Clinical trial NCT02272790: Adavosertib Plus Chemotherapy in Platinum-Resistant Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer
Official title: A Multicentre Phase II Study of Adavosertib Plus Chemotherapy in Patients With Platinum-Resistant Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Ovarian, Fallopian Tube, Peritoneal Cancer, P53 Mutation
Keywords: Ovarian, Fallopian Tube, or Primary Peritoneal Cancer
Lead sponsor: AstraZeneca
Sponsor class: INDUSTRY
First posted: 2014-10-23
Enrollment: 95
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 130
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Adavosertib in combination with carboplatin, paclitaxel, gemcitabine, or PLD.

Detailed description: This is an open-label, four-arm lead-in safety and efficacy study in which adavosertib will be combined in four separate treatment arms as follows: adavosertib plus gemcitabine (Arm A); adavosertib plus weekly paclitaxel (Arm B); adavosertib plus carboplatin (Arm C); and adavosertib plus PLD (Arm D). A subset of patients will be evaluated for the safety assessment of each treatment arm.

The adavosertib plus paclitaxel arm (Arm B) will enrol approximately 30 additional patients at selected sites as part of a further efficacy evaluation based on emerging data that suggests clinical activity.

In addition, the adavosertib plus carboplatin arm (Arm C) will enrol approximately 23 patients overall at selected sites as part of a further efficacy evaluation based on emerging data that suggests clinical activity.

To further optimise the dosing schedule of adavosertib in Arm C, a safety expansion arm (referred to as Arm C2) of approximately 12 additional patients will be enrolled at selected sites to explore emerging pre-clinical and clinical data that suggest that prolonged adavosertib exposure may increase the clinical activity.

Eligibility criteria: Inclusion

* Has read and understands the informed consent form (ICF) and has given written IC prior to any study specific procedures.
* Histologic or cytologic diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer.
* Progressed within 6 months of completing at least 4 cycles of a first-line platinum-containing regimen for Stage III/IV disease. Patients with refractory disease (progression during platinum-containing therapy) are ineligible.
* No more than 2-4 prior treatment regimens for Stage III/IV disease, defined as investigational, chemotherapy, hormonal, biologic, or targeted therapy.
* Prior doxorubicin (or other anthracycline) at a cumulative dose of ≤ 360 mg/m² or cumulative epirubicin dose of ≤ 720 mg/m² (calculated using doxorubicin equivalent doses: 1 mg of doxorubicin = 1 mg PLD = 0.3 mg mitoxantrone = 0.25 mg idarubicin). Subjects without any prior anthracycline exposure can also be included. Applies to Arm D only.
* At least 1 measurable lesion according to RECIST v1.1.
* Any prior palliative radiation therapy must be completed at least 7 days prior to start of study treatment and patients must have recovered from any acute adverse effects prior to start of study treatment.
* Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) score of 0 - 1.
* Baseline Laboratory Values:

  1. ANC ≥1500/μL
  2. HgB ≥ 9 g/dL with no blood transfusions in the past 28 days
  3. Platelets ≥ 100,000/μL
  4. ALT \& AST ≤3 x ULN or ≤5 x ULN if known hepatic metastases
  5. Serum bilirubin within normal limits (WNL) or ≤1.5 x the ULN in patients with liver metastases; or total bilirubin ≤3.0 x ULN with direct bilirubin WNL in patients with well documented Gilbert's Syndrome.
  6. Serum creatinine ≤1.5 x the ULN and a calculated creatinine clearance (CrCl) ≥45 mL/min by the Cockcroft-Gault method.
* Left ventricular ejection fraction (LVEF) WNL of the institution as determined by multiple uptake gated acquisition (MUGA) or echocardiography (ECHO) (applies to Arm D only).
* Female patients, ≥18, (not of childbearing potential and fertile female patients of childbearing potential) who agree to use adequate contraceptive measures from 2 weeks prior to the study and until 1 month after study treatment discontinuation, who are not breastfeeding, and who have a negative serum or urine pregnancy test within 72 hours prior to start.
* Predicted life expectancy ≥ 12 weeks

Exclusion

* Use of a study drug (approved or investigational drug therapy) ≤21 days or 5 half-lives (whichever is shorter) prior to the first dose of study treatment. For study drugs for which 5 half-lives is ≤21 days, a minimum of 10 days between termination of the study drug and administration of study treatment is required.
* Major surgical procedures ≤ 28 days of beginning study, or minor surgical procedures ≤ 7 days. No waiting period following port-a-cath placement, or any other central venous access placement.
* Grade \>1 toxicity from prior therapy (except alopecia or anorexia).
* Known malignant CNS disease other than neurologically stable, treated brain metastases, defined as metastasis having no evidence of progression or haemorrhage after treatment for at least 2 weeks (including brain radiotherapy). Must be off any systemic corticosteroids for the treatment of brain metastases for at least 14 days prior to enrolment.
* Patient has had prescription or non-prescription drugs or other products (i.e. grapefruit juice) known to be sensitive CYP3A4 substrates or CYP3A4 substrates with a narrow therapeutic index, or to be moderate to strong inhibitors or inducers of CYP3A4 which cannot be discontinued 2 weeks prior to Day 1 of dosing and withheld throughout the study until 2 weeks after last dose of study drug.
* Caution should be exercised when inhibitors or substrates of P-gP, substrates of CYP1A2 with a narrow therapeutic range, sensitive substrates of CYP2C19 or CYP2C19 substrates with a narrow therapeutic range are administered with adavosertib.
* Herbal medications should be discontinued 7 days prior to the first dose of study treatment.
* Any of the following cardiac diseases currently or within the last 6 months as defined by New York Heart Association (NYHA) ≥ Class 2:

  1. Unstable angina pectoris
  2. Congestive heart failure
  3. Acute myocardial infarction
  4. Conduction abnormality not controlled with pacemaker or medication
  5. Significant ventricular or supraventricular arrhythmias (patients with chronic rate controlled atrial fibrillation in the absence of other cardiac abnormalities are eligible).
* Adavosertib should not be given to patients who have a history of Torsades de pointes unless all risk factors that contributed to Torsades have been corrected. Adavosertib has not been studied in patients with ventricular arrhythmias or recent myocardial infarction.
* Corrected QT interval (QTc) \>470 msec at study entry or congenital long QT syndrome.
* Pregnant or lactating.
* Serious active infection at the time of enrolment, or another serious underlying medical condition that would impair the patient's ability to receive study treatment.
* Presence of other active cancers, or history of treatment for invasive cancer within 3 years. Patients with Stage I cancer who have received definitive local treatment within 3 years, and whom are considered unlikely to recur, are eligible. Patients with previously treated in-situ carcinoma (i.e., non-invasive) are eligible, as are patients with prior non-melanoma skin cancers.

Primary outcomes:
measure: Objective Response Rate (ORR)
timeFrame: Throughout the duration of the study (up to 19 months)
Secondary outcomes:
measure: Disease Control Rate (DCR)
timeFrame: Throughout the duration of the study (up to 19 months)
measure: Duration of Response (DoR)
timeFrame: Throughout the duration of the study, approximately 19 months.
measure: Progression Free Survival (Median, 80% CI)
timeFrame: Throughout the Study, Approximately 4 years
measure: Progression Free Survival (Median, 95% CI)
timeFrame: Throughout the Study, Approximately 4 years
measure: Overall Survival (Median, 80% CI)
timeFrame: Throughout the Study, Approximately 4 years
measure: Overall Survival (Median, 95% CI)
timeFrame: Throughout the Study, Approximately 4 years
measure: Gynecologic Cancer Intergroup (GCIG) CA-125 Response
timeFrame: Throughout the study, approximately 4 years
measure: The Number of Patients Experiencing Treatment-emergent Adverse Events (TEAEs) by Maximum CTCAE Grade.
timeFrame: Throughout the duration of the study (up to 19 months)
measure: The Number of Patients Experiencing Treatment-emergent Adverse Events (TEAEs) Related to Adavosertib by Maximum CTCAE Grade
timeFrame: Throughout the duration of the study (up to 19 months)
measure: The Number of Patients Experiencing Treatment-emergent Adverse Events (TEAEs) Related to Chemotherapy by Maximum CTCAE Grade
timeFrame: Throughout the duration of the study (up to 19 months)
measure: Serious Adverse Events
timeFrame: Throughout the duration of the study (up to 19 months)
measure: Serious Adverse Events Leading to Death
timeFrame: Throughout the duration of the study (up to 19 months)
measure: Treatment-Related Adverse Events Related to Adavosertib Leading to Treatment Discontinuation
timeFrame: Throughout the duration of the study (up to 19 months)
measure: Treatment-Related Adverse Events Related to Adavosertib Leading to Dose Reduction
timeFrame: Throughout the duration of the study (up to 19 months)
measure: Treatment-Related Adverse Events Related to Adavosertib Leading to Treatment Interruption
timeFrame: Throughout the duration of the study (up to 19 months)
measure: Treatment-Related Adverse Events Related to Chemotherapy Leading to Treatment Discontinuation
timeFrame: Throughout the duration of the study (up to 19 months)
measure: Treatment-Related Adverse Events Related to Chemotherapy Leading to Dose Reduction
timeFrame: Throughout the duration of the study (up to 19 months)
measure: Treatment-Related Adverse Events Related to Chemotherapy Leading to Treatment Interruption
timeFrame: Throughout the duration of the study (up to 19 months)
measure: Single Dose Adavosertib Cmax
timeFrame: Pre-dose, 0.5 hr, 1 hr, 2 hr, 4 hr, 6 hr, and 8 hr
measure: Multiple Dose Adavosertib Cmax
timeFrame: Pre-dose, 1 hr, 2 hr, 4 hr, 6 hr, and 8 hr
measure: Single Dose Adavosertib Tmax
timeFrame: Pre-dose, 0.5 hr, 1 hr, 2 hr, 4 hr, 6 hr, and 8 hr
measure: Multiple Dose Adavosertib Tmax
timeFrame: Pre-dose, 1 hr, 2 hr, 4 hr, 6 hr, and 8 hr
Other outcomes:
Locations:
city: Gilbert
country: United States
facility: Research Site
state: Arizona
city: Tucson
country: United States
facility: Research Site
state: Arizona
city: La Jolla
country: United States
facility: Research Site
state: California
city: Los Angeles
country: United States
facility: Research Site
state: California
city: San Francisco
country: United States
facility: Research Site
state: California
city: Tampa
country: United States
facility: Research Site
state: Florida
city: West Palm Beach
country: United States
facility: Research Site
state: Florida
city: Augusta
country: United States
facility: Research Site
state: Georgia
city: Boston
country: United States
facility: Research Site
state: Massachusetts
city: Detroit
country: United States
facility: Research Site
state: Michigan
city: New York
country: United States
facility: Research Site
state: New York
city: New York
country: United States
facility: Research Site
state: New York
city: Cleveland
country: United States
facility: Research Site
state: Ohio
city: Oklahoma City
country: United States
facility: Research Site
state: Oklahoma
city: Abington
country: United States
facility: Research Site
state: Pennsylvania
city: Nashville
country: United States
facility: Research Site
state: Tennessee
city: Dallas
country: United States
facility: Research Site
state: Texas
city: Milwaukee
country: United States
facility: Research Site
state: Wisconsin
city: Toronto
country: Canada
facility: Research Site
state: Ontario
city: Amsterdam
country: Netherlands
facility: Research Site
Study officials:
affiliation: Stephenson Cancer Center, University of Oklahoma Health Sciences Center
name: Kathleen Moore, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Moore KN, Chambers SK, Hamilton EP, Chen LM, Oza AM, Ghamande SA, Konecny GE, Plaxe SC, Spitz DL, Geenen JJJ, Troso-Sandoval TA, Cragun JM, Rodrigo Imedio E, Kumar S, Mugundu GM, Lai Z, Chmielecki J, Jones SF, Spigel DR, Cadoo KA. Adavosertib with Chemotherapy in Patients with Primary Platinum-Resistant Ovarian, Fallopian Tube, or Peritoneal Cancer: An Open-Label, Four-Arm, Phase II Study. Clin Cancer Res. 2022 Jan 1;28(1):36-44. doi: 10.1158/1078-0432.CCR-21-0158. Epub 2021 Oct 13.