Clinical trial NCT04267939: ATR Inhibitor Elimusertib (BAY1895344) Plus Niraparib Phase 1b Study in Advanced Solid Tumors and Ovarian Cancer
Official title: An Open-label Phase 1b Study to Determine the Maximum Tolerated and/or Recommended Phase 2 Dose of the ATR Inhibitor Elimusertib (BAY 1895344) in Combination With PARP Inhibitor Niraparib, in Participants With Recurrent Advanced Solid Tumors and Ovarian Cancer
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE1
Conditions: Advanced Solid Tumors (Excluding Prostate Cancer)
Ovarian Cancer
Lead sponsor: Bayer
Sponsor class: INDUSTRY
Collaborators: name: GlaxoSmithKline
First posted: 2020-02-13
Enrollment: 14
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SEQUENTIAL
Primary purpose: OTHER

Brief summary: The purpose of the study is to test how well patients with advanced solid tumors and ovarian cancer respond to treatment with elimusertib in combination with niraparib. In addition researchers want to find for patients the optimal dose of elimusertib in combination with niraparib, how the drug is tolerated and the way the body absorbs, distributes and discharges the drug. The study medication elimusertib works by blocking a substance produced by the body (ATR Kinase) which is important for the growth of tumor cells. Niraparib works by blocking a substance produced by the body (PARP enzymes) in a way that tumor cells can be killed, or made more susceptible to chemotherapy.


Eligibility criteria: Inclusion Criteria:

* Participant must be ≥ 18 years of age, at the time of signing the informed consent.
* Participants must have histologically confirmed diagnosis of the following indications as described below:

  * Dose escalation (Part A): recurrent advanced solid tumors, excluding prostate cancer, who experienced disease progression after treatment with standard of care therapy for metastatic disease.
  * Dose expansion (Part B): recurrent EOC, fallopian tube or primary peritoneal cancer

    * Sub-population 1: participants PARPi naïve and with a platinum-resistant/refractory disease (recurrence with a PFI \< 6 months from last platinum-based regimen). Participants may not have had more than 3 prior therapies since the development of platinum resistance.
    * Sub-population 2: participants with disease progression on PARPi (including niraparib), administered as maintenance as well active line of therapy. Participants must have not received further line of therapy after disease progression on PARPi.
* Participants in dose escalation (Part A) of the study will need to have tumor-associated DDR deficiency and/or CCNE1 gene amplification.

  -- A homozygous deletion and/or a deleterious mutation in a gene reported to be involved in DNA repair and/or sensitive to ATRi's and/or PARPi's.
* Participants in dose expansion (Part B) of the study will need to have tumor associated DDR deficiency (Sub-population 1). Participants in Part B (Sub-population 2) are not enrolled based on the presence or absence of a particular biomarker.
* Participants must have disease progression and measurable disease, as defined by RECIST 1.1.
* Available archival tumor tissue ≤ 12 months old, otherwise a fresh baseline tumor biopsy should be obtained.
* ECOG PS of 0 to 1
* Life expectancy of at least 12 weeks
* Adequate bone marrow function as assessed by the following laboratory tests to be conducted within 7 (±2) days before the first dose of study intervention:

  * Hemoglobin (Hb) ≥ 10 g/dL
  * Platelet count ≥ 150 x 10\^9/L
  * Absolute neutrophil count (ANC) ≥ 1.5 x 10\^9/L
* Participants must have adequate organ function.
* Participants must have adequate coagulation.
* Adequate cardiac function per institutional normal measured by echocardiography (recommended) or cardiac MRI per institutional guidelines.
* A female participant is eligible to participate if she is not pregnant (confirmed by a negative serum pregnancy test within 7 (±2) days of first study intervention), not breastfeeding, or is not a woman of childbearing potential (WOCBP). WOCBP must agree to use highly effective contraception during the intervention period and for at least 6 months (180 days) after the last dose of study intervention.

Exclusion Criteria:

* Inability to swallow oral medication
* Known hypersensitivity to elimusertib and/or niraparib or excipients of the preparations or any agent given in association with this study
* History of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) diagnosis
* Ongoing or active uncontrolled infection (bacterial, fungal, or viral; e.g. hepatitis viral) of CTCAE grade ≥ 2 that requires systemic treatment
* Participants with HIV may be be ineligible depending on various parameters, but are not automatically excluded.
* Immunocompromised participants (e.g. diagnosis of immunodeficiency or ongoing immunosuppressive therapy)
* Pleural effusion or ascites that causes respiratory compromise (CTCAE grade ≥ 2 dyspnea)
* Active HBV or HCV infection that requires treatment.
* Moderate or severe hepatic impairment, i.e. Child Pugh Class B or C
* Participants with significant cardiovascular disease and/or relevant findings meeting the below criteria are excluded:

  * History of cardiac disease: congestive heart failure NYHA class \> II, unstable angina (angina symptoms at rest), new-onset angina (within the past 6 months before study entry), myocardial infarction within the past 6 months before study entry, or cardiac arrhythmias requiring anti-arrhythmic therapy (beta-blockers, calcium channel blockers, and digoxin are permitted).
  * Clinically relevant findings in the ECG such as a second- or third-degree atrioventricular block, prolongation of the QRS complex ≥ 120 ms, or prolongation of the of the QTc interval (Fridericia) over 450 ms unless agreed otherwise between the investigator and the sponsor's medically responsible person. QTc \> 450 ms detected in 2 or more time points within a 24-hour period are excluded.
  * Clinically significant arterial hypertension despite optimal medical management (per investigator´s opinion). Clinically significant hypertension defined as systolic blood pressure above 150 mmHg and/or diastolic blood pressure above 90 mmHg, despite optimal medical management. For participants taking antihypertensive medication, blood pressure should be stable/ controlled for more than 7 days before first dose of study medication.
* Previous treatment with an ATR Inhibitor
* Participants in Part A and Part B (Sub-population 2): Previous treatment with known or putative PARPi, if discontinued for CTCAE grade ≥ 3 AEs or CTCAE grade ≥ 3 hypersensitivity to PARPi. Participants in Part B Sub-population 1 must not have received prior PARPi treatment.

Primary outcomes:
measure: Incidence of treatment emergent adverse events (TEAEs)
timeFrame: Up to 30 days after the last administration of study intervention
measure: Severity of treatment emergent adverse events (TEAEs)
timeFrame: Up to 30 days after the last administration of study intervention
measure: Incidence of treatment emergent serious adverse events (TESAEs)
timeFrame: Up to 30 days after the last administration of study intervention
measure: Severity of treatment emergent serious adverse events (TESAEs)
timeFrame: Up to 30 days after the last administration of study intervention
measure: Maximum tolerated dose (MTD): Frequency of Dose Limiting Toxicities (DLTs) at each dose level during the DLT observation period for Cycle 1
timeFrame: Cycle 1, 28 days after first administration of study intervention
measure: Recommended Phase II dose (RP2D) of elimusertib
timeFrame: Up to 30 days after last administration of study Intervention
Secondary outcomes:
measure: Incidence of participants with complete response (CR)
timeFrame: At baseline and at the start of every 2nd cycle (each cycle is 28 days) starting with Cycle 3, and at the start of every 4th cycle after Cycle 11 up to 24 months.
measure: Incidence of participants with partial response (PR)
timeFrame: At baseline and at the start of every 2nd cycle (each cycle is 28 days) starting with Cycle 3, and at the start of every 4th cycle after Cycle 11 up to 24 months.
measure: Incidence of participants with stable disease (SD)
timeFrame: At baseline and at the start of every 2nd cycle (each cycle is 28 days) starting with Cycle 3, and at the start of every 4th cycle after Cycle 11 up to 24 months.
measure: Incidence of participants with progressive disease (PD)
timeFrame: At baseline and at the start of every 2nd cycle (each cycle is 28 days) starting with Cycle 3, and at the start of every 4th cycle after Cycle 11 up to 24 months.
measure: Objective response rate (ORR)
timeFrame: At baseline and at the start of every 2nd cycle (each cycle is 28 days) starting with Cycle 3, and at the start of every 4th cycle after Cycle 11 up to 24 months.
measure: Disease control rate (DCR)
timeFrame: At baseline and at the start of every 2nd cycle (each cycle is 28 days) starting with Cycle 3, and at the start of every 4th cycle after Cycle 11 up to 24 months.
measure: Cmax (Maximal plasma exposure) of elimusertib after single dose administration
timeFrame: Cycle 1 Day 5 and Cycle 1 Day 21, each cycle is 28 days.
measure: AUC(0-8) of elimusertib after single dose administration
timeFrame: Cycle 1 Day 5 and Cycle 1 Day 21, each cycle is 28 days.
measure: Cmax,md of elimusertib after multiple dose administration
timeFrame: Cycle 1 Day 5 and Cycle 1 Day 21, each cycle is 28 days.
measure: AUC(0-8)md of elimusertib after multiple dose administration
timeFrame: Cycle 1 Day 5 and Cycle 1 Day 21, each cycle is 28 days.
Other outcomes:
Locations:
city: Boston
country: United States
facility: Dana-Farber Cancer Institute
state: Massachusetts
city: New York
country: United States
facility: Memorial Sloan-Kettering Cancer Center
state: New York
city: Houston
country: United States
facility: University of Texas MD Anderson Cancer Center
state: Texas
Study officials:
affiliation: Bayer
name: Bayer Study Director
role: STUDY_DIRECTOR
References:
citation: Smith G, Alholm Z, Coleman RL, Monk BJ. DNA Damage Repair Inhibitors-Combination Therapies. Cancer J. 2021 Nov-Dec 01;27(6):501-505. doi: 10.1097/PPO.0000000000000561.