Clinical Trials /

Pamiparib in Fusion Positive, Reversion Negative High Grade Serous Ovarian Cancer or Carcinosarcoma With BRCA1/2 Gene Mutations If Progression on Substrate Poly ADP Ribose Polymerase Inhibitbor (PARPI) or Chemotherapy

NCT03933761

Description:

This study is a phase II, multi-centre, open label study in patients with advanced ovarian cancer. The treatment being tested is Pamiparib, with daily dosing. All patients enrolled to the study will receive treatment with pamiparib. Patients will be selected for entry into the study based on the molecular signature of their cancer.

Related Conditions:
  • Ovarian Carcinoma
  • Ovarian Carcinosarcoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Pamiparib in Fusion Positive, Reversion Negative High Grade Serous Ovarian Cancer or Carcinosarcoma With BRCA1/2 Gene Mutations If Progression on Substrate Poly ADP Ribose Polymerase Inhibitbor (PARPI) or Chemotherapy
  • Official Title: A Phase II, Signal-Seeking Trial of the Clinical Benefit Rate Associated With Pamiparib in Subjects With Germline or Somatic BRCA1/2 High Grade Serous Ovarian Cancer or Carcinosarcoma Who Have Progressed on P-gp Substrate Chemotherapy or PARPi With the Presence of an ABCB1 Fusion and the Absence of a BRCA1/2 Reversion

Clinical Trial IDs

  • ORG STUDY ID: ANZGOG 1721/2018
  • NCT ID: NCT03933761

Conditions

  • Ovarian Cancer
  • Carcinosarcoma

Interventions

DrugSynonymsArms
PamiparibBGB-290Pamiparib (BGB-290)

Purpose

This study is a phase II, multi-centre, open label study in patients with advanced ovarian cancer. The treatment being tested is Pamiparib, with daily dosing. All patients enrolled to the study will receive treatment with pamiparib. Patients will be selected for entry into the study based on the molecular signature of their cancer.

Detailed Description

      Ovarian cancer is the deadliest gynaecologic cancer in Western women. Although initially
      responsive to therapy, drug resistance commonly evolves.

      Novel mechanisms of drug resistance in ovarian cancer have been identified and include
      genetic mutations that result in the activation of a drug efflux pump and secondary mutations
      in BRCA1/2 genes that restore the cancer cell's ability to repair treatment related DNA
      damage. It is hypothesized that patients with BRCA1/2 mutant high grade serous ovarian cancer
      or carcinosarcoma who have progressed on recent therapy and have an activated efflux pump
      without a secondary BRCA1/1 mutation will be selectively sensitive to a new PARPi, Pamiparib,
      which does not get effluxed out of cancer cells.

      The primary objective of this trial is to assess the clinical benefit rate at > 4 months in 2
      cohorts of patients (cohort 1: post substrate-PARP inhibitor and cohort 2: post chemotherapy)
      defined as response or absence of progression. Secondary objectives are to determine the
      median progression free and overall survival of patients treated with Pamiparib and the
      impact on symptom burden and benefit.
    

Trial Arms

NameTypeDescriptionInterventions
Pamiparib (BGB-290)ExperimentalDrug: Pamiparib Oral capsules 60mg twice daily continuously Although treatment is continuous, a cycle is defined as 4 weeks or 28 days.
  • Pamiparib

Eligibility Criteria

        Inclusion Criteria - Pre-Screening

          1. Patient has provided written informed consent for pre-screening

          2. Patient is able to comply with the study protocol and follow-up procedures, in the
             Investigator's judgement

          3. Patient is female aged ≥ 18 years at time of consent

          4. ECOG performance status 0-2 (refer to Appendix 1)

          5. Patient has the ability to take oral medications without medical history of
             malabsorption or other chronic gastrointestinal disease, or other conditions that may
             harm compliance and/or absorption of the study agent

          6. Patients with a histopathological diagnosis of HGSC or carcinosarcoma of the ovary
             (including primary peritoneal cancers and fallopian tube cancers) as defined by
             histological diagnosis and immunohistochemistry (IHC) and with a germline or somatic
             BRCA1/2 mutation:

               -  Mixed histologies are allowed provided that >80% of the primary tumour is a HGSC
                  based on diagnostic pathology review and IHC profile

          7. Progressive symptomatic or asymptomatic recurrent disease defined by GCIG CA- 125
             and/or RECIST v1.1 criteria after 1 or more line/s of substrate chemotherapy and/or
             after P-gp substrate PARPi

               -  Patients may continue on treatment as per standard of care by their usual
                  clinician while awaiting the results of pre-screening with no impact on usual
                  care

               -  Patients who have been treated with both substrate PARPi and substrate
                  chemotherapy will be considered eligible for either cohort 1 or cohort 2 based on
                  the therapy they have most recently progressed on (cohort 1 is progression on
                  PARPi and cohort 2 is progression on chemotherapy)

          8. Disease that is amenable to a biopsy and/or ascitic drainage

               -  Lesions intended to be biopsied should not be target lesions with the preference
                  of the biopsy site having progressed on most recent imaging where clinically safe
                  and feasible

          9. Patient has a life expectancy > 12 weeks

         10. Patient has consented to the collection and use of their fresh tumour biopsies and/or
             ascites samples

        Exclusion Criteria - Pre-Screening

          1. Patients with a clear cell, mucinous, or other non-high grade serous histological
             subtype

          2. Prior treatment with non-substrate P-gp PARPi (pamiparib or veliparib)

               -  Prior treatment with substrate PARPi is allowed (olaparib, niraparib, rucaparib,
                  and talazoparib)

          3. Patients who are pregnant or nursing

          4. Patient has a diagnosis of myelodysplastic syndrome (MDS)

          5. Patient has other diagnoses of malignancy

               -  Except for surgically excised non-melanoma skin cancer, adequately treated
                  carcinoma in situ of the cervix, adequately treated non-invasive bladder cancer,
                  ductal carcinoma in situ treated surgically with curative intent, or a malignancy
                  diagnosed >2 years ago with no current evidence of disease and no therapy ≤2
                  years prior to registration to pre-screening

          6. Prior radiation therapy to target lesions in the absence of documented progression at
             the treated target lesion

          7. Patient has uncontrolled pleural effusion, pericardial effusion, or ascites requiring
             weekly recurrent drainage procedures

          8. Known history of intolerance to the excipients of the pamiparib capsule

          9. Active bleeding disorder, including gastrointestinal bleeding, as evidenced by
             hematemesis, significant hemoptysis, or melena ≤6 months prior to registration to
             pre-screening

         10. Previous complete gastric resection, chronic diarrhea, active inflammatory
             gastrointestinal disease, or any other disease-causing malabsorption syndrome

               -  Gastroesophageal reflux disease under treatment with proton-pump inhibitors is
                  allowed

        Inclusion Criteria - Main Study

          1. Patient has provided written informed consent for main PRECISE study

          2. Patient continues to meet all pre-screening inclusion criteria

          3. Patient has an ABCB1 fusion(s) and the absence of a BRCA1/2 reversion

          4. Patient has platinum sensitive or platinum resistant HGSC

               -  Patients who are refractory (progress during or within 4 weeks) to second or
                  subsequent lines of platinum-based chemotherapy are eligible

               -  Patients who are primary platinum refractory (progress during or within 4 weeks
                  of first line chemotherapy) are considered ineligible

          5. Recurrent disease that is measurable according to RECIST v1.1 or evaluable disease
             using CA-125 according to GCIG criteria

          6. Adequate haematologic and end-organ function, as defined by the following laboratory
             results (obtained within 7 days prior to registration to the main study):

               -  Absolute neutrophil count (ANC) ≥1.5 x 109/L

               -  Platelet count ≥ 100 x 109/L

               -  Haemoglobin (Hb) ≥ 90 g/L (≥ 28 days after transfusion)

               -  Estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2 by the Modification of
                  Diet in Renal Disease study equation (MDRD STUDY EQ; www.mdrd.com or Appendix 5)

               -  Total serum bilirubin ≤ 1.5 x upper limit of normal (ULN)

               -  ≤ 4 x ULN, if Gilbert's syndrome or if indirect bilirubin concentrations
                  suggestive of extrahepatic source of elevation

               -  Aspartate and alanine aminotransferase (AST and ALT) ≤ 3 x upper limit of normal
                  (ULN) or ≤ 5 x ULN for patients with liver metastases

          7. Patients who are pregnant

               -  Females of childbearing potential require a negative serum pregnancy test within
                  7 days prior to registration into the main study

          8. Females of childbearing potential must practice highly effective methods of birth
             control (refer to Appendix 2) for the duration of the study and for at least 6 months
             after last study drug

          9. Patients must have recovered to ≤ grade 1 from their treatment-related adverse event
             (AE) with the exception of alopecia and peripheral neuropathy

         10. Able to provide a formalin-fixed paraffin embedded (FFPE) tumour block, representative
             of the patient's primary disease

               -  In cases where there is insufficient FFPE tumour, a discussion with the
                  Coordinating Principal Investigator (CPI) must be had before registration to the
                  main study

        Exclusion Criteria - Main Study

          1. Patients who have received chemotherapy, biologic therapy, immunotherapy,
             investigational agent, anticancer Chinese medicine, or herbal remedies ≤ 5 half-lives
             if the half-life is known, ≤ 14 days if not known, prior to registration to the main
             study

               -  Bisphosphonate and denosumab use is allowed on study, if administered at a stable
                  dose > 28 days prior to registration to the main study

          2. The use or anticipated need for food or drugs known to be strong or moderate
             cytochrome P450 (CYP) 3A inhibitors or strong CYP3A inducers (Appendix 6) ≤ 5
             half-lives if the half-life is known or ≤ 14 days if not known prior to registration
             to the main study

          3. Major surgical procedure, open biopsy, or significant traumatic injury ≤ 14 days prior
             to registration to the main study, or anticipation of need for major surgical
             procedure during the course of the study

               -  Placement of vascular access device is not considered major surgery

          4. Prior radiation therapy ≤ 14 days prior to registration to the main study to
             non-target lesions. Patients who have received palliative radiotherapy of non-target
             lesions for local symptom control > 14 days prior to registration to the main study
             must have stabilisation of any AEs or a return to baseline prior to registration to
             the main study

          5. Leptomeningeal disease or uncontrolled, untreated brain metastases

          6. Patients with a history of treated and asymptomatic brain metastases are eligible,
             provided they meet all of the following:

               -  Only supratentorial metastases

               -  Brain imaging at screening without evidence of interim progression

               -  No ongoing requirement for corticosteroids as therapy for brain metastases

               -  Anticonvulsants at a stable dose allowed (except for contraindicated medications
                  carbamazepine and phenytoin)

               -  No stereotactic radiation or whole-brain radiation ≤ 14 days prior to
                  registration to the main study

          7. Any of the following cardiovascular criteria:

               -  Cardiac chest pain, defined as moderate pain that limits instrumental activities
                  of daily living, ≤ 28 days prior to registration to the main study

               -  Symptomatic pulmonary embolism ≤ 28 days prior to registration to the main study

               -  Any history of acute myocardial infarction ≤ 6 months prior to registration to
                  the main study

               -  Any history of heart failure meeting New York Heart Association (NYHA)
                  Classification III or IV (refer to Appendix 8) ≤ 6 months prior to registration
                  to the main study

               -  Any event of ventricular arrhythmia ≥ Grade 2 in severity ≤ 6 months prior to
                  registration to the main study

               -  Any history of cerebrovascular accident (CVA) ≤ 6 months prior to registration to
                  the main study

          8. Active infection requiring systemic treatment, acute/viral hepatitis or active chronic
             hepatitis B or C or active tuberculosis

               -  Patients with untreated chronic hepatitis B or chronic hepatitis B virus (HBV)
                  carriers whose HBV DNA is > 500 IU/mL or patients with active hepatitis C should
                  be excluded. Note: Inactive hepatitis B surface antigen carriers, treated and
                  stable hepatitis B (HBV DNA < 500 IU/mL), and cured hepatitis C patients can be
                  enrolled
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:Clinical benefit rate
Time Frame:Assessed at 16 weeks after commencing treatment.
Safety Issue:
Description:as assessed by RECIST v1.1 or by Gynaecological Cancer Intergroup (GCIG) Cancer antigen (CA)-125 criteria

Secondary Outcome Measures

Measure:Frequency of ABCB1 fusions and BRCA1/2 reversions
Time Frame:At Baseline
Safety Issue:
Description:in patients with germline or somatic BRCA1/2 high grade serous cancer or carcinosarcoma
Measure:Median progression free survival
Time Frame:Through study completion, on average 6 months.
Safety Issue:
Description:in BRCA1/2 high grade serous cancer or carcinosarcoma patients with ABCB1 fusions in the absence of BRCA1/2 reversions treated with pamiparib.
Measure:Median overall survival
Time Frame:Assessed for up to 3 years after the last patient enrolled has commenced treatment.
Safety Issue:
Description:in BRCA1/2 high grade serous cancer or carcinosarcoma patients with ABCB1 fusions in the absence of BRCA1/2 reversions treated with pamiparib.
Measure:Duration of response
Time Frame:Assessed for up to 3 years after the last patient enrolled has commenced treatment.
Safety Issue:
Description:Duration of response according to RECIST v1.1 in the subset of patients who achieved partial response or complete response.
Measure:Best overall response according to RECIST v1.1
Time Frame:Assessed for up to 3 years after the last patient enrolled has commenced treatment.
Safety Issue:
Description:Best overall response is the best response from commencement of treatment according to RECIST v1.1
Measure:Best overall response according to CA-125
Time Frame:Assessed for up to 3 years after the last patient enrolled has commenced treatment.
Safety Issue:
Description:defined as best response from commencement of treatment determined by GCIG CA-125 criteria
Measure:Patient reported symptom burden
Time Frame:At the time of consent to screening, at every cycle to 16 weeks, then every 4 cycles, and again at the time of progression. Assessed for up to 3 years after the last patient enrolled has commenced treatment.
Safety Issue:
Description:Using the Measure of Ovarian Cancer Symptoms and Treatment Concerns (MOST) v2 patient reported outcome measure (PROM) The scale measures disease or therapy related symptoms and symptom burden and well-being Scale ranges: Subscales are reported in five different categories with the subscale score ranges below Abdominal symptoms, higher values reflecting worst possible symptoms Disease or treatment-related symptoms, higher values reflecting worst possible symptoms Chemotherapy-related symptoms, higher values reflecting worst possible symptoms Psychological symptoms, higher values reflecting worst possible symptoms Well-being, higher values reflecting best possible symptoms Each of the 5 subscales can be scored and analysed separately (item by item) or by taking the average of the component items.
Measure:Patient reported results of the 40 item State-trait anxiety inventory for adults (STAI-ADTM)
Time Frame:This will be assessed 3 times - at the time of pre-screening consent, immediately prior to clinician consult with notification of pre-screening results, and immediately following notification of pre-screening results.
Safety Issue:
Description:The scale measures state level anxiety (S-Anxiety or current levels) and trait anxiety levels (T-anxiety or how someone generally feels) Scale ranges: STA Form Y-1 includes 20 items/questions, with a total score range of 20-80, and STA Form Y-2 includes 20 items/questions, with a total score range of 20-80. Each scored item/question is then given a weighted score of 1 to 4 with a rating of 4 indicative of a high level of anxiety for 10 x S-Anxiety items and 11 x T-Anxiety items. A high rating indicates the absences of anxiety for the remaining 10 S-Anxiety items and 9 T-Anxiety items. The scoring weights for the anxiety-present items are the same as the chosen numbers on the form and the scoring weight for the anxiety-absent items are reversed. For each form separately, weighted scores are then totalled and averaged. Groups of respondents will be identified (including most anxious, least anxious, and middle) based on top, bottom, and middle percentiles.
Measure:The type, grade and relationship to treatment of adverse events
Time Frame:During the treatment period, on average 3 years
Safety Issue:
Description:The type, grade and relationship to treatment of adverse events, assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v5.0

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Australia New Zealand Gynaecological Oncology Group

Trial Keywords

  • High grade serous
  • ABCB1 fusion
  • BRCA 1/2 reversion
  • Platinum resistant
  • Platinum sensitive

Last Updated

August 7, 2020