Clinical trial NCT02101684: Orteronel (TAK-700) in Metastatic or Advanced Non-resectable Granulosa Cell Ovarian Tumors. The Greko II Study.
Official title: Open Label Phase II Clinical Trial of Orteronel (TAK-700) in Metastatic or Advanced Non-resectable Granulosa Cell Ovarian Tumors. The Greko II Study.
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE2
Conditions: Metastatic or Advanced Non-resectable Granulosa Cell Ovarian Tumors
Keywords: Orteronel, Granulosa Cell Tumour
Lead sponsor: Grupo Español de Tumores Huérfanos e Infrecuentes
Sponsor class: OTHER
Collaborators: name: Takeda
First posted: 2014-04-02
Enrollment: 10
Sex: FEMALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Granulosa Cell ovarian carcinoma is an infrequent subtype of neoplasia well differentiated from epithelial tumors. They account for 5% of all ovarian malignancies and, with an incidence of 0.4-1.2 cases per 100000 habitants, is considered as a rare disease.

Though most cases are identified at initial stages and can be cured through surgical resection, distant recurrences have been documented even 10 years after resecting the primary tumor. At advanced stage it is a lethal disease.

Unfortunately because of the low incidence of this disease randomized clinical trials are lacking. In fact current evidence for treatment is provided by case reports, retrospective studies and phase II clinical trials performed one decade ago.

Orteronel, a novel, orally active, selective inhibitor of 17,20-lyase, is being developed as an endocrine therapy for relevant hormone-sensitive cancers such as prostate cancer and breast cancer. Orteronel is expected to suppress sex hormone levels in both circulation and relevant hormone-dependent malignant tissue. Since sex hormone overproduction has been demonstrated in granulosa cell ovarian tumors and seems to play a major role in this disease, this study will assess the efficacy or orteronel treating such tumors.


Eligibility criteria: Inclusion Criteria:

* Voluntary written informed consent.
* Patients, even if surgically sterilized who:

  1. Agree to practice effective barrier contraception during the entire study treatment period and for 4 months after the last dose of study drug, or
  2. Agree to completely abstain from intercourse.
* Patients 18 years or older.
* Screening clinical laboratory values as specified below:
* Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) must be \<=2.5 X ULN.
* Total bilirubin \<=1.5 X ULN.
* Estimated creatinine clearance using the Cockcroft-Gault formula must be \>40 mL/minute.
* Absolute neutrophil count (ANC) \>=1500/mcL and platelet count \>=100,000/mcL.
* Histologically confirmed granulosa cell ovarian tumor with locally advanced non-resectable or metastatic disease, measurable or evaluable by RECIST.
* Availability of sufficient biopsy material to confirm the malignant diagnosis of granulosa cell ovarian tumor by a centralized pathologist and to perform the determine the FOXL2 402C mutation → G (C134W). However study entry will be allowed based just on the histological local diagnosis.
* Life expectancy \>=12 weeks
* Screening calculated ejection fraction of greater than or equal to normal by multiple gated acquisition (MUGA) scan, or by echocardiogram (ECHO).
* Stable medical condition, including the absence of acute exacerbations of chronic illnesses, serious infections, or major surgery within 4 weeks before first dose of study drug/randomization.

Exclusion Criteria:

* History of myocardial infarction, unstable symptomatic ischemic heart disease, ongoing arrhythmias of Grade \> 2 (NCI CTCAE, version 4.02)(56), thromboembolic events (eg, deep vein thrombosis, pulmonary embolism, or symptomatic cerebrovascular events), or any other cardiac condition (eg, pericardial effusion restrictive cardiomyopathy) within 6 months prior to first dose of study drug. Chronic stable atrial fibrillation on stable anticoagulant therapy is allowed.
* New York Heart Association Class III or IV heart failure.
* ECG abnormalities of:

  1. Q-wave infarction, unless identified 6 or more months prior to screening
  2. QTc interval \> 460 msec
* Female subject is pregnant or breast-feeding. Confirmation that the subject is not pregnant must be established by a negative serum ?- human chorionic gonadotropin (?-hCG) pregnancy test result obtained during screening.
* Patient has received other investigational drugs within 28 days before enrollment
* Diagnosed or treated for another malignancy within 2 years of enrollment, with the exception of complete resection of basal cell carcinoma or squamous cell carcinoma of the skin, an in situ malignancy.
* Prior therapy with orteronel, ketoconazole, abiraterone, aminoglutethimide or enzalutamide.
* Patients received radical radiotherapy \<= 4 weeks before starting the study treatment or who have not recovered from the toxicities of radiotherapy. Palliative radiotherapy of painful bone lesions is allowed up to 14 days before the start of study treatment.
* Known hypersensitivity to compounds related to orteronel or to orteronel excipients.
* Uncontrolled hypertension despite appropriate medical therapy (BP of greater than 160 mmHg systolic and 90 mmHg diastolic at 2 separate measurements no more than 60 minutes apart during the Screening visit). Note: patients may be rescreened after adjustment of antihypertensive medications.
* Known active chronic hepatitis B or C, life-threatening illness unrelated to cancer, or any serious medical or psychiatric illness that could, in the investigator?s opinion, potentially interfere with participation in this study.
* Likely inability to comply with the protocol or cooperate fully with the investigator and site personnel.
* Known gastrointestinal (GI) disease or GI procedure that could interfere with the GI absorption or tolerance of orteronel, including difficulty swallowing tablets.

Primary outcomes:
measure: Clinical benefit at 6 months
timeFrame: 6 months
Secondary outcomes:
measure: Overall Response Rate
timeFrame: Every 8 weeks, during 6 months
measure: Progression free survival
timeFrame: Every 8 weeks, during 6 months
measure: Overall Survival
timeFrame: Every 12 weeks, untill death
measure: Reduction of sex hormones production.
timeFrame: Every 8 weeks, during 6 months
measure: Toxicity profile
timeFrame: Every 4 weeks, untill end of treatment (6 months estimated)
Other outcomes:
Locations:
city: Palma de Mallorca
country: Spain
facility: Hospital Son Llatzer
state: Islas Baleares
city: Santiago de Compostela
country: Spain
facility: Complexo Hospitalario Universitario de Santiago
state: La Coruña
city: Alcorcón
country: Spain
facility: Hospital Universitario Fundación Alcorcón
state: Madrid
city: Pamplona
country: Spain
facility: Complejo Hospitalario de Navarra
state: Navarra
city: Barcelona
country: Spain
facility: Hospital Del Mar
city: Córdoba
country: Spain
facility: Complejo Hospitalario Regional Reina Sofía
city: Madrid
country: Spain
facility: Hospital Universitario La Paz
city: Madrid
country: Spain
facility: Hospital Universitario Madrid Sanchinarro
city: Valencia
country: Spain
facility: Hospital Universitari I Politècnic La Fe
Study officials:
affiliation: Hospital Universitario Madrid Sanchinarro
name: Jesús García-Donas, MD
role: STUDY_DIRECTOR
affiliation: Hospital Universitario Fundación Alcorcón
name: Alicia Hurtado, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: COMPLEXO HOSPITALARIO UNIVERSITARIO DE SANTIAGO
name: Juan Cueva, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Hospital del Mar
name: Laia Garrigos, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: COMPLEJO HOSPITALARIO REGIONAL REINA SOFÍA
name: María Jesús Rubio, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Hospital Universitario La Paz
name: Andrés Redondo, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Hospital Son Llatzer
name: Isabel Bover, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Complejo Hospitalario de Navarra
name: Nuria Lainez, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Hospital Universitario La Fe
name: Ana Santaballa, MD
role: PRINCIPAL_INVESTIGATOR
References: