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Pilot Trial of BMN 673, an Oral PARP Inhibitor, in Patients With Advanced Solid Tumors and Deleterious BRCA Mutations

NCT01989546

Description:

Background: - The poly (ADP-ribose) polymerase (PARP) family of enzymes is critical for maintaining genomic stability by regulating a variety of deoxyribonucleic acid (DNA) damage repair mechanisms. - Talazoparib (BMN 673) is a PARP inhibitor with greater in vitro activity than any other PARP inhibitor currently in development. BMN 673 has been shown to cause single-agent synthetic lethality in breast cancer 1 and breast cancer 2 (BRCA1/2)- and phosphatase and tensin homolog (PTEN)-deficient cell lines and has potent antitumor activity in animal models of tumors harboring mutations in DNA repair pathways. - BMN 673 is showing promising single-agent activity in patients with advanced ovarian and breast cancer harboring deleterious BRCA mutations. - This pilot study will evaluate the pharmacodynamic effects of BMN 673 on DNA damage and apoptosis markers in tumor biopsy tissue. Primary Objective: -Determine the pharmacodynamic effect of BMN 673 in tumor biopsies from patients with advanced ovarian, breast, or other solid tumor and deleterious BRCA mutations. Secondary Objectives: - Determine the response rate (Complete Response (CR) + Partial Response (PR) of treatment with BMN 673 in patients with advanced ovarian or primary peritoneal carcinoma and deleterious BRCA mutations. - Determine the response rate (CR + PR) of treatment with BMN 673 in patients with advanced breast carcinoma and deleterious BRCA mutations. - Determine the response rate (CR + PR) of treatment with BMN 673 in patients with advanced solid tumor (other than breast or ovarian) and deleterious BRCA mutations. Eligibility: - Adult patients with documented deleterious BRCA 1 or 2 mutations with histologically confirmed ovarian, primary peritoneal, breast, prostate, pancreas, gastric or other solid tumor whose disease has progressed following at least one standard therapy or who have no acceptable standard treatment options. - No major surgery, radiation, or chemotherapy within 4 weeks prior to study enrollment, and recovered from toxicities of prior therapies to at least eligibility levels. - Age greater than or equal to 18 years of age; Eastern Cooperative Oncology Group (ECOG) performance status less than equal to 2 - Adequate organ function. - Willingness to undergo tumor biopsies. Study Design: - BMN 673 will be administered orally each day in 28-day cycles. - Dosing will be at the established recommended Phase II dose of 1000 mcg/day each day for 28 days. - We plan to accrue a total of 12 evaluable patients per cohort for a total of 36 patients. To allow for some patients who will not be evaluable, the accrual ceiling is 42 patients. - Tumor biopsies will be mandatory at baseline (pre-dose), and then approximately 3-6 hours post BMN 673 on day 8. An optional tumor biopsy may also be collected at time of disease progression. SCHEMA - BMN 673 is administered orally each day in 28-day cycles - Tumor biopsies will be performed at baseline (pre-treatment) and 3-6 hrs post dose on cycle 1 day 8. An optional tumor biopsy may also be collected at time of disease progression. Tumor biopsies will be evaluated for protease activated receptor (PAR) levels, DNA damage response markers such as >=H2A.X Variant Histone (H2AX), cleaved caspase 3, excision repair cross-complementing group 1 (ERCC1), pNbs1, XPF, RAD51, and pT1989ATR, and, as indicators of ataxia telangiectasia and Rad3-related protein (ATR)/ataxia telangiectasia mutated (ATM) activation, Checkpoint kinase 1 (chk1) and Checkpoint kinase 2 (chk2) - Blood samples for circulating tumor cells (CTC) analyses will be collected at baseline (pre-treatment), on cycle 1 day 1(3-6 hours post dose), on cycle 1 day 8 (3-6 hours post dose), and on cycle 2 day 1 (3-6 hours post dose) - Blood samples for pharmacokinetic (PK) analysis will be collected on cycle 1 day 1 pre-dose and 0.5, 1, 2, 3, 4, 6,8, and 24 hours post-dose, on cycle 1 day 8 (3-6 hours post dose), and on cycle 2 day 1 pre-dose and 3-6 hours post dose.

Related Conditions:
  • Malignant Solid Tumor
Recruiting Status:

Completed

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Pilot Trial of BMN 673, an Oral PARP Inhibitor, in Patients With Advanced Solid Tumors and Deleterious BRCA Mutations
  • Official Title: Pilot Trial of BMN 673, an Oral PARP Inhibitor, in Patients With Advanced Solid Tumors and Deleterious BRCA Mutations

Clinical Trial IDs

  • ORG STUDY ID: 140015
  • SECONDARY ID: 14-C-0015
  • NCT ID: NCT01989546

Conditions

  • Advanced Ovarian Cancer
  • Primary Peritoneal Cancer
  • Advanced Breast Cancer
  • Advanced Solid Tumors

Interventions

DrugSynonymsArms
BMN 673Talazoparib1/Talazoparib (BMN 673)

Purpose

Background: - The poly (ADP-ribose) polymerase (PARP) family of enzymes is critical for maintaining genomic stability by regulating a variety of deoxyribonucleic acid (DNA) damage repair mechanisms. - Talazoparib (BMN 673) is a PARP inhibitor with greater in vitro activity than any other PARP inhibitor currently in development. BMN 673 has been shown to cause single-agent synthetic lethality in breast cancer 1 and breast cancer 2 (BRCA1/2)- and phosphatase and tensin homolog (PTEN)-deficient cell lines and has potent antitumor activity in animal models of tumors harboring mutations in DNA repair pathways. - BMN 673 is showing promising single-agent activity in patients with advanced ovarian and breast cancer harboring deleterious BRCA mutations. - This pilot study will evaluate the pharmacodynamic effects of BMN 673 on DNA damage and apoptosis markers in tumor biopsy tissue. Primary Objective: -Determine the pharmacodynamic effect of BMN 673 in tumor biopsies from patients with advanced ovarian, breast, or other solid tumor and deleterious BRCA mutations. Secondary Objectives: - Determine the response rate (Complete Response (CR) + Partial Response (PR) of treatment with BMN 673 in patients with advanced ovarian or primary peritoneal carcinoma and deleterious BRCA mutations. - Determine the response rate (CR + PR) of treatment with BMN 673 in patients with advanced breast carcinoma and deleterious BRCA mutations. - Determine the response rate (CR + PR) of treatment with BMN 673 in patients with advanced solid tumor (other than breast or ovarian) and deleterious BRCA mutations. Eligibility: - Adult patients with documented deleterious BRCA 1 or 2 mutations with histologically confirmed ovarian, primary peritoneal, breast, prostate, pancreas, gastric or other solid tumor whose disease has progressed following at least one standard therapy or who have no acceptable standard treatment options. - No major surgery, radiation, or chemotherapy within 4 weeks prior to study enrollment, and recovered from toxicities of prior therapies to at least eligibility levels. - Age greater than or equal to 18 years of age; Eastern Cooperative Oncology Group (ECOG) performance status less than equal to 2 - Adequate organ function. - Willingness to undergo tumor biopsies. Study Design: - BMN 673 will be administered orally each day in 28-day cycles. - Dosing will be at the established recommended Phase II dose of 1000 mcg/day each day for 28 days. - We plan to accrue a total of 12 evaluable patients per cohort for a total of 36 patients. To allow for some patients who will not be evaluable, the accrual ceiling is 42 patients. - Tumor biopsies will be mandatory at baseline (pre-dose), and then approximately 3-6 hours post BMN 673 on day 8. An optional tumor biopsy may also be collected at time of disease progression. SCHEMA - BMN 673 is administered orally each day in 28-day cycles - Tumor biopsies will be performed at baseline (pre-treatment) and 3-6 hrs post dose on cycle 1 day 8. An optional tumor biopsy may also be collected at time of disease progression. Tumor biopsies will be evaluated for protease activated receptor (PAR) levels, DNA damage response markers such as >=H2A.X Variant Histone (H2AX), cleaved caspase 3, excision repair cross-complementing group 1 (ERCC1), pNbs1, XPF, RAD51, and pT1989ATR, and, as indicators of ataxia telangiectasia and Rad3-related protein (ATR)/ataxia telangiectasia mutated (ATM) activation, Checkpoint kinase 1 (chk1) and Checkpoint kinase 2 (chk2) - Blood samples for circulating tumor cells (CTC) analyses will be collected at baseline (pre-treatment), on cycle 1 day 1(3-6 hours post dose), on cycle 1 day 8 (3-6 hours post dose), and on cycle 2 day 1 (3-6 hours post dose) - Blood samples for pharmacokinetic (PK) analysis will be collected on cycle 1 day 1 pre-dose and 0.5, 1, 2, 3, 4, 6,8, and 24 hours post-dose, on cycle 1 day 8 (3-6 hours post dose), and on cycle 2 day 1 pre-dose and 3-6 hours post dose.

Detailed Description

      Background:

        -  The poly (ADP-ribose) polymerase (PARP) family of enzymes is critical for maintaining
           genomic stability by regulating a variety of deoxyribonucleic acid (DNA) damage repair
           mechanisms.

        -  Talazoparib (BMN 673) is a PARP inhibitor with greater in vitro activity than any other
           PARP inhibitor currently in development. Talazoparib (BMN 673) has been shown to cause
           single-agent synthetic lethality in breast cancer 1 and breast cancer 2 (BRCA1/2)- and
           phosphatase and tensin homolog (PTEN)-deficient cell lines, and has potent antitumor
           activity in animal models of tumors harboring mutations in DNA repair pathways.

        -  Talazoparib (BMN 673) is showing promising single-agent activity in patients with
           advanced ovarian and breast cancer harboring deleterious BRCA mutations.

        -  This pilot study will evaluate the pharmacodynamic effects of talazoparib (BMN 673) on
           DNA damage and apoptosis markers in tumor biopsy tissue.

      Primary Objective:

      -Determine the pharmacodynamic effect of talazoparib (BMN 673) in tumor biopsies from
      patients with advanced ovarian, breast, or other solid tumor and deleterious BRCA mutations.

      Secondary Objectives:

      -Determine the response rate (Complete Response (CR) + Partial Response (PR) of treatment
      with talazoparib (BMN 673) in patients with deleterious BRCA mutations.

      Eligibility:

        -  Adult patients with documented deleterious BRCA 1 or 2 mutations with histologically
           confirmed ovarian, primary peritoneal, breast, prostate, pancreas, gastric or other
           solid tumor whose disease has progressed following at least one standard therapy or who
           have no acceptable standard treatment options.

        -  No major surgery, radiation, or chemotherapy within 4 weeks prior to study enrollment,
           and recovered from toxicities of prior therapies to at least eligibility levels.

        -  Age greater than or equal to 18 years of age; Eastern Cooperative Oncology Group (ECOG)
           performance status less than equal to 2

        -  Adequate organ function.

        -  Willingness to undergo tumor biopsies.

      Study Design:

        -  Talazoparib (BMN 673) will be administered orally each day in 28-day cycles.

        -  Dosing will be at the established recommended Phase II dose of 1000 microgram/day each
           day for 28 days.

        -  To meet the primary, pharmacodynamic endpoint of the trial, we plan to accrue a total of
           12 patients with matched, evaluable baseline and day 8 biopsies. To allow for some
           patients whose biopsies will not be evaluable (i.e., will contain <5% tumor content),
           the accrual ceiling is 24 patients. The number of patients evaluable for objective
           response, while relevant to the secondary objective of the trial, will not be considered
           in determining completion of accrual.

        -  Tumor biopsies will be mandatory at baseline (pre-dose), and then approximately 3-6
           hours post talazoparib (BMN 673) on day 8. One optional tumor biopsy may also be
           collected either on day 1 (+/- 2 days) of the cycle following any restaging at which a
           10-19% increase in tumor volume is observed (according to Response Evaluation Criteria
           in Solid Tumors (RECIST) criteria) if the patient has been on study for at least 4
           cycles, or at time of disease progression.
    

Trial Arms

NameTypeDescriptionInterventions
1/Talazoparib (BMN 673)ExperimentalSingle agent
  • BMN 673

Eligibility Criteria

        -  INCLUSION CRITERIA:

        Adult patients with documented deleterious breast cancer 1 and breast cancer 2 (BRCA 1 or
        2) mutations with histologically confirmed ovarian, primary peritoneal, breast, prostate,
        pancreas, gastric or other solid tumor whose disease has progressed following at least one
        standard therapy or who have no acceptable standard treatment options.

        Patients with ovarian cancer should have one prior platinum-based

        chemotherapeutic regimen for management of primary disease containing carboplatin,
        cisplatin, or another organoplatinum compound. This initial treatment may have included
        intraperitoneal therapy, consolidation, biologic/targeted (noncytotoxic) agents or extended
        therapy administered after surgical or non-surgical

        assessment. Ovarian cancer patients with both platinum-sensitive and platinum resistant
        disease are eligible. Patients with platinum-refractory disease are NOT eligible.

        Patients with metastatic disease must have received at least one line of standard of care
        (SOC) treatment for metastatic disease prior to enrollment

          -  Age greater than or equal to 18 years of age.

          -  Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 2

          -  Life expectancy of greater than 3 months.

          -  Patients must have normal organ and marrow function as defined below:

               -  leukocytes greater than or equal to 3,000/mcL

               -  absolute neutrophil count greater than or equal to 1,500/mcL

               -  platelets greater than or equal to 100,000/mcL

               -  total bilirubin less than or equal to 1.5 times institutional upper limit of
                  normal

               -  Aspartate aminotransferase (AST) Serum glutamic-oxaloacetic transaminase
                  (SGOT)/alanine aminotransferase (ALT) Serum glutamic pyruvic transaminase (SGPT)
                  less than or equal to 3 times institutional upper limit of normal

               -  creatinine less than or equal to 1.5 times institutional upper limit of normal

        OR

        --creatinine clearance greater than or equal to 60 mL/min for patients with creatinine
        levels above institutional normal.

        The effects of BMN 673 on the developing human fetus are unknown. For this reason and
        because PARP inhibitors are known to be teratogenic, women of childbearing potential and
        men must agree to use adequate contraception (hormonal or barrier method of birth control;
        abstinence) prior to study entry, for the duration of study participation, and for 30 days
        after completing study treatment. Should a woman become pregnant or suspect she is pregnant
        while she or her partner is participating in this study, she should inform her treating
        physician immediately. Men treated or enrolled on this protocol must also agree to use
        adequate contraception prior to the study, for the duration of study participation, and for
        3 months after completion of BMN 673 administration.

          -  Patients must be able to swallow whole tablets or capsules. Nasogastric or G-tube
             administration is not allowed. Any gastrointestinal disease which would impair ability
             to swallow, retain, or absorb drug is not allowed.

          -  Ability to understand and the willingness to sign a written informed consent document.

          -  Patients with human epidermal growth factor receptor 2 (HER2)-positive advanced breast
             cancer or ovarian cancer should have received at least two lines of systemic therapy
             in the advanced setting.

          -  Patients with prostate cancer can continue to receive treatment with
             Gonadotropin-releasing hormone (GnRH) agonists while on study, as long as there is
             evidence of disease progression on therapy.

        EXCLUSION CRITERIA:

          -  Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
             nitrosoureas or mitomycin C) prior to entering the study or those who have not
             recovered from adverse events due to agents administered more than 4 weeks earlier.
             Patients who have had prior treatment with any PARP inhibitors are ineligible.

          -  Patients who are receiving any other investigational agents.

          -  Patients with known active brain metastases or carcinomatous meningitis are excluded
             from this clinical trial. Patients whose brain metastatic disease status has remained
             stable for greater than or equal to 4 weeks following treatment of brain metastases
             are eligible to participate at the discretion of the principal investigator.

          -  Eligibility of subjects receiving any medications or substances with the potential to
             affect the activity or pharmacokinetics of BMN 673 will be determined following review
             by the principal investigator.

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
             arrhythmia, or psychiatric illness/social situations that would limit compliance with
             study requirements.

          -  Pregnant women are excluded from this study because the effects of the study drugs on
             the developing fetus are unknown.

          -  human immunodeficiency virus (HIV)-positive patients on combination antiretroviral
             therapy are ineligible because of the potential for pharmacokinetic interactions with
             BMN 673. In addition, these patients are at increased risk of lethal infections when
             treated with marrow suppressive therapy. Appropriate studies will be undertaken in
             patients receiving combination antiretroviral therapy when indicated.

          -  Patients who require use of coumarin-derivative anticoagulants such as warfarin are
             excluded. Low molecular weight heparin is permitted for prophylactic or therapeutic
             use. Low-dose warfarin (less than or equal to 1 mg/day) is permitted.

          -  Women who are currently lactating
      
Maximum Eligible Age:120 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Percent of Participants Who Achieve a Sustained Progressive Disease (PD) Response, Defined to be at Least 4% Nuclear Area Positive (NAP) γH2AX at the Day 8 Biopsy
Time Frame:Cycle 1, day 8
Safety Issue:
Description:Evaluation of drug effect on deoxyribonuclecic acid (DNA) damage response will be performed using immunofluorescence assays to measure the DNA damage repair marker γH2A (the phosphorylated form of histone family member X, H2AX) in the nucleus of tumor cells obtained via core biopsy.

Secondary Outcome Measures

Measure:Response Rate (Complete Response (CR) + Partial Response (PR) of Treatment With Talazoparib (BMN 673) in Participants With Deleterious Breast Cancer (BRCA) Mutations
Time Frame:Restaging scans will be carried out every 2 cycles (8 weeks) until the end of treatment (average, 7 months)
Safety Issue:
Description:Response will be evaluated by the Response Evaluation Criteria in Solid Tumors (RECIST)1. 1 guidelines; restaging scans will be carried out every 2 cycles. Complete Response (CR) is disappearance of all target lesions. Any pathological lymph nodes (whether target or nontarget) must have reduction in short axis to <10 mm. Partial Response (PR) is at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. And progression is at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). The appearance of one or more new lesions is also considered progressions.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • DNA Damage
  • Advanced Solid Tumors
  • BRCA Mutations
  • PARP Inhibitor
  • Pharmacodynamics

Last Updated

February 23, 2021