Olaparib + Durvalumab (MEDI4736) in Patients With Advanced or Metastatic Solid Tumor Malignancies.
Actual Study Start Date : December 3, 2018
Estimated Primary Completion Date : December 31, 2021
Estimated Study Completion Date : December 31, 2023

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: AZD5363+Olaparib+Durvalumab

A traditional 3+3 design will be used during the dose escalation part of the study.

Patients will receive AZD5363 orally twice a day 4 days-on/ 3 days-off starting 14 days prior to cycle 1 day 1 (C1D1). Olaparib continuously twice a day at 300mg and Durvalumab intravenously at 1500mg once every 4 weeks will commence at C1D1. Treatment will continue until disease progression or the development of unacceptable toxicities.

Drug: AZD5363+Olaparib+Durvalumab
Patients will receive AZD5363 orally twice a day 4 days-on/ 3 days-off starting 14 days prior to cycle 1 day 1 (C1D1). Olaparib continuously twice a day at 300mg and Durvalumab intravenously at 1500mg once every 4 weeks will commence at C1D1. Treatment will continue until disease progression or the development of unacceptable toxicities.




Primary Outcome Measures :
  1. Objective response rate [ Time Frame: 5 years ]
    Percentage of patients who have a confirmed visit response of CR or PR.

  2. Best objective response [ Time Frame: 5 years ]
    Calculated as the best response recorded from date the combination treatment started for each patient.



Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years to 99 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. All patients must sign an informed consent in accordance with local institutional guidelines.
  2. Age >= 21
  3. Histologically confirmed advanced or metastatic solid tumors who have radiological evidence of progressive disease on study entry and at least 2 measurable lesions, that is deemed unlikely to benefit from further conventional therapy, or for which no standard therapy is available. Although optional, where practicable and safe, all effort should be made by the investigator to obtain serial tumour biopsies from patients enrolled.
  4. Provision of an archived tumour tissue block (or at least 10 newly cut unstained slides) where such samples exist in a quantity sufficient to allow for analysis
  5. Any number of prior chemotherapy regimens will be allowed and may include biologics
  6. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 1;
  7. Patients must have adequate bone marrow function and organ function within 2 weeks of study treatment;

    • Adequate hematologic function defined as:

      (i) platelets >= 100 x 109/L in dose escalation phase, (ii) hemoglobin >= 6.21 mmol/L or 10 g/dL, (iii) ANC >= 1.5 x 109/L, (iv) WBC >= 3.0 x 109/L. Up to 5% deviation is tolerated. Transfusions and growth factors are allowed prior to and throughout the study.

    • Hepatic function: bilirubin < 1.5 times the upper limit of normal (ULN), ALT and AST < 2.5 times ULN. For patients with hepatic metastasis ALT and AST < 5 times ULN is permitted. Up to 10% deviation is acceptable.
    • Adequate renal function: estimated creatinine clearance of >= 60 mL/min, calculated using the formula of Cockcroft and Gault: (140-Age) • Mass (kg)/(72 • creatinine mg/dL); multiply by 0.85 if female.
    • Amylase and lipase <= 1.5 x ULN;
    • Alkaline phosphatase limit <= 2.5 x ULN (<= 5 x ULN for patients with liver involvement of their cancer);
    • International normalization ratio (INR) (if not on anticoagulation therapy) and partial thromboplastin time (PTT) <= 1.5 x ULN;
    • Normal TSH and ACTH
  8. Females of childbearing potential who are sexually active with a non sterilized male partner must use at least 2 highly effective method of contraception from the time of screening and must agree to continue using such precautions for 180 days after the last dose of durvalumab + any drug combination therapy or 90 days after the last dose of durvalumab monotherapy. Non-sterilized male partners of a female patient must use male condom plus spermicide throughout this period. Cessation of birth control after this point should be discussed with a responsible physician. Not engaging in sexual activity for the total duration of the drug treatment and the drug washout period is an acceptable practice; however, periodic abstinence, the rhythm method, and the withdrawal method are not acceptable methods of birth control. Female subjects should also refrain from breastfeeding throughout this period. Acceptable methods of contraception are as below:

    • Established use of oral, injected or implanted hormonal methods of contraception.
    • Placement of an intrauterine device or intrauterine system.
    • Barrier methods of contraception: condom or occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/suppository.
    • Male partner sterilisation (with the appropriate post-vasectomy documentation of the absence of sperm in the ejaculate).
    • True abstinence
    • It is not known whether AZD5363 has the capacity to affect the metabolism of hormonal contraceptives, so hormonal contraception should also be combined with a barrier method of contraception or patients must have evidence of non-child-bearing potential by fulfilling one of the following criteria at screening:

      • Post-menopausal: defined as aged more than 50 years and amenorrhoeic for at least 12 months following cessation of all exogenous hormonal treatments.
      • Documentation of irreversible surgical sterilisation by hysterectomy, bilateral oophorectomy or bilateral salpingectomy, but not tubal ligation
  9. Non-sterilized males who are sexually active with a female partner of childbearing potential must use a male condom plus spermicide from screening through 180 days after receipt of the final dose of durvalumab + any drug combination therapy or 90 days after receipt of the final dose of durvalumab monotherapy. Not engaging in sexual activity is an acceptable practice; however, occasional abstinence, the rhythm method, and the withdrawal method are not acceptable methods of contraception. Male patients are required to use barrier methods of contraception and refrain from sperm donation throughout the study and for 180 days after the last dose of study drug. Male patients wishing to father children should be advised to arrange for freezing of sperm samples prior to the start of study treatment. Breastfeeding women are also excluded from study entry.
  10. At time of registration, if the patient has had previous treatment it must have been at least 4 weeks since major surgery or radiation therapy; four weeks from any other previous anti-cancer therapy including biologics. Patients must have recovered from their treatment-related events to <=G1 with the exception of alopecia and neuropathy (<= G2 sufficient).
  11. Life expectancy greater than 12 weeks
  12. Patients must weigh at least 30kg
  13. Patients previously treated on check point inhibitor or PARP inhibitor monotherapy will be allowed on study

Exclusion Criteria:

  1. Patients with significant medical illness that in the investigator's opinion cannot be adequately controlled with appropriate therapy or would compromise the patient's ability to tolerate this therapy;
  2. Radiation (except planned or ongoing palliative radiation to bone outside of the region of measurable disease) <= 3 weeks prior to starting first dose of study medication
  3. Participation in another clinical study with an investigational product (IP) within 30 days of the first dose of AZD5363 or matching placebo.Treatment with any of the following:

    • Nitrosourea or mitomycin C within 6 weeks of the first dose of study treatment
    • Any investigational agents or study drugs from a previous clinical study within 30 days of the first dose of study treatment (<= 4 weeks for previous PD-1/PD-L1)
    • Any other chemotherapy, immunotherapy or anticancer agents within 3 weeks of the first dose of study treatment, except hormonal therapy with LHRH analogues for medical castration in patients with prostate cancer, which are permitted
    • Potent inhibitors or inducers or substrates of CYP3A4 or substrates of CYP2D6 within 2 weeks before the first dose of study treatment (3 weeks for St John's Wort )
  4. Uncontrolled hypertension or controlled hypertension (<140/90) on more than 3 antihypertensive agents
  5. Clinically significant abnormalities of glucose metabolism as defined by any of the following:

    o Diabetes mellitus type I

    o Fasting plasma glucose [fasting is defined as no calorific intake for at least 8 hours]: (i) >= 7.0mmol/L (126 mg/dL) for those patients without a pre-existing diagnosis of Type 2 diabetes mellitus (ii) >= 9.3 mmol/L (167mg/dL) for those patients with a pre-existing diagnosis of Type 2 diabetes mellitus (iii) Glycosylated haemoglobin (HbA1C) >=8.0% (63.9 mmol/mol). (iv) Requirement for insulin or more than two oral hypoglycaemic medications for routine diabetic management and control

  6. Major surgical procedure within the last 28 days
  7. Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [eg, colitis or Crohn's disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc]). The following are exceptions to this criterion:

    • Subjects with vitiligo or alopecia
    • Subjects with hypothyroidism (eg, following Hashimoto syndrome) stable on hormone replacement
    • Any chronic skin condition that does not require systemic therapy
    • Subjects without active disease in the last 5 years may be included but only after consultation with the study physician
    • Subjects with celiac disease controlled by diet alone
  8. Any of the following cardiac criteria:

    • Mean resting corrected QT interval (QTc) >470 msec obtained from 3 consecutive ECGs.
    • Any clinically important abnormalities in rhythm, conduction or morphology of resting ECG eg, complete left bundle branch block, third degree heart block
    • Any factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, hypokalaemia, potential for torsades de pointes, congenital long QT syndrome, family history of long QT syndrome or unexplained sudden death under 40 years of age or any concomitant medication known to prolong the QT interval.
    • Experience of any of the following procedures or conditions in the preceding 6 months: coronary artery bypass graft, angioplasty, vascular stent, myocardial infarction, angina pectoris, congestive heart failure NYHA Grade >=2.
    • Uncontrolled hypotension - SBP <90 mmHg and/or DBP <50 mmHg.
    • Cardiac ejection fraction outside institutional range of normal or <50% (whichever is higher) as measured by echocardiogram (or MUGA scan if an echocardiogram cannot be performed or is inconclusive).Left ventricular ejection fraction (LVEF) below lower limit of normal for site.
  9. Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, known immunodeficiency syndrome, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease (history of interstitial lung disease will also be excluded), serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs or compromise the ability of the patient to give written informed consent
  10. Proteinuria 3+ on dipstick analysis or >500 mg/24 hours
  11. Sodium or potassium levels > CTCAE v4.1 grade 1
  12. Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab. The following are exceptions to this criterion:

    • Intranasal, inhaled, topical steroids, or local steroid injections (eg, intra articular injection)
    • Systemic corticosteroids at physiologic doses not to exceed <<10 mg/day>> of prednisone or its equivalent
    • Steroids as premedication for hypersensitivity reactions (eg, CT scan premedication)
  13. Female subjects who are pregnant or breastfeeding or male or female subjects of reproductive potential who are not willing to employ effective birth control from screening to 90 days after the last dose of durvalumab monotherapy.
  14. Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients.
  15. History of allogeneic organ transplant
  16. Known history of previous clinical diagnosis of tuberculosis
  17. Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice), hepatitis B (known positive HBV surface antigen (HBsAg) result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Patients positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA
  18. Renal failure requiring haemodialysis or peritoneal dialysis;
  19. Clinically unstable, active infection requiring systemic antibiotics;
  20. Concurrent cancer (except non-melanoma skin cancer or carcinoma in-situ of the cervix), unless in complete remission and off all therapy for that disease for a minimum of 3 years;
  21. Patients with significantly diseased or obstructed gastrointestinal tract, malabsorption, uncontrolled vomiting or diarrhea or inability to swallow oral medications.
  22. Patients with serious psychiatric or medical conditions that could interfere with treatment.
  23. Patients with prior MDS/ AML
  24. Require therapeutic doses of anti-coagulation with warfarin or warfarin derivatives. However, treatment with low molecular weight heparin (LMWH) is allowed.
  25. Brain metastases or spinal cord compression unless asymptomatic, treated and stable off steroids and anti-convulsants for at least 1 month prior to entry into the study
  26. Concurrent therapy with approved or investigational anticancer therapeutics;
  27. Receipt of live attenuated vaccination within 30 days prior to study entry

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): NCT03772561


Contacts
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Contact: David SP Tan (65) 6779 5555 david_sp_tan@nuhs.edu.sg

Locations
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Singapore
National University Hospital Recruiting
Singapore, Singapore, 119074
Contact: David SP Tan    65 6779 5555    david_sp_tan@nuhs.edu.sg   
Sponsors and Collaborators
National University Hospital, Singapore
Investigators
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Principal Investigator: David SP Tan National University Hospital, Singapore

Publications:
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Responsible Party: National University Hospital, Singapore
ClinicalTrials.gov Identifier: NCT03772561     History of Changes
Other Study ID Numbers: MC01/01/18
2018/00137 ( Other Identifier: NHG Domain Specific Research Board )
First Posted: December 11, 2018    Key Record Dates
Last Update Posted: December 24, 2018
Last Verified: December 2018
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
Keywords provided by National University Hospital, Singapore:
AZD5363
Olaparib
Durvalumab
Solid Tumor
Additional relevant MeSH terms:
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Neoplasms
Durvalumab
Olaparib
Antibodies, Monoclonal
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs
Poly(ADP-ribose) Polymerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action