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A Study of Niraparib Combination Therapies for the Treatment of Metastatic Castration-Resistant Prostate Cancer

NCT03431350

Description:

The purpose of this study is to establish the recommended phase 2 dose (RP2D) of niraparib combination therapies of Part 1 and to evaluate the antitumor activity and safety of niraparib combination therapies of Part 2.

Related Conditions:
  • Prostate Adenocarcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: A Study of Niraparib Combination Therapies for the Treatment of Metastatic Castration-Resistant Prostate Cancer
  • Official Title: A Phase 1b-2 Study of Niraparib Combination Therapies for the Treatment of Metastatic Castration-Resistant Prostate Cancer

Clinical Trial IDs

  • ORG STUDY ID: CR108406
  • SECONDARY ID: 64091742PCR2002
  • SECONDARY ID: 2017-003552-23
  • NCT ID: NCT03431350

Conditions

  • Prostatic Neoplasms, Castration-Resistant

Interventions

DrugSynonymsArms
Niraparib 200 mgCombination 1:Dose Selection: Niraparib + JNJ-63723283(Part 1)
JNJ-63723283 240 mgCombination 1:Dose Selection: Niraparib + JNJ-63723283(Part 1)
JNJ-63723283 480 mgCombination 1:Dose Selection: Niraparib + JNJ-63723283(Part 1)
Abiraterone AcetateZytigaCombination 2: Dose Expansion: Niraparib + AA-P (Part 2)
PrednisoneCombination 2: Dose Expansion: Niraparib + AA-P (Part 2)

Purpose

The purpose of this study is to establish the recommended phase 2 dose (RP2D) of niraparib combination therapies of Part 1 and to evaluate the antitumor activity and safety of niraparib combination therapies of Part 2.

Detailed Description

      This multicenter study will evaluate safety and efficacy of niraparib in combination with
      other anti-cancer agents. Two combinations are being studied: the first combination study
      will combine niraparib with the anti-programmed cell death protein (PD)-1 monoclonal
      antibody, JNJ-63723283 in participants with metastatic castration-resistant prostate cancer
      (mCRPC). The second combination will combine niraparib with abiraterone acetate plus
      prednisone (AA-P) in mCRPC participants with DNA-repair gene defects (DRD). Combination 1 has
      2 parts: in Part 1 (dose selection), participants will be enrolled to explore 2 doses of
      niraparib and JNJ-63723283; and Part 2 (dose expansion) will evaluate the combination therapy
      in an expanded number of participants. In Part 2, participants will be enrolled into 2
      cohorts based on biomarker status. Combination 2 has only 1 part (Part 2) and no Part 1. In
      Part 2, participants will be enrolled into 4 cohorts (breast cancer gene [BRCA] biallelic
      loss [2A], other DRD biallelic loss [2B], BRCA monoallelic loss [2C], and other DRD
      monoallelic loss [2D]). Each combination in the study will have 4 phases: A Prescreening
      Phase, a Screening Phase, a Treatment Phase, and a Follow-up Phase. Study evaluations will
      include efficacy, pharmacokinetic (PK), PK/pharmacodynamics, biomarkers, safety and
      tolerability.
    

Trial Arms

NameTypeDescriptionInterventions
Combination 1:Dose Selection: Niraparib + JNJ-63723283(Part 1)ExperimentalDose regimen 1: The participants will receive niraparib 200 milligram (mg) orally once daily in combination with JNJ-63723283 240 mg intravenously (IV) once every 2 weeks. Dose regimen 2: The participants will receive niraparib 200 mg orally once daily in combination with JNJ-63723283 480 mg IV once every 4 weeks in 28-day treatment cycles until disease progression, unacceptable toxicity, death, or the sponsor terminates the study. The safety evaluation team (SET) will determine if an additional cohort is necessary, based on the data from dose regimens 1 and 2.
  • Niraparib 200 mg
  • JNJ-63723283 240 mg
  • JNJ-63723283 480 mg
Combination 1:Dose Expansion: Niraparib + JNJ-63723283(Part 2)ExperimentalParticipants will be assigned to either Cohort 1A (Biomarker [BM] positive [+]) or Cohort 1B (BM negative [-]) and will receive 480 mg of JNJ-63723283 IV once every 4 weeks and niraparib 200 mg once daily as RP2D, in Part 2. A futility analysis will be performed for the Cohort 1B after 10 BM- participants are enrolled in Part 2. This cohort will be closed if the response rate is 13 percent (%) or less for the participants.
  • Niraparib 200 mg
  • JNJ-63723283 480 mg
Combination 2: Dose Expansion: Niraparib + AA-P (Part 2)ExperimentalParticipants will be assigned to one of 4 cohorts based on biomarker status - Cohort 2A (BRCA biallelic loss), 2B (other DRD biallelic loss), 2C (BRCA monoallelic loss), or 2D (other DRD monoallelic loss), and will receive niraparib 200 mg once daily as RP2D in combination with abiraterone acetate 1000 mg (4*250 mg) plus 10 mg prednisone (5 mg twice daily) throughout treatment phase.
  • Niraparib 200 mg
  • Abiraterone Acetate
  • Prednisone

Eligibility Criteria

        Inclusion Criteria:

          -  Participants willing to undergo all protocol-specified biopsies

          -  Diagnosis of prostate adenocarcinoma as confirmed by the investigator

        Combination 1:

          -  Must have determination of biomarker (BM) status for DNA-repair gene defects (DRD)
             (either BM positive [+] or BM negative [-]) by the sponsor's blood or tissue assay

          -  Participants must have measurable disease as defined by response evaluation criteria
             in solid tumors (RECIST) 1.1 (soft tissue lesion of greater than or equal to (>=) 10
             millimeter (mm) in the long axis or extrapelvic lymph node of >=15 mm in the short
             axis)

          -  Must have previously received at least 1, but no more than 2, lines of novel androgen
             receptor (AR)-targeted therapy (that is, abiraterone acetate with prednisone,
             enzalutamide) for metastatic castration-resistant prostate cancer (mCRPC).
             Participants must have had at least 4 weeks of AR-targeted therapy

        Combination 2:

          -  Must be biomarker positive for DRD by either the sponsor's blood or tissue assay

          -  Must have progressed on 1 prior line of novel AR-targeted therapy (that is,
             abiraterone acetate with prednisone, enzalutamide) for mCRPC. Prior treatment with
             taxane-based therapy and AR-targeted therapy outside of the mCRPC setting is allowed

        Exclusion Criteria:

          -  Prior treatment with a poly (adenosine diphosphate [ADP]-ribose) polymerase (PARP)
             inhibitor

          -  History or current diagnosis of myelodysplastic syndrome (MDS)/acute myeloid leukemia
             (AML)

          -  Active malignancy (exceptions: adequately treated basal cell or squamous cell skin
             cancer, superficial bladder cancer, or any other cancer in situ currently remission)
             less than or equal to (<=) 2 years prior to enrollment

          -  Active infection requiring systemic therapy

          -  Allergies, hypersensitivity, or intolerance to niraparib or the corresponding
             excipients
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Male
Healthy Volunteers:No

Primary Outcome Measures

Measure:Part 1: Combination 1: Incidence of Specified Toxicities
Time Frame:Up to 28 days
Safety Issue:
Description:Incidence defined as number of participants with specified toxicities will be reported. The dose will be considered intolerable if a participant developed Grade greater than or equal to (>=) 3 non-hematological toxicity (with exceptions including anorexia, fever, constipation, fatigue that improves to Grade less than or equal to (<=) 2 in <=7 days, vomiting and diarrhea that resolves in <=3 days with best supportive care), treatment-related Grade 4 thrombocytopenia or Grade >= 3 thrombocytopenia, treatment-related Grade 4 neutropenia >= 7 days, or Grade 3 or 4 neutropenia, treatment-related serious adverse events.

Secondary Outcome Measures

Measure:Part 1 and Part 2 (Combination 1): Plasma Concentrations of Niraparib and JNJ-63723283
Time Frame:Cycle 1 up to 12 (each cycle is of 28 days)
Safety Issue:
Description:Plasma concentrations of niraparib and JNJ-63723283 will be assessed.
Measure:Part 1 and Part 2 (Combination 1): Number of participants with Anti-Drug Antibodies
Time Frame:Approximately 24 months
Safety Issue:
Description:Number of participants with Anti-Drug Antibodies will be reported.
Measure:Part 2: Combinations 1 and 2: Number of Participants with Circulating Tumor Cell (CTC) Response
Time Frame:From screening up to end of treatment (30 days of last dose) (approximately up to 24 months)
Safety Issue:
Description:CTC response is defined as CTC=0 per 7.5 milliliter (mL) of blood at 8 weeks for participants who have CTC >= 1 at baseline or CTC<5 per 7.5 mL with CTC >=5 at baseline, confirmed by a second consecutive value obtained 4 or more weeks later.
Measure:Part 2: Combination 1: Composite Response Rate (RR)
Time Frame:Screening, Cycle 1 (each cycle of 28 days) Day 1 (every 8 weeks for the first 6 months and then every 12 weeks thereafter) until follow-up phase (for 3 months) (approximately up to 24 months)
Safety Issue:
Description:Composite RR is defined as percentage of participants who have 1 of the following by PCWG3: Objective response (confirmed per RECIST 1.1), or CTC response: defined as CTC=0 per 7.5 mL of blood at 8 weeks for participants who have CTC >=1 at baseline or CTC <5 baseline per 7.5 mL with CTC>5 at baseline, confirmed by a second consecutive value obtained 4 or more weeks later, or PSA decline of >= 50%, measured twice 3 to 4 weeks apart.
Measure:Part 2: Combination 2: Objective Response Rate (ORR)
Time Frame:Approximately 24 months
Safety Issue:
Description:ORR of soft tissue (visceral or nodal disease) as defined by RECIST 1.1 with no evidence of bone progression according to PCWG3 criteria. As per RECIST 1.1 criteria, ORR is defined as the percentage of participants who achieve complete response (CR) or partial response (PR), as assessed by response evaluation criteria in solid tumors (RECIST) 1.1 criteria with no evidence of bone progression according to prostate cancer working group 3 (PCWG3) criteria. CR defined as disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to less than 10 millimeter (mm). PR defined as at least 30 percent (%) decrease in sum of the diameters of the target lesions taking as reference the baseline sum diameters.
Measure:Part 2: Combinations 1 and 2: Duration of Objective Response
Time Frame:Screening, Cycle 1 (each cycle of 28 days) Day 1 (every 8 weeks for the first 6 months and then every 12 weeks thereafter) until follow-up phase (approximately up to 24 months)
Safety Issue:
Description:Duration of objective response is defined as time from complete response (CR) or partial response (PR) to radiographic progression of disease (PD), unequivocal clinical progression, or death, whichever occurs first. CR defined as disappearance of all target lesions. Any pathological lymph nodes must have reduction in short axis to less than 10 millimeter (mm). PR defined as at least 30 % decrease in sum of the diameters of the target lesions taking as reference the baseline sum diameters. PD is defined as a 20% increase in the sum of diameters of all target lesions and a minimum absolute increase of 5 mm in the sum.
Measure:Part 2: Combinations 1 and 2: Overall Survival (OS)
Time Frame:Up to follow-up (approximately up to 24 months)
Safety Issue:
Description:OS is defined as time from start of treatment to death from any cause.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Janssen Research & Development, LLC

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