Description:
Background:
Drugs known as PARP inhibitors are known to help stop tumor growth in patients with breast,
ovarian cancers and many other cancers including prostate and pancreatic cancers. Many
research studies done in animals and human cells have shown that these type of drugs can
improve how well chemotherapy works. Standard chemotherapy can be too toxic to be combined
with PARP inhibitors. In this study, we use a new form of chemotherapy called PLX038 to see
if it can be safely combined with PARP inhibitors to shrink tumors.
Objective:
To find a safe combination of PLX038 and rucaparib, and to see if this mix will cause tumors
to shrink.
Eligibility:
People age 18 and older with solid tumors, SCLC, or small cell cancer outside their lungs.
Design:
Participants will be screened with:
Physical exam
Blood tests
Records of their diagnosis (or they will have a tumor biopsy)
A review of their symptoms and medications
A review of their ability to perform their normal activities
Electrocardiograms to measure the electrical activity of the heart
Computed tomography (CT) scans of the chest, abdomen, and pelvis. CT scans are a series of
X-rays.
Participants will get PLX038 by intravenous catheter on Day 1 of each cycle (1 cycle = 21
days). For this, a small plastic tube is put into an arm vein. They will take rucaparib twice
daily by mouth on Days 3 to 19 of each cycle. They will keep a medicine diary.
Participants may give a hair sample. They may have optional tumor biopsies.
Screening tests are repeated throughout the study.
About 30 days after treatment ends, participants will have a safety follow-up visit. They
will give blood samples, talk about their health, and get a physical exam. Then they will be
called or emailed every 6 months....
Title
- Brief Title: PLX038 (PEGylated SN38) and Rucaparib in Solid Tumors and Small Cell Cancers
- Official Title: Phase I/II Trial of PLX038 (PEGylated SN38) and Rucaparib in Solid Tumors and Small Cell Cancers.
Clinical Trial IDs
- ORG STUDY ID:
200013
- SECONDARY ID:
20-C-0013
- NCT ID:
NCT04209595
Conditions
- Small Cell Lung Cancer
- Extra-Pulmonary Small Cell Carcinomas
Interventions
Drug | Synonyms | Arms |
---|
PLX038 | | 1/Arm 1 |
Rucaparib | | 1/Arm 1 |
Purpose
Background:
Drugs known as PARP inhibitors are known to help stop tumor growth in patients with breast,
ovarian cancers and many other cancers including prostate and pancreatic cancers. Many
research studies done in animals and human cells have shown that these type of drugs can
improve how well chemotherapy works. Standard chemotherapy can be too toxic to be combined
with PARP inhibitors. In this study, we use a new form of chemotherapy called PLX038 to see
if it can be safely combined with PARP inhibitors to shrink tumors.
Objective:
To find a safe combination of PLX038 and rucaparib, and to see if this mix will cause tumors
to shrink.
Eligibility:
People age 18 and older with solid tumors, SCLC, or small cell cancer outside their lungs.
Design:
Participants will be screened with:
Physical exam
Blood tests
Records of their diagnosis (or they will have a tumor biopsy)
A review of their symptoms and medications
A review of their ability to perform their normal activities
Electrocardiograms to measure the electrical activity of the heart
Computed tomography (CT) scans of the chest, abdomen, and pelvis. CT scans are a series of
X-rays.
Participants will get PLX038 by intravenous catheter on Day 1 of each cycle (1 cycle = 21
days). For this, a small plastic tube is put into an arm vein. They will take rucaparib twice
daily by mouth on Days 3 to 19 of each cycle. They will keep a medicine diary.
Participants may give a hair sample. They may have optional tumor biopsies.
Screening tests are repeated throughout the study.
About 30 days after treatment ends, participants will have a safety follow-up visit. They
will give blood samples, talk about their health, and get a physical exam. Then they will be
called or emailed every 6 months....
Detailed Description
Background:
- We hypothesize that a dose-escalation strategy that incorporates tumor targeted DNA-
damaging chemotherapy and DNA-damage response (DDR) inhibitors could allow safe and
effective administration of DDR inhibitor-chemotherapy combination.
- PLX038 is a PEGylated conjugate of SN38 with improved properties including increased
solubility, higher exposure and longer half-life. SN-38 is the active metabolite of
CPT-11 (irinotecan) that inhibits topoisomerase 1 (Top1) and causes DNA strand breakage.
As a specific DNA damaging agent, SN-38 enhances cell kill in tumors deficient in the
DNA- damage response and when combined with inhibitors of the DDR.
- Rucaparib is a potent oral poly ADP ribose polymerase (PARP) inhibitor that is approved
for the maintenance treatment of participants with recurrent epithelial ovarian,
fallopian tube, or primary peritoneal cancer who are in a complete or partial response
to platinum-based chemotherapy and for the treatment of adult participants with
deleterious BRCA mutation- associated epithelial ovarian, fallopian tube, or primary
peritoneal cancer who have been treated with two or more chemotherapies.
- We hypothesize that the combination of PLX038 plus rucaparib is more efficacious than
either agent alone.
Objectives:
- Phase I: To identify the maximum tolerated dose (MTD) of PLX038 in combination with
rucaparib.
- Phase II: To assess the efficacy with respect to clinical benefit rate (CBR) (CR+PR+SD)
for 4 months according to Response Evaluation Criteria (RECIST 1.1) of a combination of
PLX038 and rucaparib in participants with small cell lung cancer and extra-pulmonary
small cell carcinomas.
Eligibility:
- Subjects with histologically confirmed solid tumors (Phase I) OR histologically or
cytologically confirmed small cell lung cancer (SCLC) (Phase II) OR histologically or
cytologically confirmed extra-pulmonary small cell carcinomas (Phase II).
- Age greater than or equal to 18 years
- Subjects must have evaluable or measurable disease.
- ECOG performance status less than or equal to 2
- Adequate organ function
Design:
- This is an open label Phase I/II trial accruing initially one cohort to determine
maximum tolerated dose (MTD) of combined treatment of PLX038 and rucaparib (Phase I);
and to examine the safety and efficacy of PLX038 in combination with rucaparib in the
following cohort (Phase II).
- PLX038 will be administered by IV infusion on day 1 of every 21-days cycle, rucaparib
will be administered PO twice daily on days 5 to 19 of every cycle.
- Treatment will continue until progression or unacceptable toxicity.
- Biomarkers of participants response to treatment will be investigated in an exploratory
manner pre and post-treatment.
Trial Arms
Name | Type | Description | Interventions |
---|
1/Arm 1 | Experimental | Escalating doses of PLX038 and rucaparib | |
2/Arm 2 | Experimental | MTD of PLX038 and rucaparib | |
Eligibility Criteria
- INCLUSION CRITERIA:
- Subjects with:
- histologically confirmed solid tumors (Phase I), OR
- histologically or cytologically confirmed SCLC (Phase II), OR
- histologically or cytologically confirmed extra-pulmonary small cell carcinomas
(Phase II).
- Age greater than or equal to 18 years. Because no dosing or adverse event data are
currently available on the use of PLX038 in combination with rucaparib in participants
<18 years of age, children are excluded from this study, but will be eligible for
future pediatric trials.
- Subjects must have progressed on or after standard first-line systemic chemotherapy.
- Participants must have disease that is not amenable to potentially curative resection.
- Participants must have measurable disease per RECIST 1.1. See Section 6.3 for the
evaluation of measurable disease.
- Participants with asymptomatic brain metastases and treated brain metastases are
eligible.
- ECOG performance status less than or equal to 2.
- Adequate hematological function defined by:
- white blood cell (WBC) count greater than or equal to 3 x 10(9)/L,
- absolute neutrophil count (ANC) greater than or equal to 1.5 x10(9)/L,
- platelet count greater than or equal to 100 x 10(9)/L,
- Hgb greater than or equal to 9 g/ dL
- Adequate hepatic function defined by:
- a total bilirubin level less than or equal to 1.5 x ULN,
- an AST level less than or equal to 2.5xULN, (less than or equal to 5X ULN if
liver metastasis)
- an ALT level less than or equal to 2.5 xULN, (less than or equal to 5X ULN if
liver metastasis).
- Adequate renal function defined by:
- Creatinine OR Measured or calculated creatinine clearance (CrCl) (eGFR may also
be used in place of CrCl): < 1.5x institution upper limit of normal OR greater
than or equal to 45 mL/min/1.73 m(2) for participant with creatinine levels
greater than or equal to 1.5 X institutional ULN.
Note: Creatinine clearance (CrCl) or eGFR should be calculated per institutional standard.
- The effects of the study treatment on the developing human fetus are unknown; thus,
women of childbearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry, for
the duration of study treatment and up to 6 months after the last dose of the study
drug (s). Should a woman become pregnant or suspect she is pregnant while she or her
partner is participating in this study, she should inform her treating physician
immediately.
- Subjects must be able to understand and willing to sign a written informed consent
document.
EXCLUSION CRITERIA:
- Participants who are receiving any other investigational agents.
- Systemic anti-cancer treatment or major surgery within 2 weeks prior to enrollment.
- Radiotherapy within 24 hours prior to enrollment.
- Participants who require treatment with strong inhibitors or inducers of CYP3A or with
UGT1A1 inhibitors during the planned period of investigational treatment with PLX038.
- Participants with known Gilbert s syndrome.
- Participants homozygous for the UGT1A1*28 variant allele with severely reduced UGT1A1
activity.
- Participants with known HIV, HCV, HBV status on antiviral drugs are excluded due to
the absence of previous experience with concurrent use of antiviral medications and
the investigational drug product to be evaluated in the current study and possible for
adverse pharmacokinetic and/or pharmacodynamic interactions.
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to PLX038 or rucaparib.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that may impair the participants
tolerance of study treatments.
- Pregnant women are excluded from this study because PEGSN38 and rucaparib potential
for teratogenic or abortifacient effects are unknown. Because there is an unknown but
potential risk for adverse events in nursing infants secondary to treatment of the
mother with PEGSN38 and rucaparib, breastfeeding should be discontinued if the mother
is treated with study drugs.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Phase I: MTD |
Time Frame: | Phase I |
Safety Issue: | |
Description: | Identify the maximum tolerated dose (MTD) of PLX038 in combination with rucaparib. |
Secondary Outcome Measures
Measure: | Clinical response rate |
Time Frame: | Disease progression |
Safety Issue: | |
Description: | The fraction of patients who experience a clinical response (CR+PR) will be reported along with a 95% confidence interval. |
Measure: | Overall survival |
Time Frame: | Death |
Safety Issue: | |
Description: | Among participants in the phase IIA cohort, median overall survival (OS) will be calculated from the on-study date using the Kaplan-Meier method, along with 95% confidence intervals on the median OS. |
Measure: | Progression-free survival |
Time Frame: | Disease progression |
Safety Issue: | |
Description: | Among partaicipants in the phase IIA cohort, median progression free survival (PFS) will be calculated from the on-study date using the Kaplan-Meier method, along with 95% confidence intervals on the median PFS. |
Measure: | Toxicities |
Time Frame: | Phase I and phase II |
Safety Issue: | |
Description: | The safety of the treatment will be monitored, and any toxicities identified will be reported by type and grade. |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | National Cancer Institute (NCI) |
Trial Keywords
- PARP Inhibitor
- Chemotherapy
- DDR Inhibitor
Last Updated
June 7, 2021