Clinical Trials /

LCI-BRE-MTN-NIR-001:Ph I Study of Niraparib in Combo With Standard Chemo in Metastatic Trip Neg Breast Cancer

NCT04762901

Description:

This is an open-label, two-stage, multi-arm Phase 1 study designed to evaluate the safety and preliminary efficacy of combining niraparib with four standard chemotherapy regimens used to treat TNBC.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Withdrawn

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: LCI-BRE-MTN-NIR-001:Ph I Study of Niraparib in Combo With Standard Chemo in Metastatic Trip Neg Breast Cancer
  • Official Title: LCI-BRE-MTN-NIR-001: A Phase I Study of Niraparib in Combination With Standard Chemotherapy in Metastatic Triple-Negative Breast Cancer

Clinical Trial IDs

  • ORG STUDY ID: LCI-BRE-MTN-NIR-001
  • SECONDARY ID: 00048055
  • NCT ID: NCT04762901

Conditions

  • Breast Cancer

Interventions

DrugSynonymsArms
NiraparibZEJULAStage 1 Arm 1
DoxorubicinStage 1 Arm 1
CyclophosphamideStage 1 Arm 1
PaclitaxelStage 1 Arm 3
PegfilgrastimStage 1 Arm 1
CarboplatinStage 1 Arm 4

Purpose

This is an open-label, two-stage, multi-arm Phase 1 study designed to evaluate the safety and preliminary efficacy of combining niraparib with four standard chemotherapy regimens used to treat TNBC.

Detailed Description

      Niraparib is an oral, selective poly ADP ribose polymerase (PARP)-1 and PARP-2 inhibitor. A
      strategy of combining a PARP inhibitor, as a chemopotentiator, with chemotherapy is a
      promising approach in the treatment of triple-negative breast cancer. This study will
      evaluate the combination of niraparib with several standard chemotherapy regimens used to
      treat breast cancer to determine a recommended Stage 2 dose (RS2D) of chemotherapy regimens
      with niraparib. Stage 1 will be conducted in subjects with metastatic TNBC and will include 4
      chemotherapy treatment arms in escalating dose levels (Arm 1: doxorubicin + cyclophosphamide
      (AC) every 14 days with pegfilgrastim (or biosimilar) for 4 cycles followed by AC every 21
      days; Arm 2: AC every 21 days; Arm 3: weekly paclitaxel; Arm 4: weekly paclitaxel +
      carboplatin every 21 days), each combined with oral daily niraparib. Treatment will continue
      until disease progression, unacceptable toxicity, or subject withdrawal.Stage 2 will be
      conducted in subjects with non-metastatic TNBC. Subjects will receive neoadjuvant
      chemotherapy with either AC every 14 days (Arm 1A) or every 21 days (Arm 2A) at the RS2D of
      chemotherapy combined with oral daily niraparib from Stage 1. Treatment will continue for 4
      cycles.
    

Trial Arms

NameTypeDescriptionInterventions
Stage 1 Arm 1ExperimentalNiraparib 100 mg orally once daily, Doxorubicin and Cyclophosphamide (AC) IV every 14 days with pegfilgrastim (or biosimilar) for 4 cycles, followed by AC IV every 21 days
  • Niraparib
  • Doxorubicin
  • Cyclophosphamide
  • Pegfilgrastim
Stage 1 Arm 2ExperimentalNiraparib 100 mg orally once daily, Doxorubicin and Cyclophosphamide (AC) IV every 21 days
  • Niraparib
  • Doxorubicin
  • Cyclophosphamide
Stage 1 Arm 3ExperimentalNiraparib 100 mg orally once daily, Paclitaxel IV Days 1, 8, 15, and 22 every 28 days
  • Niraparib
  • Paclitaxel
Stage 1 Arm 4ExperimentalNiraparib 100 mg orally once daily, Paclitaxel IV Days 1, 8, and 15 every 21 days and carboplatin IV every 21 days
  • Niraparib
  • Paclitaxel
  • Carboplatin
Stage 2 Arm 1ExperimentalNiraparib 100 mg orally once daily, Doxorubicin and Cyclophosphamide (AC) IV every 14 days with pegfilgrastim (or biosimilar) for 4 cycles
  • Niraparib
  • Doxorubicin
  • Cyclophosphamide
  • Pegfilgrastim
Stage 2 Arm 2ExperimentalNiraparib 100 mg orally once daily, Doxorubicin and Cyclophosphamide (AC) IV every 21 days
  • Niraparib
  • Doxorubicin
  • Cyclophosphamide

Eligibility Criteria

        Inclusion Criteria

        Subject must meet all of the following applicable inclusion criteria to participate in this
        study:

          1. Able to understand and willing to provide written informed consent and HIPAA
             authorization for release of personal health information. NOTE: HIPAA authorization
             may be included in the informed consent or obtained separately.

          2. Male or female and age ≥ 18 years at the time of consent.

          3. ECOG Performance Status of 0, 1 or 2 (Stage 1), or 0-1 (Stage 2) within 14 days prior
             to day 1 of treatment.

          4. Histologically or cytologically confirmed hormone receptor negative tumor (estrogen
             and progesterone) on pathology immunohistochemistry (IHC) assessment defined as <10%
             staining and HER2-negative, non-overexpressing defined by an IHC 0 or 1+ or
             fluorescence in-situ hybridization (FISH) HER2:CEP17 ratio < 2.0 with an average HER2
             gene copy number of <4 signals/nucleus, and:

             Stage 1 (metastatic):

             a. Measurable (by RECIST v1.1) or evaluable lesions

             Stage 2 (non-metastatic, treatment naïve, with no prior excisional
             biopsy/lumpectomy/LND staging):

               1. Primary tumor size ≥ 2 cm by at least one radiographic or clinical measurement.
                  NOTE: this requirement does not apply to subjects with inflammatory TNBC.

               2. Clinical stage at presentation: cT1c-cT4, cN0-cN3

          5. Tumor tissue:

             Stage 1:

             Willing to provide tumor tissue for research purposes. Fresh biopsy of metastatic
             lesion prior to day 1 of treatment preferred if feasible. If fresh biopsy of
             metastatic lesion is not feasible, fresh biopsy can be obtained from the primary tumor
             site (i.e. breast). Tumor tissue from bone metastases is not acceptable. If fresh
             biopsy from metastatic tumor or primary tumor site is not possible, archival tumor
             tissue (formalin-fixed paraffin embedded [FFPE] or tumor block) may be used as long as
             it is from within 12 months of study entry. NOTE: If tissue is not available within
             required timeframe (i.e., either fresh or archival) subject will still be eligible for
             trial.

             Stage 2:

             Willing to undergo fresh biopsy of the primary tumor prior to day 1 of treatment for
             research purposes (breast is preferred; lymph node is acceptable). If not clinically
             feasible, then provide archived tumor tissue (FFPE or tumor block) of the primary
             tumor within 12 months of study entry. If archived tissue will be submitted rather
             than fresh biopsy, the archived tissue must be assessed and documented by pathology to
             ensure adequate tumor is present for correlative analysis. NOTE: For subjects who do
             not have archival tumor tissue available within required timeframe or if archival
             tissue insufficient, a pre-treatment core biopsy of the primary breast tumor must be
             obtained. If subjects have inflammatory breast cancer and a core biopsy is not
             possible, consideration can be given to obtain a skin punch biopsy.

          6. Demonstrate adequate organ function as defined in the table below; all screening labs
             to be obtained within 14 days prior to day 1 of treatment.

               -  Absolute Neutrophil Count (ANC): greater than or equal to 1,000/µL

               -  Platelet Count greater than or equal to 100,000/µL without platelet transfusion
                  within 4 weeks of day 1 of treatment

               -  Hemoglobin (Hgb): greater than or equal to 9 g/dL without red blood cell
                  transfusion within 4 weeks of day 1 of treatment

               -  Serum creatinine (SCr): less than or equal to 1.5 × upper limit of normal (ULN)

          7. For subjects anticipated to receive anthracyclines, adequate cardiac function as
             defined by ≥50% Left Ventricular Ejection Fraction (LVEF) by ECHO or MUGA within 28
             days prior to day 1 of treatment.

          8. Females of childbearing potential (FCBP) must have a negative serum pregnancy test
             within 7 days prior to day 1 of treatment and documented. NOTE: Females are considered
             of childbearing potential unless they are surgically sterile (have undergone a
             hysterectomy, bilateral salpingectomy, or bilateral oophorectomy) or are
             postmenopausal (>45 years of age and at least 12 consecutive months with no menses
             without an alternative medical cause).

          9. FCBP must be willing to use a highly effective contraceptive method (i.e., highly
             effective achieves a failure rate of <1% per year when used consistently and
             correctly) or a combination method from the time of informed consent until 30 days
             after treatment discontinuation. Contraceptive methods with low user dependency are
             preferable but not required.

             Acceptable methods of contraception (highly effective) are:

             Single method (one of the following is acceptable):

               -  Non-hormonal Intrauterine device (IUD)

               -  Vasectomy of a female subject's partner

               -  Sexual abstinence is considered a highly effective method only if defined as
                  refraining from heterosexual intercourse during the entire period of risk
                  associated with the study treatments.

             Combination method (requires use of two of the following):

               -  Diaphragm with spermicide (Cannot be used in conjunction with cervical
                  cap/spermicide)

               -  Cervical cap with spermicide (nulliparous women only)

               -  Contraceptive sponge with spermicide (nulliparous women only)

               -  Male condom or female condom (cannot be used together) with spermicide

         10. Male subjects with female partners who are of child-bearing potential, should use a
             highly effective method of contraception during niraparib therapy and for 90 days
             after receiving the last dose of niraparib.

         11. Subjects must agree to not donate blood for 90 days after receiving the last dose of
             niraparib.

         12. Female subjects must agree to not breastfeed during the study or for 30 days after the
             last dose of study treatment and male subjects must not donate sperm during niraparib
             therapy and for 90 days after receiving the last dose of niraparib.

         13. As determined by the enrolling physician, ability of the subject to understand and
             comply with study procedures for the entire length of the study.

         14. Ability to swallow oral medications.

        Stage 1 Exclusion Criteria

        Subjects meeting any of the criteria below may not participate in Stage 1 of the study:

          1. Subject has known active central nervous system (CNS) metastases and/or carcinomatous
             meningitis. Note: Subjects with previously treated brain metastases may participate if
             there is no evidence of disease progression for at least 4 weeks after CNS-directed
             treatment as ascertained by clinical examination and brain imaging (MRI or CT) during
             the screening period, are asymptomatic, have no requirement for steroids, no
             requirement for anticonvulsants, and stable CNS radiographic study showing no
             significant vasogenic edema ≥ 4 weeks since completion of radiation and ≥ 1 week since
             discontinuation of steroids. Carcinomatous meningitis precludes a subject from study
             participation regardless of clinical stability.

          2. More than 3 prior lines of chemotherapy for triple-negative metastatic disease.

          3. Not recovered (i.e., ≥ Grade 1) from adverse events due to agents previously
             administered; NOTE: Subjects with ≤ Grade 2 neuropathy or alopecia of any grade are an
             exception.

          4. Prior chemotherapy within 3 weeks, prior targeted small molecule therapy or radiation
             therapy within 2 weeks, or prior anti-cancer monoclonal antibody for direct
             anti-neoplastic treatment within 3 weeks prior to day 1 of treatment.

          5. History or known allergic reaction to doxorubicin, cyclophosphamide, paclitaxel or
             carboplatin.

          6. For Arm 1, any prior anthracycline exposure.

          7. For Arm 2, prior doxorubicin exposure of > 300 mg/m2 or equivalent anthracycline
             exposure (i.e. epirubicin dose > 540 mg/m2).

        Stage 2 Exclusion Criteria

        Subjects meeting any of the criteria below may not participate in Stage 2 of the study:

          1. Final needle aspirate (FNA) alone to diagnose primary breast cancer.

          2. Excisional biopsy or lumpectomy performed prior to screening.

          3. Surgical axillary staging procedure prior to screening; NOTE: the following procedures
             are permitted prior to screening:

               1. FNA or core biopsy of an axillary node for any subject

               2. Although not recommended, a pre-neoadjuvant therapy sentinel node (SN) biopsy for
                  subjects with clinically negative axillary nodes

          4. Definitive radiologic evidence of metastatic disease.

          5. History of ipsilateral invasive breast cancer regardless of treatment or ipsilateral
             ductal carcinoma in-situ (DCIS) treated with radiotherapy (NOTE: subjects with a
             lobular CIS (LCIS) are eligible).

          6. Treatment including chemotherapy, radiation, and/or targeted therapy administered for
             the currently diagnosed breast cancer prior to screening.

          7. Previous therapy with anthracyclines for any malignancy.

          8. History of known allergic reaction to doxorubicin or cyclophosphamide.

        Overall Exclusion Criteria

        Subjects meeting any of the criteria below may not participate in the study:

          1. Active infection requiring systemic therapy (NOTE: at discretion of investigator,
             subjects with uncomplicated urinary tract infections may be eligible).

          2. Major surgery within 3 weeks of day 1 of treatment.

          3. Pregnant or breastfeeding (NOTE: breast milk cannot be stored for future use while the
             mother is being treated on study).

          4. Has had diagnosis, detection or treatment of another type of cancer ≤ 2 years prior to
             day 1 of treatment (exceptions include basal cell or squamous cell skin cancer, or
             in-situ cervical cancer that has been definitively treated).

          5. Known hypersensitivity to the components of niraparib or the excipients.

          6. Prior treatment with any PARP inhibitor.

          7. Has received any other investigational agents within 4 weeks of day 1 of treatment or
             within a time interval less than at least 5 half-lives of the investigational agent,
             whichever is longer, prior to day 1 of treatment.

          8. Has a known history of Human Immunodeficiency Virus (HIV) or known acquired
             immunodeficiency disorder (AIDS).

          9. Known history or current diagnosis of myelodysplastic syndrome (MDS) or acute myeloid
             leukemia (AML).

         10. Poor medical risk as evidenced by uncontrolled intercurrent illness including, but not
             limited to, uncontrolled hypertension, symptomatic congestive heart failure, unstable
             angina pectoris, cardiac arrhythmia, recent (within 90 days) myocardial infarction;
             uncontrolled major seizure disorder; unstable spinal cord compression; superior vena
             cava syndrome; or any psychiatric or substance abuse disorders or psychiatric
             illness/social situations that would limit compliance with study requirements as
             determined by the investigator.

         11. Received a transfusion (platelets or red blood cells) ≤ 4 weeks of day 1 of treatment.

         12. Subject has a condition (such as transfusion dependent anemia or thrombocytopenia)
             that might confound the results of the study or interfere with the subject's
             participation for the full duration of the study treatment or that makes it not in the
             best interest of the subject to participate.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Stage 1 - Evaluate dose-limiting toxicities (DLT) separately for Arms 1, 2, 3, and 4 and establish recommended Stage 2 dose of chemotherapy in combination with niraparib
Time Frame:up to 28 days
Safety Issue:
Description:The DLT variable will be determined for each subject as a binary variability indicating whether or not subject experienced a protocol-defined DLT.

Secondary Outcome Measures

Measure:Stage 1 - Objective response rate (ORR)
Time Frame:up to 30 days post-treatment discontinuation
Safety Issue:
Description:Objective response will be determined for each subject in Stage 1 as a binary variable indicating whether or not the subject achieved a best overall response of CR or PR
Measure:Stage 1 - Duration of response (DoR)
Time Frame:up to 5 years post-treatment discontinuation
Safety Issue:
Description:Duration of Response (DoR) will be determined for subjects in Stage 1 who experience a PR or better and is defined as the duration of time from the first assessment that determined a CR or PR to the date of the first occurrence of progressive disease or death.
Measure:Stage 1 - Clinical benefit rate (CBR)
Time Frame:up to 30 days post-treatment discontinuation
Safety Issue:
Description:Clinical benefit will be determined for each subject in Stage 1 as a binary variable indicating whether or not the subject achieved a best overall response of CR, PR, or SD
Measure:Stage 1 - Progression free survival (PFS)
Time Frame:up to 5 years post-treatment discontinuation
Safety Issue:
Description:PFS will be determined for all subjects in Stage 1 and is defined as the duration of time from enrollment to the first occurrence of either progressive disease or death.
Measure:Stage 1 - Overall survival (OS)
Time Frame:up to 5 years post-treatment discontinuation
Safety Issue:
Description:Overall survival is defined as the duration of time from enrollment to the date of death from any cause.
Measure:Stage 1 - Cumulative incidence of secondary malignancies including MDS
Time Frame:up to 5 years post-treatment discontinuation
Safety Issue:
Description:Secondary malignancies (including MDS) will be defined as a time to event endpoint and will be calculated from the date of enrollment.
Measure:Stage 1 - Overall safety profile - Adverse Events of Special Interest (AESIs)
Time Frame:up to 30 days post-treatment discontinuation
Safety Issue:
Description:The AESI variable will be determined for each subject as a binary variability indicating whether or not subject experienced a protocol-defined AESI.
Measure:Stage 1 - Overall safety profile - Adverse Events (AEs)
Time Frame:up to 30 days post-treatment discontinuation
Safety Issue:
Description:The AE variable will be determined for each subject as a binary variability indicating whether or not subject experienced an AE per CTCAE V5.0.
Measure:Stage 1 - Overall safety profile - Death on Study Therapy
Time Frame:up to 30 days post-treatment discontinuation
Safety Issue:
Description:The death of study therapy variable will be determined for each subject as a binary variability indicating whether or not subject experienced a Grade 5 event.
Measure:Stage 1 - Overall safety profile - Complete Blood Count with Differential (CBCD)
Time Frame:up to 30 days post-treatment discontinuation
Safety Issue:
Description:The CBCD variable will be collected quantitatively for each subject.
Measure:Stage 1 - Overall safety profile - Comprehensive Metabolic Profile (CMP)
Time Frame:up to 30 days post-treatment discontinuation
Safety Issue:
Description:The CMP variable will be collected quantitatively for each subject.
Measure:Stage 2 - Pathologic complete response (pCR)
Time Frame:up to 4 weeks post-surgery
Safety Issue:
Description:Pathologic complete response (pCR) will be determined for each subject in Stage 2 as a binary variable indicating whether the subject experiences a pCR to neoadjuvant therapy.
Measure:Stage 2 - Clinical complete response (cCR)
Time Frame:up to 4 weeks post-surgery
Safety Issue:
Description:Clinical complete response (cCR) will be determined for each subject in Stage 2 as a binary variable indicating whether the subject experiences a cCR to neoadjuvant therapy.
Measure:Stage 2 - Relapse-free survival
Time Frame:up to 5 years post-treatment discontinuation
Safety Issue:
Description:RFS will be determined for all subjects in Stage 2 and is defined as the duration of time from enrollment to the first occurrence of either disease progression prior to surgery, disease relapse after surgery, or death.
Measure:Stage 2 - Overall survival
Time Frame:up to 5 years post-treatment discontinuation
Safety Issue:
Description:Overall survival is defined as the duration of time from enrollment to the date of death from any cause.
Measure:Stage 2 - Cumulative incidence of secondary malignancies including MDS
Time Frame:up to 5 years post-treatment discontinuation
Safety Issue:
Description:Secondary malignancies (including MDS) will be defined as a time to event endpoint and will be calculated from the date of enrollment.
Measure:Stage 2 - Overall safety profile - Adverse Events of Special Interest (AESIs)
Time Frame:up to 4 weeks post-surgery
Safety Issue:
Description:The AESI variable will be determined for each subject as a binary variability indicating whether or not subject experienced a protocol-defined AESI.
Measure:Stage 2 - Overall safety profile - Adverse Events (AEs)
Time Frame:up to 4 weeks post-surgery
Safety Issue:
Description:The AE variable will be determined for each subject as a binary variability indicating whether or not subject experienced an AE per CTCAE V5.0.
Measure:Stage 2 - Overall safety profile - Serious Adverse Events (SAEs)
Time Frame:up to 4 weeks post-surgery
Safety Issue:
Description:The SAE variable will be determined for each subject as a binary variability indicating whether or not subject experienced a protocol-defined SAE.
Measure:Stage 2 - Overall safety profile - Death on Study Therapy
Time Frame:up to 4 weeks post-surgery
Safety Issue:
Description:The death of study therapy variable will be determined for each subject as a binary variability indicating whether or not subject experienced a Grade 5 event.
Measure:Stage 2 - Overall safety profile - Complete Blood Count with Differential (CBCD)
Time Frame:up to 4 weeks post-surgery
Safety Issue:
Description:The CBCD variable will be collected quantitatively for each subject.
Measure:Stage 2 - Overall safety profile - Comprehensive Metabolic Profile (CMP)
Time Frame:up to 4 weeks post-surgery
Safety Issue:
Description:The CMP variable will be collected quantitatively for each subject.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Withdrawn
Lead Sponsor:Antoinette Tan, MD

Trial Keywords

  • Triple-negative

Last Updated

June 3, 2021