Clinical Trials /

Testing the Addition of an Anti-cancer Drug, BAY 1895344 ATR Inhibitor, to the Chemotherapy Treatment (Gemcitabine) for Advanced Pancreatic and Ovarian Cancer, and Advanced Solid Tumors

NCT04616534

Description:

This phase I trial identifies the best dose, possible benefits and/or side effects of gemcitabine in combination with BAY 1895344 in treating patients with pancreatic, ovarian, and other solid tumors that have spread to other places in the body (advanced). Gemcitabine is a chemotherapy drug that blocks the cell from making DNA and may kill tumor cells. BAY 1895344 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving gemcitabine and BAY 1895344 in combination may shrink or stabilize cancer.

Related Conditions:
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Testing the Addition of an Anti-cancer Drug, BAY 1895344 ATR Inhibitor, to the Chemotherapy Treatment (Gemcitabine) for Advanced Pancreatic and Ovarian Cancer, and Advanced Solid Tumors
  • Official Title: Phase 1 Trial of Gemcitabine Combined With the BAY 1895344 ATR Inhibitor With Expansion Cohorts in Advanced Pancreatic and Ovarian Cancer

Clinical Trial IDs

  • ORG STUDY ID: NCI-2020-08370
  • SECONDARY ID: NCI-2020-08370
  • SECONDARY ID: 10403
  • SECONDARY ID: 10403
  • SECONDARY ID: UM1CA186709
  • NCT ID: NCT04616534

Conditions

  • Advanced Fallopian Tube Carcinoma
  • Advanced Malignant Solid Neoplasm
  • Advanced Ovarian Carcinoma
  • Advanced Pancreatic Adenocarcinoma
  • Advanced Primary Peritoneal Carcinoma
  • High Grade Fallopian Tube Serous Adenocarcinoma
  • High Grade Ovarian Serous Adenocarcinoma
  • Metastatic Pancreatic Adenocarcinoma
  • Platinum-Resistant Fallopian Tube Carcinoma
  • Platinum-Resistant Ovarian Carcinoma
  • Platinum-Resistant Primary Peritoneal Carcinoma
  • Primary Peritoneal High Grade Serous Adenocarcinoma
  • Stage II Pancreatic Cancer AJCC v8
  • Stage IIA Pancreatic Cancer AJCC v8
  • Stage IIB Pancreatic Cancer AJCC v8
  • Stage III Fallopian Tube Cancer AJCC v8
  • Stage III Ovarian Cancer AJCC v8
  • Stage III Pancreatic Cancer AJCC v8
  • Stage III Primary Peritoneal Cancer AJCC v8
  • Stage IIIA Fallopian Tube Cancer AJCC v8
  • Stage IIIA Ovarian Cancer AJCC v8
  • Stage IIIA Primary Peritoneal Cancer AJCC v8
  • Stage IIIA1 Fallopian Tube Cancer AJCC v8
  • Stage IIIA1 Ovarian Cancer AJCC v8
  • Stage IIIA2 Fallopian Tube Cancer AJCC v8
  • Stage IIIA2 Ovarian Cancer AJCC v8
  • Stage IIIB Fallopian Tube Cancer AJCC v8
  • Stage IIIB Ovarian Cancer AJCC v8
  • Stage IIIB Primary Peritoneal Cancer AJCC v8
  • Stage IIIC Fallopian Tube Cancer AJCC v8
  • Stage IIIC Ovarian Cancer AJCC v8
  • Stage IIIC Primary Peritoneal Cancer AJCC v8
  • Stage IV Fallopian Tube Cancer AJCC v8
  • Stage IV Ovarian Cancer AJCC v8
  • Stage IV Pancreatic Cancer AJCC v8
  • Stage IV Primary Peritoneal Cancer AJCC v8
  • Stage IVA Fallopian Tube Cancer AJCC v8
  • Stage IVA Ovarian Cancer AJCC v8
  • Stage IVA Primary Peritoneal Cancer AJCC v8
  • Stage IVB Fallopian Tube Cancer AJCC v8
  • Stage IVB Ovarian Cancer AJCC v8
  • Stage IVB Primary Peritoneal Cancer AJCC v8
  • Unresectable Pancreatic Adenocarcinoma

Interventions

DrugSynonymsArms
ElimusertibATR Inhibitor BAY1895344, ATR Kinase Inhibitor BAY1895344, BAY 1895344, BAY-1895344, BAY1895344Treatment (gemcitabine, BAY 1895344)
GemcitabinedFdC, dFdCyd, DifluorodeoxycytidineTreatment (gemcitabine, BAY 1895344)

Purpose

This phase I trial identifies the best dose, possible benefits and/or side effects of gemcitabine in combination with BAY 1895344 in treating patients with pancreatic, ovarian, and other solid tumors that have spread to other places in the body (advanced). Gemcitabine is a chemotherapy drug that blocks the cell from making DNA and may kill tumor cells. BAY 1895344 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving gemcitabine and BAY 1895344 in combination may shrink or stabilize cancer.

Detailed Description

      PRIMARY OBJECTIVES:

      I. Evaluate the safety and tolerability of gemcitabine in combination with elimusertib (BAY
      1895344), as assessed by Common Terminology Criteria for Adverse Events (CTCAE) 5.0. (Dose
      Escalation and Expansion Cohort) II. Determine the maximum tolerated dose (MTD) of
      gemcitabine in combination with BAY 1895344. (Dose Escalation Cohort)

      SECONDARY OBJECTIVES:

      I. To observe and record anti-tumor activity. II. Analyze the pharmacokinetic (PK) profile of
      the gemcitabine and BAY 1895344 combination.

      III. Assessing whether immunohistochemical markers of deoxyribonucleic acid (DNA) damage,
      gamma-H2AX and phosphorylated (p)NBS1, increase in on-treatment biopsies compared to the
      levels seen in pre-treatment biopsies.

      EXPLORATORY OBJECTIVES:

      I. Explore biomarkers that predict response to this combination. II. Evaluate mechanisms of
      acquired resistance to this combination.

      OUTLINE: This is a dose-escalation study of gemcitabine followed by a dose expansion study.

      Patients receive gemcitabine intravenously (IV) over 30 minutes on days 1 and 8 and BAY
      1895344 orally (PO) twice daily (BID) on days 1-3 and 8-10. Cycles repeat every 21 days in
      the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up for 30 days.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (gemcitabine, BAY 1895344)ExperimentalPatients receive gemcitabine IV over 30 minutes on days 1 and 8 and BAY 1895344 PO BID on days 1-3 and 8-10. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  • Elimusertib
  • Gemcitabine

Eligibility Criteria

        Inclusion Criteria:

          -  DOSE ESCALATION COHORT:

          -  Patients must have histologically confirmed solid tumor malignancy that is not curable
             with standard approaches. Gemcitabine must be considered a standard therapy for the
             participant's malignancy

          -  Patients must have a measurable disease, in at least one lesion, for both the dose
             escalation and expansion cohorts, as defined by Response Evaluation Criteria in Solid
             Tumors (RECIST) version (v)1.1

          -  Patients must have received one line of treatment for their incurable cancer before
             enrolling in this trial. Patients with rare malignancies for which there is no
             accepted standard chemotherapy regimen can enroll without any prior treatments

          -  Patients must not have received more than two lines of cytotoxic chemotherapy

               -  Patients can have received prior gemcitabine

               -  Adjuvant chemotherapy is counted as one line of treatment if patients received it
                  within 6 months of their cancer recurring

               -  There is no limit for lines of prior targeted therapies or immunotherapy

               -  Patients who received a prior PARP inhibitor must have had progressive disease,
                  or intolerable toxicity, on the PARP inhibitor prior to enrolling on the study

          -  DOSE EXPANSION COHORT:

          -  Participants must have a histologically confirmed advanced pancreatic adenocarcinoma
             or ovarian cancer (high grade serous ovarian, primary peritoneal or fallopian tube
             cancer) that is not curable with standard approaches. Patients with both metastatic
             pancreatic cancer and unresectable pancreatic cancer are eligible

          -  Ovarian cancer:

               -  Patients with ovarian cancer must have platinum-resistant disease, defined as
                  progression within 6 months after the last platinum regimen

               -  Patients with ovarian cancer cannot have received more than one prior regimen in
                  the platinum-resistance setting

          -  Pancreatic cancer:

               -  Patients with pancreatic cancer cannot have received more than one line of
                  cytotoxic chemotherapy in the metastatic setting

                    -  Adjuvant chemotherapy is not counted as one line of treatment, if patients
                       received it more than 6 months prior to their cancer recurring

               -  There is no limit for lines of prior targeted therapies, such as PARP inhibitors,
                  or immunotherapy

          -  Patients must have a biopsiable disease and at least one separate measurable lesion

          -  DOSE ESCALATION AND EXPANSION COHORTS:

          -  Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)

          -  Leukocytes >= 3,000/mcL

          -  Hemoglobin >= 10 g/dL (no red blood cell transfusion is allowed within 3 weeks before
             starting the trial)

          -  Neutrophil count >= 1,500 K/mcL (participants must not have received colony
             stimulating factors [e.g., granulocyte colony-stimulating factor, granulocyte
             macrophage colony stimulating factor or recombinant erythropoietin] within 3 weeks
             before initiation of protocol therapy)

          -  Platelets >= 100,000 /mcL

          -  Albumin >= 2.8 mg/dL

          -  Total bilirubin =< 1.5 x institutional upper limit of normal (ULN)

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) /
             alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 3 x
             institutional ULN

          -  Creatinine clearance =< 1.5 x institutional ULN OR glomerular filtration rate (GFR) >=
             50 mL/min/1.73 m^2

          -  Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral
             therapy with undetectable viral load within 6 months are eligible for this trial

          -  For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral
             load must be undetectable on suppressive therapy, if indicated

          -  Patients with a history of hepatitis C virus (HCV) infection must have been treated
             and cured. For patients with HCV infection who are currently on treatment, they are
             eligible if they have an undetectable HCV viral load

          -  Patients with treated brain metastases or primary brain tumors are eligible if
             follow-up brain imaging after central nervous system (CNS)-directed therapy shows no
             evidence of progression for >= 4 weeks after the last date of treatment are permitted,
             and if they are no longer taking corticosteroids for at least 4 weeks prior to
             beginning the protocol

          -  Patients with a prior or concurrent malignancy whose natural history or treatment does
             not have the potential to interfere with the safety or efficacy assessment of the
             investigational regimen are eligible for this trial with permission of the principle
             investigator of the trial

          -  Patients with known history or current clinically significant symptoms of cardiac
             disease, or history of treatment with cardiotoxic agents, should have a clinical risk
             assessment of cardiac function using the New York Heart Association functional
             classification. To be eligible for this trial, patients should be class 2B or better

          -  The effects of BAY 1895344 on the developing human fetus are unknown. For this reason
             and because DNA-damage response inhibitor agents as well as other therapeutic agents
             used in this trial are known to be teratogenic, women of child-bearing potential and
             men must agree to use adequate contraception (hormonal or barrier method of birth
             control; abstinence) prior to study entry and for the duration of study participation
             and for 6 months after completion of BAY 1895344 administration. 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. Men treated or enrolled
             on this protocol must also agree to use adequate contraception prior to the study, for
             the duration of study participation, and 6 months after completion of BAY 1895344
             administration

          -  Ability to understand and the willingness to sign a written informed consent document

        Exclusion Criteria:

          -  Patients cannot receive chemotherapy, targeted therapy or immunotherapy within 3 weeks
             of study entry

          -  Patients who have had radiotherapy within 4 weeks prior to entering the study

          -  Patients who have not recovered from adverse events due to prior anti-cancer therapy
             (i.e., have residual toxicities > grade 1) with the exception of alopecia and
             lymphopenia

          -  Participants must not have received investigational therapy administered =< 4 weeks or
             within a time interval less than at least five half-lives of the investigational
             agent, whichever is longer, before initiation of protocol therapy

          -  Participants with known untreated brain metastases are excluded from this clinical
             trial

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to BAY 1895344 or gemcitabine

          -  Patients receiving any medications that are substrates of CYP3A4 with a narrow
             therapeutic window, or strong inhibitors/inducers of CYP3A4 are ineligible, if they
             cannot be transferred to alternative medication. Because the lists of these agents are
             constantly changing, it is important to regularly consult a frequently-updated medical
             reference. As part of the enrollment/informed consent procedures, the patient will be
             counseled on the risk of interactions with other agents, and what to do if new
             medications need to be prescribed or if the patient is considering a new
             over-the-counter medicine or herbal product

          -  Patients with uncontrolled intercurrent illness including but not limited to ongoing
             or active infection, symptomatic congestive heart failure, unstable angina pectoris,
             clinically significant cardiac arrhythmia, uncontrolled major seizure disorder,
             unstable spinal cord compression, superior vena cava syndrome or psychiatric
             illness/social situations that would limit compliance with study requirements are
             excluded

          -  Patients with psychiatric illness/social situations that would limit compliance with
             study requirements

          -  Pregnant women are excluded from this study because BAY 1895344 as a DNA-damage
             response inhibitor, and gemcitabine may have the potential for teratogenic or
             abortifacient effects. Because there is an unknown but potential risk for adverse
             events in nursing infants secondary to treatment of the mother with BAY 1895344
             breastfeeding should be discontinued if the mother is treated with BAY 1895344 and for
             4 months after end of treatment. These potential risks may also apply to other agents
             used in this study

          -  Patients who have successfully undergone treatment for another, unrelated clinically
             relevant cancer, >= 3 years post final treatment, are eligible to participate in this
             study

          -  Patients cannot have received radiation to more than 25% of their hematopoietically
             active bone marrow. Pelvic radiation is considered to affect 25% of the
             haematopoietically active bone marrow, and only one prior course of pelvic radiation
             is allowed (Hayman et al., 2011)

          -  Patients previously treated with an ATR inhibitor are excluded

          -  Participants who have undergone major surgery =< 4 weeks before initiating protocol
             therapy must have sufficiently recovered from adverse events caused by the procedure,
             as judged by the treating investigator

          -  Subjects with a gastrointestinal disorder or malabsorption that could potentially
             affect the absorption of the study drug are excluded

          -  Participants with a history of a clinically relevant second primary malignancy within
             the past 2 years are excluded. Exceptions include resected basal and squamous cell
             carcinomas of the skin and completely resected carcinoma in situ of any type

          -  Patients not able to swallow tablets

          -  For the Dose Expansion Cohort, patients who cannot safely undergo tumor biopsies are
             excluded
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of adverse events
Time Frame:Up to 1 year
Safety Issue:
Description:The toxicity of the combination of gemcitabine plus BAY1895344 will be assessed with Common Terminology Criteria for Adverse Events (CTCAE) v. 5.0 criteria.

Secondary Outcome Measures

Measure:Pharmacokinetic (PK) profile of BAY1895344 in combination with gemcitabine
Time Frame:Day 1 of dose-escalation phase
Safety Issue:
Description:Individual PK parameters will be estimated for the maximum concentration (Cmax), area under the concentration-time curve (AUC), half-life (t1/2), apparent clearance (Cl/F) and apparent volume of distribution (V/F), as feasible with non-compartmental methods. The PK variables will be tabulated, and descriptive statistics (e.g., geometric means and coefficients of variation) will be calculated for each dose level. PK parameters will be reported descriptively.
Measure:Gemcitabine pharmacokinetics
Time Frame:Days 1 and 8 of dose-escalation
Safety Issue:
Description:The CDA phenotype will be correlated with gemcitabine half-life, AUC and the dFdU/gemcitabine metabolic ratio.
Measure:Presence or absence of homologous recombination (HR) repair proficiency
Time Frame:Pre-treatment to time of disease progression, assessed up to 1 year
Safety Issue:
Description:Will be defined according to formation of RAD51 foci. Will also be evaluated in relation to the clinical outcomes of ORR and PFS time.
Measure:Presence or absence of replication stress
Time Frame:Pre-treatment to time of disease progression, assessed up to 1 year
Safety Issue:
Description:Will be defined at the gene expression and protein levels for phosphorylated (p)KAP1, pRPA32, cyclin E and MYC. Will also be evaluated in relation to the clinical outcomes of ORR and PFS time.
Measure:Presence or absence of ATR activation
Time Frame:Pre-treatment to time of disease progression, assessed up to 1 year
Safety Issue:
Description:Will be defined by the expression of pATR and pCHK1. Will also be evaluated in relation to the clinical outcomes of ORR and PFS time.
Measure:Conversion of cancer with stable replication forks to one with unstable replication forks
Time Frame:Pre-treatment to time of disease progression, assessed up to 1 year
Safety Issue:
Description:DNA fiber assays will be used to assess whether gemcitabine/BAY1895344 treatment converts a cancer with stable replication forks to one with unstable replication forks. Will also be evaluated in relation to the clinical outcomes of ORR and PFS time.
Measure:Increase in deoxyribonucleic acid (DNA) damage level (expansion cohort)
Time Frame:Pre-treatment and on-treatment
Safety Issue:
Description:Changes in immunohistochemical markers of DNA damage, gamma-H2AX and phosphorylated (p)NBS1.

Details

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

Last Updated

July 6, 2021