Biomarker-driven Targeted Therapy in Patients With Recurrent Platinum-resistant Epithelial Ovarian Cancer

Ovarian Cancer Clinical Trial

— BRIGHT  

Official title:

The Efficiency of Biomarker-driven Targeted Therapy in Patients With Recurrent Platinum-resistant Epithelial Ovarian Cancer (PROC): An Umbrella Study

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05044871
• Other study ID #: 2021-TJ-PROC
• Status: Not yet recruiting
• Phase: Phase 2
• Start date: January 1, 2023
• Est. completion date: December 1, 2027

Study information

• Verified date: October 2022
• Source: Tongji Hospital
• Contact: Qinglei Gao, MD. PhD
• Phone: 15391566981
• Email: qingleigao[@]hotmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study is an open-label, multicenter, umbrella study aimed to evaluate the combined, biomarker-driven, targeted treatment efficiency of Pamiparib, Bevacizumab, Tislelizumab, and Nab-paclitaxel in patients with platinum-resistant recurrent ovarian cancer (PROC).

Description:

BRCA1/2 gene status and CD8+ tumor-infiltrating T cell count (CD8 + TILs count) were evaluated as biomarkers using archived tumor tissue samples. Treatment arms were arranged according to pathological diagnosis and biomarker detection results.

Arm1 (Pathological classification: Serous, Endometrioid, and Clear cell Ovarian cancer; Biomarkers: BRCA 1/2 mutant): Pamiparib 40mg PO. bid. plus Bevacizumab 7.5mg/kg IV. D1 (q3w.).

Arm2 (Pathological classification: Serous, Endometrioid, and Clear cell Ovarian cancer; Biomarkers: BRCA 1/2 wildtype and ≥3 CD8+ TILs count): Tislelizumab 200mg IV. D1 + Bevacizumab 7.5mg/kg IV. D1 + Nab-paclitaxel 125mg / m2 IV. D1, 8 (q3w).

Arm3 (Pathological classification: Serous, Endometrioid, and Clear cell Ovarian cancer; Biomarkers: BRCA 1/2 wildtype and <3 CD8+ TILs count): Bevacizumab 7.5mg/kg IV D1, 15 + Nab-paclitaxel 100mg / m2 IV D1, 8, 15 (Q4w).

Arm4 (Pathological classification: Mucinous Ovarian cancer, Ovarian carcinosarcoma; Biomarkers: ≥3 CD8+ TILs count): Tislelizumab 200mg IV D1 + Bevacizumab 7.5mg/kg IV D1 + Nab-paclitaxel 125mg / m2 IV D1, 8 (q3w).

Arm5 (Pathological classification: Mucinous Ovarian cancer, Ovarian carcinosarcoma; Biomarkers: <3 CD8+ TILs count: Bevacizumab 7.5mg/kg IV. D1, 15 + Nab-paclitaxel 100mg / m2 IV. D1, 8, 15 (Q4w).

Treatment would continue until disease progression, intolerable toxicity, death, withdrawal of consent, or sponsor termination of the study, whichever occurs first.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 160
• Est. completion date: December 1, 2027
• Est. primary completion date: June 1, 2024
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Voluntary participation and signing of informed consent

2. Age = 18 years;

3. the Eastern United States cancer cooperation group (ECoG) score 0-1;

4. Platinum-resistant recurrent ovarian cancer (PROC): the patient was diagnosed with platinum-resistant recurrence for the first time. PROC refers to the disease progression that occurred < 6 months after the last dose of platinum-based chemotherapy. Imaging-based evaluation for the latest recurrence/progression before enrollment was required;

5. Malignant epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer confirmed by histology or cytology, including high-grade serous cancer, low-grade serous cancer, endometrioid cancer, clear cell cancer, mucinous cancer, and carcinosarcoma;

6. Biomarker detection and tumor sample collection meet the following standards:

• Patients must provide archived tumor tissue samples (formalin-fixed, paraffin-embedded tumor tissue blocks [preferred], or about 20 unstained tissue sections), except for patients with serous carcinoma, endometrioid carcinoma, clear cell carcinoma and gBRCAm

• If the patient has been tested for BRCA1 / 2 gene in the past, only the corresponding test report needs to be provided

7. Sufficient organ functions, which is defined as:

• neutrophil absolute value (ANC) = 1.5 × 109/L

• platelet count (PLT) = 75 × 10*9/L

• hemoglobin = 9 g / dl

• serum creatinine CR < 1.5 × Upper normal value (ULN)

• total serum bilirubin = 1.5 × Upper normal range (ULN)

• both aspartate aminotransferase and alanine aminotransferase = 3 × ULN

• coagulation function: international normalized ratio (INR) = 1.5; Activated partial prothrombin time (APTT) = 1.5 × ULN

8. Patients must have lesions that can be measured according to RECIST v1.1 standard;

9. Participants were allowed to have previously VEGF / VEGFR inhibitors treatment, but the proportion of these patients would not exceed 20%;

10. Participants were allowed to have previously PARP inhibitors treatment. However, for treatment arm 1 (arm1), the exposure time of PARP inhibitors should = 12 months after first-line chemotherapy or = 6 months after second-line and above chemotherapy;

11. Life expectancy = 3 months;

Exclusion Criteria:

1. The exclusion criteria of bevacizumab were clinically significant cardiovascular and cerebrovascular diseases, history of abdominal fistula or gastrointestinal perforation, acute intestinal obstruction or sub obstruction, and active bleeding;

2. Uncontrolled hypertension (systolic blood pressure > 150 mmHg and/or diastolic blood pressure > 100 mmHg) or clinically significant (active) cardiovascular disease: cerebrovascular accident (CVA) / stroke = 6 months from the treatment of the first clinical study; Myocardial infarction = 6 months from the first clinical study treatment; Unstable angina pectoris; Congestive heart failure (CHF) of grade II or above in the cardiac function classification standard of the New York Heart Association (NYHA); Serious arrhythmias requiring treatment;

3. Previous medical history showed newly discovered thrombotic diseases within 6 months before or during the screening period; Patients with severe wound nonunion, ulcer, or fracture;

4. Major surgery within 30 days before the first administration of study treatment; Patients expected to have invasive surgery during treatment;

5. Patients with other malignant tumors;

6. Patients who have previously received anti-programmed cell death protein-1 (anti-PD-1), anti-programmed death ligand-1 (anti-PD-L1) or anti-PD-L2 drugs, or another drug treatment for T cell inhibitory receptors (e.g., cytotoxic T lymphocyte-associated antigen-4 [CTLA-4], OX-40, CD137 [tumor necrosis factor receptor superfamily member 9 (tnfrsf9)];

7. Active autoimmune diseases requiring systemic treatment in the past 2 years;

8. Any case requiring systemic treatment with corticosteroids (prednisone or equivalent > 10 mg/day) or other immunosuppressive drugs = 14 days before the first administration of the study drug;

9. Known history of human immunodeficiency virus (HIV) infection;

10. Untreated chronic hepatitis B or chronic hepatitis B virus (HBV) carriers (HBV DNA > 500 IU / ml) or active HCV carriers with detectable HCV RNA; Note: inactive hepatitis B surface antigen (HBsAg) carriers and treated and stable hepatitis B patients (HBV DNA < 500 IU / ml) can be included in the group;

11. History of interstitial lung disease, noninfectious pneumonia, or uncontrolled diseases, including pulmonary fibrosis, acute lung disease, etc;

12. Previous heterologous stem cell transplantation or organ transplantation;

13. Peripheral neuropathy = grade 2;

14. Foods or drugs that are expected to use CYP3A4 strong inducers or strong inhibitors within 28 days before the use of the study drug;

15. Participate in another clinical study at the same time, unless it is an observational (non-intervention) clinical study or is in the follow-up period of intervention study;

16. Women of childbearing age who are unwilling or unable to use effective methods for contraception during the whole treatment period of this trial and within 6 months after the last administration of the study drug [women of childbearing age include: any women who have had menarche and have not undergone successful artificial sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy), or premenopausal], pregnant or lactating women.

17. Other conditions judged by the researcher that do not meet the enrollment requirements.

Related Conditions & MeSH terms

• Carcinoma, Ovarian Epithelial
• Ovarian Cancer
• Ovarian Neoplasms

Intervention

Drug:
• Pamiparib
40mg PO. bid.
• Bevacizumab
7.5mg/kg IV. D1 (q3w.)
• Tislelizumab
200mg IV. D1
• Nab paclitaxel
125mg / m2 IV. D1, 8 (q3w).
• Bevacizumab + Nab paclitaxel (intense dose-dense)
Bevacizumab 7.5mg/kg IV. D1, 15 (Q4w). + Nab paclitaxel 100mg / m2 IV. D1, 8, 15 (Q4w).

Locations

Country	Name	City	State
China	Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology	Wuhan	Hubei

Sponsors (11)

Lead Sponsor	Collaborator
Tongji Hospital	Affiliated Hospital of Jiangnan University, Anhui Provincial Cancer Hospital, First Affiliated Hospital, Sun Yat-Sen University, Hubei Cancer Hospital, Hunan Cancer Hospital, Jilin Provincial Tumor Hospital, Obstetrics and Gynecology Hospital of Zhejiang University, Peking University Cancer Hospital & Institute, Qilu Hospital of Shandong University, Sun Yat-sen University

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Objective response rate (ORR)	ORR is defined as the proportion of patients with complete response(CR) and partial response(PR) assessed by the investigator in accordance with the RECIST 1.1 criteria.	Up to 3 years
Secondary	Progression-free survival (PFS)	PFS is defined as the time from enrollment to the first imaging disease progression or death (whichever occurs first). Assessed according to RECIST v1.1 by investigator.	Up to 3 years
Secondary	Overall survival (OS)	OS is defined as the time between enrollment and the patient's death due to any cause.	Up to 5 years
Secondary	Disease control rate (DCR)	DCR is defined as the proportion of the patients with complete response, partial remission, and stable disease after treatment. Assessed according to RECIST v1.1 by investigator.	Up to 5 years
Secondary	Duration of remission (DOR)	DOR is defined as the time interval from the first record of disease response to disease progression or death (whichever occurs first). Assessed according to RECIST v1.1 by investigator.	Up to 3 years
Secondary	Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]	Safety includes the adverse event profile of all drugs included according to the Common Terminology Criteria for Adverse Events version 5.0.	Up to 5 years