Phase II Study of Niraparib and TSR-042 in Patients With Germline or Somatic BRCA1/2 and PALB2-Related Pancreatic Cancer
Phase: PHASE2
Conditions: Metastatic Pancreatic Ductal Adenocarcinoma, Stage IV Pancreatic Cancer AJCC v8
Sponsor: Mayo Clinic

 
 
 
 
 
MC1841 / 18-003525 
 
 
Phase II Study of Niraparib and TSR-042 in Patients with 
Germline or Somatic BRCA1/2 and PALB2-related Pancreatic 
Cancer 
 
 
NCT04493060 
 
 
Document Date: 05/18/2021 

MC1841 
Protocol Version Date: 18May2021 
Mayo Clinic Cancer Center 
MC1841: Phase II Study of Niraparib and TSR-042 in Patients with Germline or Somatic BRCA1/2 
and PALB2-related Pancreatic Cancer 
Sponsor/Principal Investigator: Robert R McWilliams MD 
Mayo Clinic 
200 First Street SW 
Rochester MN 55905 
507/284-2511 
Co-Principal Investigators: 
Kabir Mody MD 
Mayo Clinic 
4500 San Pablo Rd 
Jacksonville FL 32224 
904/953-2790 
Daniel H Ahn DO 
Mayo Clinic  
13400 East Shea Boulevard  
Scottsdale AZ 85259  
480/301-8000 
Co-Investigators: 
Fergus J Couch PhD√ 
Haidong Dong MD PhD √ 
Svetomir N Markovic MD PhD√ 
Statistician: 
Nathan R Foster MS√ 
FDA IND #:  141914 
Trial Supported by:  
Funding: GSK  
Drug Availability:  
Supplied Investigational Agents: niraparib, TSR-042 
Drug Company Supplied: niraparib, TSR-042 (GSK) 
√Study contributor(s) not responsible for patient care 
Document History 
Effective Date 
Amendment 1 
29Dec2020 
Activation 
29Dec2020 
Amendment 2 
pending 
 
 
 
 
 
 
 
 
 
 

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Protocol Resources 
Questions: 
Contact Name: 
Patient eligibility*, test schedule, 
treatment delays/interruptions 
/adjustments, dose modifications, 
adverse events, forms completion 
and submission 
Sharon F Solinger 
Quality Assurance Specialist 
Phone: 507/266-1714 
E-mail: solinger.sharon@mayo.edu 
Drug administration, infusion 
pumps, nursing guidelines 
Lisa Kottschade, APRN CNP 
Phone: 507/266-3570 
E-mail: kottschade.lisa@mayo.edu  
Forms completion and submission  Angela Gosch 
MCR Data Coordinator 
Phone: 507/538-0415 
Email: gosch.angela@mayo.edu  
Nhi Baltazar 
MCR Clinical Coordinator 
Phone: 507/422-6953 
Email: baltazar.nhi@mayo.edu  
LaTarra Davis 
MCF Data Coordinator 
Phone: N/A 
Email:Davis.LaTarra@mayo.edu  
Kaitlin Marrache 
MCF Clinical Coordinator 
Pager: 904/953-4404 
Email:marrache.kaitlin@mayo.edu 
Vincent Vu 
MCA Data Coordinator 
Phone: 480/342-1740 
Email: Vu.Vincent@mayo.edu  
Morgan Hope 
MCA Clinical Coordinator 
Phone: 480/342-6010 
Email: Hope.Morgan@mayo.edu 
Protocol document, consent form, 
regulatory issues 
Mitchell Perrizo, Senior Research Protocol Specialist (Rochester) 
Phone: 507/284-9104 
Email: perrizo.mitchell@mayo.edu 
Laurie Mihalik, Senior Research Protocol Specialist (Arizona) 
Phone: 480/342-3256 
Email: mihalik.laurie@mayo.edu  
Marnisha James, Research Protocol Specialist (Florida) 
Phone: N/A 
Email: James.Marnisha@mayo.edu 
Non-paraffin biospecimens 
Biospecimens Accessioning and Processing (BAP) Service Center 
Website: biospecimens-accessioning-processing-rst  
Phone: 507/538-7898 
Serious Adverse Event Reporting Patricia G McNamara, SAE Coordinator 
E-mail: RSTP2CSAES@mayo.edu  
*No waivers of eligibility allowed 

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Table of Contents 
MC1841: Phase II Study of Niraparib and TSR-042 in Patients with Germline or Somatic BRCA1/2 and 
PALB2-related Pancreatic Cancer ................................................................................................................. 1 
Protocol Resources ........................................................................................................................................ 2 
Table of Contents .......................................................................................................................................... 3 
Schema .......................................................................................................................................................... 4 
1.0 
Background ................................................................................................................................... 5 
2.0 
Goals ........................................................................................................................................... 11 
3.0 
Registration Patient Eligibility .................................................................................................... 12 
4.0 
Test Schedule .............................................................................................................................. 16 
5.0 
Stratification Factors OR Grouping Factor: ................................................................................ 18 
6.0 
Registration/Randomization Procedures ..................................................................................... 18 
7.0 
Protocol Treatment ...................................................................................................................... 20 
8.0 
Dosage Modification Based on Adverse Events ......................................................................... 21 
9.0 
Ancillary Treatment/Supportive Care ......................................................................................... 27 
10.0 
Adverse Event (AE) Monitoring and Reporting ......................................................................... 31 
11.0 
Treatment Evaluation/Measurement of Effect ............................................................................ 43 
12.0 
Descriptive Factors ..................................................................................................................... 51 
13.0 
Treatment/Follow–up Decision at Evaluation of Patient ............................................................ 51 
14.0 
Body Fluid Biospecimens ........................................................................................................... 53 
15.0 
Drug Information ........................................................................................................................ 55 
16.0 
Statistical Considerations and Methodology ............................................................................... 59 
17.0  
Pathology Considerations/Tissue Biospecimens ......................................................................... 63 
18.0 
Records and Data Collection Procedures .................................................................................... 65 
19.0  
Budget ......................................................................................................................................... 66 
20.0 
References ................................................................................................................................... 66 
Appendix I 
ECOG Performance Status ............................................................................................... 68 
Appendix II 
Patient Medication Diary .................................................................................................. 69 
Appendix III 
Examples of confirmed progression ................................................................................. 70 
Appendix IV 
PAXgene Manufacturer’s Recommendations ................................................................... 71 
Appendix V 
Patient Blood Pressure and Heart Rate Monitoring Diary ................................................ 75 
.

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Schema 
 
Registration 
 
 
↓ 
 
 
Treatment with niraparib and TSR-
042 
 
 
↓ 
 
 
Events at any time: 
Disease Progression 
Intolerable adverse effects 
Patient refusal 
 
 
↓ 
 
 
Clinical Follow-up 
 
 
↓ 
 
 
Survival Follow-up 
 
Cycle = 21 days  
Treatment with niraparib and TSR-042 will continue until confirmed progressive disease according to 
iRECIST, clinical progression, intolerable adverse effects or patient/investigators decision, whichever is 
applicable. 
 
Generic name: niraparib 
Brand name(s): ZEJULA® 
Availability: Investigational 
Generic name: TSR-042, dostarlimab 
Brand name(s): N/A 
Availability: Investigational 
 
 
 

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1.0 
Background  
Pancreatic cancer is currently the 4th leading cause of cancer death in the US and will soon cause 
the death of more Americans than breast cancer. Therapies are very limited and largely 
ineffective. In our own data sequencing 3,000 patients with pancreatic cancer (accepted in 
JAMA), approximately 3% of pancreatic cancer patients harbor germline mutations in DNA 
repair genes such as BRCA1/2 and PALB2, and are therefore potential candidates for PARP-
inhibitor therapy. In addition, somatic mutations in Homologous Recombination Repair (HRR) 
genes can confer sensitivity as well, and have been reported to double the number of patients 
potentially eligible for such therapy. Recently, Waddell et al defined 5 subtypes of pancreatic 
adenocarcinoma, with BRCA-like tumors, categorized as such by genomic instability, comprising 
15-20% of pancreatic cancer, with the latter identified as a potential target for immunotherapy 
strategies. (1) In breast and ovarian BRCA-mutant tumors, neoantigen load alone did not 
correlate with T-cell infiltration, suggesting that other therapies to disrupt the tumor 
microenvironment may be necessary to induce an immune response. (2) The Keynote-162 study 
of niraparib and pembrolizumab has validated this approach, with early reports of impressive 
efficacy. Of the first 8 platinum-resistant ovarian cancer patients, 4 had confirmed responses, and 
4 had stable disease. One triple negative breast cancer patient (of 5) had SD for 10 cycles. (3) 
Although unselected trials in pancreatic cancer with immunotherapy alone have yet to be 
successful, we hypothesize that induced genetic variation with PARP inhibition disrupting the 
tumor microenvironment and increasing neoepitope expression can sensitize tumors to immune 
checkpoint inhibition. 
We are currently funded by a Project in our NCI Pancreas SPORE grant to more fully define 
genetic identification of this subset of patients and develop a therapeutic strategy. We have 
developed preliminary data (Figure 1) with RNAseq suggesting that potent PARP inhibition (in 
this case, talazoparib) is associated with gain of novel mutations in pancreas cell lines, even 
compared to cisplatin alone, or irinotecan alone. In addition, double-stranded break repair 
deficient tumors are associated with increased expression of genes involved in antitumor 
immunity, including CD8 positive T cell activators and regulatory molecules, in a similar pattern 
of that seen with MMR deficient tumors. (4)  
We propose that a combination of PARP inhibition and anti-PD1 therapy has valuable therapeutic 
potential in this subset of pancreatic cancer. The strong activity seen in the dose escalation phase 
of Keynote 162 in refractory ovarian and TNBC cancer hold promise for pancreatic cancer as 
well, as long as properly selected patients are enrolled. No reports have been published for the 
combination of PARP inhibition and checkpoint blockade in pancreatic cancer to date. However, 
given the potential for neoepitope formation in patients with defective HRR deficiency upon 
exposure to PARP inhibition, we propose that there could be an additive or synergistic effect of 
the combination in HRR deficient pancreatic cancer. HRR deficient pancreatic cancer has largely 
been defined to date based on mutations in well-established genes such as BRCA1/2 and PALB2. 
However, more DNA repair associated genes are becoming associated with risk for pancreatic 
cancer and may well impact tumor phenotype.  
Therefore, we propose this single arm-cohort study. The goal would be to evaluate the 
combination of niraparib and TSR-042 in patients with germline or somatic mutations in 
BRCA1/2 or PALB2.  

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Pre-clinical data: 
There are in vitro studies to suggest that the immunotherapy in combination with PARP 
inhibition provides synergy.(Higuchi, Flies et al. 2015) In a syngeneic model of breast cancer, 
PARP inhibition was shown to increase PD-L1 expression (Figure 1 from Jiao et al). (Jiao, Xia et 
al. 2017) Additionally in the same set of experiments, to corroborate these findings of extent of 
PARP inhibition (through measurement of PARylation enzyme activity, which are inhibited by 
PARP inhibitors), showed an inverse correlation (Figure 2 – see below). This supports that high 
level of PARP activity suppresses PD-L1 expression or stated another way, PARP inhibition was 
led to increased PD-L1 expression in these tumors.(Jiao, Xia et al. 2017) 
 
 

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Figure 1: PARPi upregulates PD-L1 expression in xenograft tumors. A–C, BT549 (A), SUM149 
(B), andMDA-MB-231 cells (C)were inoculated into the mammary fad pad of nude mice, and the 
mice with established tumors were treated with olaparib or rucaparib. Tumors were then isolated 
to evaluate PD-L1 expression by immunoblotting (A and B) or IHC staining (C). Black 
arrowheads, detected PD-L1 signals. Scale bar, 50 mm.  
[From Open Access Article Jiao et al: (Jiao, Xia et al. 2017)] 
 

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Figure 2: Inverse correlation between PAR and PD-L1 in surgical specimens of breast cancer. 
Top, representative images of IHC staining of PAR and PD-L1 in human breast cancer tissues (n 
¼ 116). Scale bar, 50 mm; bottom, correlation analysis between PAR and PD-L1 was analyzed 
using the Pearson c2 test (P ¼ 0.02). A P value of less than 0.05 was considered to be statistically 
significant. 
[From Open Access Article Jiao et al: (Jiao, Xia et al. 2017)] 
 
PARP inhibition combinatorial strategies: 
PARP inhibitors are being explored in various clinical trials in combination with various other 
classes of drugs.(Drean, Lord et al. 2016) These include chemotherapies, targeted therapies, novel 
targeted therapies, as a radiation sensitizer, endocrine therapies and most recently several trials 
exploring the combination with immunotherapies.(Schaefer, James et al. 2011, Drean, Lord et al. 
2016, Papa, Caruso et al. 2016) This as noted above has been of particular interest in patients with 
homologous-repair related breast and/or ovarian cancers as well as increased interest to study this 

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now in prostate and pancreas cancers.(Javle, Golan et al. 2016, Ang and Tan 2017, Golan and 
Javle 2017, Ramakrishnan Geethakumari, Schiewer et al. 2017, Turk and Wisinski 2018) 
Furthermore, there is some data to support use of immunotherapy for BRCA-related tumors 
whereby immunotherapy alone could potentially be effective.(Matsuo, Spragg et al. 2018) The 
addition of PARP inhibition to further help augment responses in an aggressive disease like 
pancreas cancer would be of further value with rationale to supports its use as outlined. Figure 3 
from a recent review summarizes some of the ways how some of the ‘DNA-damaging’ drugs 
including PARP inhibition can affect the immunogenicity of tumors.(Brown, Sundar et al. 2018)    
 
Figure 3: Mechanisms by which DNA damaging agents affect the immunogenicity of tumors 
From Open Access Article (Brown, Sundar et al. 2018) 
 
Current PARP inhibitor and immunotherapy combination trials: 
At present, there are several clinical trials trying to explore this combination in various tumor 
types where HR-deficiency plays a role. These include but are not limited to the following: 

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From Open Access Article: (Brown, Sundar et al. 2018) Ongoing combination trials with DDR 
and immune checkpoint inhibitors (www.clinicaltrials.gov) 
 
Resources available: 
Mayo Clinic Cancer Center operates in 3 physical sites – Rochester, MN, Phoenix, AZ, and 
Jacksonville, Fl. We have pancreatic cancer expertise at all 3 sites, with annual unique pancreatic 
adenocarcinoma patients seen upwards of 700 patients. TEMPUS, FoundationOne, Carris or 
equivalent testing will be performed on patients as part of standard of care testing. We anticipate 
5-8% of patients to be eligible for cohort based on our experience and published data on 
frequency of BRCA1/2, and PALB2 mutations. Given genomic testing is now done as part of 
standard of care, we anticipate rapid accrual. 

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All 3 sites are fully capable of research blood draws and biopsies. Tissue will be managed in 
FFPE, which will not require special handling or shipping. Fresh samples would also be collected 
for xenograft and/or organoid development and potentially RNA-Seq. There is one Mayo Clinic 
IRB and Cancer Center approval process, and though all 3 sites contract independently, there is 
an internal requirement for budgets to align within a tight range of one another. We have recently 
hired a program coordinator for our pancreas cancer group to speed timelines for trial 
development.  
Publication plan: 
ASCO/ASCI GI, Journal of Clinical Oncology likely in 2019/20 
 
2.0 
Goals  
2.1 
Primary Goal 
To determine antitumor activity as measured by disease control rate at 12 weeks 
(DCR12) as assessed using iRECIST in select homologous recombination repair 
(HRR) deficient pancreatic cancer patients with HRR deficiency (defined as 
mutations in BRCA 1/ 2, or PALB2)  
2.2 
Secondary Goals 
2.21 
To assess adverse events according to the current National Cancer Institute 
(NCI) Common Terminology Criteria for Adverse Events (CTCAE) and 
other safety parameters. 
2.22 
To assess the time to next treatment (TTNT), objective response rate 
(ORR), time to and duration of response and duration of confirmed stable 
disease according to iRECIST. 
2.23 
To assess progression-free survival. 
2.24 
To assess overall survival. 
2.3 
Correlative Research 
2.31 
To assess germline DNA and serum markers of immune response. 
2.32 
To determine changes in circulating tumor DNA (ctDNA) profile after 
therapy with a PARPi and a PD-1 inhibitor. 
2.33 
To study mechanisms of resistance in ctDNA profile after therapy with a 
PARPi and a PD-1 inhibitor. 
2.34 
To assess the tumor microenvironment for immune related changes 
(immune infiltration, PD-L1 and PD-1 expression, tumor-infiltrating 
lymphocytes [TIL]). 
2.35 
To assess genetic profile of the tumor pre- and post-treatment. 
2.36 
To determine changes in the cytokine profile pre- and post-treatment. 
 

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3.0 
Registration Patient Eligibility 
3.1 
Registration - Inclusion Criteria 
3.11 
Presence of either a germline deleterious mutation or somatic deleterious 
mutation in any one of the genes in our proposed gene-panel as 
determined by any of the commercially available or institutional testing 
platforms. 
Note: The somatic mutation could be either on a tissue-based test or the 
circulating tumor DNA (ctDNA)-based assay. The 6 genes that would 
determine eligibility would be: BRCA1/2, PALB2, BARD1, RAD51c, 
RAD51d.  
3.12 
Provide written informed consent 
3.13 
Age ≥ 18 years 
3.14 
Histological/cytological confirmation of diagnosis of metastatic pancreatic 
ductal adenocarcinoma 
3.15 
At least one but no more than two prior lines of systemic therapy for 
metastatic disease (maintenance therapy is not considered a line of 
treatment).  
Note: Patients who have not had any prior chemotherapy can refuse 
chemotherapy and be considered eligible. This refusal and their reason for 
refusal would have to be documented.  
3.16 
Received a platinum agent as part of first or second line treatment (unless 
contraindicated). 
3.17 
ECOG performance status of 0 or 1 
3.18 
Adequate hematologic and end-organ function as evidenced by the 
following ≤14 days prior to registration: 
a. Serum creatinine ≤1.5 x ULN or eGFR ≥60mL/min using the 
Cockroft-Gault Equation  
b. Hemoglobin ≥9.0 g/dL 
c. Absolute neutrophil count ≥1500/μL 
d. Platelets ≥100x109/L 
e. Total bilirubin ≤1.5 x ULN, (2.0 x ULN for subjects with Gilbert’s 
disease) 
f. Aspartate Transaminase (AST) and Alanine Transaminase (ALT) 
≤2.5x ULN (for subjects with hepatic metastases ≤5 x ULN) 
Note: One time repeat testing to meet eligibility is allowed. If more 
testing is required, discuss with PI. 
g. International normalized ratio (INR) or prothrombin time (PT) ≤1.5× 
ULN unless patient is receiving anticoagulant therapy as long as PT or 
partial thromboplastin (PTT) is within therapeutic range of intended 
use of anticoagulants. Activated partial thromboplastin time (aPTT) 
≤1.5× ULN unless patient is receiving anticoagulant therapy as long as 

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PT or PTT is within therapeutic range of intended use of 
anticoagulants 
3.19a Evaluable or measurable disease per iRECIST (See Section 11.0). 
3.19b Life expectancy of ≥3 months 
3.19c Willingness to consent to translational studies 
3.19d Willingness to undergo repeat biopsies of tumor lesions amenable to 
biopsy.  
Note: While biopsies are mandatory, subjects are allowed to participate if 
no lesions are amenable to biopsy, or if biopsy is not possible due to 
safety.  
3.19e Willingness to not donate blood during the study or for 90 days after the 
last dose of study treatment 
3.19f Willingness to not breastfeed during the study or for 90 days after the last 
dose of study treatment 
3.19g Negative pregnancy test done ≤7 days prior to registration, for persons of 
childbearing potential only. 
3.2 
Registration - Exclusion Criteria 
3.21 
Known hypersensitivity to any component of study treatments (either 
niraparib and/or TSR-042 or similar medications).  
3.22 
Prior treatment with the combination of PARP inhibition and 
immunotherapy (either CTLA-4 or anti-PD1/PD-L1 therapies). Prior 
treatment consisting of monotherapy with either PARP inhibitors and/or 
with immunotherapy are allowed. Treatment with PARPi or PD1 inhibitor 
as the most recent treatment prior to enrollment is not allowed.   
3.23 
Patient experienced ≥ Grade 3 immune-related AE with prior 
immunotherapy, with the exception of non-clinically significant lab 
abnormalities. 
3.24 
Radiotherapy ≤ 2 weeks prior to first study treatment or radionuclide 
treatment ≤ 4 weeks of first study treatment. 
3.25 
Live attenuated vaccine administration within 30 days prior to registration 
and/or expected during study period. 
3.26 
Known brain metastases, uncontrolled seizure disorder, or active 
neurologic disease which in the opinion of the investigator would impede 
participation within the trial. Subjects with treated brain metastases are 
allowed to enroll. 
3.27 
Allogenic bone marrow transplantation or high-dose chemotherapy 
requiring hematopoietic stem cell rescue. 
3.28  Received a transfusion (platelets or red blood cells) ≤ 4 weeks prior to 
registration. 

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NOTE: patients are also deemed ineligible if they have received a 
transfusion ≤ 4 weeks prior to first dose of niraparib. 
3.29a  Received colony-stimulating factors (eg, granulocyte colony-stimulating 
factor, granulocyte macrophage colony-stimulating factor, or recombinant 
erythropoietin) ≤ 4 weeks prior to registration. 
NOTE: patients are also deemed ineligible if they have received 
colony-stimulating factors ≤ 4 weeks prior to first dose of niraparib. 
3.29b  Known Grade 3 or 4 anemia, neutropenia or thrombocytopenia due to 
prior chemotherapy that persisted > 4 weeks and was related to the most 
recent treatment. 
3.29c  Known history of myelodysplastic syndrome (MDS) or acute myeloid 
leukemia (AML) 
3.29d ≤ 4 weeks since receiving treatment with another investigational drug, or 
anti-cancer therapy, or within a time interval less than at least 5 half-lives 
of the investigational agent (whichever is shorter), or insufficient recovery 
(to the judgement of the investigator) from adverse events due to such a 
previously administered agent, except for alopecia prior to initiating 
protocol therapy. Bisphosphonate therapy and RANKL inhibitors are not 
considered anti-cancer therapy.  
3.29e Inadequate recovery from toxicity and/or complications from previous 
interventions, including due to major surgery to the judgement of the 
investigator. Minor surgery allowed up to 3 weeks from registration.  
3.29f Primary or secondary immunodeficiency, including immunosuppressive 
disease, and immunosuppressive doses of corticosteroids (e.g., prednisone 
> 20 mg per day during 2 weeks prior to first study treatment) or other 
immunosuppressive medications at dose levels that to the judgement of the 
investigator would preclude participation within the past 4 weeks prior to 
registration. Subjects with HIV who are stable on highly active 
antiretroviral therapy (HAART) will not be excluded. 
3.29g Participant has known active hepatitis B (e.g., hepatitis B surface antigen 
[HBsAg] reactive) or hepatitis C (e.g., hepatitis C virus [HCV] ribonucleic 
acid [qualitative] is detected). 
3.29h  Pregnant or lactating. 
3.29i Clinically significant, active, bacterial infections that, to the judgement of 
the investigator makes it undesirable for the subject to participate in the 
study. 
3.29j Persons of childbearing potential (POCBP) or those capable of causing 
pregnancy whose sexual partners are POCBP who are unwilling or unable 
to use an effective method of contraception for at least 1 month prior to 
study entry, for the duration of the study, and for at least 180 days after the 
last dose of study drug. 

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Nonchildbearing potential is defined as follows (by other than medical 
reasons): 
• ≥45 years of age and has not had menses for >1 year 
• Patients who have been amenorrhoeic for <2 years without history 
of a hysterectomy and oophorectomy must have a follicle 
stimulating hormone value in the postmenopausal range upon 
screening evaluation 
• Post-hysterectomy, post-bilateral oophorectomy, or post-tubal 
ligation. Documented hysterectomy or oophorectomy must be 
confirmed with medical records of the actual procedure or 
confirmed by an ultrasound. Tubal ligation must be confirmed with 
medical records of the actual procedure, otherwise the patient must 
be willing to use an adequate barrier method throughout the study, 
starting with the screening visit through 180 days after the last 
dose of study treatment. Information must be captured 
appropriately within the site’s source documents. Note: Abstinence 
is acceptable if this is the established and preferred contraception 
for the patient. 
3.29k History or active TB (Bacillus Tuberculosis) that in the investigator’s 
opinion would preclude participation within the study. 
3.29l Any gastro-intestinal conditions that to the judgement of the investigator 
would interfere with the absorption of niraparib. 
3.29m Active, known or suspected unstable auto-immune disease, are excluded 
from this study. Exceptions to this criterion are all auto-immune disease 
that have remained stable within the past 3 months on corticosteroids (≤ 
prednisone 20 mg or equivalent) prior to first study treatment are allowed 
to enroll. Patients with autoimmune diseases that do not require active 
immunosuppression are also allowed to enroll. 
Note: Paraneoplastic disease as a cause of auto-immune phenomenon 
will not be considered as auto-immune disease and are allowed to enroll. 
3.29n Evidence of serious uncontrolled medical disorder, active infection or 
mental disorder that, to the judgement of the investigator, makes it 
undesirable for the subject to participate in the study or that would 
jeopardize compliance with the protocol. Examples include, but are not 
limited to, uncontrolled ventricular arrhythmia, recent (within 90 days) 
myocardial infarction, uncontrolled major seizure disorder, unstable spinal 
cord compression, superior vena cava syndrome, or any psychiatric 
disorder that prohibits obtaining informed consent 
3.29o Prior malignancy which required active systemic treatment within 2 years 
prior to first study treatment. Exceptions are: successfully treated 
squamous cell carcinoma of the skin, superficial bladder cancer, and in 
situ carcinoma of the cervix. Since patients with BRCA 1/2 or PALB2 can 
have other tumors, as long as they have been definitively treated, it would 
not be considered an exclusion.  

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4.0 
Test Schedule 
4.1 
Test schedule for niraparib and TSR-042 in Pancreatic Cancer 
 
Screening1 
Baseline2 
Cycle 1 
End of Each 
Cycle 
Clinical Follow-up 
(30 days after EOT) 
Tests and procedures 
≤30 days prior to 
Registration 
≤14 days prior to 
Registration 
Day 8 
Day 15 
Window* 
-30 days 
-14 days 
 
±3 days 
±3 days 
±3 days 
±5 days 
History, physical exam, PS3 
 
X 
X 
 
 
X 
X 
Height 
 
X 
 
 
 
 
 
MSI/MMR status4 
 
X 
 
 
 
 
 
Adverse event assessment 
 
X 
X 
X5 
X6 
X 
X 
Pregnancy test7 
 
X 
X 
 
 
X 
X 
Hematology8 
 
X 
X9 
X 
X 
X 
X 
Chemistry10 
 
X 
X11 
 
 
X 
X 
Thyroid Panel 
 
X 
 
 
 
X12 
X 
Urinalysis 
 
X 
X 
 
 
X 
X 
HBV/HCV test 
X 
 
 
 
 
 
 
PT/PTT/INR 
 
X 
 
 
 
X13 
 
 
1 One time retesting of single or multiple screening assessments is allowed per investigator’s discretion in case patient does not meet specified inclusion and exclusion criteria. 
2 Patients are deemed ineligible if they have received a transfusion or colony-stimulating factors ≤ 4 weeks prior to first dose of niraparib. (refer to Sections 3.28 and 3.29a) 
3 Physical examination includes vital signs (temperature, blood pressure, pulse) and weight; and should be performed at screening and on the days treatment is being administered, 
prior to TSR-042 treatment. Blood pressure and heart rate monitoring will be required weekly for the first 2 months of therapy (until C3D15). After the first 2 months of therapy, 
blood pressure and heart rate monitoring only needs to be checked on D1 of each new cycle. For the weekly checks, monitoring at or near home is acceptable. 
4 Collect and record MSI/MMR status (if known) 
5 Cycle 1 Day 8 Adverse Event Assessments will be done clinically but they will not be captured in Rave until end of cycle for worst grade in the cycle. 
6 Cycle 1 Day 15 Adverse Event Assessments will be done clinically but they will not be captured in Rave until end of cycle for worst grade in the cycle. 
7 Persons of childbearing potential: a serum pregnancy test must be performed ≤7 days prior to registration followed by a confirmatory urine pregnancy test ≤7 days prior to study 
treatment start (if necessary). Pregnancy test will be performed before initiating protocol therapy, every 3 cycles (i.e. end of Cycles 3 and 6), and at Clinical Follow-Up visit. 
8 Hematology includes: hemoglobin, hematocrit, red blood cell (RBC) count, white blood cell (WBC) count with differential and platelet count. Blood sampling for all safety 
laboratory tests should be performed at the end of the cycle, prior to the next treatment administration. 
NOTE: hematology testing must be performed on Cycle 1 Day 1 
9 Labs do not need to be repeated if collected ≤ 7 days prior to start of Cycle 1. 
10 Chemistry includes: SGOT (AST), SGPT (ALT), alkaline phosphatase, total bilirubin, creatinine, calcium, phosphate, glucose, sodium (Na), and potassium (K). Blood sampling 
for all safety laboratory tests should be performed at the end of the cycle, prior to the next treatment administration. Baseline labs do not need to be repeated if collected ≤ 7 days 
prior to Cycle 1 Day 1. 
11 Labs do not need to be repeated if collected ≤ 7 days prior to start of Cycle 1. 
12 Thyroid panel to include TSH, T3 or FT3, and FT4. Done at the end of Cycle 1 and every 6 weeks thereafter through the remainder of the study (can be done up to 7 days prior 
to TSR-042 administration) and at End of Treatment Visit. 
13 Testing required only when clinically indicated. Will require coagulation tests (PT/PTT/INR) prior to biopsies. 

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Screening1 
Baseline2 
Cycle 1 
End of Each 
Cycle 
Clinical Follow-up 
(30 days after EOT) 
Tests and procedures 
≤30 days prior to 
Registration 
≤14 days prior to 
Registration 
Day 8 
Day 15 
Window* 
-30 days 
-14 days 
 
±3 days 
±3 days 
±3 days 
±5 days 
CA19-9 
 
X 
 
 
 
X 
 
Bone marrow aspirate and 
biopsy 
 
 
X14 
 
Tumor measurement by 
CT, MRI, or Bone Scan15 
X 
 
 
 
 
X 
 
Patient Medication Diary 
 
 
 
 
 
X 
 
Research Collections 
 
 
 
 
 
 
 
Research blood samplesR 
 
 
X 
 
X 
X16 
 
Research tissue samples17, R 
 
 
X 
 
 
X 
 
Cycle = 21 days; R = Research funded 
 
4.2 
Survival Follow-up 
 
Survival Follow-up 
q. 3months 
until PD 
At PD 
After PD  
q. 6 months Death 
New Primary 
Survival Follow-up 
X 
X 
X 
X 
X 
1. If a patient is still alive 5 years after registration, no further follow-up is required 
 
 
14 For any patient diagnosed with MDS/AML while on study, a bone marrow aspirate/biopsy must be completed by a local hematologist. A copy of the hematologist's report of 
aspirate/biopsy findings including a classification according to WHO criteria and other sample testing results related to MDS/AML will be provided to the PI and to GSK. 
Testing completed as part of standard of care is sufficient as long as the methods are acceptable to GSK. Will only be collected once while on study. Upload this documentation 
into the Supporting Documents form within Rave. 
15 All lesions identified at screening should be followed using the same imaging procedure (i.e. either CT or MRI). A bone scan should only be done if clinically indicated and 
performed as needed if the patient develops symptoms or signs of bone disease. If bone metastases are present at screening, bone scans during treatment should be performed in 
addition to and at the same time as the CT/MRI-scans only to confirm complete response. Response should be assessed based on iRECIST criteria. Starting at screening and then 
at 6-week intervals while on study treatment and until immune confirmed objective progressive disease (iCPD) according to iRECIST (See Section 11.0). 
16 Research blood sample collected at end of Cycles 1, 2, 4, and (last day) End of Treatment (ie. progression) (See Section 14.1). 
17 Research tissue sample collection to be performed at baseline (after registration, prior to treatment), end of Cycle 4, and (last day) End of Treatment (ie. progression). The (last 
day) End of Treatment collection is optional. Only allowed to be omitted if there are no lesions amenable to biopsy or if biopsy is not possible due to patient safety. Will require 
coagulation tests (PT/PTT/INR) prior to biopsies. 

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5.0 
Stratification Factors OR Grouping Factor:  
Grouping factor: Platinum unexposed vs platinum exposed but not refractory vs platinum 
resistant. 
6.0 
Registration/Randomization Procedures 
6.1 
Registration /Registering a patient 
To register a patient, access the Mayo Clinic Cancer Center (MCCC) web page and enter 
the registration/randomization application. The registration/ randomization application is 
available 24 hours a day, 7 days a week. Back up and/or system support contact 
information is available on the website. If unable to access the website, call the Mayo 
Clinic Research Site Management Office at (507) 284-2753 between the hours of 8 a.m. 
and 4:30 p.m. Central Time (Monday through Friday). 
The instructions for the registration/randomization application are available on the 
MCCC web page (http://ccswww/training/index.html) and detail the process for 
completing and confirming patient registration. Prior to initiation of protocol treatment, 
this process must be completed in its entirety and an MCCC subject ID number must be 
available as noted in the instructions. It is the responsibility of the individual registering 
the patient to confirm the process has been successfully completed prior to release of the 
study agent. Patient registration via the registration/randomization application can be 
confirmed in any of the following ways: 
• 
Contact the MC Research Site Management Office (507) 284-2753. If the patient 
was fully registered, the MC Research Site Management Office staff can access 
the information from the centralized database and confirm the registration. 
• 
Refer to “Instructions for Remote Registration” in section “Finding/Displaying 
Information about A Registered Subject.” 
6.2 
Verification of materials 
Prior to accepting the registration, registration/randomization application will verify the 
following: 
• 
IRB approval at the registering institution 
• 
Patient eligibility 
• 
Existence of a signed consent form 
• 
Existence of a signed authorization for use and disclosure of protected health 
information  
6.3 
Documentation of IRB approval 
Documentation of IRB approval must be on file in the Site Management Office before an 
investigator may register any patients.  
In addition to submitting initial IRB approval documents, ongoing IRB approval 
documentation must be on file (no less than annually) at the Site Management Office 
(fax: 507-284-0885). If the necessary documentation is not submitted in advance of 
attempting patient registration, the registration will not be accepted and the patient may 
not be enrolled in the protocol until the situation is resolved. 
When the study has been permanently closed to patient enrollment, submission of annual 
IRB approvals to the Site Management Office is no longer necessary. 
 
 

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6.4 
Correlative Research Mandatory 
A mandatory correlative research component is part of this study, the patient will be 
automatically registered onto this component (see Sections 3.19b, 14.1 and 17.1). 
6.5 
Banking 
At the time of registration, the following will be recorded: 
• 
Patient has/has not given permission to store and use his/her sample(s) for future 
research of pancreatic cancer at Mayo. 
• 
Patient has/has not given permission to store and use his/her sample(s) for future 
research to learn, prevent, or treat other health problems. 
• 
Patient has/has not given permission for MCCC to give his/her sample(s) to 
researchers at other institutions. 
6.6 
Treatment on protocol 
Treatment on this protocol must commence at a Mayo Clinic Rochester/Arizona/Florida 
institution under the supervision of a medical oncologist. 
6.7 
Treatment start 
Treatment cannot begin prior to registration and must begin ≤30 days after registration. 
6.8 
Pretreatment 
Pretreatment tests/procedures (see Section 4.0) must be completed within the guidelines 
specified on the test schedule. 
6.9a 
Baseline symptoms 
All required baseline symptoms (see Section 10.6) must be documented and graded. 
6.9b 
Study drug 
Study drug is available on site.  
6.9c 
Blood draw kits (Include if kits must be used for this study) 
Blood draw kit is available on site (See Section 14.0).  
6.9d 
Study Conduct 
The clinical trial will be conducted in compliance with regulations (21 CFR 312, 50, and 
56), guidelines for Good Clinical Practice (ICH Guidance E6), and in accordance with 
general ethical principles outlined in the Declaration of Helsinki; informed consent will 
be obtained from all participating patients; the protocol and any amendments will be 
subject to approval by the designated IRB prior to implementation, in accordance with 
21 CFR 56.103(a); and subject records will be stored in a secure location and subject 
confidentiality will be maintained. The investigator will be thoroughly familiar with the 
appropriate use of the study drug as described in the protocol and Investigator’s 
Brochure. Essential clinical documents will be maintained to demonstrate the validity of 
the study and the integrity of the data collected. Master files should be established at the 
beginning of the study, maintained for the duration of the study and retained according to 
the appropriate regulations. 
 

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7.0 
Protocol Treatment 
7.1 
Treatment Schedule 
Use actual weight or estimated dry weight if fluid retention 
• 
Quality Control and Definitions of Deviations will be done according to the 
guidelines in Appendix IV 
7.11 
Treatment medication table 
Agent 
Dose Level 
Route 
ReRx 
Days* 
niraparib 
200 mg 
Oral 
Once daily 
1-21 
TSR-042 
Cycles 1-4: 500 mg  
IV 
Q3W 
1 
 
Cycles 5+: 1000 mg 
IV 
Q6W 
1 
*Each cycle is 21 days. 
7.12 
TSR-042 
TSR-042 will be administered via a 30-minute (-5-minute/+15-minute infusion 
window allowed) IV infusion on Day 1 of every 21-day cycle (i.e., Q3W) at 
500 mg for the first 4 doses, followed by 1,000 mg on Day 1 of every other 
21-day cycle (i.e., Q6W) thereafter until the patient discontinues study treatment. 
7.13  
Niraparib 
Niraparib will be administered as a flat-fixed, continuous daily dose. Niraparib 
should be swallowed whole and not opened, crushed or chewed. Food does not 
significantly affect the absorption of niraparib; therefore, niraparib may be taken 
without regard to meals. Participants should take doses at approximately the 
same times each day. Bedtime administration may be a potential method for 
managing nausea. 
Vomited doses should not be made up. 
If a participant misses a dose (greater than 12 hours from normal dosing time) of 
niraparib, they should skip that dose and take their next dose at its regularly 
scheduled time.  
If niraparib is dose reduced, participants should be instructed to continue using 
their current supply at their new dose until their supply has been exhausted.  
Participants must be instructed to return unused study drugs to the site at 
discontinuation or completion of treatment. The site personnel must ensure that 
the appropriate dose of each study drug is administered and that the drug 
accountability is performed and documented. 
7.14 
Drug Release Instructions 
When enrolling a patient to the study, the patient must be enrolled to the Tesaro 
platform (4G Prancer RTSM) to assign vial and bottle numbers for the study 
drugs. To do so, you must: 
• 
Log into the platform at https://tesaro.4gclinical.com/login 
• 
Enroll the patient in the platform 
• 
Enter specific treatment dates for each cycle 
• 
Obtain IV vial numbers and pill bottle numbers at each time point. 
NOTE: pharmacy is unable to dispense medications/treatment without the 
vial and bottle numbers entered in the pharmacy column before investigator 
sign and release 

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If you have any questions, please contact the Tesaro help desk: 
• 
Phone: (855) 299-3496 or (781) 489-3200 
• 
Submit a ticket on Tesaro web page via “4G Clinical Help Center” 
7.2 
Self-administration statement 
Patients can be instructed in administration techniques and granted treatment 
independence with nursing staff approval. 
7.3 
Return to consenting institution 
For this protocol, the patient must return to the consenting institution for evaluation at 
least every 21 days during treatment, 30 days after end of treatment (clinical follow-up), 
and every 3 months during survival follow-up (see Section 4.2). 
7.4 
Treatment by local medical doctor (LMD) 
Treatment by a local medical doctor (LMD) is not allowed. 
8.0 
Dosage Modification Based on Adverse Events  
Strictly follow the modifications in this table for the first two cycles, until individual treatment 
tolerance can be ascertained. Thereafter, these modifications should be regarded as guidelines to 
produce mild-to-moderate, but not debilitating, side effects. If multiple adverse events are seen, 
administer dose based on greatest reduction required for any single adverse event observed. 
Reductions or increases apply to treatment given in the preceding cycle and are based on adverse 
events observed since the prior dose. 
→ ALERT: 
ADR reporting may be required for some adverse events (See Section 10.0) ← 
8.1 
Dose Levels (Based on Adverse Events in Tables 8.2 and 8.3) 
Dose 
Level 
niraparib 
TSR-042 
1* 
200 mg once daily  
(two 100 mg capsules) 
500 mg q3w 
or 1000 mg q6w 
-1 
100 mg once daily  
(one 100 mg capsule) 
500 mg q3w 
or 1000 mg q6w 
*Dose level 1 refers to the starting dose. 
NOTE: If either of drug A or drug B is discontinued, the patient can continue on the other drug, 
unless specified otherwise in the dose modification tables. If both are discontinued, the patient 
will go to survival follow-up (Section 4.2). 
  Use the NCI Common Terminology Criteria for Adverse Events (CTCAE) current version 5.0* 
unless otherwise specified   
* 
Located at http:/ctep.cancer.gov/protocolDevelopment/electronic_applications.ctc.htm 
 
 

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8.2 
Dose Modifications at the of new cycle of therapy (specific for TSR-042) 
Day 1 of Subsequent Cycles 
CTCAE 
System/ 
Organ/ Class 
Adverse Event 
Withhold 
Treatment for 
AE Grade 
Restarting Treatment/Discontinuation 
Endocrine 
disorders 
Hypophysitis 
2 to 4 
For Grade 2 to 3 AEs, hold TSR-042 for a 
maximum of 6 weeks  
 
OR 
 
Hold TSR-042 until hormonal therapy results in 
return to adequate levels by laboratory values 
and restart dosing when AE resolves to 
Grade 0 to 1. For recurrence or worsening of 
Grade ≥2 hypophysitis after corticosteroid taper 
has been completed and patient is on adequate 
hormone replacement therapy, permanently 
discontinue. For Grade 4 AEs, permanently 
discontinue. 
 
Hyperthyroidism 
3 
Hold TSR-042 for a maximum of 6 weeks or 
until AE resolves to Grade 0 to 1 
 
4 
Permanently discontinue 
Gastrointestinal 
Diarrhea/colitis 
2 to 3 
Hold TSR-042 for a maximum of 6 weeks or 
until AE resolves to Grade 0 to 1 
disorders 
 
4 
Permanently discontinue 
Infections and 
infestations 
Encephalitis 
infection 
(immune-related) 
Any grade 
Permanently discontinue 
Injury, 
poisoning and 
Infusion-related 
reaction 
2a 
Hold TSR-042 for a maximum of 6 weeks or 
until AE resolves to Grade 0 to 1 
procedural 
complications 
3 or 4 
Permanently discontinue 
Investigations 
Alanine 
aminotransferase 
(ALT) increased  
or Aspartate 
aminotransferase  
2 
(AST or ALT >3 
and ≤5 × ULN or 
total bilirubin >1.5 
and ≤3 × ULN) 
Hold TSR-042 for a maximum of 6 weeks or 
until AE resolves to Grade 0 to 1 
 
(AST) increased 
or  
Blood bilirubin 
increased 
3 or 4 
(AST or ALT >5 × 
ULN or total 
bilirubin 
>3 × ULN) 
Permanently discontinue (see exception below)b 

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CTCAE 
System/ 
Organ/ Class 
Adverse Event 
Withhold 
Treatment for 
AE Grade 
Restarting Treatment/Discontinuation 
Metabolism 
and nutrition 
disorders 
Glucose 
intolerance 
(T1DM) or 
Hyperglycemia 
3 or 4 
hyperglycemia or 
T1DM (associated 
with metabolic 
acidosis or 
ketonuria) 
Hold TSR-042 for a maximum of 6 weeks or 
until appropriately managed patients are 
clinically and metabolically stable per 
investigator’s discretion. 
 
OR 
 
Hold TSR-042 until AE resolves to Grade 0 to 1. 
Renal and 
urinary 
Acute kidney 
injury 
(Renal failure or 
nephritis) 
2 
Hold TSR-042 until AE resolves to Grade 0 to 1 
disorders 
3 or 4 
Permanently discontinue 
Respiratory, 
thoracic and 
Pneumonitis 
2 
Hold TSR-042 until toxicity resolves to Grade 0 
to 1. 
If Grade 2 recurs, permanently discontinue 
mediastinal 
disorders 
 
3 or 4 
Permanently discontinue 
Skin and 
subcutaneous 
Rash  
(acneiform or 
3 
Hold TSR-042until AE resolves to Grade 0 to 1 
tissue disorders maculopapular) 
4 
Permanently discontinue 
Any 
Recurrence of 
AEs after 
resolution to 
Grade ≤1 
3 or 4 
Permanently discontinue 
a Upon resolution within 1 hour of stopping drug infusion, the infusion may be restarted at 50% of the 
original infusion rate (e.g., from 100 to 50 mL/h). Otherwise, TSR-042 will be withheld until symptoms 
resolve, and the patient should be pre-medicated for the next scheduled dose. 
b For patients with liver metastasis who begin treatment with Grade 2 AST or ALT, if AST or ALT 
increases by ≥50% relative to baseline and lasts for at least 1 week, then study treatment should be 
discontinued. 
 
 

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8.3 
Dose Modifications Based on Interval Adverse Events (occurring within a cycle of 
treatment, specific for niraparib) 
CTCAE 
System/Organ/Class 
(SOC) 
ADVERSE EVENT 
AGENT 
ACTION** 
All 
Non-laboratory 
CTCAE* ≥Grade 3 
adverse reaction where 
prophylaxis is not 
considered feasible or 
adverse reaction persists 
despite treatment 
niraparib 
Hold niraparib for a maximum of 28 days 
or until resolution of adverse reaction 
Resume niraparib at a reduced dose per. 
Table 8.1 
 
Blood and lymphatic 
system disorders 
Anemia 
≥Grade 2 
niraparib 
Hold niraparib for a maximum of 28 days 
and monitor blood counts weekly until 
hemoglobin returns to ≥9 g/dL 
Resume niraparib at a reduced dose per 
Table 8.1 
Discontinue niraparib if hemoglobin has 
not returned to acceptable levels within 
28 days of the dose interruption period, or 
if the patient has already undergone dose 
reduction to 100 mg once daily* 
Investigations 
Neutrophil count 
decreased <1,000/μL or 
Hemoglobin<8 g/dL 
niraparib 
Hold niraparib for a maximum of 28 days 
and monitor blood counts weekly until 
neutrophil counts return to ≥1,500/μL or 
hemogloblin ≥9 g/dL. 
Resume niraparib at a reduced dose per 
Table 8.1 
Discontinue niraparib if neutrophil or 
hemoglobin levels have not returned to 
acceptable levels within 28 days of the 
dose interruption period, or if the patient 
has already undergone dose reduction to 
100 mg once daily.* 

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CTCAE 
System/Organ/Class 
(SOC) 
ADVERSE EVENT 
AGENT 
ACTION** 
Investigations 
Platelet count decreased 
Grade 1 <100,000/μL) 
niraparib 
First occurrence: 
• Hold niraparib for a maximum of 28 
days and monitor blood counts 
weekly until platelet counts return to 
≥100,000/μL 
• Resume niraparib at same dose per 
Table 8.1 
Second occurrence: 
• Hold niraparib for a maximum of 28 
days and monitor blood counts 
weekly until platelet counts return to 
≥100,000/μL. 
• Resume niraparib at a reduced dose 
per Table 8.1 
 
Discontinue niraparib if the platelet count 
has not returned to acceptable levels 
within 28 days of the dose interruption 
period, or if the patient has already 
undergone dose reduction to 100 mg once 
daily.* 
Investigations 
Platelet count decreased 
Grade 2 (<75,000/μL) 
niraparib 
First occurrence: 
• Hold niraparib for a maximum of 28 
days and monitor blood counts 
weekly until platelet counts return to 
≥100,000/μL 
• Resume niraparib at reduced dose per 
Table 8.1 
Second occurrence: 
• Hold niraparib for a maximum of 28 
days and monitor blood counts 
weekly until platelet counts return to 
≥100,000/μL. 
• Resume niraparib at a reduced dose 
per table 1 
• Discontinue niraparib if the platelet 
count has not returned to acceptable 
levels within 28 days of the dose 
interruption period, or if the patient 
has already undergone dose reduction 
to 100 mg once daily.* 

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CTCAE 
System/Organ/Class 
(SOC) 
ADVERSE EVENT 
AGENT 
ACTION** 
Investigations 
Platelet count decreased  
(Grade 4) requiring 
transfusion 
niraparib 
For patients with platelet count 
≤10,000/μL, platelet transfusion should be 
considered. If there are other risk factors 
such as co-administration of 
anticoagulation or antiplatelet drugs, 
consider interrupting these drugs and/or 
transfusion at a higher platelet count. 
Resume niraparib at a reduced dose. 
Neoplasms 
AML/DS 
niraparib  Permanently discontinue niraparib.  
Nervous System 
Disorders 
Reversible posterior 
leukoencephalopathy 
syndrome / Posterior 
reversible 
encephalopathy 
syndrome (PRES) 
niraparib 
Treat symptoms, including control of 
hypertension. 
 
Permanently discontinue niraparib. 
Vascular 
Hypertension 
niraparib 
Manage with antihypertensive medicinal 
products. Resume niraparib at reduced 
dose per Table 8.1. 
 
For Grade 3 or higher: Hold niraparib 
until resolve to Grade 0. Resume niraparib 
at reduced dose per Table 8.1. 
 
Permanently discontinue niraparib in case 
of hypertensive crisis or if medically 
significant hypertension cannot be 
adequately controlled with 
antihypertensive therapy. 
**  Use the following to describe actions in the Action column: 
 Omit = The current dose(s) for the specified drug(s) during a cycle is skipped. The 
patient does not make up the omitted dose(s) at a later time. 
 Hold/Delay = The current dose(s) of all drugs during a cycle is delayed. The patient does 
make up the delayed dose(s) when the patient meets the protocol criteria to restart drugs. 
 Discontinue = The specified drug(s) are totally stopped. 
NOTE: If the patient experiences a significant adverse event requiring a dose reduction at the start of the 
next cycle, then the dose will remain lowered for that entire subsequent cycle.  
It is not recommend to reduce niraparib below 100 mg daily.  
 
 

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9.0 
Ancillary Treatment/Supportive Care 
9.1 
Full supportive care 
Patients should receive full supportive care while on this study. This includes blood 
product support, antibiotic treatment, and treatment of other newly diagnosed or 
concurrent medical conditions. All blood products and concomitant medications such as 
antidiarrheals, analgesics, and/or antiemetics received from the first day of study 
treatment administration until 30 days after the final dose will be recorded in the medical 
records. 
9.2 
Blood products and growth factors 
Blood products and growth factors should be utilized as clinically warranted and 
following institutional policies and recommendations. The use of growth factors should 
follow published guidelines of the Journal of Clinical Oncology, Volume 33, No 28 
(October 1), 2015: pp. 3199-3212 (WBC growth factors) AND Journal of Clinical 
Oncology, Volume 28, No 33 (November 20), 2010: pp. 4955-5010 
(darbepoetin/epoetin). 
9.21 
Neutropenia 
Prophylactic use of colony-stimulating factors including Granulocyte Colony-
Stimulating Factor (G-CSF), pegylated G-CSF or Granulocyte Macrophage 
Colony-Stimulating Factor GM-CSF is not allowed in this study. Therapeutic use 
of G-CSF is allowed in patients with Grade 3-4 febrile neutropenia.  
9.22  
Anemia  
Transfusions and/or erythropoietin may be utilized as clinically indicated for the 
treatment of anemia, but should be clearly noted as concurrent medications.  
9.23  
Thrombocytopenia  
Transfusion of platelets may be used if clinically indicated. ITP should be ruled 
out before initiation of platelet transfusion. 
9.3 
Antiemetics 
Antiemetics may be used at the discretion of the attending physician. 
9.4 
Diarrhea 
Diarrhea could be managed conservatively with loperamide. The recommended dose of 
loperamide is 4 mg at first onset, followed by 2 mg every 2-4 hours until diarrhea free 
(maximum 16 mg/day). 
In the event of Grade 3 or 4 diarrhea, the following supportive measures are allowed: 
hydration, octreotide, and antidiarrheals.  
If diarrhea is severe (requiring intravenous rehydration) and/or associated with fever or 
severe neutropenia (Grade 3 or 4), broad-spectrum antibiotics must be prescribed. 
Patients with severe diarrhea or any diarrhea associated with severe nausea or vomiting 
should be hospitalized for intravenous hydration and correction of electrolyte 
imbalances. 
 
 

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9.5 
Immunotherapy-related Adverse Events 
Patients should be monitored for signs and symptoms of immunotherapy-related adverse 
events, which include but are not limited to the following:  
• 
Pneumonitis  
o For Grade 2 events, treat with systemic corticosteroids (1mg/kg daily 
prednisone equivalent). When symptoms improve to Grade 1 or less, 
steroid taper should be started and continued over no less than 4 weeks.  
o For Grade 3-4 events, immediately treat with intravenous steroids (1-
2mg/kg prednisone equivalent). Administer additional anti-inflammatory 
measures, as needed.  
o Add prophylactic antibiotics for opportunistic infections in the case of 
prolonged steroid administration. 
 
• 
Diarrhea/colitis Patients should be carefully monitored for signs and 
symptoms of enterocolitis (such as diarrhea, abdominal pain, blood or mucus 
in stool, with or without fever) and of bowel perforation (such as peritoneal 
signs and ileus).  
o All patients who experience diarrhea/colitis should be advised to drink 
liberal quantities of clear fluids. If sufficient oral fluid intake is not 
feasible, fluid and electrolytes should be substituted via IV infusion. For 
Grade 2 or higher diarrhea, consider GI consultation and endoscopy to 
confirm or rule out colitis.  
o For Grade 2 diarrhea/colitis, administer oral corticosteroids (1mg/kg 
daily prednisone equivalent).  
o For Grade 3 or 4 diarrhea/colitis, treat with intravenous steroids followed 
by high dose oral steroids (1-2mg/kg prednisone equivalent).  
o When symptoms improve to Grade 1 or less, steroid taper should be 
started and continued over no less than 4 weeks.  
 
• 
Type 1 Diabetes Mellitus (if new onset, including diabetic ketoacidosis 
[DKA]) or ≥Grade 3 Hyperglycemia, if associated with ketosis 
(ketonuria) or metabolic acidosis (DKA)  
For T1DM or Grade 3-4 Hyperglycemia:  
o Insulin replacement therapy is recommended for Type I diabetes mellitus 
and for Grade 3-4 hyperglycemia associated with metabolic acidosis or 
ketonuria.  
o Evaluate patients with serum glucose and a metabolic panel, urine 
ketones, glycosylated hemoglobin, and C-peptide.  
 
• 
Hypophysitis  
o For Grade 2 events, treat with corticosteroids (1mg/kg daily prednisone 
equivalent). When symptoms improve to Grade 1 or less, steroid taper 
should be started and continued over no less than 4 weeks. Replacement 
of appropriate hormones may be required as the steroid dose is tapered.  
o For Grade 3-4 events, treat with an initial dose of IV corticosteroids (1-
2mg/kg prednisone equivalent) followed by oral corticosteroids. When 
symptoms improve to Grade 1 or less, steroid taper should be started and 
continued over no less than 4 weeks. Replacement of appropriate 
hormones may be required as the steroid dose is tapered.  

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• 
Hyperthyroidism or hypothyroidism Thyroid disorders can occur at any 
time during treatment. Monitor patients for changes in thyroid function (at 
the start of treatment, periodically during treatment, and as indicated based 
on clinical evaluation) and for clinical signs and symptoms of thyroid 
disorders.  
o Grade 2 hyperthyroidism events (and Grade 2-4 hypothyroidism):  
 
In hyperthyroidism, non-selective beta-blockers (e.g. propranolol) 
are suggested as initial therapy. 
 
In hypothyroidism, thyroid hormone replacement therapy, with 
levothyroxine or liothyroinine, is indicated per standard of care.  
o Grade 3-4 hyperthyroidism  
 
Treat with an initial dose of IV corticosteroid (1-2mg/kg prednisone 
equivalent) followed by oral corticosteroids. When symptoms 
improve to Grade 1 or less, steroid taper should be started and 
continued over no less than 4 weeks. Replacement of appropriate 
hormones may be required as the steroid dose is tapered.  
 
• 
Hepatic  
o For Grade 2 events, monitor liver function tests more frequently until 
returned to baseline values (consider weekly).  
 
Treat with IV or oral corticosteroids  
 
For Grade 3-4 events, treat with intravenous corticosteroids (1-
2mg/kg prednisone equivalent) for 24 to 48 hours.  
o When symptoms improve to Grade 1 or less, a steroid taper should be 
started and continued over no less than 4 weeks.  
 
• 
Renal failure or nephritis  
o For Grade 2 events, treat with corticosteroids.  
o For Grade 3-4 events, treat with systemic corticosteroids.  
o When symptoms improve to Grade 1 or less, steroid taper should be 
started and continued over no less than 4 weeks.  
 
• 
Rash 
o Grade 2 - Treat symptomatically with topical steroid cream, as well as 
antihistamines (i.e., loratidine, diphenhydramine, etc.). For patients that 
do not respond, consider starting steroids at 0.5 mg/kg prednisone or 
equivalent.  
o Grade 3 - As above for Grade 2 and start steroids at 1 mg/kg prednisone 
or equivalent.  
o If any signs of Steven Johnson Syndrome (SJS) or Toxic Epidermal 
Necrolysis (TENS), immediately hospitalize patient and treat with high 
dose IV steroids (1 gram methylprednisolone) and consult dermatology. 
 
• 
 Management of Infusion Reactions:  
o Signs and symptoms usually develop during or shortly after drug 
infusion and generally resolve completely within 24 hours of completion 
of infusion.  

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o Table 9.51 below shows treatment guidelines for subjects who 
experience an infusion reaction associated with administration of TSR-
042 
9.51 
Infusion reaction treatment guidelines 
NCI CTCAE Grade 
Treatment 
Premedication 
at subsequent 
dosing 
Grade 1 
Mild reaction; infusion 
interruption not indicated; 
intervention not indicated 
Increase monitoring of vital signs as 
medically indicated until the subject is 
deemed medically stable in the opinion of 
the investigator. 
None 
Grade 2 
Requires infusion interruption 
but responds promptly to 
symptomatic treatment (e.g., 
antihistamines, NSAIDS, 
narcotics, IV fluids); 
prophylactic medications 
indicated for ≤24 hrs 
Stop Infusion and monitor symptoms. 
Additional appropriate medical therapy 
may include but is not limited to: 
IV fluids Antihistamines NSAIDS 
Acetaminophen Narcotics 
Increase monitoring of vital signs as 
medically indicated until the subject is 
deemed medically stable in the opinion of 
the investigator. 
If symptoms resolve within one hour of 
stopping drug infusion, the infusion may be 
restarted at 50% of the original infusion rate 
(e.g., from 100 mL/hr to 50 mL/hr). 
Otherwise dosing will be held until 
symptoms resolve and the subject should be 
premedicated for the next scheduled dose. 
Subjects who develop Grade 2 adverse 
events despite adequate premedication 
should be permanently discontinued from 
further trial treatment administration. 
Subject may be pre- 
medicated 1.5h (±30 
minutes) prior to infusion 
of TSR-042 with: 
Diphenhydramine 50 mg 
po (or equivalent dose of 
antihistamine) 
Acetaminophen 1000 mg 
po (or equivalent dose of 
antipyretic) 
Grades 3 or 4 Grade 3: 
Prolonged (i.e., not rapidly 
responsive to symptomatic 
medication and/or brief 
interruption of infusion); 
recurrence of symptoms 
following initial improvement; 
hospitalization indicated for 
other clinical sequelae (e.g., 
renal impairment, pulmonary 
infiltrates) 
Stop Infusion. 
Additional appropriate medical therapy 
may include but is not limited to: 
IV fluids 
Antihistamines 
NSAIDS 
Acetaminophen 
Narcotics 
Oxygen Pressors 
Corticosteroids 
Epinephrine 
No subsequent dosing 
Grade 4: 
Life-threatening; pressor or 
ventilatory support indicated 
Increase monitoring of vital signs as 
medically indicated until the subject is 
deemed medically stable in the opinion of 
the investigator. 
Hospitalization may be indicated. Subject 
is permanently discontinued from 
further trial treatment administration. 
Appropriate resuscitation equipment should be available in the room and a physician readily available during 
the period of drug administration. 

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10.0 
Adverse Event (AE) Monitoring and Reporting  
The site principal investigator is responsible for reporting any/all serious adverse events to the 
sponsor as described within the protocol, regardless of attribution to study agent or treatment 
procedure. 
The sponsor/sponsor-investigator is responsible for notifying FDA and all participating 
investigators in a written safety report of any of the following: 
• 
Any suspected adverse reaction that is both serious and unexpected. 
• 
Any findings from laboratory animal or in vitro testing that suggest a significant risk for 
human subjects, including reports of mutagenicity, teratogenicity, or carcinogenicity. 
• 
Any findings from epidemiological studies, pooled analysis of multiple studies, or 
clinical studies, whether or not conducted under an IND and whether or not conducted by 
the sponsor, that suggest a significant risk in humans exposed to the drug 
• 
Any clinically important increase in the rate of a serious suspected adverse reaction over 
the rate stated in the protocol or Investigator’s Brochure (IB). 
Summary of SAE Reporting for this study  
(please read entire section for specific instructions): 
WHO: 
WHAT form: 
WHERE to send: 
All sites 
Pregnancy Reporting  
Mayo Sites – attach to MCCC Electronic 
SAE Reporting Form 
Will automatically be sent to 
CANCERCROSAFETYIN@mayo.edu 
and RSTP2CSAES@mayo.edu 
Send to GSK: 
OAX37649@gsk.com 
Fax Number:  
+44(0) 20 8754 7822 
Mayo Clinic 
Sites 
Mayo Clinic Cancer Center SAE Reporting 
Form  
 
AND attach 
 
MedWatch 3500A 
Will automatically be sent to 
CANCERCROSAFETYIN@mayo.edu 
and RSTP2CSAES@mayo.edu  
Send to GSK: 
OAX37649@gsk.com 
Fax Number:  
+44(0) 20 8754 7822 
 
 

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Definitions 
Adverse Event 
Any untoward medical occurrence associated with the use of a drug in humans, whether or not 
considered drug related.  
Suspected Adverse Reaction 
Any adverse event for which there is a reasonable possibility that the drug caused the adverse 
event. 
Expedited Reporting 
Events reported to sponsor within 24 hours, 5 days or 10 days of study team becoming aware of 
the event. 
Routine Reporting 
Events reported to sponsor via case report forms 
Events of Interest 
Events that would not typically be considered to meet the criteria for expedited reporting, but that 
for a specific protocol are being reported via expedited means in order to facilitate the review of 
safety data (may be requested by the FDA or the sponsor).  
10.1 
Adverse Event Characteristics 
CTCAE term (AE description) and grade: The descriptions and grading scales found 
in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 
5.0 will be utilized for AE reporting. All appropriate treatment areas should have access 
to a copy of the CTCAE version 5.0. A copy of the CTCAE version 5.0 can be 
downloaded from the CTEP web site: 
a. Identify the grade and severity of the event using the CTCAE version 5.0. 
b. Determine whether the event is expected or unexpected (see Section 10.2). 
c. Determine if the adverse event is related to the study intervention (agent, treatment or 
procedure) (see Section 10.3). 
d. Determine whether the event must be reported as an expedited report. If yes, 
determine the timeframe/mechanism (see Section 10.4).  
e. Determine if other reporting is required (see Section 10.5). 
f. Note: All AEs reported via expedited mechanisms must also be reported via the 
routine data reporting mechanisms defined by the protocol (see Sections 10.6 and 
18.0). 
NOTE: A severe AE is NOT the same as a serious AE, which is defined in Section 10.4. 
10.2 
Expected vs. Unexpected Events  
Expected events - are those described within the Section 15.0 of the protocol, the study 
specific consent form, package insert (if applicable), and/or the investigator brochure, (if 
an investigator brochure is not required, otherwise described in the general 
investigational plan).  
Unexpected adverse events or suspected adverse reactions are those not listed in Section 
15.0 of the protocol, the study specific consent form, package insert (if applicable), or in 
the investigator brochure (or are not listed at the specificity or severity that has been 
observed); if an investigator brochure is not required or available, is not consistent with 
the risk information described in the general investigational plan. 
Unexpected also refers to adverse events or suspected adverse reactions that are 

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mentioned in the investigator brochure as occurring with a class of drugs but have not 
been observed with the drug under investigation. 
An investigational agent/intervention might exacerbate the expected AEs associated with a 
commercial agent. Therefore, if an expected AE (for the commercial agent) occurs with a 
higher degree of severity or specificity, expedited reporting is required. 
NOTE: *The consent form may contain study specific information at the discretion of the 
Principal Investigator; it is possible that this information may NOT be included in the 
protocol or the investigator brochure. Refer to protocol or IB for reporting needs. 
10.3 
Attribution to agent(s) or procedure 
When assessing whether an adverse event (AE) is related to a medical agent(s) medical or 
procedure, the following attribution categories are utilized: 
Definite - The AE is clearly related to the agent(s)/procedure. 
Probable - The AE is likely related to the agent(s)/procedure. 
Possible - The AE may be related to the agent(s)/procedure. 
Unlikely - The AE is doubtfully related to the agent(s)/procedure. 
Unrelated - The AE is clearly NOT related to the agent(s)/procedure. 
10.31 AEs Experienced Utilizing Investigational Agents and Commercial Agent(s) 
on the SAME (Combination) Arm 
NOTE: When a commercial agent(s) is (are) used on the same treatment arm as 
the investigational agent/intervention (also, investigational drug, biologic, 
cellular product, or other investigational therapy under an IND), the entire 
combination (arm) is then considered an investigational intervention for 
reporting. 
• 
An AE that occurs on a combination study must be assessed in accordance with 
the guidelines for investigational agents/interventions.  
• 
An AE that occurs prior to administration of the investigational agent/intervention 
must be assessed as specified in the protocol. In general, only Grade 4 and 5 AEs 
that are unexpected with at least possible attribution to the commercial agent 
require an expedited report, unless hospitalization is required. Refer to Section 
10.4 for specific AE reporting requirements or exceptions. 
• 
An investigational agent/intervention might exacerbate the expected AEs 
associated with a commercial agent. Therefore, if an expected AE (for the 
commercial agent) occurs with a higher degree of severity or specificity, 
expedited reporting is required. 
• 
An increased incidence of an expected adverse event (AE) is based on the 
patients treated for this study at their site. A list of known/expected AEs is 
reported in the package insert or the literature, including AEs resulting from 
a drug overdose. 
• 
Commercial agent expedited reports must be submitted to the FDA via 
MedWatch 3500A for Health Professionals (complete all three pages of the 
form).  
 

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10.32 EXPECTED Serious Adverse Events: Protocol Specific Exceptions to 
Expedited Reporting 
For this protocol only, the following Adverse Events/Grades are expected to occur 
within this population and do not require Expedited Reporting. These events must still 
be reported via Routine Reporting (see Section 10.6).* 
*Report any clinically important increase in the rate of a serious suspected 
adverse reaction (at your study site) over that which is listed in the protocol or 
investigator brochure as an expedited event.  
*Report an expected event that is greater in severity or specificity than expected 
as an expedited event. 
*Specific protocol exceptions to expedited reporting should be reported 
expeditiously by investigators ONLY if they exceed the expected grade of the 
event. 
CTCAE 
System Organ Class 
(SOC) 
Adverse event/ Symptoms 
CTCAE Grade at which the event 
will not be reported in an expedited 
manner1 
Blood and lymphatic 
system disorders 
Anemia 
≤Grade 4 
Endocrine disorders 
Hypothyroidism 
≤Grade 3 
 
Hyperthyroidism 
≤Grade 3 
 
Hypophysitis 
≤Grade 3 
Gastrointestinal 
disorders 
Diarrhea 
≤Grade 3 
Investigations 
Alkaline phosphatase increased 
≤Grade 3 
 
Aspartate aminotransferase 
increased 
≤Grade 3 
 
Blood bilirubin in creased 
≤Grade 3 
 
Lymphocyte count decreased 
≤Grade 4 
 
Neutrophil count decreased 
≤Grade 4 
 
Platelet count decreased 
≤Grade 4 
 
White blood cell decreased 
≤Grade 4 
Respiratory, thoracic 
and mediastinal 
disorders 
Pneumonitis 
≤Grade 3 
Skin and subcutaneous  Rash acneiform 
≤Grade 4 
tissue disorders 
Rash maculo-papular 
≤Grade 4 
1 These exceptions only apply if the adverse event does not result in hospitalization. If the adverse 
event results in hospitalization, then the standard expedited adverse events reporting 
requirements must be followed.  
The following hospitalizations are not considered to be SAEs because there is no “adverse event” 
(i.e., there is no untoward medical occurrence) associated with the hospitalization: 
● Hospitalizations for respite care 
● Planned hospitalizations required by the protocol 

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● Hospitalization planned before informed consent (where the condition requiring the hospitalization 
has not changed post study drug administration) 
● Hospitalization for elective procedures unrelated to the current disease and/or treatment on this trial 
● Hospitalization for administration of study drug or insertion of access for administration of study 
drug 
● Hospitalization for routine maintenance of a device (e.g., battery replacement) that was in place 
before study entry 
● Hospitalization, or other serious outcomes for signs and symptoms of progression of the cancer. 
 
10.4 
Expedited Reporting Requirements for IND Agents  
10.41 Phase 1 and Early Phase 2 Studies: Expedited Reporting Requirements for 
Adverse Events that Occur on Studies under an IND within 30 Days of the 
Last Administration of the Investigational Agent/Intervention 1, 2 
FDA REPORTING REQUIREMENTS FOR SERIOUS ADVERSE EVENTS (21 CFR Part 312) 
NOTE: Investigators MUST immediately report to the sponsor ANY Serious Adverse Events, whether or not they 
are considered related to the investigational agent(s)/intervention (21 CFR 312.64) 
An adverse event is considered serious if it results in ANY of the following outcomes:  
1) 
Death 
2) 
A life-threatening adverse event  
3) 
An adverse event that results in inpatient hospitalization or prolongation of existing hospitalization for ≥ 24 
hours  
4) 
A persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions  
5) 
A congenital anomaly/birth defect.  
6) 
Important Medical Events (IME) that may not result in death, be life threatening, or require hospitalization 
may be considered serious when, based upon medical judgment, they may jeopardize the patient or subject 
and may require medical or surgical intervention to prevent one of the outcomes listed in this definition. (FDA, 
21 CFR 312.32; ICH E2A and ICH E6). 
ALL SERIOUS adverse events that meet the above criteria MUST be immediately reported to the sponsor within 
the timeframes detailed in the table below. 
Hospitalization 
Grade 1 and Grade 2 Timeframes 
Grade 3-5 
Timeframes 
Resulting in 
Hospitalization 
≥24 hrs 
7 Calendar Days 
24-Hour 3 Calendar 
Days 
Not resulting in 
Hospitalization 
≥24 hrs 
Not required 
Expedited AE reporting timelines are defined as: 
o “24-Hour; 3 Calendar Days” - The AE must initially be reported within 24 hours of learning of the AE, 
followed by a complete expedited report within 3 calendar days of the initial 24-hour report. 
o “7 Calendar Days” - A complete expedited report on the AE must be submitted within 7 calendar days 
of learning of the AE. 
1Serious adverse events that occur more than 30 days after the last administration of investigational 
agent/intervention and have an attribution of possible, probable, or definite require reporting as follows:  
Expedited 24-hour notification followed by complete report within 3 calendar days for: 
• All Grade 3, 4, and Grade 5 AEs 
Expedited 7 calendar day reports for: 
• Grade 2 AEs resulting in hospitalization or prolongation of hospitalization 
2 For studies using PET or SPECT IND agents, the AE reporting period is limited to 10 radioactive half-lives, 

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rounded UP to the nearest whole day, after the agent/intervention was last administered. Footnote “1” above 
applies after this reporting period. 
Effective Date: May 5, 2011 
NOTE: Refer to Section 10.32 for exceptions to Expedited Reporting  
10.42 General reporting instructions 
The Mayo IND and/or MCCC Compliance will assist the sponsor-investigator in 
the processing of expedited adverse events and forwarding of suspected 
unexpected serious adverse reactions (SUSARs) to the FDA and IRB. 
Use Mayo Expedited Event Report Form for investigational agents or 
commercial/investigational agents on the same arm.  
Submit MedWatch 3500A Form  
Mayo Clinic Cancer Center (MCCC) Institutions: 
Attach the MedWatch form to the electronic Mayo Clinic Cancer Center Safety 
Reporting Form, which will send a copy to the following email address: 
CANCERCROSAFETYIN@mayo.edu. This email will be managed by the SAE, 
IND and Safety Reporting Coordinators. 
Forward a copy to GSK: OAX37649@gsk.com 
Fax Number: +44(0) 20 8754 782210.43 
 
Reporting of re-occurring SAEs 
ALL SERIOUS adverse events that meet the criteria outlined in table10.41 
MUST be immediately reported to the sponsor within the timeframes detailed in 
the corresponding table. This reporting includes, but is not limited to SAEs that 
re-occur again after resolution. 
10.5 
Other Required Reporting 
10.51 Unanticipated Problems Involving Risks to Subjects or Others (UPIRTSOS) 
Unanticipated Problems Involving Risks to Subjects or Others (UPIRTSOS) in 
general, include any incident, experience, or outcome that meets all of the 
following criteria: 
1. Unexpected (in terms of nature, severity, or frequency) given (a) the research 
procedures that are described in the protocol-related documents, such as the 
IRB-approved research protocol and informed consent document; and (b) the 
characteristics of the subject population being studied; 
2. Related or possibly related to participation in the research (in this guidance 
document, possibly related means there is a reasonable possibility that the 
incident, experience, or outcome may have been caused by the procedures 
involved in the research); and 
3. Suggests that the research places subjects or others at a greater risk of harm 
(including physical, psychological, economic, or social harm) than was 
previously known or recognized. 
Some unanticipated problems involve social or economic harm instead of the 
physical or psychological harm associated with adverse events. In other cases, 
unanticipated problems place subjects or others at increased risk of harm, but no 
harm occurs. 

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Note: If there is no language in the protocol indicating that pregnancy is not 
considered an adverse experience for this trial, and if the consent form does not 
indicate that subjects should not get pregnant/impregnate others, then any 
pregnancy in a subject/patient or a male patient’s partner (spontaneously 
reported) which occurs during the study or within 120 days of completing the 
study should be reported as a UPIRTSO. 
Mayo Clinic Cancer Center (MCCC) Institutions: 
If the event meets the criteria for IRB submission as a Reportable 
Event/UPIRTSO, provide the appropriate documentation and use the Mayo 
Clinic Cancer Center Expedited Event Report Form. The Mayo Clinic 
Compliance Unit will review and process the submission to the Mayo Clinic IRB 
and work with the IND Coordinator for submission to FDA. 
10.52 Death 
Note: A death on study requires both routine and expedited reporting 
regardless of causality, unless as noted below. Attribution to treatment or 
other cause must be provided. 
Any death occurring within 30 days of the last dose, regardless of attribution to 
an agent/intervention under an IND requires expedited reporting within 24-
hours. 
Any death occurring greater than 30 days with an attribution of possible, 
probable, or definite to an agent/intervention under an IND requires expedited 
reporting within 24-hours. 
Reportable categories of Death  
• 
Death attributable to a CTCAE term. 
• 
Death Neonatal: A disorder characterized by cessation of life during the 
first 28 days of life.  
• 
Death NOS: A cessation of life that cannot be attributed to a CTCAE term 
associated with Grade 5. 
• 
Sudden death NOS: A sudden (defined as instant or within one hour of the 
onset of symptoms) or an unobserved cessation of life that cannot be 
attributed to a CTCAE term associated with Grade 5. 
• 
Death due to progressive disease should be reported as Grade 5 “Disease 
progression” under the system organ class (SOC) “General disorders and 
administration site conditions.” Evidence that the death was a 
manifestation of underlying disease (e.g., radiological changes suggesting 
tumor growth or progression: clinical deterioration associated with a 
disease process) should be submitted. 
10.53 Secondary Malignancy 
• 
A secondary malignancy is a cancer caused by treatment for a previous 
malignancy (e.g., treatment with investigational agent/intervention, radiation 
or chemotherapy). A secondary malignancy is not considered a metastasis of 
the initial neoplasm. 
• 
All secondary malignancies that occur following treatment with an agent under 
an IND will be reported per SAE timelines. Three options are available to 
describe the event: 

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o Leukemia secondary to oncology chemotherapy (e.g., Acute Myeloctyic 
Leukemia [AML]) 
o Myelodysplastic syndrome (MDS) 
o Treatment-related secondary malignancy 
• 
Any malignancy possibly related to cancer treatment (including AML/MDS) 
should also be reported via the routine reporting mechanisms outlined in each 
protocol. 
10.54 Second Malignancy 
A second malignancy is one unrelated to the treatment of a prior malignancy (and is 
NOT a metastasis from the initial malignancy). Second malignancies require ONLY 
routine reporting unless otherwise specified. 
10.55 Pregnancy, Fetal Death, and Death Neonatal  
If a female subject (or female partner of a male subject) taking investigational 
product becomes pregnant, the subject taking should notify the Investigator, and 
the pregnant female should be advised to call her healthcare provider 
immediately. The patient should have appropriate follow-up as deemed necessary 
by her physician. If the baby is born with a birth defect or anomaly, a second 
expedited report is required. 
Prior to obtaining private information about a pregnant woman and her infant, the 
investigator must obtain consent from the pregnant woman and the newborn 
infant’s parent or legal guardian before any data collection can occur. A consent 
form will need to be submitted to the IRB for these subjects if a pregnancy 
occurs. If informed consent is not obtained, no information may be collected. 
In cases of fetal death, miscarriage or abortion, the mother is the patient. In cases 
where the child/fetus experiences a serious adverse event other than fetal death, 
the child/fetus is the patient. 
NOTE: When submitting Mayo Expedited Adverse Event Report reports for 
“Pregnancy”, “Pregnancy loss”, or “Neonatal loss”, the potential risk of exposure 
of the fetus to the investigational agent(s) or chemotherapy agent(s) should be 
documented in the “Description of Event” section. Include any available medical 
documentation. Include this Form. 
10.551 
Pregnancy 
Pregnancy should be reported in an expedited manner as Grade 3 
“Pregnancy, puerperium and perinatal conditions - Other 
(pregnancy)” under the Pregnancy, puerperium and perinatal 
conditions SOC. Pregnancy should be followed until the outcome is 
known. 
10.552 
Fetal Death 
Fetal death is defined in CTCAE as “A disorder characterized by death 
in utero; failure of the product of conception to show evidence of 
respiration, heartbeat, or definite movement of a voluntary muscle after 
expulsion from the uterus, without possibility of resuscitation.” 
Any fetal death should be reported expeditiously, as Grade 4 
“Pregnancy, puerperium and perinatal conditions - Other 
(pregnancy loss)” under the Pregnancy, puerperium and perinatal 
conditions SOC. 

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10.553 
Death Neonatal 
Neonatal death, defined in CTCAE as “A disorder characterized by 
cessation of life occurring during the first 28 days of life” that is felt by 
the investigator to be at least possibly due to the investigational 
agent/intervention, should be reported expeditiously.  
A neonatal death should be reported expeditiously as Grade 4 
“General disorders and administration - Other (neonatal loss)” 
under the General disorders and administration SOC.  
10.6 
Required Routine Reporting  
10.61 Baseline and Adverse Events Evaluations 
Pretreatment symptoms/conditions to be graded at baseline and adverse events to 
be graded at each evaluation.  
Grading is per CTCAE v5.0 unless alternate grading is indicated in the table 
below: 
CTCAE  
System/Organ/Class (SOC) 
Adverse event/Symptoms 
Baseline 
Each 
evaluation 
Blood and lymphatic system 
disorders 
Anemia 
X 
X 
Endocrine disorders 
Hypothyroidism 
X 
X 
Gastrointestinal disorders 
Baseline number of stools 
X 
 
 
Diarrhea 
 
X 
General disorders 
Fatigue 
X 
X 
 
Fever 
X 
X 
 
Pain 
X 
X 
Immune system disorders 
Allergic reaction 
 
X 
Investigations 
Alanine aminotransferase increased 
X 
X 
 
Aspartate aminotransferase increased 
X 
X 
 
Blood bilirubin increased 
X 
X 
 
Creatinine increased 
X 
X 
 
Neutrophil count decreased 
X 
X 
 
Platelet count decreased 
X 
X 
Metabolism and nutrition 
disorders 
Hyperglycemia 
X 
X 
Respiratory, thoracic and 
mediastinal disorders 
Dyspnea 
X 
X 
Skin and subcutaneous tissue  
Rash acneiform 
X 
X 
disorders 
Rash maculopapular 
X 
X 
10.62 All other AEs 
Submit via appropriate MCCC Case Report Forms (i.e., paper or electronic, as 
applicable) the following AEs experienced by a patient and not specified in 
Section 10.6: 
10.621 Grade 2 AEs deemed possibly, probably, or definitely related to the study 
treatment or procedure. 
10.622 Grade 3 and 4 AEs regardless of attribution to the study treatment or 
procedure. 

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10.623 Grade 5 AEs (Deaths) 
10.6231 
Any death within 30 days of the patient’s last study 
treatment or procedure regardless of attribution to the study 
treatment or procedure. 
10.6232 
Any death more than 30 days after the patient’s last study 
treatment or procedure that is felt to be at least possibly 
treatment related must also be submitted as a Grade 5 AE, 
with a CTCAE type and attribution assigned. 
10.7 
Late Occurring Adverse Events 
Refer to the instructions in the Forms Packet (or electronic data entry screens, as 
applicable) regarding the submission of late occurring AEs following completion of the 
Active Monitoring Phase (i.e., compliance with Test Schedule in Section 4.0). 
10.8 
GSK - Additional Event Reporting Instructions 
10.81    Pregnancy Reporting  
The Sponsor Institution must report all pregnancies associated with GSK product 
including follow up outcomes to GSK within 24 hours of awareness.  
Each pregnancy must be reported on a Pregnancy Notification Form within 24 
hours of becoming aware of the pregnancy. Pregnancy is not an AE, and 
therefore does not need to be reported as an AE unless there is a suspicion that 
the study drug may have interfered with the effectiveness of a contraceptive 
medication.  
An elective abortion without complications should not be regarded as an AE, 
however, it should be reported as the outcome to the pregnancy on the Pregnancy 
Follow-Up Form. Therapeutic abortions should be reported as a treatment 
procedure; the reason for the therapeutic abortion should be reported on the 
Pregnancy Follow-Up Form and as an AE. Hospitalization for normal delivery of 
a healthy newborn should not be considered an SAE. 
Any SAE that occurs during pregnancy must be recorded on the Pregnancy 
Follow-Up Form reported as an SAE on the SAE Report Form (e.g., maternal 
serious complications, therapeutic abortion, ectopic pregnancy, stillbirth, 
neonatal death, congenital anomaly, birth defect) and reported to the Sponsor 
Institution and GSK within 24 hours. Hospitalization for normal delivery of a 
healthy newborn should not be considered an SAE.  
10.82 Adverse Event of Special Interest (AESI)  
An Adverse Event of Special Interest is defined as any AE (serious or non-
serious) that is of scientific and medical concern specific to the study treatment, 
for which ongoing monitoring and rapid communication to the Sponsor 
Institution and to GSK is required.  
Adverse Events of Special Interest (AESI) for niraparib include the following:  
• Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukemia (AML) 
• Secondary cancers (new malignancies [other than MDS or AML]) 
• Pneumonitis 

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• Embryo-fetal toxicity 
AESIs should be reported on SAE Report Forms whether serious or not, as 
follows: 
• MDS and AML along with other secondary cancers should be reported to 
the Sponsor Institution and to GSK upon awareness for any patient who 
has received niraparib (regardless of the timeframe since the last dose). 
• Pneumonitis should be reported to the Sponsor Institution and to GSK 
through 90 days after the last dose of niraparib. 
• Embryo-fetal toxicity should be reported as outlined in the Pregnancy 
reporting section. 
10.83 Special Situations: Abuse, Misuse, Medication Errors, Overdose, and Accidental 
or Occupational Exposure  
• Abuse: is the persistent or sporadic, intentional excessive use of the study 
treatment which is accompanied by harmful physical or psychological effects.  
• Misuse: medicinal product is intentionally and inappropriately used not in 
accordance with the authorized/approved product information. 
• Medication error: is any preventable incident that may cause or lead to 
inappropriate study treatment use or patient harm while the study treatment is 
in the control of the health care professionals or patients. Such incident may be 
due to health care professional practice, product labeling, packaging and 
preparation, procedures for administration, and systems, including the 
following: prescribing, order communication, nomenclature, compounding, 
dispensing, distribution, administration, education, monitoring, and use. 
• Overdose: is a deliberate or accidental administration of study treatment to a 
study patient, at a dose greater than that which was assigned to that patient per 
the study protocol and under the direction of the Investigator. If an overdose 
with a GSK product, the Sponsor Institution and GSK should be notified 
immediately, and the patient should be observed closely for AEs. Associated 
AEs should be treated and monitored by the Investigator. The dosage of study 
drug administered, any associated AEs, and/or treatment provided to the 
patient because of the overdose, should be reported.  
• Accidental /Occupational exposure: is the unintentional exposure to a study 
treatment as a result of one’s professional or non-professional occupation, or 
accidental exposure to a non-professional to whom exposure was not intended 
(i.e., study product given to wrong patient).  
Reporting Special Situations: All occurrences of abuse, misuse, medication error, 
overdose, and accidental or occupational exposure associated with a GSK 
product must be reported on a GSK SAE Report Form with associated coversheet 
to the Sponsor Institution and to GSK within 5 business days of awareness 
regardless of whether or not an AE or SAE has occurred. If the abuse, misuse, 
medication error, overdose, or accidental / occupational exposure is associated 
with an AE, an SAE Report Form must also be submitted to the Sponsor 
Institution and to GSK within 24 hours of awareness.  
 
 

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10.84 Reporting to GSK 
The Sponsor Institution must report all SAEs and all follow up information to 
GSK on a GSK SAE Report Form, accompanied by the GSK coversheet within 
24 hours of becoming aware of the initial event or follow-up information.  
The Sponsor Institution must provide a causality assessment and must sign and 
date all SAE Report Forms. 
If supporting documentation is included in the submission to GSK (e.g., hospital 
reports, consultant reports, death certificates, autopsy reports, etc.), please redact 
any patient identifiers (including Medical Record number). 
GSK SAE, Pregnancy, and AESI Reporting Information 
OAX37649@gsk.com 
Fax Number: +44(0) 20 8754 7822 
On at least an annual basis, the Sponsor Institution will provide a copy of the 
safety reports submitted to applicable Regulatory Authorities or IECs. Annual 
reports should be provided to GSK within 3 business days of submission to the 
applicable regulatory body. 
10.85 Suspected Unexpected Serious Adverse Reactions (SUSARs)  
Per regulatory requirements, if an event is assessed by the Sponsor Institution as 
a Serious Unexpected Adverse Reaction (SUSAR), it is the responsibility of the 
Sponsor Institution to submit the SUSAR to Regulatory Authorities according to 
applicable regulations. 
In addition, the SUSAR will be distributed to the Investigators/sites utilizing a 
Council for International Organizations of Medical Sciences (CIOMS) report 
form, or the MedWatch 3500A form). The Investigator/site will submit a copy of 
the report to their respective Institutional Review Board (IRB) or Independent 
Ethics Committee (IEC) and GSK per the governing institutional requirements 
and in compliance with local laws and guidelines. 
10.86 Reporting Product Complaints for GSK Products 
Any written, electronic or oral communication that alleges dissatisfaction related 
to manufactured clinical drug product with regards to its manufacturing, testing, 
labeling, packaging, or shipping, must be reported by the Sponsor Institution or 
qualified designee to GSK within 1 working day of first becoming aware of the 
possible defect to GSKQA at tso.qa@gsk.com .   The product and packaging 
components in question, if available, must be stored in a secure area under 
specified storage conditions until it is determined whether the product is required 
to be returned for investigation of the defect.  If the product complaint is 
associated with an SAE, the SAE must be reported separately in accordance with 
the protocol, and the SAE report should mention the product quality complaint. 
 
 

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10.87 GSK Reporting Requirements for ALL Serious Adverse Events:  
The following must be reported: 
Any untoward medical occurrence that, at any dose; 
• 
Results in death;  
• 
Is life threatening (i.e., an event in which the patient was at risk of death at 
the time of the event; it does not refer to an event that hypothetically might 
have caused death if it were more severe);  
• 
Requires inpatient hospitalization or prolongation of existing hospitalization;  
• 
Results in persistent or significant disability/incapacity;  
• 
Is a congenital anomaly/birth defect; or 
Is an important medical event (defined as follows: --Medical and scientific 
judgment should be exercised in determining whether situations or events 
should be considered serious adverse events:  an important medical event 
may not be immediately life-threatening or result in death or require 
hospitalization but may jeopardize the patient or require intervention to 
prevent one of the above outcomes.  Examples of such events are allergic 
bronchospasm, blood dyscrasias, or convulsions that may require intensive 
treatment in an emergency room or at home but do not result in 
hospitalization, development of drug) 
11.0 
Treatment Evaluation/Measurement of Effect  
Response and progression will be evaluated in this study using the new international criteria 
proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guidelines 
(version 1.1)17 and iRECIST criteria18 which is discussed further starting in Section 11.5 below. 
Since iRECIST still uses RECIST 1.1 principles, the RECIST 1.1 criteria is also in this section as 
well.  
Changes in the largest diameter (unidimensional measurement) of the tumors and the short axis 
measurements in the case of lymph nodes are used in the RECIST guideline. 
11.1 
Schedule of Evaluations 
For the purposes of this study, patients should be reevaluated every 6 weeks.  
11.2 
Definitions of Measurable and Non-Measurable Disease 
11.21 Measurable Disease 
• A non-nodal lesion is considered measurable if its longest diameter can be 
accurately measured as ≥2.0 cm with chest x-ray, or as ≥1.0 cm with CT scan, 
CT component of a PET/CT, or MRI.  
• A superficial non-nodal lesion is measurable if its longest diameter is ≥1.0 cm 
in diameter as assessed using calipers (e.g. skin nodules) or imaging. In the 
case of skin lesions, documentation by color photography, including a ruler to 
estimate the size of the lesion, is recommended. 
• A malignant lymph node is considered measurable if its short axis is >1.5 cm 
when assessed by CT scan (CT scan slice thickness recommended to be no 
greater than 5 mm).  
• Tumor lesions in a previously irradiated area are considered measurable 
disease under the following conditions:  

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- If there is a soft tissue component that has grown since completion of 
radiation. 
- Bone metastases with a soft tissue component are considered measureable.  
11.22 Non-Measurable Disease 
• All other lesions (or sites of disease) are considered non-measurable disease, 
including pathological nodes (those with a short axis ≥1.0 to <1.5 cm). Bone 
lesions, 
leptomeningeal 
disease, 
ascites, 
pleural/pericardial 
effusions, 
lymphangitis cutis/pulmonis, inflammatory breast disease, and abdominal 
masses (not followed by CT or MRI), are considered as non-measurable as 
well. 
• Note: ‘Cystic lesions’ thought to represent cystic metastases can be considered 
as measurable lesions, if they meet the definition of measurability described 
above. However, if non-cystic lesions are present in the same patient, these are 
preferred for selection as target lesions. In addition, lymph nodes that have a 
short axis <1.0 cm are considered non-pathological (i.e., normal) and should 
not be recorded or followed. 
11.3 
Guidelines for Evaluation of Measurable Disease 
11.31 Measurement Methods 
• All measurements should be recorded in metric notation (i.e., decimal fractions 
of centimeters) using a ruler or calipers. 
• The same method of assessment and the same technique must be used to 
characterize each identified and reported lesion at baseline and during follow-
up. For patients having only lesions measuring at least 1 cm to less than 2 cm 
must use CT imaging for both pre- and post-treatment tumor assessments.  
• Imaging-based evaluation is preferred to evaluation by clinical examination 
when both methods have been used at the same evaluation to assess the 
antitumor effect of a treatment.  
11.32 Acceptable Modalities for Measurable Disease 
• Conventional CT and MRI: This guideline has defined measurability of lesions 
on CT scan based on the assumption that CT slice thickness is 5 mm or less. If 
CT scans have slice thickness greater than 5 mm, the minimum size for a 
measurable lesion should be twice the slice thickness. 
o As with CT, if an MRI is performed, the technical specifications of the 
scanning sequences used should be optimized for the evaluation of the type 
and site of disease. The lesions should be measured on the same pulse 
sequence. Ideally, the same type of scanner should be used and the image 
acquisition protocol should be followed as closely as possible to prior 
scans. Body scans should be performed with breath-hold scanning 
techniques, if possible. 
• PET-CT: If the site can document that the CT performed as part of a PET-CT is 
of identical diagnostic quality to a diagnostic CT (with IV and oral contrast), 
then the CT portion of the PET-CT can be used for RECIST measurements and 
can be used interchangeably with conventional CT in accurately measuring 
cancer lesions over time.  

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• FDG-PET: FDG-PET scanning is allowed to complement CT scanning in 
assessment of progressive disease [PD] and particularly possible 'new' disease. 
A ‘positive’ FDG-PET scanned lesion is defined as one which is FDG avid 
with an update greater than twice that of the surrounding tissue on the 
attenuation corrected image; otherwise, an FDG-PET scanned lesion is 
considered ‘negative.’ New lesions on the basis of FDG-PET imaging can be 
identified according to the following algorithm: 
o Negative FDG-PET at baseline with a positive FDG-PET at follow-up is a 
sign of PD based on a new lesion. 
o No FDG-PET at baseline and a positive FDG-PET at follow-up:  
 If the positive FDG-PET at follow-up corresponds to a new site of disease 
confirmed by CT, this is PD.  
 If the positive FDG-PET at follow-up is not confirmed as a new site of 
disease on CT at the same evaluation, additional follow-up CT scans (i.e., 
additional follow-up scans at least 4 weeks later) are needed to determine if 
there is truly progression occurring at that site. In this situation, the date of 
PD will be the date of the initial abnormal PDG-PET scan.  
 If the positive FDG-PET at follow-up corresponds to a pre-existing site of 
disease on CT that is not progressing on the basis of the anatomic images, 
it is not classified as PD. 
FDG-PET may be used to upgrade a response to a CR in a manner similar to a 
biopsy in cases where a residual radiographic abnormality is thought to represent 
fibrosis or scarring. The use of FDG-PET in this circumstance has been described 
in the protocol and supported by disease-specific medical literature for the 
indication  
However, it must be acknowledged that both approaches may lead to false 
positive CR due to limitations of FDG-PET and biopsy resolution/sensitivity. 
11.33 Measurement at Follow-up Evaluation:  
The cytological confirmation of the neoplastic origin of any effusion that appears 
or worsens during treatment when the measurable tumor has met criteria for 
response or stable disease is mandatory to differentiate between response or 
stable disease (an effusion may be a side effect of the treatment) and progressive 
disease. 
Cytologic and histologic techniques can be used to differentiate between PR and 
CR in rare cases (e.g., residual lesions in tumor types such as germ cell tumors, 
where known residual benign tumors can remain.) 
11.4 
Measurement of Treatment/Intervention Effect 
11.41 Target Lesions & Target Lymph Nodes 
• The protocol defined irradiated tumor will not be considered for response in the 
primary endpoint. 
• The protocol defined irradiated tumor will be considered for secondary 
endpoint response. 
• Measurable lesions (as defined in Section 11.21) up to a maximum of 5 lesions, 
representative of all involved organs, should be identified as “Target Lesions” 

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and recorded and measured at baseline. These lesions can be non-nodal or 
nodal (as defined in Section 11.21), where no more than 2 lesions are from the 
same organ and no more than 2 malignant nodal lesions are selected.  
• Note: If fewer than 5 (for phase III trials replace with “3”) target lesions and 
target lymph nodes are identified (as there often will be), there is no reason to 
perform additional studies beyond those specified in the protocol to discover 
new lesions.  
• Target lesions and target lymph nodes should be selected on the basis of their 
size, be representative of all involved sites of disease, but in addition should be 
those that lend themselves to reproducible repeated measurements. It may be 
the case that, on occasion, the largest lesion (or malignant lymph node) does 
not lend itself to reproducible measurements in which circumstance the next 
largest lesion (or malignant lymph node) which can be measured reproducibly 
should be selected.  
• Baseline Sum of Dimensions (BSD): A sum of the longest diameter for all 
target lesions plus the sum of the short axis of all the target lymph nodes will 
be calculated and reported as the baseline sum of dimensions (BSD). The BSD 
will be used as reference to further characterize any objective tumor response 
in the measurable dimension of the disease.  
• Post-Baseline Sum of the Dimensions (PBSD): A sum of the longest diameter 
for all target lesions plus the sum of the short axis of all the target lymph nodes 
will be calculated and reported as the post-baseline sum of dimensions (PBSD). 
If the radiologist is able to provide an actual measure for the target lesion (or 
target lymph node), that should be recorded, even if it is below 0.5 cm. If the 
target lesion (or target lymph node) is believed to be present and is faintly seen 
but too small to measure, a default value of 0.5 cm should be assigned. If it is 
the opinion of the radiologist that the target lesion or target lymph node has 
likely disappeared, the measurement should be recorded as 0 cm. 
• The minimum sum of the dimensions (MSD) is the minimum of the BSD and 
the PBSD. 
11.42 Non-Target Lesions & Non-Target Lymph Nodes 
Non-measurable sites of disease (Section 11.22) are classified as non- target 
lesions or non-target lymph nodes and should also be recorded at baseline. These 
lesions and lymph nodes should be followed in accord with 11.433. 
11.43 Response Criteria 
All target lesions and target lymph nodes followed by CT/MRI/PET-CT/Chest X-
ray/physical examination must be measured on re-evaluation at evaluation times 
specified in Section 11.1. Specifically, a change in objective status to either a PR 
or CR cannot be done without re-measuring target lesions and target lymph 
nodes.  
Note: Non-target lesions and non-target lymph nodes should be evaluated at each 
assessment, especially in the case of first response or confirmation of response. 
In selected circumstances, certain non-target organs may be evaluated less 
frequently. For example, bone scans may need to be repeated only when 
complete response is identified in target disease or when progression in bone is 
suspected. 

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11.431 Evaluation of Target Lesions 
o Complete Response (CR): All of the following must be true: 
 
Disappearance of all target lesions. 
 
Each target lymph node must have reduction in short axis to < 
1.0 cm. 
o Partial Response (PR): At least a 30% decrease in PBSD (sum of the 
longest diameter for all target lesions plus the sum of the short axis 
of all the target lymph nodes at current evaluation) taking as 
reference the BSD (see Section 11.41). 
o Progression (PD): At least one of the following must be true: 
 
At least one new malignant lesion, which also includes any 
lymph node that was normal at baseline (<1.0 cm short axis) and 
increased to ≥1.0 cm short axis during follow-up.  
 
At least a 20% increase in PBSD (sum of the longest diameter 
for all target lesions plus the sum of the short axis of all the 
target lymph nodes at current evaluation) taking as reference the 
MSD (Section 11.41). In addition, the PBSD must also 
demonstrate an absolute increase of at least 0.5 cm from the 
MSD.  
 
See Section 11.32 for details in regards to the requirements for 
PD via FDG-PET imaging. 
o Stable Disease (SD): Neither sufficient shrinkage to qualify for PR, 
nor sufficient increase to qualify for PD taking as reference the 
MSD. 
11.432 Evaluation of Non-Target Lesions & Non-target Lymph Nodes 
o Complete Response (CR): All of the following must be true: 
 
Disappearance of all non-target lesions.  
 
Each non-target lymph node must have a reduction in short axis 
to <1.0 cm. 
o Non-CR/Non-PD: Persistence of one or more non-target lesions or 
non-target lymph nodes. 
o Progression (PD): At least one of the following must be true: 
 
At least one new malignant lesion, which also includes any 
lymph node that was normal at baseline (< 1.0 cm short axis) and 
increased to ≥ 1.0 cm short axis during follow-up.  
 
Unequivocal progression of existing non-target lesions and non-
target lymph nodes. (NOTE: Unequivocal progression should not 
normally trump target lesion and target lymph node status. It 
must be representative of overall disease status change.)  
 
See Section 11.32 for details in regards to the requirements for 
PD via FDG-PET imaging. 
 
 

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11.44 Overall Objective Status 
The overall objective status for an evaluation is determined by combining the 
patient’s status on target lesions, target lymph nodes, non-target lesions, non-
target lymph nodes, and new disease as defined in the following tables:  
For Patients with Measurable Disease  
Target Lesions & 
Target Lymph 
Nodes 
Non-Target Lesions & 
Non-Target Lymph 
Nodes 
New  
Sites of 
Disease 
Overall 
Objective 
Status 
CR 
CR 
No 
CR 
CR 
Non-CR/Non-PD 
No 
PR 
PR 
CR 
Non-CR/Non-PD 
No 
PR 
CR/PR 
Not All Evaluated* 
No 
PR 
SD 
CR 
Non-CR/Non-PD 
Not All Evaluated* 
No 
SD 
Not all Evaluated 
CR 
Non-CR/Non-PD 
Not All Evaluated* 
No 
Not 
Evaluated 
(NE) 
PD 
Unequivocal PD 
CR 
Non-CR/Non-PD 
Not All Evaluated* 
Yes or No 
PD 
CR/PR/SD/PD/Not 
all Evaluated 
Unequivocal PD 
Yes or No 
PD 
CR/PR/SD/PD/Not 
all Evaluated 
CR 
Non-CR/Non-PD 
Not All Evaluated* 
Yes 
PD 
* See Section 11.431 
11.45 Symptomatic Deterioration  
Patients with global deterioration of health status requiring discontinuation of 
treatment without objective evidence of disease progression at that time, and not 
either related to study treatment or other medical conditions, should be reported 
as PD due to “symptomatic deterioration.” Every effort should be made to 
document the objective progression even after discontinuation of treatment due to 
symptomatic deterioration. 
11.5 
Immune-Related Response Assessment (iRECIST) 
All study endpoints requiring measurement data will be assessed per RECIST criteria 
(defined above). Patients will not be required to end study participation at the first 
evidence of progression since Immunotherapeutics may result in infiltration of immune 
cells leading to transient increase in the size of malignant lesions, or undetectable lesions 
becoming detectable. For this reason, iRECIST18 will be utilized in order to help to make 
the decision to remove a patient from the study after first evidence of progression. The 
criteria are identical to those of RECIST 1.1 in many respects but have been adapted to 
account for instances where an increase in tumor burden, or the appearance of new 
lesions, does not reflect true tumor progression. Key differences are described below. All 
responses defined using iRECIST criteria are designated with a prefix. 

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11.51 Confirming Progression  
Unlike RECIST 1.1, iRECIST requires the confirmation of progression and uses 
the terms iUPD (unconfirmed progression) and iCPD (confirmed progression). 
Confirmatory scans should be performed at least 4 weeks, but not longer than 9 
weeks after iUPD. 
For patients that had an iUPD in the previous assessment, iCPD is confirmed in 
two ways: 
1) Existing iUPD gets worse in any lesion type (target, non-target, or new 
lesions) which contributed to the current iUPD status (a patient can have 
more than one of the following sources of iUPD). 
If iUPD was at least 
partially based on… 
Then iCPD is confirmed if… 
Target lesions 
A cumulative increase (can occur over multiple 
assessments) of at least 5 mm in the absolute 
value of the sum from the first occurrence of the 
current iUPD 
Non-target lesions 
Any increase in the non-target lesion burden 
from the first occurrence of the current iUPD 
New lesions 
A cumulative increase (can occur over multiple 
assessments) of at least 5 mm in the absolute 
value of the sum of those considered to be target 
new lesions or any new lesions (from the first 
occurrence of the current iUPD) 
2) RECIST 1.1 criteria are met in lesion types (target, non-target, or new 
lesions) which did not contribute to current iUPD status, including the 
appearance of new lesions. 
If a patient meets either (or both) of these criteria, they are considered to have 
confirmed progression (iCPD). See Appendix III for examples of confirming 
progression. 
11.52 New Lesions  
New lesions should be assessed and measured as they appear using RECIST 1.1 
criteria, and recorded as New Lesion-Target (NLT) and New Lesion-Non-Target 
(NLNT) to allow clear differentiation from baseline target and non-target lesions. 
New lesions may either meet the criteria of NLT or NLNT to drive iUPD (or 
iCPD). However, the measurements of NLT should NOT be included in the sum 
of measures of original target lesions identified at baseline. 
Progression is confirmed in the New Lesion category if the next imaging 
assessment, conducted at least 4 weeks (but not more than 9 weeks) after iUPD 
confirms further progression from iUPD with either an increase of at least 5 mm 
in the absolute value of the sum of NLT OR and increase (but not necessarily 
unequivocal increase) in the size of NLNT lesions OR the appearance of new 
lesions. 
 
 

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The following table summarizes how to use iRECIST in a number of different 
scenarios. 
 
Target 
Lesions* 
Non-Target 
Lesions* 
New 
Lesions* 
Time Point Response 
No prior 
iUPD** 
Prior iUPD**; *** 
iCR 
iCR 
No 
iCR 
iCR 
iCR 
Non-iCR/Non-
iUPD 
No 
iPR 
iPR 
iPR 
Non-iCR/Non-
iUPD 
No 
iPR 
iPR 
iSD 
Non-iCR/Non-
iUPD 
No 
iSD 
iSD 
iUPD with 
no change 
OR decrease 
from last TP 
iUPD with no 
change OR 
decrease from 
last TP 
Yes 
NA 
NLs confirms iCPD if NLs were previously 
identified and increase in size (≥5 mm in SOM for 
NLT or any increase for NLNT) or number. If no 
change in NLs (size or number) from last TP, 
remains iUPD 
iSD 
iUPD 
No 
iUPD 
Remains iUPD unless iCPD confirmed based in 
further increase in size of NT disease (need not 
meet RECIST 1.1 criteria for unequivocal PD) 
iUPD 
Non-iCR/Non-
iUPD 
No 
iUPD 
Remains iUPD unless iCPD confirmed based on: 
- further increase in SOM of at least 5 mm, 
otherwise remains iUPD 
iUPD 
iUPD 
No 
iUPD 
Remains iUPD unless iCPD confirmed based on 
further increase in: 
- previously identified T lesion iUPD SOM ≥5 
mm and / or 
- NT lesion iUPD (prior assessment - need not be 
unequivocal PD) 
iUPD 
iUPD 
Yes 
iUPD 
Remains iUPD unless iCPD confirmed based on 
further increase in: 
- previously identified T lesion iUPD ≥5 mm and 
/ or 
- previously identified NT lesion iUPD (need not 
be unequivocal) and /or 
- size or number of new lesions previously 
identified 
Non-
iUPD/PD 
Non-iUPD/PD 
Yes 
iUPD 
Remains iUPD unless iCPD confirmed based on 
- increase in size or number of new lesions 
previously identified 
*  
Using RECIST 1.1 principles. If no PSPD occurs, RECIST 1.1 and iRECIST categories for CR, PR and SD 
would be the same. 
** In any lesion category. 
*** Previously identified in assessment immediately prior to this TP. 
11.6 
Definitions of Analysis Variables 
Formal definitions of variables used in analyses can be found in the Statistical 
Considerations section of the protocol. 
 
 

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12.0 
Descriptive Factors  
12.1 
Prior treatment: 1 vs 2 vs 3+ 
12.2  
Mismatch repair status: proficient vs deficient 
12.3 
Deleterious mutation: BRCA 1 vs BRCA 2 vs PALB2 
12.4 
Exposed to platinum treatment: yes vs no 
12.5 
Refractory to cancer treatment: yes vs no 
13.0 
Treatment/Follow–up Decision at Evaluation of Patient  
13.1 
Continuation of treatment 
Patients who are iCR, iPR, or iSD will continue treatment per protocol. 
13.2 
Progressive disease (iCPD) 
Patients who develop iCPD while receiving therapy will have an end of treatment visit, 
then a clinical follow-up visit then go to the survival follow-up phase. 
13.3 
Off protocol treatment 
Patients who go off protocol treatment for reasons other than iPD will have an end of 
treatment visit, then a clinical follow-up visit 30 days post-treatment, then go to the 
survival follow-up phase per Section 4.0. 
13.4 
Duration of therapy for iCR 
Patients who achieve a iCR will receive treatment until confirmed progressive disease 
according to iRECIST, clinical progression, intolerable adverse effects, or 
patient/investigators decision. They will have an end of treatment visit, then a clinical 
follow-up visit 30 days post-treatment, then go to survival follow-up.  
13.5 
Duration of therapy for iPR or iSD 
Patients who are in iPR, iSD or iUPD will continue on treatment until confirmed 
progressive disease according to iRECIST, clinical progression, intolerable adverse 
effects, or patient/investigators decision. They will have an end of treatment visit, then a 
clinical follow-up visit 30 days post-treatment, then go to survival follow-up.  Subsequent 
treatment is at the discretion of their attending physician. 
13.6 
Non-CNS iCPD  
Patients who develop non-CNS iCPD at any time should have an end of treatment visit, 
then a clinical follow-up visit 30 days post-treatment, then go to the survival follow-up 
phase. These patients should be treated with alternative chemotherapy if their clinical 
status is good enough to allow further therapy.  
13.7 
Ineligible 
A patient is deemed ineligible if after registration, it is determined that at the time of 
registration, the patient did not satisfy each and every eligibility criteria for study entry. If 
the patient received treatment, the patient may continue treatment at the discretion of the 
physician as long as there are not safety concerns. The patient will continue in the Active 
Monitoring/Treatment phase of the study, as per Section 4.0 of the protocol.  
• 
If the patient never received treatment, on-study material must be submitted. Survival 
Follow-up will be required per Section 4.0 of the protocol.  

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13.8 
Major violation 
A patient is deemed a major violation, if protocol requirements regarding treatment in 
cycle 1 of the initial therapy are severely violated that evaluability for primary end point 
is questionable. If the patient received treatment, the patient may continue treatment at 
the discretion of the physician as long as there are not safety concerns. The patient will 
continue in the Active Monitoring/Treatment phase of the study, as per Section 4.0 of the 
protocol. 
13.9 
Cancel 
A patient is deemed a cancel if he/she is removed from the study for any reason before 
any study treatment is given. On-study material and the End of Active Treatment/Cancel 
Notification Form must be submitted. No further data submission is necessary. 
 

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14.0 
Body Fluid Biospecimens 
14.1 
Summary Table of Research Blood and Body Fluid Specimens to be Collected for this Protocol 
Research 
(Section for 
more 
information) 
Specimen 
Purpose  
(check all that 
apply) 
Blood or 
Body 
Fluid 
being 
Collected 
Type of 
Collection 
Tube 
(color of 
tube top) 
Volume to 
collect per 
tube (# of 
tubes to be 
collected) 
Baseline Cycle 1 
Day 15 
End of 
Cycle 1 
End of 
Cycle 2 
End of 
Cycle 4 EOT Process at site? 
(Yes or No) 
Temperature 
Conditions for 
Storage /Shipping 
Circulating 
Tumor DNA  
☒ Correlative 
☐ Eligibility 
Confirmation 
☐ Banking 
Blood 
Cell-Free 
DNA BCT 
Streck 
10mL 
(3 tubes) 
X 
X 
X 
X 
X 
X 
No 
Ambient 
Shipping 
Evaluation of 
Serum 
Cytokine 
Profile by 
ELISA 
☒ Correlative 
☐ Eligibility 
Confirmation 
☐ Banking 
Blood 
Red Top 
Tube 
10 mL 
(1 tube) 
X 
X 
X 
X 
X 
X 
No 
Refrigerate 
Shipping 
Circulating 
biomarker  
work, 
including DNA 
and Proteomic 
based studies 
☒ Correlative 
☐ Eligibility 
Confirmation 
☐ Banking 
Blood 
EDTA 
10 mL 
(2 tube) 
X 
X 
X 
X 
X 
X 
No 
Refrigerate 
Shipping 
RNA 
Extraction 
based studies 
☐ Correlative 
☐ Eligibility 
Confirmation 
☒ Banking 
Blood 
PaxGene 
RNA 
2.5 mL 
(1 tube) 
O 
O 
O 
O 
O 
O 
No 
Ship Frozen (dry 
ice)  
X = Mandatory, O = Optional 

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14.2 
Collection and Processing  
14.21 Kits will be used for this study. Kits to be ordered through Biospecimens 
Collection and Processing (BAP) in Rochester. All specimens must be collected 
Monday - Friday. 
14.22 Label specimen tube(s) with protocol number, patient study ID number, and time 
and date blood is drawn. Samples when processed at Mayo Biorepositories 
Florida will be labeled with RLIMS label containing subject ID, study name, 
specimen type and volume. 
14.23 Collect and process all blood/blood products according to the instructions below. 
All samples will be shipped to MCR Rochester for processing and storage.  
Samples will be processed in Rochester as indicated below. 
14.231 The cell free DNA Streck tube for circulating tumor DNA should be 
collected at room temperature. Centrifuge the Streck tube within 2 hours 
of collection at 1600g for 10 minutes at 10°C. Carefully pipette up to 
5mL of plasma into a 15mL specimen tube. Centrifuge sample at 3,220g 
for 10 minutes at 10°C. Transfer the platelet poor plasma into (2) 5mL 
cryovials and freeze cryovials at -80°C and store.  
14.232 The Red Top tube should be incubated at room temperature for 30 
minutes to allow the clotting process to complete. Centrifuge the Red 
Top Tube at lab standards (2000g x 10min at 4°C). Carefully transfer 
serum into (4) 2mL cryovials and freeze cryovials at -80°C and store.  
14.233 The 10mL EDTA tubes for circulating biomarker work is to be 
centrifuged at lab standards (2000g x 10min at 4°C). Carefully transfer 
the plasma into (4) 2mL cryovials per 10mL EDTA tube and the white 
blood cells (buffy coat layer) into (1) 2mL cryovial. Freeze all cryovials 
at -80°C and store.  
14.234 The PAXgene RNA tube for RNA bases studies is to be accessioned into 
BAP and follow a step down freezing process based on manufacturer’s 
recommendation (see Appendix IV). 
14.3 
Shipping and Handling 
14.31 Kits will be used for this study. 
14.311 
Kits will be supplied by the Rochester Biospecimen Accessioning and 
Processing (BAP).  
14.312 
The kit contains collection supplies for specimens. 
14.32 Shipping Specimens 
Specimens must be shipped on the day they are collected. 
Specimens will be shipped in a dual-temperature shipping container.  Place the 
refrigerated EDTA and No Additive tubes with a properly prepared cold pack in 
one compartment.  See kit instructions for specific details for cold pack 
preparation (i.e., frozen or refrigerated) and proper packing of blood and cold 
pack to avoid freezing of specimen. Place the Streck tubes in the ambient 
compartment of the dual-temperature shipping container. 

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Ship the frozen PaxGene RNA tube with dry ice in the properly labeled frozen 
shipping container. 
14.33 Handling Specimens 
Verify that ALL sections of the BAP Requisition form and specimen collection 
labels are completed and filled in correctly. BAP will retain residual whole 
blood, plasma, white blood cells, DNA, and serum for future research studies 
according to patient consent information.  
 
15.0 
Drug Information 
15.1 
TSR-042 (dostarlimab) 
15.11  Background 
TSR-042 is a humanized monoclonal antibody (mAb) of the immunoglobulin G4 
(IgG4) isotype that binds with high affinity to PD-1, resulting in inhibition of 
binding to PD-L1 and PD-L2. TSR-042 is produced by recombinant DNA 
technology in a mammalian expression system using a stable Chinse hamster 
ovary (CHO) cell line. 
15.12 Formulation 
TSR-042 50 mg/mL drug product is a single use sterile liquid formulation that 
can readily be diluted in an IV solution for intravenous administration. It is a pH 
6.0 formulation containing 50 mg/ml TSR-042, 25 mM sodium citrate, 100 mM 
arginine, 31 mM sodium chloride, and 0.02% polysorbate 80. The deliverable 
volume in each vial is 10 mL.15.13 
 
15.13 Preparation and storage 
The product should be stored between 2°C and 8°C, and in accordance with the 
Pharmacy Manual or protocol as provided by the Sponsor. 
15.14 Administration 
TSR-042 is administered as an intravenous infusion in accordance with the 
Storage and Handling Guidelines provided by GSK.  
15.15 Pharmacokinetic information 
Absorption: TSR-042 is administered IV, thus absorption is not 
applicable. 
Distribution: The Vss of TSR-042 was determined in subjects participating in 
Part 1 of Study 4010-01-001 following a 30-minute IV infusion. The mean Vss 
was 74.2, 71.7, and 60.7 mL/kg following the administration of 1, 3, and 10 
mg/kg, respectively. These results suggest a limited distribution outside the 
vascular space, which is consistent with the behavior of endogenous IgG.  
 
Metabolism: TSR-042 is a therapeutic mAb IgG4, which is expected to be 
catabolized into small peptides, amino acids, and small carbohydrates by 
lysosome through fluid-phase or receptor-mediated endocytosis.  
Elimination: The clearance of TSR-042 was determined in subjects participating 
in Part 1 of Study 4010-01-001 following single IV infusion. The mean 
clearances were 0.201, 0.117, and 

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0.152 mL/h/kg for the 1, 3, and 10 mg/kg dose groups, respectively. Body weight 
(range 45.6 to 145.6 kg) was not a significant covariant for TSR-042 clearance. 
The estimated terminal t½ was approximately 13 to 18 days.  
15.16 Potential Drug Interactions 
No drug-drug interaction studies have been conducted. Monoclonal antibodies 
such as TSR-042 are not substrates for cytochrome P450 or drug transporters, 
and are unlikely to be cytokine modulators. Additionally, pharmacokinetic drug-
drug interactions of TSR-042 with small molecule drugs are not expected. There 
is no evidence of drug-drug interactions mediated by non-specific clearance of 
lysosome degradation for antibodies. 
15.17 Known potential adverse events 
Common potential adverse events (>10%): 
Central nervous system: Fatigue 
Dermatologic: Pruritus, rash, maculopapular rash 
Endocrine & metabolic: immune-mediate endocrinopathy – especially thyroid, 
pituitary and adrenal  
Gastrointestinal: Nausea, diarrhea, vomiting, decreased appetite 
Hematologic: Anemia 
Neuromuscular & skeletal: arthralgia  
Less common potential adverse events, 1% - 10%: 
Hepatic: increased AST, increased ALT 
Respiratory: immune-mediated pneumonitis—dyspnea, chest pain, cough 
Rare potential adverse events, <1%: 
Gastrointestinal: immune-mediated colitis 
15.18 Drug procurement 
Investigational TSR-042 will be supplied free of charge by GSK. 
Outdated or remaining drug is to be destroyed on-site as per procedures in place 
at each institution. 
15.2 
Niraparib (Zejula®, formerly MK-4827) 
15.21 Background 
Niraparib is an orally available, potent, highly selective poly (adenosine 
diphosphate [ADP]-ribose) polymerase (PARP)1 and PARP2 inhibitor being 
developed as a monotherapy agent for tumors with defects in the homologous 
recombination (HR) DNA repair pathway and as a sensitizing agent in 
combination with cytotoxic agents and radiotherapy as well as in combination 
with immune-oncology biologics. 
15.22 Formulation 
Investigational Niraparib is available for clinical trials as 100 mg capsules filled 
with a dry blend of niraparib tosylate monohydrate, lactose monohydrate, and 
magnesium stearate in a hard gelatin capsule.  
15.23 Preparation and storage 
Niraparib 100 mg capsules are packaged in high density polyethylene (HDPE) 
bottles fitted with child-resistant plastic closures. Niraparib 100-mg capsules 

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have a proposed shelf-life of up to 36 months when stored in the intended 
container closure system and under the conditions specified in the Storage and 
Handling Guidelines. 
15.24 Administration 
Capsules should be administered once daily at approximately the same time each 
day.  
Food does not significantly affect the absorption of niraparib; therefore, niraparib 
may be taken without regard to meals. 
If a patient vomits or misses (greater than 12 hours from normal dosing time) a 
dose of niraparib, an additional dose should not be taken. The next dose should 
be taken at the regularly scheduled time.  
15.25 Pharmacokinetic information 
Niraparib exhibits linear pharmacokinetics (PK), and exposure is dose 
proportional. Absorption and clearance are dose-independent (range: 30 to 400 
mg). 
Absorption: Following a single-dose administration of 300-mg niraparib under 
fasting conditions, niraparib was measurable in plasma within 30 minutes, and 
the mean Cmax for niraparib was reached in about 3 hours. Following multiple-
oral doses of niraparib from 30 mg to 400 mg QD, accumulation of niraparib was 
approximately 2-fold. 
The systemic exposures (Cmax and AUC) to niraparib increased in a dose-
proportional manner when the dose of niraparib increased from 30 mg to 400 mg. 
The absolute bioavailability of niraparib is approximately 73%, indicating 
minimal first-pass effect. 
Concomitant intake of a high-fat meal did not significantly affect the PK of 
niraparib after administration of 300 mg of niraparib. 
Distribution: Niraparib was moderately bound to human plasma proteins 
(approximately 83.0%). The apparent Vd/F was 1220 L, indicating extensive 
tissue distribution of niraparib. In a population PK analysis, the Vd/F of niraparib 
was 1074 L in patients with cancer. 
Metabolism: Niraparib is metabolized primarily by CEs to form a major inactive 
metabolite, M1. In a mass balance study, M1 and M10 (the subsequently formed 
M1 glucuronides) were the major circulating metabolites. The mean t½ of M1 
was 88 hours. The exposure ratio of M1 to niraparib was approximately 1.3- to 
2.2- fold in plasma. 
Elimination: Following a single oral 300-mg dose of niraparib, the mean t½ of 
niraparib ranged from 48 to 51 hours (approximately 2 days). In a population PK 
analysis, the CL/F of niraparib was 16.2 L/h in patients with cancer. Niraparib is 
eliminated primarily through the hepatobiliary and renal routes. Following 
administration of a single oral 300-mg dose of [14C]-niraparib, on average, 
86.2% (range: 71% to 91%) of the dose was recovered in urine and feces over 21 
days. Radioactive recovery in urine accounted for 47.5% (range: 33.4% to 
60.2%) and in feces for 38.8% (range: 28.3% to 47.0%) of the dose. In pooled 
samples collected over 6 days, 40.0% of the dose was recovered in the urine 
primarily as metabolites, and 31.6% of the dose was recovered in the feces 
primarily as unchanged niraparib. 

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15.26 Potential Drug Interactions 
No formal drug interaction studies have been performed with niraparib. Neither 
niraparib nor the major metabolite M1 is an inhibitor of any drug-metabolizing 
CYP enzymes. A clinically meaningful drug interaction via inhibition of CYPs is 
highly unlikely. 
Niraparib weakly induces CYP1A2 in vitro; therefore, investigators should be 
advised to use caution with drugs that are sensitive substrates for CYP1A2 with a 
narrow therapeutic range, i.e., theophylline and tizanidine. M1 is not a CYP1A2 
inducer.  
15.27 Potential adverse events  
Common potential adverse events (>10%):  
Cardiac: Hypertension, palpitations   
Central nervous system: Fatigue, headache, insomnia, dizziness  
Gastrointestinal: Nausea, vomiting, diarrhea, constipation,  abdominal pain, 
dyspepsia, dysgeusia   
Genitourinary: Urinary Tract Infection  
Hematologic: Anemia, neutropenia, thrombocytopenia 
Neuromuscular & skeletal: back pain, arthralgia  
Respiratory: Cough, Dyspnea, nasopharyngitis 
Less common potential adverse events, 1% - 10%: 
Cardiac: Tachycardia, peripheral edema,  
Central nervous system: Depression, anxiety 
Endocrine & metabolic: Hypokalemia, increased gamma-glutamyl transferase  
Gastrointestinal: mucositis, stomatitis, dry mouth   
General: decrease in weight 
Hematologic: leukopenia, 
Hepatic: increased AST, increased ALT 
Ophthalmic: Conjunctivitis  
Neuromuscular: myalgia,  
Renal: Increased serum creatinine 
Respiratory: epistaxis 
Rare potential adverse events <1%: 
Acute myelocytic leukemia, hypertensive crisis, myelodysplastic syndrome 
15.28 Drug procurement 
Investigational Niraparib will be supplied free of charge by GSK. 
Outdated or remaining drug is to be destroyed on-site as per procedures in place 
at each institution.  
15.29 Nursing Guidelines 
15.291 
QTc prolongation can be seen. Monitor patient’s concomitant 
medications for potential overlap of other medications that prolong the 
QTc interval. 
15.292  
Fatigue was common. Instruct patient in energy conserving lifestyle. 
15.293 
Gastrointestinal side effects, included diarrhea, anorexia, and nausea. 
Instruct patients to report these side effects and treat symptomatically. 
Monitor for effectiveness of intervention. 

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15.294 
Dyspnea and cough have been seen. In addition isolated cases of 
pneumonitis have been seen. Instruct patient to report any shortness of 
breath to the study team. 
15.295 
Pain including headache, back and extremity pain have been reported. 
Administer analgesics as needed and assess for their effectiveness. 
15.296 
Monitor CBC w/differential as anemia, thrombocytopenia, and 
neutropenia are common. Instruct patients to report any unusual 
bruising or bleeding and/or sign/symptoms of infection to the health 
care team. 
15.297 
Electrolyte abnormalities have been seen with agent. Monitor closely.  
15.298 
Hypertension should be medically managed with antihypertensive 
medicinal products as well as adjustment of the niraparib dose, if 
necessary. Niraparib should be discontinued in case of hypertensive 
crisis or if medically significant hypertension cannot be adequately 
controlled with antihypertensive therapy. 
15.299 
Posterior revsersible encephalopathy syndrome (PRES) is a rare 
neurologic disorder that can present with the following signs and 
symptoms including seizures, headache, altered mental status, visual 
disturbance, or cortical blindness, with or without associated 
hypertension. In patients developing PRES, treatment of specific 
symptoms including control of hypertension is recommended, along 
with discontinuation of niraparib. 
16.0 
Statistical Considerations and Methodology  
16.1 
Primary Endpoint and Analysis:  
This is a single arm Phase II study designed to determine as primary endpoint the disease 
control rate at 12 weeks (DCR12), using the standard iRECIST criteria of patients 
receiving the combination of niraparib and TSR-042. Because the study features a 
heterogeneous population featuring 3 different genetic/somatic mutations, there will be 
no interim analysis. The study will stay remain open, unless a higher than expected 
toxicity issue is identified.  
DCR12 definition and determination: 
For this protocol, the patients must undergo response scanning according to the iRECIST 
criteria. The DCR12 is defined as the percentage of patients who have either iCR, iPR or 
iSD at 12 weeks. Patients who have developed a iUPD at 6 weeks will only be considered 
to have achieved disease control at 12 weeks, if at 12 weeks there is no confirmation of 
disease progression (iCPD) and the patient regresses to either iCR, iPR or iSD. DCR will 
be analyzed descriptively as a point estimate with a 95% confidence interval. 
The primary endpoint will assess the disease control rate at 12 weeks (DCR12), using the 
standard iRECIST criteria (see Section 11.0, where 11.5 specifically discusses iRECIST). 
All eligible patients who are registered and start treatment will be evaluable for the 
DCR12. A 1-stage design will be utilized (see below). This design has 80% power to 
detect an improvement in DCR12 from 25% to 50%, with a significance level of 0.10. 
See 1-stage design details below: 
Final analysis: We will enroll 19 eligible patients total. As various different types of 
mutations are to be included, various response patterns are possible; therefore the result 

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(expressed as the DCR12) might indicate but will not definitively be able to conclude that 
the treatment is worthwhile. If at least 8 patients are a success for DCR12 in the first 19 
eligible patients (41%), the treatment will be considered worthy of further investigation. 
Otherwise, depending upon per mutations results, the study might continue or the 
treatment is considered unworthwhile and can be permanently closed due to lack of 
efficacy.  
16.2 
Secondary Endpoints and Analysis:  
The following endpoints will be assessed as well: objective response rate (ORR), 
duration of confirmed stable disease according to iRECIST, time to next treatment 
(TTNT), overall survival , time to and duration of confirmed response, progression-free 
survival, and adverse events.  
Response rate: The confirmed response rate (by iRECIST ) will be assessed. Any 
confirmed response that occurs during the first 8 cycles of treatment will count as a 
success (24 weeks). Per iRECIST, responses need to be confirmed (2 consecutive 
responses at least 4 weeks apart) to count as a response. We will also assess the duration 
of confirmed stable disease according to iRECIST. All eligible patients who are 
registered and start treatment will be evaluable for response.  
Time to next treatment (TTNT): The TTNT is defined as the time from the end of study 
treatment to receiving the next treatment. TTNT will be estimated using the Kaplan-
Meier method.  
Overall Survival: Overall Survival (OS) is defined as the time from study entry to death 
from any cause. OS will be estimated using the Kaplan-Meier method.  
Time to and Duration of Confirmed Response: The time to response and duration of 
confirmed responses will be assessed using the Kaplan-Meier method, where the time to 
response will be the time from registration to confirmed response and the duration of 
confirmed response will be defined as the time from the first documented date of 
confirmed response (CR or PR) to the date at which progression is first documented.  
Progression-Free Survival: Progression-free survival (PFS) is defined as the time from 
study entry to the first of either disease progression or death from any cause, where 
disease progression will be determined based on iRECIST criteria. PFS will be estimated 
using the Kaplan-Meier method.  
Adverse events: The maximum grade for each type of adverse event will be summarized 
using CTCAE version 5.0. The frequency and percentage of grade 3+ adverse events will 
be estimated. We’ll also assess AEs at least possibly related to treatment as well.  
16.3 
Translational endpoints 
The goals of the translational studies are to assess germline DNA and serum markers of 
immune response, to determine changes in circulating tumor DNA (ctDNA) profile after 
therapy with a PARPi and a PD-1 inhibitor, to study mechanisms of resistance in ctDNA 
profile after therapy with a PARPi and a PD-1 inhibitor, to assess the tumor 
microenvironment for immune related changes (immune infiltration, PD-L1 and PD-1 
expression, tumor-infiltrating lymphocytes [TIL]), to assess genetic profile of the tumor 
pre- and post-treatment, and to determine changes in the cytokine profile pre- and post-
treatment. 
Due to the limited sample size, these analyses will be hypothesis generating and 
descriptive in nature. Descriptive statistics will be summarized and the blood and tissue 
marker data will be correlated with clinical endpoints (response, DCR12, duration of 

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response, OS, PFS, advere events, etc.). For time-to-event data, the Kaplan-Meier method 
will be used. For categorical data, we’ll use the Fisher’s exact test. For marker data used 
to predict binary outcomes (i.e. response vs. no response), we’ll use Logistic regression 
models.  
16.4 
Total sample size and study duration 
To account for possible drop-outs, cancellations, etc. we plan to accrue 20 total patients. 
We plan to accrue around 2 patients per month, so the study accrual phase should be 
around 10 months total. The final analysis can be done around 24 months after the study 
begins, which includes time for data entry, clean-up, and analysis.  
16.5 
Data & Safety Review 
16.51 Reviews 
The principal investigator(s) and the study statistician will review the study at 
least twice a year to identify accrual, adverse event, and any endpoint problems 
that might be developing. The Mayo Clinic Cancer Center (MCCC) Data Safety 
Monitoring Board (DSMB) is responsible for reviewing accrual and safety data 
for this trial at least twice a year, based on reports provided by the MCCC 
Statistical Office. 
16.52 Adverse Event Stopping Rule: The stopping rule specified below is based on the 
knowledge available at study development. We note that the Adverse Event 
Stopping Rule may be adjusted in the event of either (1) the study re-opening to 
accrual or (2) at any time during the conduct of the trial and in consideration of 
newly acquired information regarding the adverse event profile of the 
treatment(s) under investigation. The study team may choose to suspend accrual 
because of unexpected adverse event profiles that have not crossed the specified 
rule below. Accrual may be temporarily suspended to this study if at any time we 
observe events considered at least possibly related to study treatment (ie, an 
adverse event with attribute specified as “possible”, “probable”, or “definite”) 
that satisfy the following: 
• 
If 3 or more of the first 10 patients (or 30% or more of all patients after 
10 are accrued) experience a Grade 4 AE. With exceptions: cytopenia, 
fatigue,  
• 
If 2 or more experience a Grade 5 AE at any time. 
After consideration by the study team (study chair, statistician, etc.), a decision 
will be made as to whether accrual can be resumed. 
16.6 
Inclusion of Women and Minorities 
This study will be available to all eligible patients regardless of race, gender, or ethnic 
group.  
16.61 Statistical analysis by subset 
There is no information currently available regarding differential effects of this 
regimen in subsets defined by race, gender, or ethnicity, and there is no reason to 
expect such differences to exist. Therefore, although the planned analyses will 
look for differences in treatment effect based on racial groupings, the sample size 
is not increased in order to provide additional power for subset analyses.  
 
 

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16.62 Regional population 
The geographical region served by MCCC has a population which includes 
approximately 10% minorities. Expected sizes of racial by gender subsets are 
shown in the following table: 
Accrual Targets 
Ethnic Category 
Sex/Gender 
Females 
Males 
Total 
Hispanic or Latino 
1 
1 
2 
Not Hispanic or Latino 
9 
9 
18 
Ethnic Category: Total of all subjects* 
10 
10 
20 
Racial Category 
American Indian or Alaskan Native 
0 
0 
0 
Asian 
0 
0 
0 
Black or African American 
1 
0 
1 
Native Hawaiian or other Pacific Islander 
0 
1 
1 
White 
9 
9 
18 
Racial Category: Total of all subjects 
10 
10 
20 
 
Ethnic 
Categories: 
Hispanic or Latino – a person of Cuban, Mexican, Puerto Rican, South or Central 
American, or other Spanish culture or origin, regardless of race. The term “Spanish 
origin” can also be used in addition to “Hispanic or Latino.” 
Not Hispanic or Latino 
Racial 
Categories: 
American Indian or Alaskan Native – a person having origins in any of the original 
peoples of North, Central, or South America, and who maintains tribal affiliations or 
community attachment. 
Asian – a person having origins in any of the original peoples of the Far East, 
Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, 
India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and 
Vietnam. (Note: Individuals from the Philippine Islands have been recorded as Pacific 
Islanders in previous data collection strategies.)  
Black or African American – a person having origins in any of the black racial 
groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to 
“Black or African American.” 
Native Hawaiian or other Pacific Islander – a person having origins in any of the 
original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. 
White – a person having origins in any of the original peoples of Europe, the Middle 
East, or North Africa. 

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17.0  
Pathology Considerations/Tissue Biospecimens 
17.1  
Summary Table of Research Tissue Specimens to be Collected for this Protocol 
Research Study 
(Section for more 
information) 
Specimen 
Purpose 
(check all 
that apply) 
Type of 
Tissue to 
Collect 
Block, Slides, 
Core, etc. (# of 
each to submit) 
Baseline 
End of 
Cycle 4 
End of 
Treatment 
(any 
reason) 
Process at 
site? (Yes 
or No) 
Temperature 
conditions for 
storage/ 
shipping 
Sample 
Storage 
Location 
Tumor Collection 
(For xenograft 
and/or organoid) 
☒ Correlative 
☐ Eligibility 
Confirmation 
☐ Banking 
Fresh Tissue 
Core (1 core 
each) 
(1) 50mL Conical 
with MEM 
X 
X 
 
Yes in 
Rochester 
MCA, 
MCF ship 
on ice 
Wet Ice 
Dr. 
Couch’s 
Lab 
Identification/ 
Characterization of 
Intratumoral 
Immune Cells and 
BRCAness by IHC 
and CyTOF 
☒ Correlative 
☐ Eligibility 
Confirmation 
☐ Banking 
Archive 
FFPE Tissue 
or Fresh 
Tissue Cores 
FFPE blocks 
(preferred) or 
7 unstained glass 
slides with 
4 micron-thick 
sections 
 
X 
O 
Yes  
Ambient 
Dr. 
Couch’s 
Lab 
Large Panel 
Sequencing with low 
pass genome for copy 
number, tumor 
mutation burden 
☒ Correlative 
☐ Eligibility 
Confirmation 
☐ Banking 
Archive 
FFPE Tissue 
or Fresh 
Tissue Cores 
Ten (10) unstained 
glass slides with 
5 micron thick 
sections & One (1) 
H&E stained Slides 
 
X 
 
Yes 
Ambient 
Dr. 
Couch’s 
Lab 
Tumor Collection for 
DNA and RNA future 
studies 
☐ Correlative 
☐ Eligibility 
Confirmation 
☒ Banking 
Fresh Tissue 
Cores (up to 
2 cores) 
(2) Snap Frozen 
Cores 
O 
 
 
Yes 
Frozen / Liquid 
Nitrogen 
MCR BAP 
Tumor Collection for 
DNA and RNA future 
studies 
☐ Correlative 
☐ Eligibility 
Confirmation 
☒ Banking 
Fresh Tissue 
Cores (up to 
2 cores) 
(1) FFPE Block 
O 
 
 
Yes 
Ambient 
Dr. 
Couch’s 
Lab 
Tumor Collection for 
DNA and RNA future 
studies 
☐ Correlative 
☐ Eligibility 
Confirmation 
☒ Banking 
Fresh Tissue 
Core (1 core) 
(1) RNA Later 
O 
 
 
Yes 
Frozen / Dry Ice MCR BAP 
X = Mandatory, O = Optional

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17.2 
Diagnostic Slides from Original and /or Recurrent Tissue 
Along with original diagnostic slides, include pathology reporting form, surgical 
pathology report and operative report. 
17.3 
Correlative Tissue Collection  
17.31 For Research Biopsy:  
• Image guided biopsies are recommended where feasible.  
• Frozen tissue will be handled and processed for specific processes through 
BAP. 
• FFPE Core shall be created from fresh tissue biopsy procedures.  
• Tissue Kits will not be provided for this protocol 
• Ship frozen samples to MCR BAP for storage. 
• Lab contact for fresh tissue samples (on ice): 
Dr. Fergus Couch 
Stabile Building, 2-43, 200 1st Street SW 
Rochester, MN 55905  
(contact is Anil Belur Nagaraj 507-284-7904 – pager) 
17.32 Paraffin Embedded Tissue 
Paraffin embedding procedure will follow standard practices. Tissue will be 
placed in formalin cassette, processed and embedded. Afterwards, tissue will be 
sectioned based on Table 17.1.  
If samples will not be tested shortly after collection, they will be stored as FFPE 
Blocks at Dr. Couch’s lab until sectioned for testing: 
Dr. Fergus Couch 
Stabile Building, 2-43, 200 1st Street SW 
Rochester, MN 55905  
(contact is Anil Belur Nagaraj 507-284-7904 – pager) 
17.33 Frozen Tissue 
BAP MCR will collect fresh tissue cores and store at -80°C for extraction of 
DNA and RNA. Any remaining tissue is to be stored in BAP MCR, until 
investigator requests for further studies.  
Tissue must be snap frozen in liquid nitrogen and remain frozen at -80°C in 
storage.  
17.34 Fresh Tissue for xenograft 
For core biopsies from locally recurrent or metastatic biopsy prior to initiation of 
therapy, will be placed into a labeled specimen container of MEM with protocol 
number, study patient ID number, and date and time sample is obtained. 
Specimens are to be delivered to Dr. Fergus Couch’s laboratory detailed below. 
Dr. Couch’s Laboratory 
Stabile Building, 2-43, 200 1st st SW 
Rochester, MN 55905  
(contact is Anil Belur Nagaraj 507-284-7904 – pager) 
 
 

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17.4 
Background and Methodology 
17.41 For tissue biopsies before, during and post treatment, goal is to study changes in 
tumor microenvironment and mutational status post-exposure to PARP inhibition 
and immunotherapy. The biopsy samples will be biobanked for these analyses in 
the future. These would include assessment of PD-L1 expression and assessment 
of mutational status pre- and post-exposure to immunotherapy. PD-L1 expression 
and changes in microenvironment would be assessed by immunohistochemistry 
using standard approved antibodies. 
17.42 For assessment of mutational status, comprehensive tumor based genetic testing 
will be performed to study changes in mutational load to exposure of PARP 
inhibition and immunotherapy over time. 
17.43 If feasible, samples would also be collected for xenograft development for 
potential future studies looking into drug based studies and to study uptake of 
grafts from these patients. 
18.0 
Records and Data Collection Procedures  
18.1 
Submission Timetable 
Data submission instructions for this study can be found in the Data Submission 
Schedule. 
18.2 
Survival Follow-up 
See Section 4.2.  
18.3 
CRF completion 
This study will use Medidata Rave® for remote data capture (rdc) of all study data. Data 
collection for this study will be done exclusively through the Medidata Rave® clinical 
data management system. Access to the trial in Rave is granted through the iMedidata 
application to all persons with the appropriate roles assigned in Regulatory Support 
System (RSS). To access Rave via iMedidata, the site user must have an active account 
and the appropriate Rave role (Rave CRA, Read-Only, Site Investigator) on the 
organization roster at the enrolling site. 
18.4 
Site responsibilities 
Each site will be responsible for insuring that all materials contain the patient’s initials, 
MCCC registration number, and MCCC protocol number. Patient’s name must be 
removed. 
18.5 
Supporting documentation 
This study requires supporting documentation for diagnosis, progression, and genetic 
sequencing prior to study entry as well as for evidence of response to study therapy and 
progression after study therapy. These documents should be submitted within 14 days of 
registration (for prior to study entry materials) or within 14 days after the visit at which 
response or progression is determined. 
 
If a bone marrow aspirate collection is conducted (as indicated in the test schedule for 
subjects diagnosed with MDS/AML), the biopsy report will be required as supporting 
documentation. 
 
 

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18.6 
Labeling of materials 
Each site will be responsible for insuring that all materials contain the patient’s initials, 
MCCC registration number, and MCCC protocol number. Patient’s name must be 
removed. 
18.7 
Overdue lists 
A list of overdue forms and outstanding queries will be available in Rave through the 
Rave Task Summary. In addition to this, the Overdue Materials report is available on the 
Cancer Center Systems homepage. 
19.0  
Budget 
19.1 
Costs charged to patient: routine clinical care 
19.2 
Tests to be research funded 
• 
Research testing on blood and tissue specimens. 
• 
Research biopsies at Baseline, Cycle 4 and optional EOT  
19.3 
Other budget concerns: 
GSK will provide Mayo Clinic with niraparib and TSR-042 and funding to support the 
costs of running this study. 
20.0 
References 
1. Ang, Y. L. E. and D. S. P. Tan (2017). "Development of PARP inhibitors in gynecological 
malignancies." Curr Probl Cancer 41(4): 273-286. 
2. Brown, J. S., R. Sundar and J. Lopez (2018). "Combining DNA damaging therapeutics with 
immunotherapy: more haste, less speed." Br J Cancer 118(3): 312-324. 
3. Connor AA, Denroche RE, Jang GH, et al, Association of Distinct Mutational Signatures 
with Correlation of Increased Immune Activity in Pancreatic Ductal Adenocarcinoma. JAMA 
Oncology, 2017; 3(6), pp774-783. 
4. Drean, A., C. J. Lord and A. Ashworth (2016). "PARP inhibitor combination therapy." Crit 
Rev Oncol Hematol 108: 73-85. 
5. Golan, T. and M. Javle (2017). "DNA Repair Dysfunction in Pancreatic Cancer: A Clinically 
Relevant Subtype for Drug Development." J Natl Compr Canc Netw 15(8): 1063-1069. 
6. Higuchi, T., D. B. Flies, N. A. Marjon, G. Mantia-Smaldone, L. Ronner, P. A. Gimotty and S. 
F. Adams (2015). "CTLA-4 Blockade Synergizes Therapeutically with PARP Inhibition in 
BRCA1-Deficient Ovarian Cancer." Cancer Immunol Res 3(11): 1257-1268. 
7. Javle, M., T. Golan and A. Maitra (2016). "Changing the course of pancreatic cancer--Focus 
on recent translational advances." Cancer Treat Rev 44: 17-25. 
8. Jiao, S., W. Xia, H. Yamaguchi, Y. Wei, M. K. Chen, J. M. Hsu, J. L. Hsu, W. H. Yu, Y. Du, 
H. H. Lee, C. W. Li, C. K. Chou, S. O. Lim, S. S. Chang, J. Litton, B. Arun, G. N. 
Hortobagyi and M. C. Hung (2017). "PARP Inhibitor Upregulates PD-L1 Expression and 
Enhances Cancer-Associated Immunosuppression." Clin Cancer Res 23(14): 3711-3720. 
9. Konstantinopoulos PA, Sachdev JC, Schwtrzberg L, et al, Dose-finding combination study of 
niraparib and pembrolizumab in patients with metastatic triple-negative breast cancer or 
recurrent platinum-resistant epithelial ovarian cancer. Annals of Oncology, Sept 2017, Vol 
28. 
10. Kraya A, Maxwell KN, Wenz BM, et al. Aanlaysis of tumor Immunogenicity in germline 
BRCA1/2 mutation associated breast and ovarian cancers. Cancer Immunology Research, 
2017 (abstract) 

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11. Matsuo, K., S. E. Spragg, M. A. Ciccone, E. A. Blake, C. Ricker, H. Q. Pham and L. D. 
Roman (2018). "Nivolumab use for BRCA gene mutation carriers with recurrent epithelial 
ovarian cancer: A case series." Gynecol Oncol Rep 25: 98-101. 
12. Papa, A., D. Caruso, M. Strudel, S. Tomao and F. Tomao (2016). "Update on Poly-ADP-
ribose polymerase inhibition for ovarian cancer treatment." J Transl Med 14: 267. 
13. Ramakrishnan Geethakumari, P., M. J. Schiewer, K. E. Knudsen and W. K. Kelly (2017). 
"PARP Inhibitors in Prostate Cancer." Curr Treat Options Oncol 18(6): 37. 
14. Schaefer, N. G., E. James and R. L. Wahl (2011). "Poly(ADP-ribose) polymerase inhibitors 
combined with external beam and radioimmunotherapy to treat aggressive lymphoma." Nucl 
Med Commun 32(11): 1046-1051. 
15. Turk, A. A. and K. B. Wisinski (2018). "PARP inhibitors in breast cancer: Bringing synthetic 
lethality to the bedside." Cancer 124(12): 2498-2506. 
16. Waddell N, Pajic M, Patch AM, et al, Whole genomes redefine the mutational landscape of 
pancreatic cancer. Nature, 518, Feb 2015, pp 495-501. 
17. Eisenhauer, E.A., et al., New response evaluation criteria in solid tumours: revised RECIST 
guideline (version 1.1). Eur J Cancer, 2009. 45(2): p. 228-47 
18. Seymour, L., et al., iRECIST: guidelines for response criteria for use in trials testing 
immunotherapeutics. The Lancet Oncology, 2017. 18(3): p. e143-e152. 

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Appendix I 
ECOG Performance Status 
 
ECOG PERFORMANCE STATUS* 
Grade ECOG 
0 
Fully active, able to carry on all pre-disease performance without restriction 
1 
Restricted in physically strenuous activity but ambulatory and able to carry out 
work of a light or sedentary nature, e.g., light house work, office work 
2 
Ambulatory and capable of all selfcare but unable to carry out any work 
activities. Up and about more than 50% of waking hours 
3 
Capable of only limited selfcare, confined to bed or chair more than 50% of 
waking hours. 
4 
Completely disabled. Cannot carry on any selfcare. Totally confined to bed or 
chair. 
5 
Dead 
*As published in Am. J. Clin. Oncol.: 
Oken, M.M., Creech, R.H., Tormey, D.C., Horton, J., Davis, T.E., McFadden, E.T., Carbone, P.P.: 
Toxicity And Response Criteria Of The Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649-
655, 1982. 
The ECOG Performance Status is in the public domain therefore available for public use. To duplicate the 
scale, please cite the reference above and credit the Eastern Cooperative Oncology Group, Robert Comis 
M.D., Group Chair. 
From http://www.ecog.org/general/perf_stat.html 
 
 

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Appendix II Patient Medication Diary 
Name _ 
 
Study ID Number  
 
Please complete this diary on a daily basis. Write in the amount of the dose of niraparib that you 
took in the appropriate “Day” box. 
On the days that you do not take any study drug, please write in “0”. If you forget to take your 
daily dose, please write in “0”, but remember to take your prescribed dose at the next regularly 
scheduled time. 
If you experience any health/medical complaints or take any medication other than niraparib, 
please record this information. 
Week of: _________________________ 
Study Drug 
Day 1 
Day 2 
Day 3 
Day 4 
Day 5 
Day 6 
Day 7 
Niraparib 
 
 
 
 
 
 
 
Week of: _________________________ 
Study Drug 
Day 8 
Day 9 
Day 10 
Day 11 
Day 12 
Day 13 
Day 14 
Niraparib 
 
 
 
 
 
 
 
Week of: _________________________ 
Study Drug 
Day 15 
Day 16 
Day 17 
Day 18 
Day 19 
Day 20 
Day 21 
Niraparib 
 
 
 
 
 
 
 
Patient signature: ___________________________________________ 
Comments: 
 
 
 
Use a separate sheet of paper if more space is needed. 
My next scheduled visit is: _______________________________ 
If you have any questions, please call: ______________________ 
Study Coordinator Use Only 
Number of pills returned ______ 
Number of vials returned: _______ 
 
Discrepancy Yes____/No____ 
Verified by __________________ 
Date_______________ 

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Appendix III Examples of confirmed progression  
The following examples show how a patient that is currently an iUPD can become an iCPD (confirmed 
progression). These examples all use target lesion growth as the source of the first progression (iUPD) 
and show how additional information in future assessments can lead to iCPD. The examples are not 
exhaustive, but are meant to be illustrative of how iCPD can occur. Similar examples can be created 
where non-target lesions and/or new lesions led to the initial iUPD. 
1) iUPD due to target lesion growth from baseline followed by iCPD due to continued growth of 
target lesions (by at least 5 mm). 
 
Baseline 
TP1 
TP2 
T lesions (sum) 
100 
125 
132 
NT lesions 
Pres 
No change 
No change 
New lesions 
 
None 
None 
TP response (R) 
 
PD 
PD 
TP response (iR) 
 
iUPD 
iCPD 
2) iUPD due to target lesion growth from baseline followed by iCPD due to gradual continued 
growth (over 2 assessments) of target lesions (by at least 5 mm from time of first iUPD). 
 
Baseline 
TP1 
TP2 
TP3 
T lesions (sum) 
100 
125 
128 
132 
NT lesions 
Pres 
No change 
No change 
No change 
New lesions 
 
None 
None 
None 
TP response (R) 
 
PD 
PD 
PD 
TP response (iR) 
 
iUPD 
iUPD 
iCPD 
3) iUPD due to target lesion growth from baseline followed by iCPD due to new lesion appearing 
after start of iUPD. This iCPD is based on criteria #2 outlined in Section 11.5.1.  
 
Baseline 
TP1 
TP2 
T lesions (sum) 
100 
125 
125 
NT lesions 
Pres 
No change 
No change 
New lesions 
 
None 
1 new lesion 
TP response (R) 
 
PD 
PD 
TP response (iR) 
 
iUPD 
iCPD 
4) iUPD due to target lesion growth from baseline followed by iCPD due to additional target lesion 
growth as well as a new lesion. 
 
Baseline 
TP1 
TP2 
T lesions (sum) 
100 
125 
132 
NT lesions 
Pres 
No change 
No change 
New lesions 
 
None 
1 new lesion 
TP response (R) 
 
PD 
PD 
 
 
 

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Appendix IV PAXgene Manufacturer’s Recommendations 
Information below is from manufacturer’s website: https://www.qiagen.com/us/resources/  
Document: “PAXgene Blood RNA System Brochure” 
 

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Appendix V 
Patient Blood Pressure and Heart Rate Monitoring Diary 
Name _ 
 
Study ID Number  
 
Please complete this diary on the dates specified below. You will be asked to the record the 
requested information once a week for the first 2 months of therapy while on this study. 
If you are in the clinic for any of the visits listed below for this study, please leave the space 
blank as the study staff will record your blood pressure and heart rate during your visit. 
 
Cycle / Day 
Date  
(dd/mmm/yyyy)  
Blood Pressure  
Systolic/Diastolic  
(top/bottom number)  
Heart Rate (beats per 
minute) 
Cycle 1 Day 1 
 
 
 
Cycle 1 Day 8 
 
 
 
Cycle 1 Day 15  
 
 
Cycle 2 Day 1 
 
 
 
Cycle 2 Day 8 
 
 
 
Cycle 2 Day 15  
 
 
Cycle 3 Day 1 
 
 
 
Cycle 3 Day 8 
 
 
 
Cycle 3 Day 15  
 
 
Patient signature: ___________________________________________ 
Comments: 
 
 
 
Use a separate sheet of paper if more space is needed. 
My next scheduled visit is: _______________________________ 
If you have any questions, please call: ______________________