Clinical Trials /

Olaparib in Treating Patients With Metastatic or Advanced Urothelial Cancer With DNA-Repair Defects

NCT03375307

Description:

This phase II trial studies how well olaparib works in treating patients with urothelial cancer with deoxyribonucleic acid (DNA)-repair defects that has spread to other places in the body (advanced or metastatic) and usually cannot be cured or controlled with treatment. PARPs are proteins that help repair DNA mutations. PARP inhibitors, such as olaparib, can keep PARP from working, so tumor cells can't repair themselves, and they may stop growing.

Related Conditions:
  • Bladder Carcinoma
  • Urothelial Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Olaparib in Treating Patients With Metastatic or Advanced Urothelial Cancer With DNA-Repair Defects
  • Official Title: A Phase II Study of Olaparib (AZD2281) in Patients With Metastatic/Advanced Urothelial Carcinoma With DNA-Repair Defects

Clinical Trial IDs

  • ORG STUDY ID: NCI-2017-02296
  • SECONDARY ID: NCI-2017-02296
  • SECONDARY ID: P162941
  • SECONDARY ID: 19C0023
  • SECONDARY ID: 10144
  • SECONDARY ID: 10144
  • SECONDARY ID: ZIABC011078
  • NCT ID: NCT03375307

Conditions

  • Advanced Bladder Carcinoma
  • Advanced Urothelial Carcinoma
  • Metastatic Bladder Urothelial Carcinoma
  • Metastatic Urothelial Carcinoma
  • Stage III Bladder Cancer AJCC v8
  • Stage IIIA Bladder Cancer AJCC v8
  • Stage IIIB Bladder Cancer AJCC v8
  • Stage IV Bladder Cancer AJCC v8
  • Stage IVA Bladder Cancer AJCC v8
  • Stage IVB Bladder Cancer AJCC v8

Interventions

DrugSynonymsArms
OlaparibAZD 2281, AZD-2281, AZD2281, KU-0059436, Lynparza, PARP Inhibitor AZD2281Cohort I (olaparib)

Purpose

This phase II trial studies how well olaparib works in treating patients with urothelial cancer with deoxyribonucleic acid (DNA)-repair defects that has spread to other places in the body (advanced or metastatic) and usually cannot be cured or controlled with treatment. PARPs are proteins that help repair DNA mutations. PARP inhibitors, such as olaparib, can keep PARP from working, so tumor cells can't repair themselves, and they may stop growing.

Detailed Description

      PRIMARY OBJECTIVE:

      I. To evaluate the efficacy of olaparib in two cohorts of patients with metastatic/advanced
      urothelial carcinoma (UC) pre-selected by DNA-repair defects as measured by overall response
      rate (ORR).

      SECONDARY OBJECTIVES:

      I. To describe the effect of therapy on progression free survival (PFS). II. To describe the
      effect of therapy on overall survival (OS). III. To describe the safety/tolerability and
      drug-related toxicities of olaparib.

      IV. To follow patients without the pre-selected DNA-repair defects for survival.

      CORRELATIVE OBJECTIVES:

      I. To determine the proportion of patients with DNA-repair pathway-mutated genes in
      metastatic UC (patient cohort referred for screening).

      II. To correlate levels of baseline circulating tumor cells (CTCs) with survival in untreated
      patients.

      III. To explore tumor-mutational profiles in metastatic tumor biopsies, saliva "normal" DNA,
      changes in tumor or peripheral immune characteristics, or tumor associated somatic mutation
      load in blood DNA in response to treatment.

      IV. To explore changes in plasma cytokines and correlate with clinical response.

      V. To correlate levels of circulating endothelial cells with clinical outcome. VI. To
      correlate levels of circulating tumor cells (CTCs) with clinical outcome.

      VII. To correlate peripheral immune and DNA damage response transcriptional signatures with
      clinical outcomes.

      VIII. To determine the effectiveness of using next-generation sequencing (NGS) to identify
      DNA-repair pathway gene defects in tumor samples and circulating DNA and identify patients
      with UC suitable for PARP inhibition.

      IX. To determine the expression of Schlafen 11 (SLFN11) in tumor versus (vs.) stroma cells,
      and the potential tumor heterogeneity based on SLFN11 expression.

      OUTLINE: Patients are assigned to 1 of 2 cohorts.

      COHORT I: Patients that have cancer-associated DNA-repair gene mutations receive olaparib
      orally (PO) twice daily (BID) on days 1-28. Cycles repeat every 28 days in the absence of
      disease progression or unacceptable toxicity.

      COHORT II: Patients that do not have cancer-associated DNA-repair gene mutations undergo
      blood sample collection at baseline.

      After completion of study treatment, patients are followed up at 4 weeks, every 2 months for
      1 year, then every 3 months thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Cohort I (olaparib)ExperimentalPatients that have cancer-associated DNA-repair gene mutations receive olaparib PO BID on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Olaparib
Cohort II (biospecimen collection)ExperimentalPatients that do not have cancer-associated DNA-repair gene mutations undergo blood sample collection at baseline.

    Eligibility Criteria

            Inclusion Criteria:
    
              -  Patients must have a histologically confirmed diagnosis of urothelial carcinoma of the
                 urothelial tract/bladder cancer
    
              -  Patients must have Clinical Laboratory Improvement Act (CLIA) testing and fit one of
                 the following groups:
    
                   -  Confirmed presence of a cancer-associated alteration considered pathogenic/likely
                      pathogenic by FM and/or the Genetics Review Panel in one or more of the following
                      genes: BRCA1, BRCA2, ATM, BAP1, MSH2, PALB2, and BRIP1 or in one or more of the
                      DNA-repair genes tested in the FoundationOne FoundationOneCDx (F1CDx) panel
                      including the following genes (Foundation One mutation analysis results and
                      Foundation Liquid results performed prior to enrollment on this study may be
                      accepted for eligibility review): ABL1, ATR, ATRX, BARD1, BRD4, CCND1, CHEK1,
                      CHEK2, DOT1L, FANCC, FANCE, FANCG, FANCL, IKBKE, MEN1, MLH1, MSH2, MSH6, MUTYH,
                      NPM1, PMS2, POLD1, POLE, RAD51, SMARCB1, STK11
    
                        -  Note: FoundationOneCDx (F1CDx) is a next generation sequencing based in
                           vitro diagnostic device for detection of substitutions, insertion and
                           deletion alterations (indels), and copy number alterations (CNAs) in 324
                           genes and select gene rearrangements, as well as genomic signatures
                           including microsatellite instability (MSI) and tumor mutational burden (TMB)
                           using DNA isolated from formalin-fixed paraffin embedded (FFPE) tumor tissue
                           specimens
    
                   -  Patients with benign or variants of unknown significance as determined by
                      FoundationOne FoundationOneCDx (F1CDx) panel and Genetics Review Panel review
                      will be included to be followed for survival
    
              -  Patients must have measurable disease, defined as at least one lesion that can be
                 accurately measured in at least one dimension (longest diameter to be recorded for
                 non-nodal lesions and short axis for nodal lesions) as >= 20 mm (>= 2 cm) by chest
                 x-ray or as >= 10 mm (>= 1 cm) with computed tomography (CT) scan, magnetic resonance
                 imaging (MRI), or calipers by clinical exam
    
              -  Evidence of disease progression as defined by Response Evaluation Criteria in Solid
                 Tumors (RECIST) (version 1.1) during treatment or after the most recent dose of
                 therapy with at least one platinum-based regimen of chemotherapy and/or an
                 immune-checkpoint inhibitor (atezolizumab, pembrolizumab, nivolumab, avelumab or
                 durvalumab) (2-week washout from chemotherapy and 4-weeks washout from monoclonal
                 antibodies is required)
    
              -  Age >= 18 years. Because no dosing or adverse event data are currently available on
                 the use of olaparib in patients < 18 years of age, children are excluded from this
                 study, but will be eligible for future pediatric trials
    
              -  Eastern Cooperative Oncology Group (ECOG) performance status =< 1 (or Karnofsky >=
                 70%)
    
              -  Leukocytes >= 3,000/mcL
    
              -  Absolute neutrophil count >= 1,500/mcL
    
              -  Platelets >= 100,000/mcL
    
              -  Total bilirubin =< 1.5 x upper limit of normal (ULN) (for subjects with documented
                 Gilbert's disease total bilirubin =< 3.0 mg/dL)
    
              -  Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase
                 [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
                 =< 2.5 x institutional upper limit of normal (for subjects with liver metastasis
                 AST/ALT =< 5 x ULN)
    
              -  Creatinine clearance >= 50 mL/min/1.73 m^2
    
              -  Hemoglobin >= 10 g/dL; transfusions are allowed
    
              -  Prothrombin time (PT)/international normalized ratio (INR) and activated partial
                 thromboplastin time (aPTT) within 1.25 x ULN institutional limits, except where a
                 lupus anti-coagulant has been confirmed or the patient is on direct oral anticoagulant
                 (DOA)
    
              -  Patients must be able to tolerate oral medications and not have gastrointestinal
                 illnesses that would preclude absorption of olaparib
    
              -  Pre-clinical data indicate that olaparib adversely affects embryofetal survival and
                 development. Therefore, women of child-bearing potential and their partners should
                 agree to use two (2) highly effective forms of contraception throughout study
                 participation and for at least one (1) month after the last dose of olaparib. Male
                 study participants should avoid fathering a child or donating sperm during the study
                 and for three (3) months after the last dose of olaparib.
    
                   -  Note: Olaparib is a PARP inhibitor with the potential for teratogenic or
                      abortifacient effects. Because there is a potential risk for adverse events in
                      nursing infants secondary to treatment of the mother with olaparib, breastfeeding
                      should be discontinued if the mother is treated with olaparib
    
              -  Ability to understand and the willingness to sign a written informed consent document
                 or patients with impaired decision making capacity (IDMC) if they are represented by a
                 legally authorized representative (LAR)
    
              -  Patients must provide tumor sample for mutation analysis or be willing to undergo
                 mandatory screening biopsy
    
              -  Postmenopausal or evidence of non-childbearing status for women of childbearing
                 potential: negative urine or serum pregnancy test within 28 days of study treatment
                 and confirmed prior to treatment on day 1. Postmenopausal is defined as:
    
                   -  Amenorrheic for 1 year or more following cessation of exogenous hormonal
                      treatments
    
                   -  Luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels in the
                      post menopausal range for women under 50
    
                   -  Radiation-induced oophorectomy with last menses > 1 year ago
    
                   -  Chemotherapy-induced menopause with > 1 year interval since last menses
    
                   -  Surgical sterilization (bilateral oophorectomy or hysterectomy)
    
              -  Patients is willing and able to comply with the protocol for the duration of the study
                 including undergoing treatment and scheduled visits and examinations
    
            Exclusion Criteria:
    
              -  Patients who have had prior treatment with olaparib or any other PARP inhibitor
                 (PARPi)
    
              -  Patients with myelodysplastic syndrome/acute myeloid leukemia; or baseline features
                 suggestive of myelodysplastic syndrome or acute myelogenous leukemia on peripheral
                 blood smear or bone marrow biopsy, if clinically indicated
    
              -  Persistent toxicities (>= Common Terminology Criteria for Adverse Events [CTCAE] grade
                 2) with the exception of alopecia, caused by previous cancer therapy
    
              -  Patients who are receiving any other investigational agents. Patients may be on other
                 clinical trials or treatment during screening to determine eligibility
    
              -  Patients with known brain metastases should be excluded from this clinical trial
                 because of their poor prognosis and because they often develop progressive neurologic
                 dysfunction that would confound the evaluation of neurologic and other adverse events.
                 A scan to confirm the absence of brain metastases is not required. Patients with
                 spinal cord compression unless considered to have received definitive treatment for
                 this and evidence of clinically stable disease for 28 days
    
              -  History of allergic reactions attributed to compounds of similar chemical or biologic
                 composition of olaparib
    
              -  Patients receiving any medications or substances that are inhibitors or inducers of
                 CYP3A are ineligible. A washout period prior to starting olaparib for patients on
                 CYP3A inhibitors is 2 weeks; and the required washout period for CYP3A inducers is 5
                 weeks for enzalutamide or phenobarbital and 3 weeks for other agents
    
                   -  Because the lists of these agents are constantly changing, it is important to
                      regularly consult a frequently-updated medical reference texts such as the
                      Physicians' Desk Reference. As part of the enrollment/informed consent
                      procedures, the patient will be counseled on the risk of interactions with other
                      agents, and what to do if new medications need to be prescribed or if the patient
                      is considering a new over-the-counter medicine or herbal product
    
              -  Pregnant women are excluded from this study because olaparib is a PARP inhibitor agent
                 with the potential for teratogenic or abortifacient effects
    
              -  Any chronic or concurrent acute liver disease
    
              -  History of stroke, transient ischemic attack (TIA), or myocardial infarction, within 6
                 months prior to enrollment
    
              -  Uncontrolled concurrent disease or illness including but not limited to:
    
                   -  Ongoing or active infection
    
                   -  Symptomatic congestive heart failure, unstable angina pectoris, clinically
                      significant cardiac arrhythmia
    
                   -  Unstable or untreated cardiac conditions or ejection fraction of < 50% as
                      determined by echocardiogram (ECHO) or multiple gated acquisition scan (MUGA)
    
                   -  Uncontrolled diabetes mellitus
    
                   -  Psychiatric illness/social situations that would limit compliance with study
                      requirements
    
              -  Other severe, acute, or chronic medical or psychiatric condition or laboratory
                 abnormality that may increase the risk associated with study participation or study
                 drug administration or that may interfere with the interpretation of study results
                 and, in the judgment of the investigator, would make the patient inappropriate for the
                 study
    
              -  Immunocompromised patients, e.g., patients who are known to be serologically positive
                 for human immunodeficiency virus (HIV)
    
              -  Patients with known active hepatitis (i.e., hepatitis B or C) due to risk of
                 transmitting the infection through blood or other body fluids
    
              -  Other malignancy within the last 5 years except: adequately treated non-melanoma skin
                 cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ
                 (DCIS), stage 1, grade 1 endometrial carcinoma, or other solid tumors including
                 lymphomas (without bone marrow involvement) curatively treated with no evidence of
                 disease for >= 5 years. Patients with a history of localized triple negative breast
                 cancer or localized resected prostate cancer may be eligible, provided they completed
                 their adjuvant chemotherapy more than three years prior to registration, and that the
                 patient remains free of recurrent or metastatic disease
    
              -  Resting electrocardiogram (ECG) with corrected QT (QTc) > 470 msec on 2 or more time
                 points within a 24 hour period or family history of long QT syndrome
    
              -  Patients receiving any systemic chemotherapy or radiotherapy (except for palliative
                 reasons) within 2 weeks prior to study treatment
    
              -  Major surgery within 2 weeks of starting study treatment and patients must have
                 recovered from any effects of any major surgery
    
              -  Previous allogenic bone marrow transplant or double umbilical cord blood
                 transplantation (dUCBT)
          
    Maximum Eligible Age:N/A
    Minimum Eligible Age:18 Years
    Eligible Gender:All
    Healthy Volunteers:No

    Primary Outcome Measures

    Measure:Overall response rate (ORR)
    Time Frame:Up to 5 years
    Safety Issue:
    Description:Will be evaluated by Response Evaluation Criteria in Solid Tumors (RECIST). ORR will be reported along with 95% exact confidence intervals.

    Secondary Outcome Measures

    Measure:Progression free survival (PFS)
    Time Frame:From the date of olaparib initiation to investigator-assessed clinical progression or radiographic progression (by RECIST), or death from any cause, whichever occurs first, assessed up to 5 years
    Safety Issue:
    Description:PFS will be determined using a Kaplan-Meier curve, with probabilities at various time points indicated along with appropriate confidence intervals.
    Measure:Incidence of adverse events
    Time Frame:Up to 5 years
    Safety Issue:
    Description:Will be assessed according to the Common Terminology Criteria for Adverse Events version 5.0.
    Measure:Individual deoxyribonucleic acid (DNA)-repair defects
    Time Frame:Up to 5 years
    Safety Issue:
    Description:The association between individual DNA-repair defects and ORR will be determined using Fisher's exact test.

    Details

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

    Last Updated

    July 27, 2021