Clinical trial NCT06976892: Investigating Idetrexed and Olaparib in Patients With Ovarian Cancer
Official title: A Phase I/Ib Trial of Idetrexed (Alpha Folate Receptor Targeted Thymidylate Synthase Inhibitor) in Combination With Olaparib (a PARP Inhibitor) at Different Doses in Patients With Ovarian Cancer (IDOL)
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: PHASE1
Conditions: High Grade Serous Ovarian Cancer
Keywords: Ovarian Cancer
idetrexed
olaparib
Lead sponsor: Institute of Cancer Research, United Kingdom
Sponsor class: OTHER
Collaborators: name: Algok Bio Inc.
First posted: 2025-05-16
Enrollment: 33
Sex: FEMALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SEQUENTIAL
Intervention model description: Up to 4 dose levels of Olaparib in combination with Idetrexed will be explored. Dose Escalation will use a flexible TIme To Event Continual Reassessment Method (TITE-CRM) including time-to-toxicity analysis to account for dose-limiting toxicities that may arise outside the initial DLT period (2 cycles). The TITE-CRM was proposed to handle the problem of long trial duration in Phase 1 trials due to late-onset toxicities. By combining a "backfilling" feature with TITE-CRM, the aim is to significantly shorten trial duration while maintaining a good assessment of the Maximum Tolerated Dose and Recommended Phase 2 Dose. The latter will consider not only the DLT outcomes, but also other parameters including activity and patient tolerability, as well as biomarker response during dose expansion. The proposed trial design ensures that the study has the advantages of both speed and efficiency.

PLEASE NOTE: INTRA-PATIENT DOSE ESCALATION IS NOT PERMITTED ON THIS STUDY.
Primary purpose: TREATMENT

Brief summary: Two drugs called Idetrexed and olaparib are being evaluated. Idetrexed is a type of drug called an "aFR-targeted thymidylate synthase inhibitor". Idetrexed has been designed to selectively target cancer cells that have a protein called folate receptor on the surface of cancer cells. Thymidylate synthase is key to cancer cells for creating new DNA when they multiply. Blocking the action of thymidylate synthase with a drug like Idetrexed may therefore stop cancers from growing by damaging DNA in cancer cells. Olaparib is a type of drug called a "PARP inhibitor". It prevents cells repairing DNA damage. This leads to cells dying. Combining Idetrexed and olaparib should increase the number of cancer cells dying, especially those cells that have a lot of folate receptors. Cancer cells with a high number of folate receptors should be targeted more than normal healthy cells.


Eligibility criteria: Inclusion Criteria:

* Histologically or cytologically proven high grade serous ovarian cancer refractory to conventional treatment, or for which no conventional therapy exists or is declined by the patient.
* Measurable (as defined by RECIST v1.1) or evaluable (based on tumour markers) disease.
* Life expectancy of at least 12 weeks.
* World Health Organisation (WHO) performance status of 0-1 (Appendix 1 of Protocol).
* Haematological and biochemical indices within the ranges shown in Protocol section 4.1.1). These measurements must be performed within one week (Day -7 to Day 1) prior to the patient's first dose of IMP.

Normal (no clinically significant abnormalities) 12-lead ECG, QTcF interval \<470 ms

* Pulmonary function test FVC of \>70%, DLCOc (DLCO corrected for Hb) of \>60%.
* 18 years or over.
* Written (signed and dated) informed consent and be capable of co-operating with treatment and follow-up.
* For dose expansion patients only, they must have medium to high α-folate receptor expression according to the Ventana FOLR1-2.1 IHC assay.

Exclusion Criteria:

* Radiotherapy (except for palliative reasons), endocrine therapy, immunotherapy or chemotherapy during the previous four weeks (six weeks for nitrosoureas, Mitomycin-C) and 4 weeks for investigational medicinal products) before treatment.
* Ongoing toxic manifestations of previous treatments. Exceptions to this are alopecia or certain Grade 1 toxicities, which in the opinion of the Investigator and the DDU should not exclude the patient.
* Patients with new brain metastases. Patients with treated (surgically excised or irradiated) and stable brain metastases are eligible as long as the treatment was at least 4 weeks prior to initiation of study drug and brain MRI within 2 weeks of initiation of study drug is negative for new metastases.
* Patients with pulmonary metastases.
* History of thoracic radiation or other history likely to create pre-existing lung disease
* Presence of significant clinical ascites and/or pleural effusions.
* Female patients of child-bearing potential (or are already pregnant or lactating). However, those patients who have a negative serum or urine pregnancy test before enrolment and agree to use two forms of contraception (one effective form plus a barrier method) \[oral, injected or implanted hormonal contraception and condom; intra-uterine device and condom; diaphragm with spermicidal gel and condom\] or agree to sexual abstinence (see Protocol Section 16.5 - Appendix 5), effective from signing the consent form, throughout the trial and for six months afterwards are considered eligible.
* Major thoracic or abdominal surgery from which the patient has not yet recovered.
* Patients with sub-acute bowel obstruction.
* Organ transplant patients.
* At high medical risk because of non-malignant systemic disease including active uncontrolled infection.
* Known to be serologically positive for hepatitis B, hepatitis C or human immunodeficiency virus (HIV).
* Patients with history of QT prolongation, clinically significant VT, VF, heart block, MI within 1 year, CHF NYHA Class III or IV, unstable angina, angina within 6 months, or other evidence of clinically significant coronary artery disease/
* Is a participant or plans to participate in another interventional clinical trial, whilst taking part in this Phase I/Ib study of Idetrexed and Olaparib. Participation in an observational trial would be acceptable.
* Inability to tolerate Olaparib.
* Any other condition which in the Investigator's opinion would not make the patient a good candidate for the clinical trial.
* Confirmed, current COVID-19 infection.

Primary outcomes:
measure: Propose a recommended dose/schedule for Phase II evaluation of the combination of Idetrexed and Olaparib
timeFrame: End of Cycle 2 (each cycle is 28 days)
measure: Assess the safety and toxicity profile of Idetrexed and Olaparib
timeFrame: End of Cycle 6 (each cycle is 28 days)
measure: Evaluate the preliminary anti-tumour activity of the combination of Idetrexed and Olaparib in alpha folate receptor overexpressing high grade serous ovarian cancer
timeFrame: Until patient withdraws due to radiological progression, or begins new line of therapy.
Secondary outcomes:
measure: Evaluate antitumour activity of the combination of Idetrexed and Olaparib
timeFrame: From date of enrolment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
measure: Evaluate the preliminary anti-tumour activity of the combination of Idetrexed and Olaparib in ovarian cancer irrespective of alpha folate receptor expression status
timeFrame: From date of enrolment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months.
measure: CA125 responses
timeFrame: From date of enrolment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months.
Other outcomes:
measure: (Tertiary Objective): Retrospective evaluation of response biomarkers
timeFrame: Within four weeks of patient beginning treatment.
Locations:
city: Cambridge
country: United Kingdom
facility: Addenbrooke's Hospital
state: Cambridgeshire
city: Sutton
country: United Kingdom
facility: Royal Marsden Hospital - Drug Development Unit
state: London
city: Cardiff
country: United Kingdom
facility: Velindre Cancer Centre
state: Wales
Study officials:
affiliation: Institute of Cancer Research, United Kingdom
name: Professor Udai Banerji
role: PRINCIPAL_INVESTIGATOR
References: