Niraparib + Dostarlimab + RT in Pancreatic Cancer
Condition: Pancreatic Cancer; Metastatic Pancreatic Cancer
MeSH terms: Pancreatic Neoplasms
Intervention: Niraparib; Dostarlimab; Radiation
Intervention description: Niraparib oral, once a day, predetermined dose.Dosing will commence on cycle 1 day 1 and will continue until the participant is taken off treatment; Dostarlimab by intravenous infusion once every cycle for as long as they remain on the study; Radiation therapy on every other week day of cycle 2 only. Radiation will begin on Cycle 2 Day 1
Intervention MeSH terms: Niraparib; Dostarlimab
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 18.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Pancreatic Cancer; Metastatic Pancreatic Cancer

Summary:

      This research is being done to see how the combination of dostarlimab, niraparib, and
      radiation therapy works in controlling metastatic pancreatic cancer.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Histologically or cytologically confirmed metastatic adenocarcinoma of pancreatic
             origin.

          -  Age > 18 years.

          -  ECOG performance status ≤ 1.

          -  Life expectancy of greater than 3 months.

          -  Participants must have normal organ and marrow function as defined below:

               -  leukocytes ≥ 2,000/mcL

               -  absolute neutrophil count ≥ 1,500/mcL

               -  platelets ≥ 100,000/mcL

               -  hemoglobin ≥ 9 g/dL

               -  AST(SGOT)/ALT(SGPT) ≤2.5 × institutional upper limit of normal(subjects with
                  liver metastases can have an AST (SGOT) ≤ 5 x ULN

               -  creatinine ≤ 1.5 x ULN OR

               -  creatinine clearance* ≥ 60 mL/min (if using the Cockcroft-Gault formula)

               -  total bilirubin ≤ 1.5 x ULN (subjects with Gilbert Syndrome can have a total
                  bilirubin < 3 x ULN)

               -  INR, PT, aPTT ≤ 1.5 x ULN (subjects receiving anticoagulant therapy must have PT
                  or PTT within therapeutic range) *Creatinine clearance should be calculated per
                  the following: CrCl (mL/min) = (140 - age [years]) x weight [kg] x 1.23 (x 0.85
                  if female)/ Serum creatinine (micromol/L)

          -  Women of childbearing potential (WoCBP) must have a negative serum or urine pregnancy
             test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 7 days prior to
             initiating protocol therapy.

        Non childbearing 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 2
             adequate barrier methods throughout the study, starting with the screening visit
             through 150 days after the last dose of study treatment. See Section 4.4 for a list of
             acceptable birth control methods. 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.

               -  Women of childbearing potential must agree to use appropriate method(s) of
                  contraception. WOCBP should use an adequate method to avoid pregnancy for 6
                  months (30 days plus the time required for niraparib to undergo five
                  half-lives/150 days) after the last dose of investigational drug.

               -  Women must not be breastfeeding during the study or for 150 days after the last
                  dose of investigational drug.

               -  Men who are sexually active with WoCBP must use any contraceptive method with a
                  failure rate of less than 1% per year. Men receiving protocol therapy and who are
                  sexually active with WoCBP will be instructed to adhere to contraception for a
                  period of 6 months (150 days) after the last dose of investigational product.
                  (Women who are not of childbearing potential, i.e. are postmenopausal as defined
                  in the eligibility criteria or surgically sterile, as well as azoospermic men do
                  not require contraception.) Ability to understand and the willingness to sign a
                  written informed consent document

               -  If applicable, stable dose of dexamethasone of 10mg or less for 4 weeks prior to
                  initiation of investigational protocol therapy. Regimen must be completed >14
                  days prior to treatment start.

               -  One previously unirradiated lesion amenable to radiotherapy at a dose of 8 Gy x 3
                  and can meet dose constraints, and another unirradiated measurable lesion > 1 cm
                  in size outside the radiation field that can be used as measurable disease.

               -  Patients must have had at least one line of prior treatment. Any prior line of
                  treatment is permitted, including adjuvant.

        Exclusion Criteria:

        Participants who meet any of the following criteria will be excluded:

          -  Systemic anticancer or biological therapy including prior chemotherapy, immunotherapy,
             targeted small molecule therapy within 14 days prior to investigational agent, or
             those who have not recovered (i.e., ≤ grade 1 or at baseline) from adverse events due
             to agents administered more than 2 weeks earlier. Participants with ≤ grade 2
             neuropathy are an exception to these criteria and may qualify for the study. If the
             participant received major surgery, then they must have recovered adequately from the
             toxicity and/or complications from the intervention prior to starting therapy.

          -  Received investigational therapy ≥ 4 weeks, or within a time interval less than at
             least 5 half-lives of the investigational agent, whichever is shorter, prior
             initiating protocol therapy.

          -  Major surgery ≤ 3 weeks prior to initiating protocol therapy and/or not recovered from
             any surgical effects.

          -  Received radiation therapy encompassing >20% of the bone marrow within 2 weeks; or any
             radiation therapy within 1 week prior to day 1 of protocol therapy.

          -  Received a transfusion (platelets or red blood cells) ≤ 4 weeks prior to initiating
             protocol therapy

          -  Received colony-stimulating factors (e.g., granulocyte colony-stimulating factor,
             granulocyte macrophage colony-stimulating factor, or recombinant erythropoietin)
             within 4 weeks prior to initiating protocol therapy. Known history of Grade 3 or 4
             anemia, neutropenia or thrombocytopenia due to prior chemotherapy that persisted > 4
             weeks and was related to the most recent treatment.

          -  Known history of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML).

          -  Active, known or suspected autoimmune disease that has required systemic treatment
             within the past 2 years other than vitiligo, type I diabetes mellitus, residual
             hypothyroidism due to autoimmune condition only requiring hormone replacement,
             psoriasis not requiring systemic treatment, or conditions not expected to recur in the
             absence of an external trigger.

          -  Any condition requiring systemic treatment with either corticosteroids (> 10 mg daily
             prednisone equivalents) or other immunosuppressive medications within 14 days of study
             drug administration. Inhaled or topical steroids and adrenal replacement doses > 10 mg
             daily prednisone equivalents are permitted in the absence of active autoimmune
             disease. Participants are permitted to use topical, ocular, intraarticular,
             intranasal, and inhalational corticosteroids (with minimal systemic absorption).
             Physiologic replacement doses of systemic corticosteroids are permitted, even if > 10
             mg/day prednisone equivalents. A brief course of corticosteroids for prophylaxis
             (e.g., contrast dye allergy) or for treatment of non-autoimmune conditions (e.g.,
             delayed-type hypersensitivity reaction caused by contact allergen) is permitted.

          -  Known history of active TB (Bacillus Tuberculosis). Testing is not required for
             eligibility purposes.

          -  Known hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus ribonucleic
             acid (HCV antibody) indicating acute or chronic infection. Testing is not required for
             eligibility purposes.

          -  Known history of testing positive for human immunodeficiency virus (HIV) or known
             acquired immunodeficiency syndrome (AIDS). These participants are at increased risk of
             lethal infections when treated with marrow suppressive therapy. Testing is not
             required for eligibility purposes.

          -  Known ≥ Grade 3 immune-related AE with prior immunotherapy, with the exception of
             non-clinically significant lab abnormalities.

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
             arrhythmia, recent (within 90 days) myocardial infarction or psychiatric
             illness/social situations that would limit compliance with study requirements.

          -  Known psychiatric or substance abuse disorders that would interfere with cooperation
             with the requirements of the trial.

          -  Known additional malignancy diagnosed, detected or treated ≤ 2 years prior to
             initiation of protocol therapy . Exceptions include basal cell carcinoma of the skin
             and squamous cell carcinoma of the skin that has undergone potentially curative
             therapy or in situ cervical cancer.

          -  Known history of, or any evidence of active, non-infectious pneumonitis or
             interstitial lung disease.

          -  Active infection requiring systemic therapy

          -  Has received a live vaccine within 30 days of planned start of study therapy. Note:

        Seasonal influenza vaccines for injection are generally inactivated flu vaccines and are
        allowed; however intranasal influenza vaccines (e.g., Flu-Mist®) are live attenuated
        vaccines, and are not allowed.

          -  Known hypersensitivity to niraparib and dostarlimab components or excipients.

          -  History of severe hypersensitivity reaction to any monoclonal antibody

          -  Participants with known 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.

        Further imaging is not required for eligibility purposes.