Repurposing Atovaquone for the Treatment of Platinum-Resistant Ovarian Cancer

Study Overview
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Brief Summary
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This phase II trial test tests how well repurposing atovaquone works in treating patients with platinum-resistant ovarian cancer. Atovaquone is used for the treatment or prevention of certain infections. Atovaquone is in a class of medications called antiprotozoal agents. It works by stopping the growth of certain types of protozoa that can cause pneumonia. Giving atovaquone may be effective in treating platinum-resistant ovarian cancer and result in improved outcomes compared to standard chemotherapy regimens.

Detailed Description
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PRIMARY OBJECTIVE: I. To determine progression free survival of twenty-eight patients with platinum-resistant ovarian cancer treated with atovaquone. SECONDARY OBJECTIVES: I. To determine clinical benefit rate (complete response, partial response or stable disease) at six months. II. To determine overall survival. III. To quantitate the on-target STAT3 inhibitory effect of atovaquone on STAT3-dependent gene transcription. IV. To quantitate changes of the tumor immune infiltrate by inhibition of STAT3 with atovaquone. OUTLINE: Patients receive atovaquone orally (PO) on study. Patients also undergo computed tomography (CT) and biopsy or paracentesis throughout the study. After completion of study treatment, patients are followed up for 30 days and then every 6 month thereafter.

Official Title
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Phase II Clinical Trial Repurposing Atovaquone for the Treatment of Platinum-Resistant Ovarian Cancer

Conditions
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Ovarian High Grade Serous Adenocarcinoma, Platinum-Resistant Ovarian Carcinoma

Intervention / Treatment
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* Drug: Atovaquone
* Procedure: Biopsy
* Procedure: Computed Tomography
* Procedure: Paracentesis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with platinum-resistant, high-grade serous ovarian cancer, defined as disease progression within six months of completion of their last platinum-based chemotherapy Patients must maintain Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 There will be no limitations on number of prior lines of therapy Trial is open to non-English speaking patients Trial is open to patients referred from community practice Exclusion Criteria: Patients who are < 18 years old Patients who are pregnant or breastfeeding (due to cancer of their reproductive organs, patients enrolled in the trial are unable to conceive) Patients who are incarcerated Patients who are unable to provide consent / lack decision-making capacity

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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment (atovaquone)<br>Patients receive atovaquone PO on study. Patients also undergo CT and biopsy or paracentesis throughout the study. | Drug: Atovaquone<br>* Given PO<br>* Other names: Mepron;Procedure: Biopsy<br>* Undergo biopsy<br>* Other names: Bx;Procedure: Computed Tomography<br>* Undergo CT<br>* Other names: tomography;Procedure: Paracentesis<br>* Undergo paracentesis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression free survival (PFS) | Will be estimated using the Kaplan-Meier method, and a 95% confidence interval for median PFS will be estimated using the Brookmeyer-Crowley approach. | From initiation of atovaquone to progression or death, assessed up to 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical benefit rate | Clinical benefit rate is defined as complete response, partial response, and/or stable disease at six months. Clinical response will be assessed every 6 weeks for the first 24 months and every 12 weeks thereafter using Response Evaluation Criteria in Solid Tumors 1.1 criteria. Will be estimated as a proportion, with an exact 95% confidence interval estimated using the Clopper-Pearson method. | At 6 months | 
| Overall survival (OS) | OS will be estimated using the Kaplan-Meier method, and median survival will be calculated. A 95% confidence interval will be estimated using the Brookmeyer-Crowley approach. | From diagnosis to death from any cause, where patients who are alive will be censored at last follow-up date, assessed up to 1 year | 
| Incidence of adverse events | Safety will be determined according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5. Frequencies and percentages will be used to summarize safety events. | Up to 30 days |