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Pamiparib in Fusion Positive, Reversion Negative High Grade Serous Ovarian Cancer or Carcinosarcoma With BRCA1/2 Gene Mutations If Progression on Substrate Poly ADP Ribose Polymerase Inhibitbor (PARPI) or Chemotherapy (PRECISE)

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ClinicalTrials.gov Identifier: NCT03933761
Recruitment Status : Recruiting
First Posted : May 1, 2019
Last Update Posted : August 7, 2020
Sponsor:
Collaborator:
BeiGene
Information provided by (Responsible Party):
Australia New Zealand Gynaecological Oncology Group

Brief Summary:

This study is a phase II, multi-centre, open label study in patients with advanced ovarian cancer. The treatment being tested is Pamiparib, with daily dosing.

All patients enrolled to the study will receive treatment with pamiparib. Patients will be selected for entry into the study based on the molecular signature of their cancer.


Condition or disease Intervention/treatment Phase
Ovarian Cancer Carcinosarcoma Drug: Pamiparib Phase 2

Detailed Description:

Ovarian cancer is the deadliest gynaecologic cancer in Western women. Although initially responsive to therapy, drug resistance commonly evolves.

Novel mechanisms of drug resistance in ovarian cancer have been identified and include genetic mutations that result in the activation of a drug efflux pump and secondary mutations in BRCA1/2 genes that restore the cancer cell's ability to repair treatment related DNA damage. It is hypothesized that patients with BRCA1/2 mutant high grade serous ovarian cancer or carcinosarcoma who have progressed on recent therapy and have an activated efflux pump without a secondary BRCA1/1 mutation will be selectively sensitive to a new PARPi, Pamiparib, which does not get effluxed out of cancer cells.

The primary objective of this trial is to assess the clinical benefit rate at > 4 months in 2 cohorts of patients (cohort 1: post substrate-PARP inhibitor and cohort 2: post chemotherapy) defined as response or absence of progression. Secondary objectives are to determine the median progression free and overall survival of patients treated with Pamiparib and the impact on symptom burden and benefit.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II, Signal-Seeking Trial of the Clinical Benefit Rate Associated With Pamiparib in Subjects With Germline or Somatic BRCA1/2 High Grade Serous Ovarian Cancer or Carcinosarcoma Who Have Progressed on P-gp Substrate Chemotherapy or PARPi With the Presence of an ABCB1 Fusion and the Absence of a BRCA1/2 Reversion
Actual Study Start Date : July 29, 2019
Estimated Primary Completion Date : August 2025
Estimated Study Completion Date : August 2028


Arm Intervention/treatment
Experimental: Pamiparib (BGB-290)
Drug: Pamiparib Oral capsules 60mg twice daily continuously Although treatment is continuous, a cycle is defined as 4 weeks or 28 days.
Drug: Pamiparib
60 mg of pamiparib (3 capsules of 20mg) will be administered orally twice a day, once in the morning and once in the evening continuously in 28 day cycles.
Other Name: BGB-290




Primary Outcome Measures :
  1. Clinical benefit rate [ Time Frame: Assessed at 16 weeks after commencing treatment. ]
    as assessed by RECIST v1.1 or by Gynaecological Cancer Intergroup (GCIG) Cancer antigen (CA)-125 criteria


Secondary Outcome Measures :
  1. Frequency of ABCB1 fusions and BRCA1/2 reversions [ Time Frame: At Baseline ]
    in patients with germline or somatic BRCA1/2 high grade serous cancer or carcinosarcoma

  2. Median progression free survival [ Time Frame: Through study completion, on average 6 months. ]
    in BRCA1/2 high grade serous cancer or carcinosarcoma patients with ABCB1 fusions in the absence of BRCA1/2 reversions treated with pamiparib.

  3. Median overall survival [ Time Frame: Assessed for up to 3 years after the last patient enrolled has commenced treatment. ]
    in BRCA1/2 high grade serous cancer or carcinosarcoma patients with ABCB1 fusions in the absence of BRCA1/2 reversions treated with pamiparib.

  4. Duration of response [ Time Frame: Assessed for up to 3 years after the last patient enrolled has commenced treatment. ]
    Duration of response according to RECIST v1.1 in the subset of patients who achieved partial response or complete response.

  5. Best overall response according to RECIST v1.1 [ Time Frame: Assessed for up to 3 years after the last patient enrolled has commenced treatment. ]
    Best overall response is the best response from commencement of treatment according to RECIST v1.1

  6. Best overall response according to CA-125 [ Time Frame: Assessed for up to 3 years after the last patient enrolled has commenced treatment. ]
    defined as best response from commencement of treatment determined by GCIG CA-125 criteria

  7. Patient reported symptom burden [ Time Frame: At the time of consent to screening, at every cycle to 16 weeks, then every 4 cycles, and again at the time of progression. Assessed for up to 3 years after the last patient enrolled has commenced treatment. ]

    Using the Measure of Ovarian Cancer Symptoms and Treatment Concerns (MOST) v2 patient reported outcome measure (PROM)

    • The scale measures disease or therapy related symptoms and symptom burden and well-being
    • Scale ranges: Subscales are reported in five different categories with the subscale score ranges below

      • Abdominal symptoms, higher values reflecting worst possible symptoms
      • Disease or treatment-related symptoms, higher values reflecting worst possible symptoms
      • Chemotherapy-related symptoms, higher values reflecting worst possible symptoms
      • Psychological symptoms, higher values reflecting worst possible symptoms
      • Well-being, higher values reflecting best possible symptoms
    • Each of the 5 subscales can be scored and analysed separately (item by item) or by taking the average of the component items.

  8. Patient reported results of the 40 item State-trait anxiety inventory for adults (STAI-ADTM) [ Time Frame: This will be assessed 3 times - at the time of pre-screening consent, immediately prior to clinician consult with notification of pre-screening results, and immediately following notification of pre-screening results. ]
    • The scale measures state level anxiety (S-Anxiety or current levels) and trait anxiety levels (T-anxiety or how someone generally feels)
    • Scale ranges: STA Form Y-1 includes 20 items/questions, with a total score range of 20-80, and STA Form Y-2 includes 20 items/questions, with a total score range of 20-80. Each scored item/question is then given a weighted score of 1 to 4 with a rating of 4 indicative of a high level of anxiety for 10 x S-Anxiety items and 11 x T-Anxiety items. A high rating indicates the absences of anxiety for the remaining 10 S-Anxiety items and 9 T-Anxiety items. The scoring weights for the anxiety-present items are the same as the chosen numbers on the form and the scoring weight for the anxiety-absent items are reversed.
    • For each form separately, weighted scores are then totalled and averaged. Groups of respondents will be identified (including most anxious, least anxious, and middle) based on top, bottom, and middle percentiles.

  9. The type, grade and relationship to treatment of adverse events [ Time Frame: During the treatment period, on average 3 years ]
    The type, grade and relationship to treatment of adverse events, assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v5.0



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
Gender Based Eligibility:   Yes
Gender Eligibility Description:   Female patients with high grade serous ovarian cancinoma or carcinosarcoma.
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria - Pre-Screening

  1. Patient has provided written informed consent for pre-screening
  2. Patient is able to comply with the study protocol and follow-up procedures, in the Investigator's judgement
  3. Patient is female aged ≥ 18 years at time of consent
  4. ECOG performance status 0-2 (refer to Appendix 1)
  5. Patient has the ability to take oral medications without medical history of malabsorption or other chronic gastrointestinal disease, or other conditions that may harm compliance and/or absorption of the study agent
  6. Patients with a histopathological diagnosis of HGSC or carcinosarcoma of the ovary (including primary peritoneal cancers and fallopian tube cancers) as defined by histological diagnosis and immunohistochemistry (IHC) and with a germline or somatic BRCA1/2 mutation:

    • Mixed histologies are allowed provided that >80% of the primary tumour is a HGSC based on diagnostic pathology review and IHC profile
  7. Progressive symptomatic or asymptomatic recurrent disease defined by GCIG CA- 125 and/or RECIST v1.1 criteria after 1 or more line/s of substrate chemotherapy and/or after P-gp substrate PARPi

    • Patients may continue on treatment as per standard of care by their usual clinician while awaiting the results of pre-screening with no impact on usual care
    • Patients who have been treated with both substrate PARPi and substrate chemotherapy will be considered eligible for either cohort 1 or cohort 2 based on the therapy they have most recently progressed on (cohort 1 is progression on PARPi and cohort 2 is progression on chemotherapy)
  8. Disease that is amenable to a biopsy and/or ascitic drainage

    • Lesions intended to be biopsied should not be target lesions with the preference of the biopsy site having progressed on most recent imaging where clinically safe and feasible
  9. Patient has a life expectancy > 12 weeks
  10. Patient has consented to the collection and use of their fresh tumour biopsies and/or ascites samples

Exclusion Criteria - Pre-Screening

  1. Patients with a clear cell, mucinous, or other non-high grade serous histological subtype
  2. Prior treatment with non-substrate P-gp PARPi (pamiparib or veliparib)

    • Prior treatment with substrate PARPi is allowed (olaparib, niraparib, rucaparib, and talazoparib)
  3. Patients who are pregnant or nursing
  4. Patient has a diagnosis of myelodysplastic syndrome (MDS)
  5. Patient has other diagnoses of malignancy

    • Except for surgically excised non-melanoma skin cancer, adequately treated carcinoma in situ of the cervix, adequately treated non-invasive bladder cancer, ductal carcinoma in situ treated surgically with curative intent, or a malignancy diagnosed >2 years ago with no current evidence of disease and no therapy ≤2 years prior to registration to pre-screening
  6. Prior radiation therapy to target lesions in the absence of documented progression at the treated target lesion
  7. Patient has uncontrolled pleural effusion, pericardial effusion, or ascites requiring weekly recurrent drainage procedures
  8. Known history of intolerance to the excipients of the pamiparib capsule
  9. Active bleeding disorder, including gastrointestinal bleeding, as evidenced by hematemesis, significant hemoptysis, or melena ≤6 months prior to registration to pre-screening
  10. Previous complete gastric resection, chronic diarrhea, active inflammatory gastrointestinal disease, or any other disease-causing malabsorption syndrome

    • Gastroesophageal reflux disease under treatment with proton-pump inhibitors is allowed

Inclusion Criteria - Main Study

  1. Patient has provided written informed consent for main PRECISE study
  2. Patient continues to meet all pre-screening inclusion criteria
  3. Patient has an ABCB1 fusion(s) and the absence of a BRCA1/2 reversion
  4. Patient has platinum sensitive or platinum resistant HGSC

    • Patients who are refractory (progress during or within 4 weeks) to second or subsequent lines of platinum-based chemotherapy are eligible
    • Patients who are primary platinum refractory (progress during or within 4 weeks of first line chemotherapy) are considered ineligible
  5. Recurrent disease that is measurable according to RECIST v1.1 or evaluable disease using CA-125 according to GCIG criteria
  6. Adequate haematologic and end-organ function, as defined by the following laboratory results (obtained within 7 days prior to registration to the main study):

    • Absolute neutrophil count (ANC) ≥1.5 x 109/L
    • Platelet count ≥ 100 x 109/L
    • Haemoglobin (Hb) ≥ 90 g/L (≥ 28 days after transfusion)
    • Estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2 by the Modification of Diet in Renal Disease study equation (MDRD STUDY EQ; www.mdrd.com or Appendix 5)
    • Total serum bilirubin ≤ 1.5 x upper limit of normal (ULN)
    • ≤ 4 x ULN, if Gilbert's syndrome or if indirect bilirubin concentrations suggestive of extrahepatic source of elevation
    • Aspartate and alanine aminotransferase (AST and ALT) ≤ 3 x upper limit of normal (ULN) or ≤ 5 x ULN for patients with liver metastases
  7. Patients who are pregnant

    • Females of childbearing potential require a negative serum pregnancy test within 7 days prior to registration into the main study
  8. Females of childbearing potential must practice highly effective methods of birth control (refer to Appendix 2) for the duration of the study and for at least 6 months after last study drug
  9. Patients must have recovered to ≤ grade 1 from their treatment-related adverse event (AE) with the exception of alopecia and peripheral neuropathy
  10. Able to provide a formalin-fixed paraffin embedded (FFPE) tumour block, representative of the patient's primary disease

    • In cases where there is insufficient FFPE tumour, a discussion with the Coordinating Principal Investigator (CPI) must be had before registration to the main study

Exclusion Criteria - Main Study

  1. Patients who have received chemotherapy, biologic therapy, immunotherapy, investigational agent, anticancer Chinese medicine, or herbal remedies ≤ 5 half-lives if the half-life is known, ≤ 14 days if not known, prior to registration to the main study

    • Bisphosphonate and denosumab use is allowed on study, if administered at a stable dose > 28 days prior to registration to the main study
  2. The use or anticipated need for food or drugs known to be strong or moderate cytochrome P450 (CYP) 3A inhibitors or strong CYP3A inducers (Appendix 6) ≤ 5 half-lives if the half-life is known or ≤ 14 days if not known prior to registration to the main study
  3. Major surgical procedure, open biopsy, or significant traumatic injury ≤ 14 days prior to registration to the main study, or anticipation of need for major surgical procedure during the course of the study

    • Placement of vascular access device is not considered major surgery
  4. Prior radiation therapy ≤ 14 days prior to registration to the main study to non-target lesions. Patients who have received palliative radiotherapy of non-target lesions for local symptom control > 14 days prior to registration to the main study must have stabilisation of any AEs or a return to baseline prior to registration to the main study
  5. Leptomeningeal disease or uncontrolled, untreated brain metastases
  6. Patients with a history of treated and asymptomatic brain metastases are eligible, provided they meet all of the following:

    • Only supratentorial metastases
    • Brain imaging at screening without evidence of interim progression
    • No ongoing requirement for corticosteroids as therapy for brain metastases
    • Anticonvulsants at a stable dose allowed (except for contraindicated medications carbamazepine and phenytoin)
    • No stereotactic radiation or whole-brain radiation ≤ 14 days prior to registration to the main study
  7. Any of the following cardiovascular criteria:

    • Cardiac chest pain, defined as moderate pain that limits instrumental activities of daily living, ≤ 28 days prior to registration to the main study
    • Symptomatic pulmonary embolism ≤ 28 days prior to registration to the main study
    • Any history of acute myocardial infarction ≤ 6 months prior to registration to the main study
    • Any history of heart failure meeting New York Heart Association (NYHA) Classification III or IV (refer to Appendix 8) ≤ 6 months prior to registration to the main study
    • Any event of ventricular arrhythmia ≥ Grade 2 in severity ≤ 6 months prior to registration to the main study
    • Any history of cerebrovascular accident (CVA) ≤ 6 months prior to registration to the main study
  8. Active infection requiring systemic treatment, acute/viral hepatitis or active chronic hepatitis B or C or active tuberculosis

    • Patients with untreated chronic hepatitis B or chronic hepatitis B virus (HBV) carriers whose HBV DNA is > 500 IU/mL or patients with active hepatitis C should be excluded. Note: Inactive hepatitis B surface antigen carriers, treated and stable hepatitis B (HBV DNA < 500 IU/mL), and cured hepatitis C patients can be enrolled

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): NCT03933761


Contacts
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Contact: Alison Freimund +61 3 8559 7903 ali.freimund@petermac.org
Contact: John Andrews +61 2 8071 4881 trials@anzgog.org.au

Locations
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Australia, New South Wales
Macarthur Cancer Therapy Recruiting
Campbelltown, New South Wales, Australia, 2560
Sub-Investigator: Felicia Roncolato, Dr         
Royal Hospital for Women / Prince of Wales Recruiting
Randwick, New South Wales, Australia, 2031
Contact: Christie Norris       Christie.Norris@health.nsw.gov.au   
Principal Investigator: Michael Friedlander, Prof         
Sub-Investigator: Chen Lee, Dr         
Calvary Mater Newcastle Private Recruiting
Waratah, New South Wales, Australia, 2298
Contact: Kim Adler       Kim.Adler@calvarymater.org.au   
Sub-Investigator: Janine Lombard, Dr         
Australia, Queensland
Mater-Brisbane Not yet recruiting
Brisbane, Queensland, Australia
Contact: David Courtney-Rogers       David.Courtney-Rodgers@mater.org.au   
Principal Investigator: Cath Shannon, Dr         
Australia, Victoria
Monash Health VIC Recruiting
Clayton, Victoria, Australia, 3168
Contact: Merylyn Ryan       Merylyn.Ryan@monashhealth.org   
Contact: Kelly Hoffman       Kelly.Hoffman@nomashhealth.org   
Sub-Investigator: Kate Webber, Dr         
Peter MacCallum Cancer Centre Recruiting
Melbourne, Victoria, Australia, 3000
Contact: Alison Freimund    +61 3 85597903    ali.freimund@petermac.org   
Contact: Daniela Surace    +61 3 85597531    daniela.surace@petermac.org   
Australia, Western Australia
Sir Charles Gairdner Hospital Recruiting
Nedlands, Western Australia, Australia, 6009
Contact: Edwin Tan       Edwin.Tan@health.wa.gov.au   
Contact: Gemma Walker       Gemma.Walker@health.wa.gov.au   
Principal Investigator: Tarek Meniawy, Dr         
Sponsors and Collaborators
Australia New Zealand Gynaecological Oncology Group
BeiGene
Investigators
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Principal Investigator: Alison Freimund Peter MacCallum Cancer Centre, Australia
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Responsible Party: Australia New Zealand Gynaecological Oncology Group
ClinicalTrials.gov Identifier: NCT03933761    
Other Study ID Numbers: ANZGOG 1721/2018
First Posted: May 1, 2019    Key Record Dates
Last Update Posted: August 7, 2020
Last Verified: August 2020
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 Australia New Zealand Gynaecological Oncology Group:
High grade serous
ABCB1 fusion
BRCA 1/2 reversion
Platinum resistant
Platinum sensitive
Additional relevant MeSH terms:
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Ovarian Neoplasms
Carcinoma, Ovarian Epithelial
Carcinosarcoma
Mixed Tumor, Mullerian
Endocrine Gland Neoplasms
Neoplasms by Site
Neoplasms
Ovarian Diseases
Adnexal Diseases
Genital Neoplasms, Female
Urogenital Neoplasms
Endocrine System Diseases
Gonadal Disorders
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms, Complex and Mixed
Sarcoma
Neoplasms, Connective and Soft Tissue