A Study of Targeted Agents for Patients With Recurrent or Persistent Endometrial Cancer

Study Overview
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Brief Summary
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This is a Phase IB/II multi-cohort study designed to evaluate the efficacy and safety of targeted agents with or without cancer immune checkpoint therapy with atezolizumab in participant with recurrent and/or persistent endometrial cancer. The main protocol provides a platform for genomic screening with homogeneous basic eligibility criteria in order to direct study participants into biomarker-matched study cohorts consisting of testing targeted agents.

Detailed Description
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This is a Phase IB/II multi-cohort study designed to evaluate the efficacy and safety of targeted agents with or without cancer immune checkpoint therapy with atezolizumab in participants with recurrent and/or persistent endometrial cancer. This biomarker-driven study provides a platform whereby participants with persistent/recurrent endometrial cancer will be placed into study cohorts evaluating targeted agents selected on the basis of the tumor's specific genomic profile. Prospective participants with persistent and/or recurrent endometrial cancer will be prescreened within 60 days of treatment assignment to have a tumor tissue sample submitted for next-generation sequencing (NGS) using FoundationOne® companion diagnostic (CDx) testing prior to entering screening. If a participant has FoundationOne® CDx testing within five years of enrollment, the previous tumor tissue may be re-analyzed for use in the study. Depending on the cohort assignment per the tumor's biomarker profile, participants will be assigned to the AFT-50A Protocol (atezolizumab+targeted agent) or the AFT-50B Protocol (non-atezolizumab targeted agents). The current study cohorts are as follows: AFT-50A Cohorts Atezolizumab + Bevacizumab doublet Atezolizumab + Ipatasertib doublet Atezolizumab + Talazoparib doublet Atezolizumab + Trastuzumab emtansine (TDM-1) doublet Atezolizumab + Tiragolumab doublet AFT-50B Cohorts Inavolisib + Letrozole doublet Giredestrant + Abemaciclib doublet It is anticipated that approximately 20 participants will be enrolled in each study cohort in AFT-50A and 24 participants in each study cohort in AFT-50B, unless otherwise specified for a given cohort due to statistical considerations. Each study cohort will open/close independently of other study cohorts. Once a study cohort reaches the prespecified number of participants, it will be closed to further enrollment, unless an expansion phase is planned. The study is structured to allow for additional cohorts to be added as the study progresses. These additional study cohorts may be proposed by investigators, but requires approval by the Steering Committee in order to be added to the protocol.

Official Title
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A Phase IB/II Multi-Cohort Study of Targeted Agents and/or Immunotherapy With Atezolizumab for Patients With Recurrent or Persistent Endometrial Cancer

Conditions
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Endometrial Cancer

Intervention / Treatment
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* Drug: Atezolizumab - 28 Day Cycle
* Drug: Bevacizumab
* Drug: Ipatasertib
* Drug: Talazoparib
* Drug: Trastuzumab emtansine
* Drug: Tiragolumab
* Drug: Atezolizumab - 21 Day Cycle
* Drug: Inavolisib
* Drug: Letrozole
* Drug: Giredestrant
* Drug: Abemaciclib


Participation Criteria
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Eligibility Criteria
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Key Inclusion Criteria: Recurrent or persistent endometrial carcinoma which has progressed or recurred after at least 1, but no more than 2, prior lines of therapy. Prior hormonal therapies (e.g., tamoxifen, aromatase inhibitors) will not count toward the prior regimen limit. Chemotherapy given in conjunction with radiotherapy as a radiosensitizer will be counted as a systemic therapeutic regimen. Measurable disease per RECIST 1.1 Availability of a representative tumor specimen that is suitable for determination of biomarker status via central testing (F1CDx) OR If a patient has a prior F1CDx report from 1 September 2019 or later, those NGS results can be used to determine biomarker status as long as the tumor tissue used in the report was obtained within 5 years prior to prescreening and appropriate signed consent is obtained from the patient. Life expectancy > 12 weeks Recovery from effects of recent radiotherapy, surgery, or chemotherapy Key Exclusion Criteria: Endometrial tumors with the following histologies: squamous carcinomas, sarcomas Other invasive malignancies within the last 5 years, except for non-melanoma skin cancer with no evidence of disease within the past 5 years AND localized breast cancer with previous adjuvant chemotherapy treatment for breast cancer completed > 5 years ago Synchronous primary invasive ovarian or cervical cancer Have an active or history of autoimmune disease or immune deficiency Have a history of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis based on a screening chest computed tomography (CT) scan Active tuberculosis Severe infections within 4 weeks Have received therapeutic oral or IV antibiotic medication within 2 weeks, except prophylactic antibiotic medication Have significant cardiovascular disease Are administered treatment with a live attenuated vaccine within 4 weeks, or anticipation of need for such a vaccine during the course of the study Have prior allogeneic bone marrow transplantation or solid organ transplant Prior treatment with T-cell costimulating or immune checkpoint blockade therapies including, but not limited to, CD137 agonists, anti-PD-1, anti-PD-L1, and anti-CTLA-4 therapeutic antibodies History of treatment with systemic immunostimulatory agents (including but not limited to interferons, interleukin-2) within 4 weeks or 5 half-lives of the drug, whichever is longer, prior to initiation of study treatment History of treatment with systemic immunosuppressive medications within 2 weeks except acute, low-dose, systemic immunosuppressant medications, corticosteroids for chronic obstructive pulmonary disease and asthma, or mineralocorticoids and low-dose corticosteroids for participants with orthostatic hypotension or adrenocortical insufficiency Have a history or clinical evidence of any untreated CNS disease, seizures not controlled with standard medical therapy, or history of cerebrovascular accident (stroke), transient ischemic attack or subarachnoid hemorrhage within 6 months Note: Additional study cohort specific inclusion and exclusion criteria may apply based on cohort assignment.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Atezolizumab and Bevacizumab Cohort<br>Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with no specified gene signatures will be enrolled in this cohort. Twenty participants will be enrolled. Once twenty participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle. | Drug: Atezolizumab - 28 Day Cycle<br>* Atezolizumab will be given to participants intravenously at a dosage of 1680 mg on day 1 of each 28-day cycle.<br>* Other names: L01XC32;Drug: Bevacizumab<br>* Bevacizumab will be given to participants intravenously at a dosage of 10mg per participant kilogram every 2 weeks of the 28-day cycle.<br>* Other names: L01XC07;|
| Experimental: Atezolizumab and Ipatasertib Cohort<br>Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with PIK3CA/AKT1/PTEN-altered tumors will be enrolled in this cohort. Twenty participants will be enrolled. Once twenty participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle. | Drug: Atezolizumab - 28 Day Cycle<br>* Atezolizumab will be given to participants intravenously at a dosage of 1680 mg on day 1 of each 28-day cycle.<br>* Other names: L01XC32;Drug: Ipatasertib<br>* Ipatasertib will be given as an orally at a dosage of 400 mg once daily for 21 days of each 28-day cycle.<br>* Other names: GDC-0068;|
| Experimental: Atezolizumab and Talazoparib Cohort<br>Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with tumors that have a ≥16%genomic loss of heterozygosity (LOH) will be assigned to this cohort. Twenty participants will be enrolled. Once twenty participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle. | Drug: Atezolizumab - 28 Day Cycle<br>* Atezolizumab will be given to participants intravenously at a dosage of 1680 mg on day 1 of each 28-day cycle.<br>* Other names: L01XC32;Drug: Talazoparib<br>* Talazoparib will be given in an orally at a dosage of 1 mg once daily for each day of the 28-day cycle.<br>* Other names: L01XX60;|
| Experimental: Atezolizumab and Trastuzumab emtansine (TDM-1) Cohort<br>Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with tumors that with an amplification of ERBB2/HER2 will be assigned to this cohort. Twenty participants will be enrolled. Once twenty participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle. | Drug: Trastuzumab emtansine<br>* Trastuzumab emtansine be given to participants intravenously at a dosage of 3.6 mg per participant kilogram, on day 1 of each 21-day cycle.<br>* Other names: Kadcyla;Drug: Atezolizumab - 21 Day Cycle<br>* Atezolizumab will be given to participants intravenously at a dosage of 1200 mg on day 1 of each 21-day cycle.<br>* Other names: L01XC32;|
| Experimental: Atezolizumab and Tiragolumab Cohort<br>Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with tumor type MSI-H and/or tTMB >=10 mut/mb will be assigned to this cohort. Twenty participants will be enrolled initially. Once twenty participants are enrolled, the cohort may be expanded if a positive signal is shown. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle. | Drug: Atezolizumab - 28 Day Cycle<br>* Atezolizumab will be given to participants intravenously at a dosage of 1680 mg on day 1 of each 28-day cycle.<br>* Other names: L01XC32;Drug: Tiragolumab<br>* Tiragolumab will be given to participants intravenously at a dosage of 840 mg on day 1 of each 28-day cycle.<br>|
| Experimental: Inavolisib and Letrozole Cohort<br>Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with tumors that with PIK3CA activating mutations in the absence of PTEN loss-of-function alterations or AKT1 activating mutations will be assigned to this cohort. Twenty-four participants will be enrolled. Once twenty-four participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle. | Drug: Inavolisib<br>* Inavolisib will be given in an orally at a dosage of 9 mg once daily for each day of the 28-day cycle.<br>* Other names: GDC-0077;Drug: Letrozole<br>* Letrozole will be given orally at a dosage of 2.5 mg once daily for each day of the 28-day cycle.<br>* Other names: Femara;|
| Experimental: Giredestrant and Abemaciclib<br>Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with tumors that are RB1 intact with a local grade 1-2 estrogne receptor positive (ER+) are assigned to this cohort. Twenty-four participants will be enrolled. Once twenty-four participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle. | Drug: Giredestrant<br>* Giredestrant will be given orally at a dosage of 30 mg once daily for each day of the 28-day cycle.<br>* Other names: GDC-9545;Drug: Abemaciclib<br>* Giredestrant will be given orally at a dosage of 150 mg twice daily for each day of the 28-day cycle.<br>* Other names: Verzenio;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Investigator-assessed overall response rate (ORR) of each biomarker cohort | AFT-50A Protocol: Overall response rate for each biomarker cohort is defined as the proportion of participants achieving a complete (CR) or partial (PR) response on two consecutive occasions at least 4 weeks apart, as determined by the investigator from AFT50A Protocol: Tumor assessments per RECIST v1.1. | 48 Months | 
| The proportion of participants in each biomarker cohort who remain alive and progression-free for at least 6 months | AFT-50B Protocol: Progression free survival rate at 6 months is defined as the proportion of participants who have not experienced disease progression or death from any cause at 6 months, as determined by the investigator according to RECIST v1.1 | 6 Months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Relative proportion of participants in each biomarker cohort who remain progression-free for at least 6 months compared to that from historical control studies | AFT-50A Protocol: PFS rate at 6 months is defined as the proportion of participants who have not experienced disease progression or death from any cause at 6 months, as determined by the investigator according to RECIST v1.1 | 6 Months per cohort | 
| Investigator assessed disease-control rate of each biomarker cohort | AFT-50A Protocol: Disease-control rate is defined as the proportion of participants achieving either stable disease, complete response, or partial response. | 48 Months | 
| Duration of response for participants in each biomarker cohort who achieve a complete or partial response. | AFT-50A Protocol: Duration of response is defined as the time from the first occurrence of a documented objective response to disease progression or death from any cause (whichever occurs first), as determined by the investigator according to RECIST v1.1. | 48 Months | 
| Overall survival (OS) rates of participants in each biomarker cohort after 24 months | AFT-50A Protocol: 24-month overall survival rate is defined as the proportion of participants who have not experienced death from any cause at 24 months. | 24 Months per cohort | 
| Investigator assessed disease-control rate of each biomarker cohort | AFT-50B Protocol: Disease control rate is defined as the proportion of participants achieving either stable disease, complete response, or partial response at any time. | 48 Months | 
| Duration of response for participants in each biomarker cohort who achieve a confirmed response (complete or partial) | AFT-50B Protocol: Duration of response is defined as the time from the first occurrence of a documented objective response (complete or partial) to disease progression or death from any cause (whichever occurs first), as determined by the investigator according to RECIST v1.1 | 48 Months | 
| Overall survival rates of participants in each biomarker cohort | AFT-50B Protocol: 24-month overall survival rate is defined as the proportion of participants who have not experienced death from any cause at 24 months. | 24 Months |