Clinical Trials /

Trial of Olaparib in Combination With AZD5363 (ComPAKT)

NCT02338622

Description:

This is a phase I trial of the combination of the PARP inhibitor olaparib and AKT inhibitor AZD5363. There are two parts to this study. Part A: dose escalation, and Part B: dose expansion. Part A will investigate the combination of 300 mg bd of olaparib with intrapatient ascending doses of AZD5363 administered for either 4-days-on, 3-days-off, and 2-days-on, 5-days-off. Once the Maximum Tolerated Dose (MTD) is reached for both arms (or under the advice from the Safety Review Committee (SRC) one of the schedules will be discontinued), the schedule with the optimum safety and PK/PD profile will be taken forward to a dose expansion phase (Part B). Part B will evaluate the optimized dose/schedule identified in Part A of the study in patients with (1) BRCA1/2 mutant cancers (with previous disease progression on PARP inhibitor monotherapy), or (2) advanced sporadic tumours (e.g. TNBC, CRPC, HGSOC and tumours with somatic mutations or other aberrations known to result in a hyperactivated PI3K-AKT pathway).

Related Conditions:
  • Malignant Solid Tumor
Recruiting Status:

Completed

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Trial of Olaparib in Combination With AZD5363 (ComPAKT)
  • Official Title: A Phase I Multi-centre Trial of the Combination of Olaparib (PARP Inhibitor) and AZD5363 (AKT Inhibitor) in Patients With Advanced Solid Tumours

Clinical Trial IDs

  • ORG STUDY ID: CCR4058
  • SECONDARY ID: 2013-004692-13
  • NCT ID: NCT02338622

Conditions

  • Advanced Cancer

Interventions

DrugSynonymsArms
olaparibAZD2281Schedule A: 4 days on, 3 days off
AZD5363Schedule A: 4 days on, 3 days off

Purpose

This is a phase I trial of the combination of the PARP inhibitor olaparib and AKT inhibitor AZD5363. There are two parts to this study. Part A: dose escalation, and Part B: dose expansion. Part A will investigate the combination of 300 mg bd of olaparib with intrapatient ascending doses of AZD5363 administered for either 4-days-on, 3-days-off, and 2-days-on, 5-days-off. Once the Maximum Tolerated Dose (MTD) is reached for both arms (or under the advice from the Safety Review Committee (SRC) one of the schedules will be discontinued), the schedule with the optimum safety and PK/PD profile will be taken forward to a dose expansion phase (Part B). Part B will evaluate the optimized dose/schedule identified in Part A of the study in patients with (1) BRCA1/2 mutant cancers (with previous disease progression on PARP inhibitor monotherapy), or (2) advanced sporadic tumours (e.g. TNBC, CRPC, HGSOC and tumours with somatic mutations or other aberrations known to result in a hyperactivated PI3K-AKT pathway).

Detailed Description

      Part A: The starting doses for both intermittent schedules will be 300 mg bd of olaparib and
      either AZD5363 given at 320 mg bd 4-days-on, 3-days-off, or 480 mg bd 2-days-on, 5-days-off.
      These starting doses are based on available data from the first-in-human studies
      [D0810C00002] (AstraZeneca) and [D3610C00001] (AstraZeneca) of both drugs, respectively.

      A general schema for 3 potential dose levels to be pursued on the 4-days-on, 3-days-off
      AZD5363 schedule (Schedule A) and 2-days-on, 5-days-off AZD5363 schedule (Schedule B) in Part
      A of the study are listed below. The starting dose of olaparib will be fixed at 300mg bd in
      both schedules. These schema only provide general guidance; it will be possible for doses of
      one or both drugs to be escalated or de-escalated in a "seesaw" fashion contingent on the
      toxicity and/or PK/PD data reported. This may create dose cohort combinations not listed
      below. Both PK and PD data will be taken into consideration if available. With the exception
      of dose level 1, actual dose escalation/de-escalation will be determined following a
      discussion with the SRC during dose escalation teleconferences. Dose escalation will continue
      until MTD(s) are reached. Patients will be dosed on a flat scale and not by body weight or
      body surface area. Both schedules will be carried out in parallel.

      Table 1: Schema for dose escalation in schedule A (4-days-on, 3-days-off AZD5363) Dose level
      (DL) olaparib bd AZD5363 bd 4d-on, 3d-off

        -  1 200mg* 240mg

             1. 300mg 320mg

             2. 300mg 400mg

             3. 300mg 480mg

                *An intermediate dose of 250mg bd of olaparib may be considered depending on
                drug-related toxicities observed and patient tolerability

                Table 2: Schema for dose escalation in schedule B (2-days-on, 5-days-off AZD5363)
                Dose level (DL) olaparib bd AZD5363 bd 2d-on, 5d-off

        -  1 200mg* 400mg

             1. 300mg 480mg

             2. 300mg 560mg

             3. 300mg 640mg

                  -  An intermediate dose of 250mg bd of olaparib may be considered depending on
                     drug-related toxicities observed and patient tolerability

      After careful review of the clinical toxicity data, if the DLT is deemed to be caused by one
      of the agents, the responsible drug may be dose decreased and if well tolerated, the other
      agent maybe be increased in subsequent cohorts. If necessary, both drugs can also be dose
      de-escalated.

      In Part A of the study, olaparib will be administered continuously with intermittent AZD5363
      in 21-day cycles. Intrapatient dose escalation of AZD5363 will be utilised to evaluate
      different dose levels. The optimal dose schedule selected based on toxicity, PK-PD and/or
      efficacy data will be taken forward into two expansion cohorts in Part B of the study. Cohort
      1 will comprise patients with germline BRCA1/2 mutated tumours, while Cohort 2 will comprise
      advanced sporadic cancers that may harbour HR defects (e.g. TNBC, CRPC and HGSOC) or those
      with somatic mutations or other aberrations known to result in a hyperactivated
      phosphatidylinositol-3-kinase (PI3K)-AKT pathway.
    

Trial Arms

NameTypeDescriptionInterventions
Schedule A: 4 days on, 3 days offExperimental300mg olaparib + intrapatient dose escalation of AZD5363 4 days on, 3 days off Schema for dose escalation in schedule A (4-days-on, 3-days-off AZD5363) -1. Olaparib: 200mg, AZD5363 240mg Olaparib: 300mg, AZD5363 320mg Olaparib: 300mg, AZD5363 400mg Olaparib: 300mg, AZD5363 480mg
  • olaparib
  • AZD5363
Schedule B: 2 days on, 5 days offExperimental300mg olaparib + intrapatient dose escalation of AZD5363 2 days on, 5 days off Schema for dose escalation in schedule B (2-days-on, 5-days-off AZD5363) -1. Olaparib: 200mg, AZD5363 400mg Olaparib: 300mg, AZD5363 480mg Olaparib: 300mg, AZD5363 560mg Olaparib: 300mg, AZD5363 640mg
  • olaparib
  • AZD5363

Eligibility Criteria

        Inclusion Criteria:

          1. Part A: Patients with histologically or cytologically confirmed malignant advanced
             solid tumours refractory to standard therapy or for which no suitable effective
             standard therapy exists, including, but not limited to patients with: BRCA1/2 mutant
             cancers, TNBC, CRPC and HGSOC, and those with somatic mutations or other aberrations
             known to result in a hyperactivated PI3K-AKT pathway.

             Part B: (1) BRCA1/2 mutation cohort: Patients with advanced germline BRCA1/2 mutant
             solid tumours; (2) Sporadic cancers cohort: This cohort will include advanced sporadic
             cancers that are not known to harbour germline BRCA1/2 mutations, but which may
             harbour homologous recombination (HR) defects, e.g. advanced TNBC, CRPC and HGSOC, and
             those with somatic mutations or other aberrations known to result in a hyperactivated
             PI3K-AKT pathway.

          2. Life expectancy of at least 12 weeks

          3. WHO performance status of 0-1 with no significant deterioration over the previous 2
             weeks

          4. Evaluable or measurable disease as assessed by RECIST 1.1

          5. Haematological and biochemical indices within the ranges shown below. These
             measurements must be performed within one week.

               -  Hb ≥ 10.0 g/dL

               -  Absolute neutrophil count ≥ 1.5 x 109/L

               -  Platelet count ≥ 100 x 109/L

               -  Serum bilirubin ≤ 1.5 x upper limit of normal except for patient with documented
                  Gilburt's disease

               -  ALT or AST ≤ 2.5 x (ULN) unless raised due to tumour in which case up to 5 times
                  ULN is permissible

        If creatinine > 1.5 times ULN then: Either:

          -  Creatinine Clearance ≥ 50 mL/min (uncorrected value)

          -  Isotope clearance measurement ≥ 50 mL/min (corrected) 6.18 years or over 7. Signed and
             dated informed consent and be capable of co-operating with treatment and follow-up

        Exclusion Criteria:

          1. Radiotherapy (except for palliative reasons), endocrine therapy, immunotherapy or
             chemotherapy during the previous four weeks (six weeks for nitrosoureas, Mitomycin-C)
             and 4 weeks for investigational medicinal products before treatment, except for
             hormonal therapy with luteinizing hormone-releasing hormone analogues for medical
             castration in patients with CRPC, which are permitted.

          2. Ongoing toxic manifestations of previous treatments. Exceptions to this are Grade 1
             toxicities, which in the opinion of the Investigator should not exclude the patient.

          3. Ability to become pregnant (or already pregnant or lactating). However, those female
             patients who have a negative serum or urine pregnancy test before enrolment and agree
             to use two highly effective forms of contraception (oral, injected or implanted
             hormonal contraception and condom, have an intra-uterine device and condom, diaphragm
             with spermicidal gel and condom) for four weeks before entering the trial, during the
             trial and for six months afterwards are considered eligible.

          4. Male patients with partners of child-bearing potential (unless they agree to take
             measures not to father children by using one form of highly effective contraception
             [condom plus spermicide] during the trial and for six months afterwards). Men with
             pregnant or lactating partners should be advised to use barrier method contraception
             (for example, condom plus spermicidal gel) to prevent exposure to the foetus or
             neonate.

          5. Major surgery (excluding minor procedures, e.g. placement of vascular access) within 4
             weeks of the first dose of study treatment.

          6. At high medical risk because of severe or uncontrolled systemic disease including
             active bleeding diathesis or active infection including hepatitis B, hepatitis C and
             human immunodeficiency virus. Screening for chronic conditions is not required.

          7. Clinically significant abnormalities of glucose metabolism as defined by any of the
             following:

               -  Diagnosis of diabetes mellitus type I or II (irrespective of management).

               -  HbA1C ≥ 8.0% at screening (64 mmol/mol) (conversion equation for HbA1C
                  [IFCC-HbA1C (mmol/mol)] = [DCCT-HbA1C (%) - 2.15] x 10.929)

               -  Fasting Plasma Glucose ≥ 8.9mmol/L at screening. Fasting is defined as no caloric
                  intake for at least 8 hours.

          8. Proteinuria 3+ on dipstick analysis or >500mg/24 hours.

          9. Previous treatment with a PARP inhibitor or PI3K/AKT inhibitor (Part B: sporadic
             cancers arm of dose expansion cohort only).

         10. Treatment with 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).

         11. Spinal cord compression or brain metastases unless asymptomatic, treated and stable
             and not requiring steroids for at least 4 weeks prior to start of study treatment

         12. Any of the following cardiac criteria:

               -  Mean resting corrected QT interval (QTc) > 470 msec obtained from 3 consecutive
                  electrocardiograms

               -  Any clinically significant abnormalities in rhythm, conduction or morphology of
                  resting ECG

               -  Any factors that increase the risk of QTc prolongation or risk of arrhythmic
                  events, such as heart failure, hypokalaemia, 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 New York Heart Association
                  [NYHA0 Grade 2

               -  Uncontrolled hypotension - Systolic BP <90mmHg and/or diastolic BP <50mmHg

               -  LVEF below institutional lower limit of normal.

         13. Refractory nausea and vomiting, chronic gastrointestinal diseases, inability to
             swallow the formulated product or previous significant bowel resection that would
             preclude adequate absorption of olaparib and AZD5363.

         14. History of hypersensitivity to active or inactive excipients of AZD5363 or olaparib or
             drugs with a similar chemical structure or class to AZD5363 and olaparib.

         15. Is a participant or plans to participate in another interventional clinical trial,
             whilst taking part in this Phase I study. Participation in an observational trial
             would be acceptable.

         16. Any other condition which in the Investigator's opinion would not make the patient a
             good candidate for the clinical trial.

         17. Patients with myelodysplastic syndrome or acute myeloid leukaemia
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Safety/tolerability of olaparib in combination with AZD5363
Time Frame:3 to 9 weeks at least.
Safety Issue:
Description:Dose at which no more than one out of six patient at the same dose level experiences a probable drug-related dose limiting toxicity.

Secondary Outcome Measures

Measure:Plasma levels of olaparib and AZD5363 using validated assays.
Time Frame:Average of 2 years
Safety Issue:
Description:Plasma levels of olaparib and AZD5363 using validated assays.
Measure:pAkt/Akt, pGSK/GSK3, pS6 kinase/S6 kinase and pPRAS40/PRAS40 ratios in pre- and post-treatment tumour biopsies using validated assays.
Time Frame:Average of 2 years
Safety Issue:
Description:Changes in platelet rich plasma, hair follicles and pre- and post-treatment tumour biopsies using validated assays

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:Royal Marsden NHS Foundation Trust

Trial Keywords

  • olaparib
  • AZD5363
  • intrapatient dose escalation
  • advanced solid tumours

Last Updated

February 5, 2020