This is a phase II open label, non-randomized, study to evaluate the safety and efficacy of
Ipatasertib (GDC-0068) in combination with paclitaxel in platinum-resistant recurrent
epithelial ovarian cancer.
This is a phase II open label, non-randomized, study to evaluate the safety and efficacy of
Ipatasertib (GDC-0068) in combination with paclitaxel in platinum-resistant recurrent
epithelial ovarian cancer.
The primary objective of the study is to determine - the safety and objective response rate
of treatment with ipatasertib (GDC-0068) in combination with paclitaxel in platinum-resistant
recurrent epithelial ovarian cancer at week 12 for two cohorts of patients: with PI3K/AKT
mutations (altered) and without PI3K/AKT mutations (non-altered)
About 39 patients will participate in the study and the accrual will take place over a course
of 30 months Patients will be treated until disease progression and followed for 1 year
thereafter.
The two drugs are ipatasertib and paclitaxel.
- Ipatasertib will be given 400mg PO daily: day 1-21 of 28 day cycle
- Paclitaxel will be given 80mg/m2 IV weekly: day 1, 8, 15 of 28 day cycle
The study hypothesis is that the combination of Ipatasertib (GDC-0068) plus paclitaxel will
safely induce a tumor response and increase the objective response rate in patients with
platinum-resistant recurrent epithelial ovarian cancer, with or without PI3K/AKT mutations.
This trial will enroll patients with platinum-resistant recurrent epithelial ovarian cancer.
Given the relatively poor prognosis and limited treatment options for these patients, this
population is considered appropriate for trials of novel therapeutic candidates. The
benefit-risk ratio for ipatasertib in combination with paclitaxel is expected to be
acceptable in this setting.
Inclusion Criteria:
- Provision of signed and dated, written informed consent prior to any study specific
procedures, sampling and analyses
o If a patient declines to participate in any voluntary exploratory research and/or
genetic component of the study, there will be no penalty or loss of benefit to the
patient and he/she will not be excluded from other aspects of the study
- Aged at least 18 years at time of signing informed consent
- A pathologic (histology or cytology) confirmed diagnosis of epithelial ovarian cancer,
including fallopian or primary peritoneal cancer
o low grade serous histology is excluded
- Radiographic evidence of recurrent epithelial ovarian cancer (ovarian, fallopian tube,
or primary peritoneal cancer) that has become "platinum-resistant," defined as
progression of disease within 6 months from the last dose of platinum-based
chemotherapy, or platinum refractory
- Not a candidate for cytoreductive surgery
- Measurable disease (at least one lesion that can be accurately assessed repeatedly by
CT or MRI) as evidenced on pre-treatment baseline CT of Chest/Abdomen/Pelvis, MRI, or
PET/CT, or evaluable disease (defined as anything non-measurable- pleural effusions,
lesions <1cm, etc).
- World Health Organization (WHO) performance status 0-1 with no deterioration over the
previous 2 weeks and minimum life expectancy of 12 weeks
- Up to 3 lines of prior cytotoxic chemotherapy
- Previously received bevacizumab
- Has not received weekly paclitaxel-containing regimen, EXCEPT for in the front-line
setting
o Patients with prior paclitaxel reactions may be enrolled if they have been
successfully re-treated with steroid pre-medication in the past
- Patients must use adequate contraceptive measures, should not be breast feeding and
must have a negative pregnancy test prior to start of dosing (within 7 days) if of
child-bearing potential or must have evidence of non-child-bearing potential by
fulfilling one of the following criteria at screening:
- Post-menopausal defined as aged more than 50 years and amenorrhea for at least 12
months following cessation of all exogenous hormonal treatments
- Documentation of irreversible surgical sterilization by hysterectomy, bilateral
oophorectomy or bilateral salpingectomy but not tubal ligation
- For women of childbearing potential: agreement to remain abstinent (refrain from
heterosexual intercourse) or use contraceptive methods with a failure rate of < 1% per
year during the treatment period and for 28 days after the last dose of study
treatment. Women must refrain from donating eggs during this same period.
Exclusion Criteria:
- Treatment with any of the following:
- Any investigational agents or study drugs from a previous clinical study within
28 days of the first dose of study treatment
- Any other chemotherapy, immunotherapy or anticancer agents within 14 days of the
first dose of study treatment
- Potent inhibitors or inducers or substrates of CYP3A4 or substrates of CYP2D6
within 2 weeks before the first dose of study treatment (3 weeks for St John's
Wort)
- Any prior exposure to Ipatasertib
- Major surgery (excluding placement of vascular access) within 4 weeks of the first
dose of study treatment
- Radiotherapy with a wide field of radiation within 4 weeks or radiotherapy with a
limited field of radiation for palliation within 2 weeks of the first dose of study
treatment
- With the exception of alopecia, any unresolved toxicities from prior therapy greater
than Common Terminology Criteria for Adverse Events (CTCAE) grade 1 at the time of
starting study treatment
- Spinal cord compression or brain metastases unless asymptomatic, treated and stable
and not requiring steroids for at least 2 weeks prior to start of study treatment
- Concurrent use of endocrine therapy
- As judged by the investigator, any evidence of severe or uncontrolled systemic
diseases, including active bleeding diatheses, or active infection including hepatitis
B, hepatitis C and human immunodeficiency virus (HIV). Screening for chronic
conditions is not required.
- Any of the following cardiac criteria:
- Any clinically important abnormalities in rhythm, known prolonged QTc, conduction
or morphology of resting ECG, complete left bundle branch block, third degree
heart block
- Experience of any of the following procedures or conditions in the preceding 6
months: coronary artery bypass graft, angioplasty, vascular stent, myocardial
infarction, angina pectoris, congestive heart failure NYHA Grade 2 or greater
- Uncontrolled hypotension - Systolic BP <90mmHg and/or diastolic BP <50mmHg
- Left ventricular ejection fraction (LVEF) below lower limit of normal for site
- Inadequate bone marrow reserve or organ function as demonstrated by any of the
following laboratory values:
- Absolute neutrophil count < 1.5 x 109/L
- Platelet count < 100 x 109/L
- Hemoglobin < 9 g/L
- Alanine aminotransferase > 2.5 times the upper limit of normal (ULN)
- Aspartate aminotransferase > 2.5 times ULN
- Total bilirubin > 1.5 times ULN
- Creatinine >1.5 times ULN concurrent with creatinine clearance < 50 ml/min
(measured or calculated by Cockcroft and Gault equation); confirmation of
creatinine clearance is only required when creatinine is > 1.5 times ULN
- Proteinuria 3+ on dipstick analysis or >500mg/24 hours
- Sodium or potassium outside normal reference range for site
- Peripheral neuropathy grade 2 or greater
- Refractory nausea and vomiting, chronic gastrointestinal diseases, inability to
swallow the formulated product or previous significant bowel resection that would
preclude adequate absorption Ipatasertib
- History of hypersensitivity to Ipatasertib, or drugs with a similar chemical structure
or class to Ipatasertib
- Clinically significant abnormalities of glucose metabolism as defined by any of the
following:
- Diagnosis of type I or type II diabetes mellitus requiring insulin
- A baseline fasting glucose value of ≥ 200 mg/dL (fasting glucose value to be
obtained only if non-fasting glucose >200mg/dL)
- Glycosylated hemoglobin (HbA1C) >7.5%
- Uncontrolled pleural effusion, pericardial effusion, or ascites
- Other malignancies within the past 3 years, with the exception of adequately resected
basal or squamous carcinoma of the skin
- Clinically significant pulmonary symptoms or disease
- Judgment by the investigator that the patient should not participate in the study if
the patient is unlikely to comply with study procedures, restrictions and requirements