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A Study to Evaluate TAlazoparib, Radiotherapy and Atezolizumab in gBRCA 1/2 Negative Patients With PD-L1+ Metastatic Triple Negative Breast Cancer (TARA)

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ClinicalTrials.gov Identifier: NCT04690855
Recruitment Status : Recruiting
First Posted : December 31, 2020
Last Update Posted : August 8, 2022
Sponsor:
Collaborators:
Genentech, Inc.
Pfizer
Emory University
Information provided by (Responsible Party):
Mylin A. Torres, MD, Hoosier Cancer Research Network

Brief Summary:

This is a Phase II study designed to assess efficacy and safety of talazoparib, high dose radiation, and atezolizumab in patients with metastatic TNBC that is PD-L1 positive. A total of 23 gBRCA pathogenic variant negative patients will be enrolled. All patients will be treated with induction talazoparib of 1mg PO daily starting Day 1. Patients will then receive 8 Gy x 3 fractions to 2-4 metastatic lesions beginning Day 12,13, or 14 and given QOD. 840 mg of atezolizumab will be given intravenously (IV) on Day 15 of the 1st cycle and then on Day 1 and Day 15 of the remaining cycles. The sequence of administration is not specified on the days in which talazoparib and atezolizumab are given on the same day. Each cycle equals 28 days. Treatment will continue until progression or severe toxicity.

A safety lead in of up to 6 patients will be performed. Immune-related and non-immune related adverse events will be tracked up to 12 weeks post initiation of atezolizumab, as the majority of treatment-related toxicities from talazoparib, radiation, and atezolizumab occur within this time period.


Condition or disease Intervention/treatment Phase
Breast Cancer Triple Negative Breast Cancer Drug: Talazoparib Drug: Atezolizumab Radiation: Radiation Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 23 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Multi-institutional Phase II Study to Evaluate Efficacy and Safety of TAlazoparib, Radiotherapy and Atezolizumab in gBRCA 1/2 Negative Patients With PD-L1+ Metastatic Triple Negative Breast Cancer
Actual Study Start Date : April 1, 2021
Estimated Primary Completion Date : July 2023
Estimated Study Completion Date : July 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Breast Cancer

Arm Intervention/treatment
Experimental: Study Treatment Arm

All patients will be treated with induction talazoparib of 1mg PO daily starting Day 1. Patients will then receive 8 Gy x 3 fractions to 1-4 metastatic lesions beginning Day 12,13, or 14 and given QOD. 840 mg of atezolizumab will be given intravenously (IV) on Day 15 of the 1st cycle and then on Day 1 and Day 15 of the remaining cycles. The sequence of administration is not specified on the days in which talazoparib and atezolizumab are given on the same day. Each cycle equals 28 days. Treatment will continue until progression or severe toxicity.

A safety lead in of up to 6 patients will be performed. Immune-related and non-immune related adverse events will be tracked up to 12 weeks post initiation of atezolizumab, as the majority of treatment-related toxicities from talazoparib, radiation, and atezolizumab occur within this time period.

Drug: Talazoparib
Talazoparib 1 mg Orally Day 1 to Day 28
Other Name: Talzenna

Drug: Atezolizumab
Atezolizumab 840 mg IV over 60 minutes Day 15 of Cycle 1 then Day 1 and Day 15 of subsequent Cycles
Other Name: Tecentriq

Radiation: Radiation
Radiation 8 Gy will be given in 3 fractions QOD beginning Day 12, 13 or 14 of Cycle 1 but 24-72 hours prior to 1st dose of Atezolizumab




Primary Outcome Measures :
  1. Objective response rate (ORR) by RECIST [ Time Frame: 8 weeks ]
    ORR by RECIST which will include confirmed complete response (CR) + confirmed partial response (PR) determined as per RECIST


Secondary Outcome Measures :
  1. Frequency and severity of adverse events [ Time Frame: 1 year ]
    Assessment of the frequency and severity of adverse events will be based on CTCAE criteria v5

  2. Progression free survival (PFS) [ Time Frame: 1 year ]
    Progression free survival (PFS) is defined as the day of study treatment initiation until disease progression by RECIST 1.1 or death whichever occurs first.

  3. Overall survival (OS) [ Time Frame: 1 year ]
    Overall survival (OS) is defined as the day of study treatment initiation until death from any cause.

  4. ORR by immune-related RECIST (irRECIST) [ Time Frame: 1 year ]
    ORR by immune-related RECIST (irRECIST) which will include confirmed complete response (CR) + confirmed partial response (PR) determined as per irRECIST

  5. Duration of overall response (DOR) [ Time Frame: 1 year ]
    Duration of overall response (DOR) is defined as the time that measurement criteria are met for complete or partial response (whichever status is recorded first) until the date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since treatment started).

  6. Disease control rate (DCR) [ Time Frame: 1 year ]
    Disease control rate (DCR) is defined as the percentage of patients with advanced or metastatic cancer who have achieved complete response, partial response and stable disease.

  7. Time to progression (TTP) [ Time Frame: 1 year ]
    Time to progression (TTP) is defined as the day of study treatment initiation until disease progression by RECIST 1.1.

  8. Best overall tumor response [ Time Frame: 1 year ]
    Best overall tumor response is defined as the best response recorded from the start of the study treatment until disease progression/recurrence.

  9. Adherence to protocol prescribed study treatment [ Time Frame: 1 year ]
    Adherence to prescribed talazoparib, high dose radiation, and atezolizumab in the second or third-line setting among PD-L1 positive mTNBC patients measured by intravenous infusion, oral medication, and radiation treatment compliance with prescribed systemic therapy and radiation dose and days of treatment.



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:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Be willing and able to provide written informed consent/assent and HIPPA for the trial.
  2. Ages 18-75 years old at time of consent. Female or male patients allowed.
  3. ECOG PS of 0-2, KPS >/= 60%.
  4. Biopsy proven metastatic triple negative breast cancer (estrogen receptor (<10%), progesterone receptor (<10%) and no overexpression of HER2 as evaluated by local institutions with at least 2 exracranial lesions of metastatic disease on imaging.
  5. PD-L1 positive tumor infiltrate as defined as >/= 1% on IHC using the SP142 Ventana Assay.
  6. Known gBRCA 1/2 status (gBRCA 1/2 negative [e.g. gBRCA wild-type, gBRCA variants of uncertain significance] are eligible).
  7. Patients must have at least 1 extracranial metastatic lesion (may be measurable or non-measurable disease by RECIST v 1.1) that is amenable to high dose radiotherapy and at least one additional extracranial lesion of measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST v1.1) that will not receive radiotherapy on this study. Of note, lesions maybe in the same organ but must be 2 cm apart and breast lesions may be treated.
  8. Patients must have received at least one and no more than three previous lines of systemic treatment in the advanced setting with or without immune therapy. Patients with disease recurrence or progression following neoadjuvant or adjuvant cytotoxic chemotherapy are not eligible unless they have received at least one line of chemotherapy with or without immune therapy in the advanced setting. NOTE: Targeted small molecules (e.g. tyrosine kinase inhibitors), hormonal agents and monoclonal antibodies that inhibit angiogenesis (e.g. bevacizumab, afilbercept) are not counted in the number of lines of therapy. Cytotoxic chemotherapy with or without immune therapy for advanced disease prior to protocol treatment is not permitted within 2 weeks of the protocol treatment. Patients may or may not have received radiotherapy or neoadjuvant or adjuvant chemotherapy in the treatment of their initial, non-metastatic breast cancer, but must be entered on study 2 weeks after their last dose of radiotherapy, last cycle of chemotherapy and biologic therapy (if applicable) for mTNBC and have sufficient resolution of side effects per physician assessment at time of talazoparib.
  9. Demonstrate adequate organ function as defined in the table below. All screening labs to be obtained within 14 days prior to registration.

    • Absolute neutrophil count > 1500/mcL
    • Platelets >/= 100,000 mm
    • Anemia >/= 9.0 g/dL (NOTE: The use of transfusion or other intervention to achieve Hgb >/= 9.0g/dl is acceptable)
    • Serum creatinine ≤ 1.5 × upper limit of normal (ULN) or calculated creatinine clearance ≥ 60 mL/min using Cockcroft-Gault equation for patients with creatinine levels > 1.5× institutional ULN
    • Total bilirubin ≤ 1.5× ULN OR direct bilirubin ≤ 1× ULN
    • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5× ULN unless liver metastases are present, in which case they must be ≤ 5×ULN
    • International normalized ratio (INR) or prothrombin time (PT) ≤1.5× ULN unless patient is receiving anticoagulant therapy as long as PT or partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants
    • Activated partial thromboplastin time (aPTT) ≤ 1.5× ULN unless patient is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants
  10. Patients must be eligible for radiotherapy, talazoparib, and atezolizumab.
  11. Females of childbearing potential must have a negative serum or urine pregnancy test within 14 days prior to Cycle 1 Day 1. If a urine test is done and it is positive or cannot be confirmed as negative, a serum pregnancy test will be required. NOTE: Females are considered of child bearing potential unless they are surgically sterile (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are naturally postmenopausal for at least 12 consecutive months.
  12. Women of childbearing potential and males must agree to use two effective methods of contraception or complete abstinence, from the time of signing the informed consent (females) or first day of study treatment (males), during the course of the study and for 7 months (females) and for 4 months (males) after the last dose of study drug.
  13. Patients must not have active wound healing issues from surgery and sufficient resolution of surgical side effects, per physician assessment, at time of radiotherapy.
  14. During participation on this study, no other investigation or commercial agents or therapy for cancer other than bisphosphonate, rank ligand inhibitors, atezolizumab, radiotherapy and talazoparib should be administered. NOTE: Patients may have received bisphosphonates or rank ligand inhibitors prior to and while on enrollment on study.
  15. Patients must have the psychological ability and general health that permits completion of the study requirements and required follow up.

Exclusion Criteria

  1. gBRCA1/2 pathogenic variant positive
  2. Four or more lines of cytotoxic chemotherapy for mTNBC.
  3. Previous radiation to the metastases to be treated with radiation on this protocol.
  4. Previous PARPi treatment (e.g. talazoparib, niraparib, olazaparib).
  5. Progression of breast cancer within the first 3 months of prior immune therapy for non-metastatic or metastatic breast cancer.
  6. Untreated CNS disease (patients with stable CNS disease for at least 28 days and asymptomatic treated CNS metastases are permitted).
  7. History of leptomeningeal disease.
  8. History of autoimmune disease that has required systemic treatment (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
  9. Use of systemic glucocorticoid or immunosuppressive medications at time of enrollment.
  10. Severe, active co-morbidity such as CHF or unstable angina within last 6 months, transmural MI within the last 6 months.
  11. Acute bacterial or fungal infection requiring IV antibiotics at time of registration.
  12. COPD or other respiratory illness requiring hospitalization at time of registration.
  13. HIV positive with CD4 count <200 cells/ microliter.
  14. Current hormone replacement therapy use.
  15. Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy. Indolent cancers (such as low risk prostate or in-situ cancers) that are not being treated, are acceptable.
  16. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
  17. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
  18. Receipt of the last dose or treatment of anti-cancer chemotherapy, radiotherapy, surgery, endocrine therapy, targeted therapy, biologic therapy, or tumor embolization ≤ 2 weeks (4 weeks for any monoclonal Antibody (mAb), 6 weeks for nitrosoureas or mitomycin C) prior to first dose of study treatment, or has not recovered (i.e., to ≤Grade 1 or Baseline) from clinically significant adverse events (AEs) due to these previously administered agents.

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): NCT04690855


Contacts
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Contact: Mylin Torres, MD 404-778-5047 matorre@emory.edu
Contact: Ahran Lee 317-634-5842 ext 14 alee@hoosiercancer.org

Locations
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United States, Alabama
University of Alabama at Birmingham Recruiting
Birmingham, Alabama, United States, 35294
Contact: Ginger Reeves    205-996-2782    greeves@uab.edu   
Principal Investigator: Ahmed Elkhanany, MD         
United States, Georgia
Winship Cancer Institute of Emory University Recruiting
Atlanta, Georgia, United States, 30322
Contact: India Green    404-778-1738    Igreen3@emory.edu   
Principal Investigator: Mylin Torres, MD         
Sponsors and Collaborators
Mylin A. Torres, MD
Genentech, Inc.
Pfizer
Emory University
Investigators
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Principal Investigator: Mylin Torres, MD Winship Cancer Institute, Emory University
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Responsible Party: Mylin A. Torres, MD, Sponsor-Investigator, Hoosier Cancer Research Network
ClinicalTrials.gov Identifier: NCT04690855    
Other Study ID Numbers: HCRN BRE19-433
First Posted: December 31, 2020    Key Record Dates
Last Update Posted: August 8, 2022
Last Verified: August 2022
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
Additional relevant MeSH terms:
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Breast Neoplasms
Triple Negative Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Atezolizumab
Talazoparib
Antineoplastic Agents
Poly(ADP-ribose) Polymerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action