Ph II Study to Evaluate Olaparib With Abiraterone in Treating Metastatic Castration Resistant Prostate Cancer.

Metastatic Castration-resistant Prostate Cancer Clinical Trial

Official title:

A Randomised, Double-Blind, Placebo-Controlled, Multicentre Phase II Study to Compare the Efficacy, Safety and Tolerability of Olaparib Versus Placebo When Given in Addition to Abiraterone Treatment in Patients With Metastatic Castrate-Resistant Prostate Cancer Who Have Received Prior Chemotherapy Containing Docetaxel

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01972217
• Other study ID #: D081DC00008
• Secondary ID: UVA979342013-003
• Status: Completed
• Phase: Phase 2
• Start date: April 1, 2014
• Est. completion date: August 24, 2023

Study information

• Verified date: October 2023
• Source: AstraZeneca
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a 2-part study in patients with metastatic CRPC. Part A is an open-label safety run-in study to assess the safety, tolerability and pharmacokinetics (PK) of olaparib when given in addition to abiraterone 1000 mg once daily. Part B is a randomised, double-blind, placebo controlled comparison of the efficacy, safety and tolerability of the dose of olaparib selected from Part A when given in addition to abiraterone, versus placebo given in addition to abiraterone. Abiraterone is indicated in combination with prednisone or prednisolone for the treatment of patients with metastatic CRPC. Prednisone or prednisolone 5 mg twice daily (bid) will be administered with the abiraterone in this study.

Description:

This is a 2-part study in patients with metastatic CRPC. Part A is an open-label safety run-in study to assess the safety, tolerability and PK of olaparib when given in addition to abiraterone 1000 mg once daily. Part B is a randomised, double-blind, placebo-controlled comparison of the efficacy, safety and tolerability of the dose of olaparib selected from Part A when given in addition to abiraterone, versus placebo in addition to abiraterone.

Abiraterone is indicated in combination with prednisone or prednisolone for the treatment of patients with metastatic CRPC. Prednisone or prednisolone 5 mg bid will be administered with the abiraterone in this study, but throughout this protocol the treatment will be referred to simply as abiraterone.

For Part A of the study, 15 to 18 evaluable patients (Cohorts 1 and 2) are planned to be enrolled from approximately 4 sites in approximately 1 or 2 countries, and a further 12 patients may be recruited into a 3rd cohort if necessary.

For Part B of the study, approximately 140 patients who have received prior chemotherapy containing docetaxel will be randomised from approximately 40 sites in North America and Europe. Patients who have been dosed in Part A of the study may not participate in Part B.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 158
• Est. completion date: August 24, 2023
• Est. primary completion date: September 22, 2017
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 18 Years to 130 Years

Eligibility

Inclusion Criteria:

1. Provision of signed and dated written informed consent prior to any study specific procedures.

2. Male aged 18 years and older.

3. Histologically or cytologically proven diagnosis of prostate cancer.

4. Candidate for abiraterone therapy with documented evidence of metastatic castration-resistant prostate cancer. Metastatic status is defined as at least one documented metastatic lesion on either bone scan or CT/MRI scan. Castration resistant prostate cancer is defined as rising PSA or other signs of disease progression despite treatment with androgen deprivation therapy and the presence of a castrate level of testosterone (=50 ng/dL).

5. Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2 with no deterioration over the previous 2 weeks.

6. Patients must have a life expectancy =12 weeks.

7. Patients are willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations, and completing PRO instruments.

8. Patients must be on a stable concomitant medication regimen, defined as no changes in medication or in dose within 2 weeks prior to start of olaparib dosing, except for bisphosphonates, denosumab and corticosteroids, which should be stable for at least 4 weeks prior to start of olaparib dosing.

9. For the randomised phase only, patients must have received chemotherapy in the form of docetaxel treatment for metastatic castration-resistant prostate cancer. Note: patients who discontinued docetaxel for toxicity reasons and without completing the full course will still be eligible to enter this study provided they received at least 2 cycles of chemotherapy.

Provide informed consent for the pharmacogenetic sampling and analyses.

Exclusion Criteria:

1. Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff, its agents and/or staff at the study site).

2. Previous treatment in the present study.

3. Treatment with any of the following:

• Previous exposure to any 2nd generation anti-hormonal including abiraterone and enzalutamide

• More than 2 prior courses of chemotherapy for metastatic prostate cancer

• Previous use of immunotherapy or radium-223 for the treatment of metastatic prostate cancer

• Any investigational agents or study drugs from a previous clinical study within 30 days of the first dose of study treatment;

• Any previous exposure to a CYP17 (17a-hydroxylase/C17,20-lyase) inhibitor;

• Substrates of CYP2D6 with a narrow therapeutic index (eg, thioridazine);

• Potent inhibitors or inducers of CYP3A4 within 2 weeks before the first dose of study treatment (3 weeks for St John's Wort).

• Any previous treatment with a PARP inhibitor, including olaparib.

4. With the exception of alopecia or toxicities related to the use of gonadotropinreleasing hormone agonists, any unresolved toxicities from prior therapy greater than CTCAE Grade 2 at the time of starting study treatment.

5. Spinal cord compression or brain metastases unless asymptomatic, treated and stable and not requiring steroids for at least 4 weeks prior to start of study treatment.

6. As judged by the Investigator, any evidence of severe or uncontrolled systemic diseases, including uncontrolled hypertension, active bleeding diatheses, or active infection including hepatitis B, hepatitis C and human immunodeficiency virus (HIV). Screening for chronic conditions is not required.

7. Any of the following cardiac criteria:

• Mean resting QTc >470 msec obtained from 3 ECGs

• Any clinically important abnormalities in rhythm, conduction or morphology of resting ECG eg, complete left bundle branch block, third degree heart block

• Any factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, hypokalaemia, congenital long QT syndrome, family history of long QT syndrome or unexplained sudden death under 40 years of age or any concomitant medication known to prolong the QT interval.

8. Other malignancy within the last 5 years except: adequately treated non-melanoma skin cancer or other solid tumours including lymphomas (without bone marrow involvement) curatively treated with no evidence of disease for =5 years.

9. Inadequate bone marrow reserve or organ function as demonstrated by any of the following laboratory values:

• Absolute neutrophil count (ANC) <1.5 x 109/L

• Platelet count <100 x 109/L

• Haemoglobin (Hb) <100 g/L

• Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >2.5 x upper limit of normal (ULN) if no demonstrable liver metastases or >5 x ULN in the presence of liver metastases

• Total bilirubin >1.5 x ULN if no liver metastases or >3 x ULN in the presence of liver metastases (except in the case of Gilbert's disease)

• Creatinine >1.5 x ULN concurrent with creatinine clearance <50 mL/min (measured or calculated by Cockcroft and Gault equation); confirmation of creatinine clearance is only required when creatinine is >1.5 x ULN

• If bone metastases are present and liver function is otherwise considered adequate by the Investigator then elevated alkaline phosphatase (ALP) will not exclude the patient.

10. Refractory nausea and vomiting, chronic gastrointestinal diseases, inability to swallow the formulated product or previous significant bowel resection that would preclude adequate absorption of olaparib or abiraterone.

11. History of hypersensitivity to active or inactive excipients of olaparib or abiraterone or drugs with a similar chemical structure or class to olaparib or abiraterone.

12. Patients with myelodysplastic syndrome/acute myeloid leukaemia.

13. Current disease or condition known to interfere with absorption, distribution, metabolism, or excretion of drugs, at the Investigator's discretion.

14. Major surgery within 2 weeks of starting study treatment and patients must have recovered from any effects of any major surgery.

15. Judgment by the Investigator that the patient should not participate in the study if the patient is unlikely to comply with study procedures, restrictions and requirements.

Exclusion from the genetic research may be for any of the exclusion criteria specified in the main study or any of the following:

16. Previous allogeneic bone marrow transplant.

17. Non-leukocyte depleted whole blood transfusion within 120 days of the date of the pharmacogenetic sample collection.

Related Conditions & MeSH terms

• Metastatic Castration-resistant Prostate Cancer
• Prostatic Neoplasms

Intervention

Drug:
• Olaparib
Olaparib bid
• Placebo
Placebo bid
• Abiraterone
Abiraterone 1000 mg
• Prednisone or prednisolone
Prednisone or prednisolone 5 mg bid will be co-administered with the abiraterone in this study.

Locations

Country	Name	City	State
Belgium	Research Site	Edegem
Belgium	Research Site	Liège
Belgium	Research Site	Wilrijk
Canada	Research Site	Greenfield Park	Quebec
Canada	Research Site	London	Ontario
Canada	Research Site	Montreal	Quebec
Czechia	Research Site	Brno
Czechia	Research Site	Brno
Czechia	Research Site	Liberec
France	Research Site	Angers
France	Research Site	Dijon
France	Research Site	LYON cedex 08
Italy	Research Site	Lecce
Italy	Research Site	Mirano
Italy	Research Site	Napoli
Italy	Research Site	Parma
Italy	Research Site	Pisa
Netherlands	Research Site	Arnhem
Netherlands	Research Site	Maastricht
Netherlands	Research Site	Nijmegen
Poland	Research Site	Gdansk
Poland	Research Site	Warszawa
Russian Federation	Research Site	Ivanovo
Russian Federation	Research Site	Moscow
Russian Federation	Research Site	Moscow
Russian Federation	Research Site	St. Petersburg
Spain	Research Site	Badalona
Spain	Research Site	Córdoba
Spain	Research Site	Gerona
Spain	Research Site	L'Hospitalet de Llobregat
Spain	Research Site	Madrid
Spain	Research Site	Palma de Mallorca
Spain	Research Site	Valencia
United Kingdom	Research Site	Cardiff
United Kingdom	Research Site	Exeter
United Kingdom	Research Site	Manchester
United Kingdom	Research Site	Plymouth
United Kingdom	Research Site	Torquay
United Kingdom	Research Site	Westcliff-on-Sea
United States	Research Site	Lake Success	New York
United States	Research Site	San Diego	California

Sponsors (2)

Lead Sponsor	Collaborator
AstraZeneca	Merck Sharp & Dohme LLC

Countries where clinical trial is conducted

United States,  Belgium,  Canada,  Czechia,  France,  Italy,  Netherlands,  Poland,  Russian Federation,  Spain,  United Kingdom, 

References & Publications (1)

Clarke N, Wiechno P, Alekseev B, Sala N, Jones R, Kocak I, Chiuri VE, Jassem J, Flechon A, Redfern C, Goessl C, Burgents J, Kozarski R, Hodgson D, Learoyd M, Saad F. Olaparib combined with abiraterone in patients with metastatic castration-resistant prostate cancer: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Oncol. 2018 Jul;19(7):975-986. doi: 10.1016/S1470-2045(18)30365-6. Epub 2018 Jun 4. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Part A: Percentage of Patients Experiencing Adverse Events (AEs)	The safety and tolerability of olaparib in combination with abiraterone was assessed during Part A of the study. The percentage of patients experiencing AEs, including information on seriousness, severity, study treatment relationship and those leading to discontinuation for all doses of olaparib and for abiraterone are presented.; Severity of AEs was assessed using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse events (CTCAE) v4.0. AEs were assigned to a Grade from 1 through 5 as follows: Grade 1: Mild; Grade 2: Moderate; Grade 3: Severe or medically significant but not immediately life-threatening requiring hospitalisation; Grade 4: Life-threatening consequences; Grade 5: Death related to AE.; 'c-r' = causally related 'discont' = discontinuation.	Cohort 1 and 2: From baseline in Part A (Day 1 for each cohort) up to 30 days following last dose of study treatment.
Primary	Part A: Number of Patients With Dose Limiting Toxicities (DLTs)	DLTs were assessed by a Safety Review Committee (SRC) after a minimum of 3 patients had received at least 14 days of treatment in Part A.; A DLT was defined as any toxicity which was not a recognised AE of abiraterone or prednisolone, and was not attributable to the disease or disease-related processes under investigation, which occurred during a minimum period of 14 days treatment and which included: 1. haematological toxicity CTCAE v4.0 Grade 4 or higher present for more than 4 days (except anaemia); 2. non-haematological toxicity CTCAE v4.0 Grade 3 or higher including infection, corrected QT interval prolongation; 3. any other toxicity that was greater than that at baseline, was clinically significant and/or unacceptable, did not respond to supportive care, resulted in a disruption of dosing schedule of 7 days or more, or was judged to be a DLT by the SRC.; A DLT excluded alopecia and isolated laboratory changes of any grade without clinical sequelae or clinical significance.	From Day 1 for Cohort 1 and from Day 4 for Cohort 2 up to 14 days treatment with olaparib + abiraterone for 3 patients.
Primary	Part B: Median Radiological Progression-Free Survival (rPFS) Time	The efficacy of olaparib when given in combination with abiraterone was assessed by rPFS, defined as the time from randomisation to disease progression using Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1 (for soft tissue disease) and Prostate Cancer Working Group 2 (PCWG-2) (for bone disease) criteria, or death.; Progression using RECIST 1.1 criteria was defined as at least 20% increase from baseline in the sum of diameters of target lesions, progression of existing non-target lesions, or the appearance of at least 1 new lesion.; Progression using PCWG-2 criteria was determined if 2 or more new metastatic bone lesions were observed (with a total of at least 4 new lesions since baseline assessment if observed at the 12 week scan, or persistence of or increase in number of lesions if observed after the 12 week scan as determined by a confirmatory scan at least 6 weeks later or at next scheduled visit).	From baseline, every 12 weeks up to Week 72, then every 24 weeks up to 24 months.
Primary	Part B: Percentage of Patients With Progression Events or Death (rPFS)	The efficacy of olaparib when given in combination with abiraterone was assessed by rPFS, defined as the time from randomisation to disease progression using RECIST version 1.1 (for soft tissue disease) and PCWG-2 (for bone disease) criteria, or death.; Progression using RECIST 1.1 criteria was defined as at least 20% increase from baseline in the sum of diameters of target lesions, progression of existing non-target lesions, or the appearance of at least 1 new lesion.; Progression using PCWG-2 criteria was determined if 2 or more new metastatic bone lesions were observed (with a total of at least 4 new lesions since baseline assessment if observed at the 12 week scan, or persistence of or increase in number of lesions if observed after the 12 week scan as determined by a confirmatory scan at least 6 weeks later or at next scheduled visit).; The percentage of patients with progression events is presented overall and according to RECIST 1.1 and/or PCWG-2 criteria, or death.	From baseline, every 12 weeks up to Week 72, then every 24 weeks up to 24 months.
Secondary	Part A Pharmacokinetics (PK): Olaparib Maximum Plasma Concentration at Steady State (Cmax,ss)	Following multiple dosing to steady state of olaparib 300 mg bid, the Cohort 2 olaparib Cmax,ss is presented for olaparib monotherapy and for olaparib given in combination with abiraterone.; Only patients with data available for analysis at each time point are presented.	PK sampling for Cohort 2 Group 1 was between Days 3 and 7 for olaparib, and Days 4 and 8 for olaparib and abiraterone. PK sampling for Cohort 2 Group 2 was between Days 5 and 7 for abiraterone, and Days 6 and 8 for olaparib and abiraterone.
Secondary	Part A PK: Abiraterone Cmax,ss	Following multiple dosing to steady state of abiraterone 1000 mg once daily, the Cohort 2 abiraterone Cmax,ss is presented for abiraterone monotherapy and for olaparib given in combination with abiraterone.; Only patients with data available for analysis at each time point are presented.	PK sampling for Cohort 2 Group 1 was between Days 3 and 7 for olaparib, and Days 4 and 8 for olaparib and abiraterone. PK sampling for Cohort 2 Group 2 was between Days 5 and 7 for abiraterone, and Days 6 and 8 for olaparib and abiraterone.
Secondary	Part A PK Analysis: Olaparib Time to Reach Maximum Plasma Concentration at Steady State (Tmax,ss)	Following multiple dosing to steady state of olaparib 300 mg bid, the Cohort 2 olaparib tmax,ss is presented for olaparib monotherapy and for olaparib given in combination with abiraterone.; Only patients with data available for analysis at each time point are presented.	PK sampling for Cohort 2 Group 1 was between Days 3 and 7 for olaparib, and Days 4 and 8 for olaparib and abiraterone. PK sampling for Cohort 2 Group 2 was between Days 5 and 7 for abiraterone, and Days 6 and 8 for olaparib and abiraterone.
Secondary	Part A PK: Abiraterone Tmax,ss	Following multiple dosing to steady state of abiraterone 1000 mg once daily, the Cohort 2 abiraterone tmax,ss is presented for abiraterone monotherapy and for olaparib given in combination with abiraterone.; Only patients with data available for analysis at each time point are presented.	PK sampling for Cohort 2 Group 1 was between Days 3 and 7 for olaparib, and Days 4 and 8 for olaparib and abiraterone. PK sampling for Cohort 2 Group 2 was between Days 5 and 7 for abiraterone, and Days 6 and 8 for olaparib and abiraterone.
Secondary	Part A PK Analysis: Olaparib Minimum Plasma Concentration at Steady State (Cmin,ss)	Following multiple dosing to steady state of olaparib 300 mg bid, the Cohort 2 olaparib Cmin,ss is presented for olaparib monotherapy and for olaparib given in combination with abiraterone.; Only patients with data available for analysis at each time point are presented.	PK sampling for Cohort 2 Group 1 was between Days 3 and 7 for olaparib, and Days 4 and 8 for olaparib and abiraterone. PK sampling for Cohort 2 Group 2 was between Days 5 and 7 for abiraterone, and Days 6 and 8 for olaparib and abiraterone.
Secondary	Part A PK: Abiraterone Cmin,ss	Following multiple dosing to steady state of abiraterone 1000 mg once daily, the Cohort 2 abiraterone Cmin,ss is presented for abiraterone monotherapy and for olaparib given in combination with abiraterone.; Only patients with data available for analysis at each time point are presented.	PK sampling for Cohort 2 Group 1 was between Days 3 and 7 for olaparib, and Days 4 and 8 for olaparib and abiraterone. PK sampling for Cohort 2 Group 2 was between Days 5 and 7 for abiraterone, and Days 6 and 8 for olaparib and abiraterone.
Secondary	Part A PK Analysis: Olaparib Area Under the Plasma Concentration-Time Curve at Steady State (AUCss)	Following multiple dosing to steady state of olaparib 300 mg bid, the Cohort 2 olaparib AUCss is presented for olaparib monotherapy and for olaparib given in combination with abiraterone.; Only patients with data available for analysis at each time point are presented.	PK sampling for Cohort 2 Group 1 was between Days 3 and 7 for olaparib, and Days 4 and 8 for olaparib and abiraterone. PK sampling for Cohort 2 Group 2 was between Days 5 and 7 for abiraterone, and Days 6 and 8 for olaparib and abiraterone.
Secondary	Part A PK: Abiraterone AUCss	Following multiple dosing to steady state of abiraterone 1000 mg once daily, the Cohort 2 abiraterone AUCss is presented for abiraterone monotherapy and for olaparib given in combination with abiraterone.; Only patients with data available for analysis at each time point are presented.	PK sampling for Cohort 2 Group 1 was between Days 3 and 7 for olaparib, and Days 4 and 8 for olaparib and abiraterone. PK sampling for Cohort 2 Group 2 was between Days 5 and 7 for abiraterone, and Days 6 and 8 for olaparib and abiraterone.
Secondary	Part B: Percentage of Patients Experiencing AEs	The safety and tolerability of olaparib when given in combination with abiraterone was assessed during Part B of the study. The percentage of patients experiencing AEs, including information on seriousness, severity, study treatment relationship and those leading to discontinuation for all doses of olaparib and for abiraterone are presented.; Severity of AEs was assessed using the NCI Common Terminology CTCAE v4.0. AEs were assigned to a Grade from 1 through 5 as follows: Grade 1: Mild; Grade 2: Moderate; Grade 3: Severe or medically significant but not immediately life-threatening requiring hospitalisation; Grade 4: Life-threatening consequences; Grade 5: Death related to AE.; 'c-r' = causally related. 'discont' = discontinuation. 'ola/pla' = olaparib/placebo.	From first dose of study treatment following randomisation in Part B up to 30 days following last dose of study treatment (up to approximately 3 years).
Secondary	Part B: Median Best Percentage Change From Baseline in Prostate Specific Antigen (PSA) Levels	The best percentage change from baseline in PSA levels was determined to assess the anti-tumour activity of olaparib when given in addition to abiraterone, compared with placebo given in addition to abiraterone.; The best percentage change was defined as the biggest reduction in PSA level compared with baseline or smallest increase in the absence of a decrease.	From baseline, then every 4 weeks up to Week 52, and then every 12 weeks.
Secondary	Part B: Percentage of Patients With PSA Responses	The percentages of patients with single visit responses and with confirmed responses are presented to assess the anti-tumour activity of olaparib when given in addition to abiraterone, compared with placebo given in addition to abiraterone.; A single visit response was defined as any post-dose visit PSA level reduced by 50% or more compared with baseline.; A confirmed response was defined as a reduction in PSA level of 50% or more on 2 consecutive occasions at least 4 weeks apart compared with baseline.; Patients may have had more than 1 single visit response or confirmed response but were counted once.	From baseline, then every 4 weeks up to Week 24, and then every 12 weeks.
Secondary	Part B: Median Best Percentage Change From Baseline in Circulating Tumour Cell (CTC) Level	The median best percentage change from baseline in CTC levels was determined to assess the anti-tumour activity of olaparib when given in combination with abiraterone, compared with placebo given in addition to abiraterone.; The best percentage change was defined as the biggest CTC level reduction compared with baseline or smallest increase in the absence of a decrease.	From baseline, then every 4 weeks up to Week 24, and then every 12 weeks.
Secondary	Part B: Percentage of Patients With at Least One Objective Response (Objective Response Rate [ORR])	The overall radiological ORR was calculated to assess the anti-tumour activity of olaparib in combination with abiraterone, compared with placebo in combination with abiraterone.; The best overall ORR was defined as the percentage of patients with at least 1 visit response of complete response (CR) or partial response (PR) in soft tissue disease assessed by RECIST 1.1 and also bone scan status of non-progressive disease or non-evaluable for their bone scans assessed by PCWG-2.; CR: Disappearance of all target lesions. Reduction of pathological lymph nodes to <10 millimetres.; PR: At least a 30% decrease in the sum of diameters of target lesions from baseline.; The percentage of patients with a response is presented.	From baseline, then every 4 weeks up to Week 52, and then every 12 weeks.
Secondary	Median Time to First Subsequent Therapy (TFST) and Median Time to Second Subsequent Therapy (TSST)	The TFST and TSST were determined to assess the anti-tumour activity of olaparib when given in combination with abiraterone, compared with placebo given in addition to abiraterone.; TFST was defined as the time from randomisation to the earlier of first subsequent anti-cancer therapy start date following study treatment discontinuation, or death.; TSST was defined as the time from randomisation to the earlier of the second subsequent anti-cancer therapy start date following study treatment discontinuation, or death.	From randomisation until analysis cut-off date (up to approximately 3 years).
Secondary	Part B: Median Overall Survival (OS)	OS was determined to assess the efficacy of olaparib when given in addition to abiraterone, compared with placebo given in addition to abiraterone.; OS was performed at the time of the analysis of rPFS, and the median OS, calculated using the Kaplan-Meier technique, is presented.	From baseline, every 12 weeks up to Week 72, then every 24 weeks up to 24 months.
Secondary	Part B: Median Time to Second Progression or Death (PFS2)	The efficacy of olaparib when given in combination with abiraterone was assessed by PFS2, defined by local standard clinical practice and included objective radiological progression by RECIST 1.1 (soft tissue), symptomatic progression, rise in PSA level or death in the absence of overall progression.	From randomisation until analysis cut-off date (up to approximately 3 years).

External Links

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