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Testing the Sequential Combination of the Anti-cancer Drugs Olaparib Followed by Adavosertib (AZD1775) in Patients With Advanced Solid Tumors With Selected Mutations and PARP Resistance, STAR Study

NCT04197713

Description:

This phase I trial studies the side effects and best dose of adavosertib when given together with olaparib in treating patients with solid tumors that have spread to other places in the body (advanced) with selected mutations. Adavosertib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. 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. Giving olaparib and adavosertib one after the other may shrink or stabilize advanced solid tumors as successfully as using them together, with fewer side effects.

Related Conditions:
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Testing the Sequential Combination of the Anti-cancer Drugs Olaparib Followed by Adavosertib (AZD1775) in Patients With Advanced Solid Tumors With Selected Mutations and PARP Resistance, STAR Study
  • Official Title: Phase I Sequential Trial of Agents Against DNA Repair (STAR)

Clinical Trial IDs

  • ORG STUDY ID: NCI-2019-08262
  • SECONDARY ID: NCI-2019-08262
  • SECONDARY ID: 10329
  • SECONDARY ID: 10329
  • SECONDARY ID: UM1CA186688
  • NCT ID: NCT04197713

Conditions

  • Advanced Malignant Solid Neoplasm
  • Metastatic Malignant Solid Neoplasm
  • Refractory Malignant Solid Neoplasm
  • Unresectable Malignant Solid Neoplasm

Interventions

DrugSynonymsArms
AdavosertibAZD-1775, AZD1775, MK-1775, MK1775Treatment (olaparib, adavosertib)
OlaparibAZD 2281, AZD-2281, AZD2281, KU-0059436, Lynparza, PARP Inhibitor AZD2281Treatment (olaparib, adavosertib)

Purpose

This phase I trial studies the side effects and best dose of adavosertib when given together with olaparib in treating patients with solid tumors that have spread to other places in the body (advanced) with selected mutations. Adavosertib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. 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. Giving olaparib and adavosertib one after the other may shrink or stabilize advanced solid tumors as successfully as using them together, with fewer side effects.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To determine the safety and tolerability of olaparib in sequential treatment with
      adavosertib (AZD1775).

      II. To establish the maximum tolerated dose/recommended phase 2 dose (MTD/RP2D) of this
      sequential schedule in patients with advanced solid tumors in a post-poly adenosine
      diphosphate (ADP) ribose polymerase inhibitor (PARPi) population.

      III. To assess the safety and toxicity profile of the sequential treatment of olaparib and
      AZD1775 in a post-PARPi population.

      SECONDARY OBJECTIVES:

      I. To assess putative predictive biomarkers of response and resistance to the sequential
      treatment of olaparib and AZD1775 in a post-PARPi population.

      II. To evaluate a novel experimental trial design involving sequential dosing of olaparib and
      AZD1775 in a post-PARPi population.

      III. To observe and record anti-tumor activity.

      OUTLINE: This is a dose-escalation study of adavosertib.

      Patients receive olaparib orally (PO) twice daily (BID) on days 1-5 and 15-19 of each cycle
      and adavosertib PO once daily (QD) on days 8-12 and 22-26 of each cycle. Cycles repeat every
      28 days in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up at 30 days and then every 3-6
      months for up to 2 years.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (olaparib, adavosertib)ExperimentalPatients receive olaparib PO BID on days 1-5 and 15-19 of each cycle and adavosertib PO QD on days 8-12 and 22-26 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Adavosertib
  • Olaparib

Eligibility Criteria

        Inclusion Criteria:

          -  Subjects must have histologically confirmed malignancy that is metastatic or
             unresectable and for which standard curative measures do not exist or are no longer
             effective

          -  Patients in dose expansion Cohort A (intrinsic resistance), must have:

               -  Prior treatment with PARP inhibitors

               -  Disease progression per Response Evaluation Criteria in Solid Tumors (RECIST) at
                  1st re-staging, and

               -  Germline or somatic mutations in BRCA1 or BRCA2

          -  Patients in dose expansion Cohort B (acquired resistance) must have:

               -  Prior treatment with PARP inhibitors,

               -  Complete/partial response followed by disease progression per RECIST, and

               -  Germline or somatic mutations in any of the following deoxyribonucleic acid (DNA)
                  damage response (DDR) genes: BRCA1, BRCA2, BRIP1, FANCA, PALB2, ATM, or the
                  non-DDR gene marker cyclin E amplification. Local testing in Clinical Laboratory
                  Improvement Act (CLIA)-certified laboratory will be accepted. All alterations
                  will be reviewed by MD Anderson's Precision Oncology Decision Support (PODS)
                  team. No variants of uncertain significance (VUS) will be allowed. Recruitment of
                  patients with relevant molecular aberrations in the dose escalation phase is
                  encouraged but not mandated.

          -  Subjects must have RECIST measureable disease and a tumor that is safely accessible
             for biopsy and must be willing to undergo biopsy

          -  Subjects must have received at least one line of systemic therapy in the
             advanced/metastatic setting. Subjects with diseases without known effective options,
             and subject who have declined standard or care therapy prior to study introduction are
             also eligible

          -  Any prior palliative radiation therapy must have been completed at least 14 days prior
             to the start of study drugs, and patients must have recovered from any acute adverse
             effects prior to the start of study treatment

          -  Human immunodeficiency virus (HIV)-infected (HIV1/2 antibody-positive) patients may
             participate if they meet all the following eligibility requirements:

               -  They must be on an anti-retroviral regimen with evidence of at least two
                  undetectable viral loads within the past 6 months on this same regimen; the most
                  recent undetectable viral load must be within the past 12 weeks

               -  They must have a CD4 count >= 250 cells/uL over the past 6 months on this same
                  anti-retroviral regimen and must not have had a CD4 count < 200 cells/ul over the
                  past 2 years, unless it was deemed related to the cancer and/or
                  chemotherapy-induced bone marrow suppression. For patients who have received
                  chemotherapy in the past 6 months, a CD4 count < 250 cells/ul during chemotherapy
                  is permitted as long as viral loads were undetectable during this same
                  chemotherapy

               -  They must have an undetectable viral load and a CD4 count >= 250 cells/uL within
                  7 days of enrollment

               -  They must not be currently receiving prophylactic therapy for an opportunistic
                  infection and must not have had an opportunistic infection within the past 6
                  months. Monitoring for HIV-infected patients should include:

                    -  Viral load and CD4 count every 12 weeks (q12w)

                    -  If CD4 count drops to less than 200 cells/ul while on study, initiate viral
                       load test. If viral load proves undetectable at this time, continue CD4 and
                       viral load checks every 8 weeks (q8w). If 2 consecutive viral load tests are
                       undetectable, revert to q12w testing for CD4 and viral load testing

                    -  If an opportunistic infection occurs with a CD4 count of < 200 cells/ul,
                       hold study treatment. Initiate treatment of the infection and continue to
                       hold study treatment; once clinically stable, CD4 count is > 200 cells/ul
                       and viral load has remained undetectable, reinitiate study treatment

          -  Patients with a past or resolved hepatitis B virus (HBV) infection (defined as the
             presence of hepatitis B core antibody and absence of HBsAg) are eligible. Active HBV
             is defined by a known positive HBV surface antigen (HBsAg) result. Patients positive
             for hepatitis C virus (HBC) antibody are eligible only if polymerase chain reaction
             (PCR) is negative for HCV RNA. Patients with known active HBV or HBC infection are
             ineligible

          -  Patients with treated brain metastases are eligible if follow-up brain imaging after
             central nervous system (CNS)-directed therapy shows no evidence of progression within
             28 days

          -  Patients with new or progressive brain metastases (active brain metastases) or
             leptomeningeal disease are eligible if the treating physician determines that
             immediate CNS specific treatment is not required and is unlikely to be required during
             the first cycle of therapy

          -  Absolute neutrophil count (ANC) >= 1500/uL (within 7 days of study drugs initiation)

          -  Hemoglobin (Hgb) >= 10 g/dL (within 7 days of study drugs initiation) with no blood
             transfusion in the past 28 days

          -  Platelets >= 100,000/uL (within 7 days of study drugs initiation)

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
             [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvate transaminase [SGPT])
             =< 2.5 X upper limit of normal (ULN) (within 7 days of study drugs initiation), unless
             liver metastases are present in which case they must be =< 5 X ULN

          -  Serum bilirubin within normal limits (WNL) (within 7 days of study drugs initiation)
             or =< 1.5 X ULN in patients with liver metastases, or total bilirubin =< 3 X ULN with
             direct bilirubin WNL in patients with well-documented Gilbert's syndrome

          -  Serum creatinine =< 1.5 X ULN (within 7 days of study drugs initiation). If elevated,
             check creatinine clearance (CrCl) with cut off >= 51 mL/min as calculated by the
             Cockcroft-Gault method or based on a 24-hour urine test (confirmation of creatinine
             clearance is only required when serum creatinine is > 1.5 X institutional ULN)

          -  The effects of AZD1775 and olaparib on the developing human fetus are either unclear
             or are known to be teratogenic, women of childbearing potential and their partners,
             who are sexually active, must agree to the use of TWO highly effective forms of
             contraception in combination. This should be started from the signing of the informed
             consent and continue throughout the period of taking study treatment and for at least
             1 month after last dose of study drug(s), or they must totally/truly abstain from any
             form of sexual intercourse. Male patients must use a condom during treatment and for 3
             months after the last dose of study drug when having sexual intercourse with a
             pregnant woman or with a woman of childbearing potential. Female partners of male
             patients should also use a highly effective form of contraception if they are of
             childbearing potential. Male patients should not donate sperm throughout the period of
             taking study drugs and for 3 months following the last dose of study drugs.

               -  Acceptable non-hormonal birth control methods include:

                    -  Total/True abstinence: When the patient refrains from any form of sexual
                       intercourse and this is in line with their usual and/or preferred lifestyle;
                       this must continue for the total duration of the trial and for at least 1
                       month after the last dose of study drug for women of child bearing
                       potential. For male patients, 3 months after last dose. (Periodic abstinence
                       [e.g., calendar, ovulation, symptothermal, post-ovulation methods, or
                       declaration of abstinence solely for the duration of a trial] and withdrawal
                       are not acceptable methods of contraception.)

                    -  Vasectomized sexual partner PLUS male condom. With participant assurance
                       that partner received post-vasectomy confirmation of azoospermia

                    -  Tubal occlusion PLUS male condom

                    -  Intrauterine device (IUD) PLUS male condom. Provided coils are copper-banded

               -  Acceptable hormonal methods:

                    -  Normal and low dose combined oral pills PLUS male condom

                    -  Cerazette (desogestrel) PLUS male condom. Cerazette is currently the only
                       highly efficacious progesterone based pill

                    -  Hormonal shot or injection (e.g., Depo-Provera) PLUS male condom

                    -  Etonogestrel implants (e.g., Implanon, Norplant) PLUS male condom

                    -  Norelgestromin / ethinyl estradiol (EE) transdermal system PLUS male condom

                    -  Intrauterine system (IUS) device (e.g., levonorgestrel releasing IUD-Mirena)
                       PLUS male condom

                    -  Intravaginal device (e.g., EE and etonogestrel) PLUS male condom

                    -  In the case of use of oral contraception, women should be stable on the same
                       pill before taking study treatment

                    -  Note: oral contraceptives are allowed but should be used in conjunction with
                       a barrier method of contraception due to unknown effect of drug-drug
                       interaction. Women are considered post-menopausal and not of childbearing
                       potential if they have had 12 or more months of natural (spontaneous)
                       amenorrhea following cessation of exogenous hormonal treatment with an
                       appropriate clinical profile (e.g. age appropriate, history of vasomotor
                       symptoms) or have had surgical bilateral oophorectomy (with or without
                       hysterectomy). In the case of oophorectomy alone, she will be considered not
                       of childbearing potential only when her reproductive status has been
                       confirmed by follow up hormone level assessment

          -  Male patients will be advised to arrange for the freezing of sperm samples prior to
             the start of the study should they wish to father children while on study drugs or
             during the 3 months after stopping study drugs

          -  Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0-1
             (Karnofsky >= 70%)

          -  Ability to understand and the willingness to sign a written informed consent document.
             Participants with impaired decision-making capacity (IDMC) who have a
             legally-authorized representative (LAR) and/or family member available will also be
             eligible. Has read and understands the informed consent form (ICF) and has given
             written informed consent (IC) prior to any study procedures

          -  Willingness and ability to comply with study and follow-up procedures

        Exclusion Criteria:

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to AZD1775 or olaparib

          -  Use of an investigational drug during the past 28 days or 5 half-lives (whichever is
             longer) prior to the first dose of study treatment

          -  Use of anti-cancer treatment drug =< 28 days or 5 half-lives (whichever is shorter)
             prior to the first dose of study treatment. For drugs for which 5 half-lives is =< 21
             days, a minimum of 10 days between termination of the prior treatment and
             administration of study treatment is required

          -  Use of radiotherapy (except for palliative reasons) within =< 28 days prior to study
             treatment

          -  No other anti-cancer therapy (chemotherapy, immunotherapy, hormonal anticancer therapy
             radiotherapy), biological therapy or other novel agent is to be permitted while the
             patient is receiving study medication. Patients with castration-resistant prostate
             cancer on luteinizing hormone-releasing hormone (LHRH) analogue treatment for more
             than 6 months are allowed entry into the study and may continue at the discretion of
             the investigator

          -  Concomitant use of CYP3A inducers/inhibitors:

               -  Concomitant use of known strong CYP3A inhibitors (e.g., itraconazole,
                  telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or
                  cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or
                  moderate CYP3A inhibitors (e.g., ciprofloxacin, erythromycin, diltiazem,
                  fluconazole, verapamil). The required washout period prior to starting olaparib
                  is 2 weeks

               -  Concomitant use of known strong (e.g., phenobarbital, enzalutamide, phenytoin,
                  rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John's Wort)
                  or moderate CYP3A inducers (e.g., bosentan, efavirenz, modafinil). The required
                  washout period prior to starting study treatment is 5 weeks for enzalutamide or
                  phenobarbital and 3 weeks for other agents

          -  Major surgical procedures =< 28 days of beginning study treatment, or minor surgical
             procedures =< 7 days. Patients must have recovered from any of the effects of any
             major surgery. No waiting period required following port-a-cath placement or other
             central venous access placement

          -  Known malignant central nervous system (CNS) disease other than neurologically stable,
             treated brain metastases - defined as metastasis having no evidence of progression or
             hemorrhage for at least 2 weeks after treatment (including brain radiotherapy). Must
             be off any systemic corticosteroids for the treatment of brain metastases for at least
             14 days prior to enrollment. Subjects with brain metastases must have completed
             treatment, either surgery or radiation, and be stable for at least 28 days off steroid
             prior to screening. A brain magnetic resonance imaging (MRI) demonstrating there is no
             current evidence or progressive brain metastases is required in subjects with previous
             brain metastasis. Patients with breast tissue expanders may have brain computed
             tomography (CT) for assessment

          -  Patients with either previous or current myelodysplastic syndrome (MDS)/acute myeloid
             leukemia (AML) or features suggestive of MDS/AML and excluded because olaparib and
             AZD1775 are agents with the potential to induce anemia

          -  AZD1775 should not be given to patients who have a history of Torsades de pointes
             (TdP) unless all risk factors that contributed to TdP have been corrected

          -  Any of the following cardiac diseases currently or within the last 6 months:

               -  Unstable angina pectoris

               -  Acute myocardial infarction

               -  Congestive heart failure >= class 2 (as defined by New York Heart Association
                  [NYHA])

               -  Conduction abnormality not controlled with pacemaker or medication

               -  Significant ventricular or supraventricular arrhythmias (patients with chronic
                  rate-controlled atrial fibrillation in the absence of other cardiac abnormalities
                  are eligible)

          -  Participants with a mean resting corrected QT interval (QTc) >= 480 msec at study
             entry, as calculated by the Frederica formula (QTcF) by institutional standards
             obtained from an electrocardiogram (ECG) or congenital long QT syndrome. (Note: if one
             ECG demonstrates a QTcF > 480 msec, then a mean QTcF of =< 480 msec obtained from 3
             ECGs 2-5 minutes apart is required at study entry

          -  Patients considered a poor medical risk due to a serious, uncontrolled medical
             disorder, non-malignant systemic disease or active, uncontrolled infection. Examples
             include, but are not limited to, uncontrolled ventricular arrhythmia, recent (within 3
             months) myocardial infarction, uncontrolled major seizure disorder, unstable spinal
             cord compression, superior vena cava syndrome, extensive interstitial bilateral lung
             disease on high resolution computed tomography (HRCT) scan or any psychiatric disorder
             that prohibits obtaining informed consent

          -  Patients with uncontrolled intercurrent illness

          -  Patients with psychiatric illness/social situations, or other psychological, familial,
             sociological, or geographical conditions that would limit compliance with study
             requirements

          -  Persistent grade > 1 toxi
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence and severity of dose-limiting toxicities
Time Frame:Up to 28 days
Safety Issue:
Description:Graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Secondary Outcome Measures

Measure:Anti-tumor activity
Time Frame:Up to 2 years
Safety Issue:
Description:Will correlate antitumor activity of the sequentially-administered combination of olaparib and adavosertib (AZD1775) with the detection of putative predictive biomarkers of response and resistance.
Measure:Maximum tolerated dose (MTD)
Time Frame:Up to 2 years
Safety Issue:
Description:Will assess if an MTD can be safely established using sequentially administered combination olaparib and AZD1775.
Measure:Overall response rate (ORR) ( complete response [CR] + partial response [PR])
Time Frame:Up to 2 years
Safety Issue:
Description:We will estimate ORR with 95% confidence intervals (CI). Inferences and estimation are based on the exact binomial test.
Measure:Duration of response (DOR)
Time Frame:From the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented, assessed up to 2 years
Safety Issue:
Description:Will use the Kaplan-Meier method to estimate DOR in these distributions.
Measure:Progression-free survival (PFS)
Time Frame:From start of treatment to time of progression or death, whichever occurs first, assessed up to 2 years
Safety Issue:
Description:Will use the Kaplan-Meier method to estimate PFS in these distributions.
Measure:Overall survival (OS)
Time Frame:From start of treatment to time of death, assessed up to 2 years
Safety Issue:
Description:Will use the Kaplan-Meier method to estimate OS in these distributions.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:National Cancer Institute (NCI)

Last Updated

July 8, 2020