Description:
This is a proof-of-concept study to define efficacy of gemcitabine, carboplatin and VELIPARIB
(ABT-888) in patients with refractory germ cell tumors (GCTs). PARP proteins are involved in
base excision repair (BER), one of the major DNA repair system in cells and PARP is
overexpressed in testicular GCTs (TGCTs) compared to normal testis and data suggest that PARP
overexpression is early event in TGCTs development. Patients with low PARP expression in
primary tumour had non-significantly better OS compared to patients with high PARP expression
(5-year OS 89.2% vs 78.7%; HR=0.50, 95% CI 0.21 to 1.17, p=0.12). The aim of this study is to
evaluate PARP inhibitor VELIPARIB in combination with gemcitabine, carboplatin in patients
with refractory germ cell tumors (GCTs).
Title
- Brief Title: Study of Gemcitabine, Carboplatin and VELIPARIB (ABT-888) in Refractory Testicular Germ Cell Cancer
- Official Title: Phase II Study of Gemcitabine, Carboplatin and VELIPARIB (ABT-888) in Refractory Testicular Germ Cell Cancer
Clinical Trial IDs
- ORG STUDY ID:
GCTSK004
- NCT ID:
NCT02860819
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Veliparib | ABT-888 | Gemcitabine, Carboplatin, Veliparib |
Gemcitabine | | Gemcitabine, Carboplatin, Veliparib |
Carboplatin | | Gemcitabine, Carboplatin, Veliparib |
Purpose
This is a proof-of-concept study to define efficacy of gemcitabine, carboplatin and VELIPARIB
(ABT-888) in patients with refractory germ cell tumors (GCTs). PARP proteins are involved in
base excision repair (BER), one of the major DNA repair system in cells and PARP is
overexpressed in testicular GCTs (TGCTs) compared to normal testis and data suggest that PARP
overexpression is early event in TGCTs development. Patients with low PARP expression in
primary tumour had non-significantly better OS compared to patients with high PARP expression
(5-year OS 89.2% vs 78.7%; HR=0.50, 95% CI 0.21 to 1.17, p=0.12). The aim of this study is to
evaluate PARP inhibitor VELIPARIB in combination with gemcitabine, carboplatin in patients
with refractory germ cell tumors (GCTs).
Detailed Description
PARP proteins are involved in base excision repair (BER), one of the major DNA repair system
in cells. Recently, it was showed that PARP inhibitors have striking efficacy in patients
with BRCA1 deficient or triple negative breast cancer in monotherapy or in combination with
cisplatin based chemotherapy, without increased systemic toxicity. Pertubations affecting
homologous recombination (HR) involved in DNA repair are associated with higher probability
of response to PARP inhibitors. Inactivation of PTEN, tumor suppressor protein, is associated
with defects in HR and response to PARP inhibitors.
Recently, PARP expression was evaluated in TGCTs. It was showed that PARP is overexpressed in
testicular germ cell tumours compared to normal testis and PARP overexpression is early event
in TGCTs development. Patients with low PARP expression in primary tumour had
non-significantly better OS compared to patients with high PARP expression (5-year OS 89.2%
vs 78.7%; HR=0.50, 95% CI 0.21 to 1.17, p=0.12).Loss of the tumor suppressor gene PTEN marks
the transition from intratubular germ cell neoplasias (ITGCN) to invasive germ cell tumors.
In the testis, PTEN was abundantly expressed in germ cells whereas it was virtually absent
from 56% of seminomas as well as from 86% of embryonal carcinomas and virtually all
teratomas. On the contrary, ITGCN intensely expressed PTEN, indicating that loss of PTEN
expression is not in early event in testicular tumor development, but is associated with
progression of disease. Previously, it was showed, that testicular germ cell tumors cell
lines have low activity of proteins involved in nuclear excision repair (NER) and it is
assumed that low NER activity is related to the favorable response of testis tumors to
cisplatin-based chemotherapy.
Gemcitabine and carboplatin showed activity in refractory TGCTs. Recently, maximal tolerated
dose of Veliparib (ABT-888) with gemcitabine and carboplatin was established.
Based on aforementioned data, there is strong rationale to inhibit PARP in TGCT. Inactivation
of PARP by Veliparib along with defects of homologous recombination due to PTEN inactivation
in GCTs and low activity of nucleotide excision repair system will dramatically increase
antitumor effect gemcitabine and carboplatin in patients with progressing or relapsing germ
cell cancer.
Trial Arms
Name | Type | Description | Interventions |
---|
Gemcitabine, Carboplatin, Veliparib | Experimental | Gemcitabine 800mg/m2 day 1 and 8 every 3 weeks; Carboplatin AUC = 4, day 1, every 3 weeks, Veliparib 250mg bid day continuously. | - Veliparib
- Gemcitabine
- Carboplatin
|
Eligibility Criteria
Inclusion Criteria:
1. Signed written informed consent
2. Men aged 18 years or older
3. ECOG performance status: 0-1,
4. Histologically confirmed extracranial primary germ cell cancer, seminoma, or
nonseminoma
5. Rising serum markers (i.e., alpha-fetoprotein and human chorionic gonadotropin) on
sequential measurement or biopsy-proven unresectable germ cell cancer
6. Refractory GCTs e.g. patients relapsing after high-dose chemotherapy or for patients
non fit enough for high-dose chemotherapy
7. Primary mediastinal GCTs in first relapse
8. Patient's disease must not be amenable to cure with either surgery or chemotherapy in
the opinion of investigator,
9. Measurable disease radiologically
10. Adequate hematologic function defined by ANC > 1500/mm3, platelet count > 100 000/mm3
and hemoglobin level > 9g/dl.
11. Adequate liver function defined by a total bilirubin level < 1.5 ULN, and ALT, AST < 3
ULN or < 5 in case of liver metastases. For subjects with Gilbert's syndrome bilirubin
> 1.5 × ULN is allowed if no symptoms of compromised liver function are present
12. Adequate renal function: measured or calculated (by Cockcroft formula) creatinine
clearance > 50 ml/min. Cockcroft formula: CLcr = [(140-age) x weight(Kg)]/[72 x
creatinine (mg/dl)]
13. At least 4 weeks must have elapsed since the last radiotherapy and/or chemotherapy
before study entry,
14. At least 4 weeks must have elapsed since the last major surgery
15. Complete recovery from prior surgery, and/or reduction of all adverse events from
previous systemic therapy or radiotherapy to grade 1,
16. Absence of any psychological, familial, sociological or geographical condition
potentially hampering compliance with the study protocol and follow-up schedule
Exclusion Criteria:
1. Patients who do not fit inclusion criteria
2. Other prior malignancy except successfully treated nonmelanoma skin cancer
3. Prior PARP1 inhibitor
4. Other concurrent approved or investigational anticancer treatment, including surgery,
radiotherapy, chemotherapy, biologic-response modifiers, hormone therapy, or
immunotherapy
5. Female patients
6. Patients infected by the Human Immunodeficiency Virus (HIV)
7. Patients with other severe acute or chronic medical condition, or laboratory
abnormality that would impair, in the judgment of investigator, excess risk associated
with study treatment, or which, in judgment of the investigator, would make the
patient inappropriate for entry into this study
8. Inability of oral intake, or drug absorption (e.g. malabsorption syndrome)
9. Hypersensitivity to any compound of the drug
10. Sexually active men not using highly effective birth control if their partners are
women of child-bearing potential
11. Patients with history of or current CNS metastasis
12. Patients with history of seizures
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Male |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Percentage of patients that will be free of disease progression according to RECIST criteria 12-months after the first administration of the treatment. |
Time Frame: | 12-months |
Safety Issue: | |
Description: | Percentage of patients that will be free of disease progression according to RECIST criteria 12-months after the first administration of the treatment. |
Secondary Outcome Measures
Measure: | Response rate |
Time Frame: | 6-weeks |
Safety Issue: | |
Description: | Response rate as measured by RECIST 1.1 |
Measure: | Median overall survival |
Time Frame: | 12 months |
Safety Issue: | |
Description: | Median overall survival. Overall survival will be measured from the date of first administration of the treatment until death or date of last follow-up. |
Measure: | Median progression-free survival |
Time Frame: | 12-months |
Safety Issue: | |
Description: | Median progression-free survival. Progression-free survival will be measured from the date of first administration of the treatment until progression, death or date of last follow-up. |
Measure: | Frequency of grade III and IV adverse events |
Time Frame: | 3-weeks |
Safety Issue: | |
Description: | Number of participants with treatment-related adverse events as assessed by CTCAE v4.0 |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | National Cancer Institute, Slovakia |
Trial Keywords
- Multiple relapsed/refractory testicular germ cell tumors
- PARP inhibition
- Chemotherapy
- Gemcitabine
- Carboplatin
Last Updated
March 3, 2021