Olaparib in People With Malignant Mesothelioma
Condition: Mesothelioma
MeSH terms: Mesothelioma; Mesothelioma, Malignant
Study type: Interventional
Phase: Phase 2

Summary: 
      Background:

      The drug olaparib may stop cancer cells from fixing damage to their deoxyribonucleic acid
      (DNA). It has been approved to treat certain cancers in people that were born with a mutation
      in the breast cancer (BRCA) gene. It has not been approved for treating mesothelioma. But
      some people with mesothelioma have mutations in a gene, BRCA1 Associated Protein 1 (BAP1)
      related to BRCA. Researchers want to see if olaparib can work in patients with mutations in
      this gene. They also want to see if works on mutations in other genes or patients without any
      mutations. They want to see if olaparib causes mesothelioma tumors to shrink.

      Objective:

      To study the effect of olaparib on mesothelioma.

      Eligibility:

      People ages 18 and older with malignant mesothelioma that has already been treated

      Design:

      Participants will be screened with

      Sample of tumor tissue or fluid

      Medical history

      Physical exam

      Blood, heart, and urine tests

      Scans and x-rays

      Participants will give blood and tissue samples. These will be genetically tested.

      The study will be done in 21-day cycles.

      Participants will take tables of the study drug 2 times each day. They will get information
      on what food and drugs to avoid during the study. They will get information about birth
      control. They will keep a diary of doses and symptoms.

      Participants will have blood and urine tests and scans every few weeks.

      Participants will be told any important genetic testing results.

      Participants will stay in the study until their disease gets worse or the participant or
      their doctor chooses to stop it.

      About 30 days after stopping the study drug, participants will have a follow-up visit. They
      will have a medical history, physical exam, blood tests, and scans.

      Some participants will continue to have scans every 6 weeks.

      ...
    

Detailed description: 
      Background:

        -  Malignant mesothelioma is an invasive and often fatal neoplasm that arises from
           mesothelium that lines several organs.

        -  Recent studies have identified germline mutations in the gene encoding breast cancer
           type 1 (BRCA1) associated protein-1 (BAP1) which can predispose to mesothelioma

        -  In addition to mesothelioma, germline BAP1 mutations confer increased susceptibility for
           the development of several other tumors including uveal melanoma, cutaneous melanoma,
           renal cell cancers and possibly other cancers

        -  In addition to BAP1, we found several novel germline variants that have previously not
           been associated with risk of developing mesothelioma.

        -  As evidenced by recent data derived from ovarian and prostate cancer patients, mutations
           in deoxyribonucleic acid (DNA) repair genes can define subgroups of cancer patients with
           distinct vulnerabilities to DNA damage response inhibitors.

        -  Olaparib is a Poly (ADP-ribose) polymerase (PARP) inhibitor indicated as monotherapy in
           patients with deleterious or suspected deleterious germline BRCA mutated

        -  Both established and patient derived mesothelioma cell lines with mutated DNA repair
           genes are sensitive to olaparib.

      Objective:

      -Determine the efficacy with respect to objective response rate of olaparib in patients with
      malignant mesothelioma based on somatic or germline mutation status of DNA repair genes

      Eligibility:

        -  Patients must have progressive, histologically or cytologically confirmed malignant
           mesothelioma.

        -  Age greater than or equal to 18 years

        -  Patients must have received prior platinum and pemetrexed based therapies

        -  Adequate organ and bone marrow function

      Design:

        -  This is a phase II, single center study of olaparib in subjects with malignant
           mesothelioma

        -  All subjects will take olaparib by mouth twice daily until disease progression or
           intolerable side effects

        -  Subjects will be assessed for safety (continuously) and efficacy (every 6 weeks)

        -  Subjects will be analyzed in 3 separate comparison groups according to their mutation
           status

             -  Comparison Group 1: Patients with a germline mutation in DNA repair genes

             -  Comparison Group 2: Patients with BAP1 somatic mutations

             -  Comparison Group 3: Patients with neither germline mutations nor BAP 1 somatic
                mutations

        -  Up to 30 evaluable subjects will be enrolled
    

Intervention name(s): Olaparib; ClinOmics
Intervention type(s): Drug; Device
Intervention description(s): All subjects will take olaparib by mouth twice per day until disease progression or unacceptable toxicity; Non-significant risk (NSR) device
Other intervention name(s): Lynparza
Intervention MeSH terms: Olaparib
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: DNA Mismatch Repair; BAP1; BRCA