Olaparib and Onalespib in Treating Patients With Solid Tumors That Are Metastatic or Cannot Be Removed by Surgery or Recurrent Ovarian, Fallopian Tube, Primary Peritoneal, or Triple-Negative Breast Cancer
Condition: Metastatic High Grade Fallopian Tube Serous Adenocarcinoma; Metastatic Malignant Solid Neoplasm; Metastatic Primary Peritoneal Serous Adenocarcinoma; Metastatic Triple-Negative Breast Carcinoma; Platinum-Resistant Fallopian Tube Carcinoma; Platinum-Resistant Ovarian Carcinoma; Platinum-Resistant Primary Peritoneal Carcinoma; Recurrent Breast Carcinoma; Recurrent High Grade Fallopian Tube Serous Adenocarcinoma; Recurrent High Grade Ovarian Serous Adenocarcinoma; Recurrent Primary Peritoneal High Grade Serous Adenocarcinoma; Recurrent Triple-Negative Breast Carcinoma; Refractory Fallopian Tube Serous Adenocarcinoma; Refractory Ovarian Serous Adenocarcinoma; Refractory Primary Peritoneal Serous Adenocarcinoma; Refractory Triple-Negative Breast Carcinoma; Unresectable High Grade Fallopian Tube Serous Adenocarcinoma; Unresectable Malignant Solid Neoplasm; Unresectable Primary Peritoneal Serous Adenocarcinoma
MeSH terms: Carcinoma; Neoplasms; Adenocarcinoma; Triple Negative Breast Neoplasms; Breast Neoplasms; Cystadenocarcinoma, Serous; Recurrence
Intervention: Olaparib; Onalespib
Intervention description: Given PO; Given IV
Intervention MeSH terms: Olaparib; Poly(ADP-ribose) Polymerase Inhibitors
Phase: Phase 1
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Sequential Assignment
Masking: None (Open Label)
Enrollment: 28.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase I trial studies the side effects and best dose of olaparib and onalespib when
      given together in treating patients with solid tumors that have spread to other places in the
      body (metastatic) or cannot be removed by surgery (unresectable) or ovarian, fallopian tube,
      primary peritoneal, or triple-negative breast cancer that has come back (recurrent). Olaparib
      and onalespib may stop the growth of tumor cells by blocking some of the enzymes needed for
      cell growth.
    

Eligibility criteria:

        Inclusion Criteria:

          -  For the dose escalation cohort, patients must have histologically or cytologically
             confirmed malignancy that is metastatic or unresectable and for which standard
             curative or palliative measures do not exist or are no longer effective

          -  For the dose escalation cohort, patients may have received any number of prior
             therapies

          -  For the dose expansion cohort, participants must have histologically or cytologically
             confirmed diagnosis of either:

               -  Ovarian, fallopian tube, or primary peritoneal cancer of high grade serous
                  histology which has recurred despite standard therapy; up to 3 prior lines in the
                  platinum resistant setting (i.e. up to 3 lines after patients have become
                  platinum resistant); patients may have received unlimited lines while platinum
                  sensitive

               -  Triple-negative breast cancer (TNBC) which has recurred despite standard therapy;
                  recurrent TNBC needs to have metastatic disease and patients with an in breast
                  recurrence are not eligible; up to 4 prior lines in the recurrent setting for
                  patients with triple-negative breast cancer are allowed

          -  For the dose expansion cohort, patients with ovarian, fallopian tube or primary
             peritoneal cancer must have platinum resistant disease defined as progression within 6
             months after last platinum regimen; platinum refractory disease is allowed

          -  For the dose expansion cohort, patients with triple-negative breast cancer may not be
             BRCA1/2 germline mutation carriers

          -  Because no dosing or adverse event data are currently available on the use of olaparib
             in combination with AT13387 in patients < 18 years of age, children are excluded from
             this study, but will be eligible for future pediatric trials.

          -  There must be availability of a formalin-fixed, paraffin-embedded tumor specimen

          -  Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 (Karnofsky > 60%)

          -  Life expectancy of greater than 12 weeks

          -  Leukocytes >= 3,000/mcL

          -  Hemoglobin >= 10 g/dL with no blood transfusion in the past 28 days

          -  Absolute neutrophil count >= 1,500/mcL

          -  Platelets >= 100,000/mcL

          -  Total bilirubin within normal institutional limits

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
             [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
             =< 3 x institutional upper limit of normal

          -  Creatinine =< the institutional upper limit of normal OR creatinine clearance >= 60
             mL/min/1.73 m^2 for patients with creatinine levels above institutional normal

          -  Corrected QT using Fridericia's formula (QTcF) =< 450 ms

          -  Any clinically significant electrolyte imbalance, particularly hypokalemia and
             hypomagnesemia, should be corrected before treatment

          -  Pre-study evaluation must include an ophthalmologic exam by an ophthalmologist (not
             optometrist) and should minimally include visual acuity testing, slit lamp
             examination, and funduscopic examination; follow up eye-exams will only be performed
             if subjects develop/report any visual impairment; visual impairment may include
             peripheral flashes (photopsia), blurred or double vision, floaters, color distortion
             and dimness, difficulties with light/dark accommodation, tunnel vision or other field
             defects, halos, apparent movement of stationary objects, and complex disturbances;
             follow up eye-exams will minimally include visual acuity testing, slit lamp
             examination, and funduscopic examination; additional testing will be based on
             symptoms, what is observed and ophthalmologist recommendations

          -  For the expansion cohort only: measurable disease by RECIST v1.1 with at least one
             measurable target lesion

          -  The effects of olaparib in combination with AT13387on the developing human fetus are
             unknown; for this reason and because olaparib and AT13387 are anti-neoplastic small
             molecule inhibitors, which are agents that are potentially teratogenic, women of
             child-bearing potential and men must agree to use adequate contraception (hormonal or
             barrier method of birth control; abstinence) prior to study entry, for the duration of
             study participation, and for 3 months after the last dose of study drugs; should a
             woman become pregnant or suspect she is pregnant while she or her partner is
             participating in this study, she should inform her treating physician immediately; men
             treated or enrolled on this protocol must also agree to use adequate contraception
             prior to the study, for the duration of study participation, and 4 months after
             completion of olaparib and/or AT13387 administration

          -  Patients must be able to swallow tablets and have no significant impairment in
             gastrointestinal absorption

          -  Ability to understand and the willingness to sign a written informed consent document

        Exclusion Criteria:

          -  Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
             nitrosoureas or mitomycin C) prior to entering the study or those who have not
             recovered from adverse events due to agents administered more than 4 weeks earlier

          -  All acute, clinically significant treatment-related toxicity from prior therapy,
             except for alopecia, must have resolved to grade =< 1

          -  Patients who are receiving any other investigational agents

          -  Patients with known active or history of brain metastases should be excluded from this
             clinical trial because of their poor prognosis and because they often develop
             progressive neurologic dysfunction that would confound the evaluation of neurologic
             and other adverse events

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to olaparib and AT13387 used in study

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
             arrhythmia, or psychiatric illness/social situations that would limit compliance with
             study requirements

          -  Pregnant women are excluded from this study because olaparib and AT13387 are agents
             with the potential for teratogenic or abortifacient effects; because there is an
             unknown but potential risk for adverse events in nursing infants secondary to
             treatment of the mother with AT13387 or olaparib, breastfeeding should be discontinued
             if the mother is treated with olaparib or AT13387

          -  Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral
             therapy are ineligible because of the potential for pharmacokinetic interactions with
             olaparib or AT13387; in addition, these patients are at increased risk of lethal
             infections when treated with marrow-suppressive therapy; appropriate studies will be
             undertaken in patients receiving combination antiretroviral therapy when indicated

          -  Known history of QT/corrected QT (QTc) prolongation or torsades de pointes (TdP);
             patients who are currently receiving treatment with medication with a known risk to
             prolong the QT interval or inducing torsades de pointes and the treatment cannot
             either be discontinued or switched to a different medication prior to starting study
             drugs

          -  Participants receiving any medications or substances that are strong inhibitors or
             inducers of CYP3A4 or moderate inhibitors of CYP3A4 are ineligible; the study team
             should check a frequently-updated medical reference for a list of drugs to avoid or
             minimize use of; as part of the enrollment/informed consent procedures, the patient
             will be counseled on the risk of interactions with other agents, and what to do if new
             medications need to be prescribed or if the patient is considering a new
             over-the-counter medicine or herbal product

          -  Participants with myelodysplastic syndrome/acute myeloid leukemia or with features
             suggestive of myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML)