Cancer Stem Cell Assay Directed Chemotherapy in Recurrent Platinum Resistant Ovarian Cancer

Recurrent Ovarian Carcinoma Clinical Trial

Official title:

Standard Chemotherapy Versus Cancer Stem Cell Assay Directed Chemotherapy in Recurrent Platinum Resistant Ovarian Cancer

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03949283
• Other study ID #: CG03
• Status: Active, not recruiting
• Phase: Phase 3
• Start date: July 26, 2019
• Est. completion date: December 30, 2024

Study information

• Verified date: January 2023
• Source: Cordgenics, LLC
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this clinical study is to confirm the utility of chemosensitivity (ChemoID) tumor testing on cancer stem cells as a predictor of clinical response in recurrent platinum resistant epithelial ovarian cancer (EOC), fallopian tube, or primary peritoneal cancer. Population studied will be female participants experiencing a recurrent platinum-resistant ovarian cancer (no mucinous, low grade serous, or pure sarcoma types), with ≤ 5 prior treatments, and a performance status 0-1.

Description:

This study is designed as a parallel group randomized controlled clinical trial to determine if recurrent platinum resistant epithelial ovarian cancer (EOC) patients treated with chemotherapy predicted by the ChemoID assay will have better outcomes than patients treated with standard-of-care control therapy chosen by the physician. Upon obtaining informed consent, all eligible participants affected by recurrent platinum-resistant ovarian cancer (no mucinous, low grade serous, or pure sarcoma types), with ≤ 5 prior treatments, and a performance status 0-1 will have a tumor biopsy or a cancer-positive fluid collection sample to undergo ChemoID drug response testing with multiple FDA-approved chemotherapeutic agents. Eligible participants will be randomized to a standard treatment arm with control treatment (chemotherapy chosen by the Physician from a provided list), or to a study arm of FDA-approved drugs selected by the ChemoID drug response assay. A stratified randomization approach for treatment arm assignment will be used with strata based on number of prior platinum treatments and BRCA status to ensure balance within these cells.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 150
• Est. completion date: December 30, 2024
• Est. primary completion date: June 30, 2024
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Informed consent obtained and signed.

2. Participant is willing and able to commit to study procedures including long-term follow-up visit(s);

3. Participant must be a female and at least 18 years of age at the time of enrollment.

4. Negative pregnancy test for women of childbearing potential.

5. Participant has been diagnosed with recurrent platinum resistant epithelial ovarian, peritoneal, or fallopian tube carcinoma.

6. Participants must have an evaluable disease - defined as one of the following:

1) RECIST 1.1 measurable disease (defined as one or more solid and/or cystic tumors on cross-sectional imaging that measures 1 cm or greater in long axis and/or lymph nodes measuring 1.5 cm or greater in short axis) 2) Evaluable disease (defined as solid and/or cystic tumors on radiographic imaging or physical exam that do not meet RECIST 1.1 definitions for target lesions) with elevated CA125 (GCIG recurrence and response criteria) by more than 2 times the upper limits of normal, confirmed in two successive samples, drawn at least one week apart).

7. Participant has agreed to provide a core biopsy of the primary site, a secondary metastatic site, or to undergo a paracentesis or thoracentesis for fluid collection.

8. An adequate fresh sample can be provided and submitted for ChemoID testing.

9. Participant has disease of one of the following histologic epithelial cell types:

high-grade serous adenocarcinoma, endometrioid adenocarcinoma, undifferentiated carcinoma, transitional cell carcinoma, clear cell carcinoma, or adenocarcinoma, not otherwise specified (N.O.S.). Cytologic confirmation of diagnosis is acceptable for participants treated with neoadjuvant therapy who have not had a surgical procedure for a histologic confirmation. Patients with low-grade serous or mucinous adenocarcinoma are not eligible, nor are patients with pure ovarian sarcomas.

10. Participant has received = 5 prior regimens including at least one platinum-based regimen for their ovarian, peritoneal, or fallopian tube carcinoma.

11. Participant must have an estimated life expectancy of greater than six months, as determined by the investigator.

12. Participant requires chemotherapy and the investigator plans to administer one of the regimens of interest as deemed by her physician.

13. Participant must have an ECOG Performance Status Score of = 2, KPS=70, or 0-2 GOG status.

14. Adequate laboratory values within 60 days of enrollment to study defined as follows:

1. ANC = 1500/mm3

2. Hgb = 10 mg/dl

3. Hct = 28%

4. Platelet count = 100,000/µL

5. Serum creatinine = 2.0 mg/dl

6. Total bilirubin = 2.5 mg/dl

7. AST/SGOT = 3 times ULN. If intrahepatic liver metastases are present, AST and ALT must be = 5 times institutional ULN.

Exclusion Criteria:

1. Use of Avastin planned to treat participant.

2. Participant has ovarian stromal, germ cell tumors or pure sarcomas.

3. Participant has borderline carcinoma (uncertain malignant potential), mutinous or low-grade serous carcinoma.

4. Participant is pregnant or lactating.

5. Participants of childbearing potential not employing adequate contraception.

6. Participants who are at risk of failure of compliance to the visit schedules and procedures including those with psychiatric disease that would substantially impact compliance or consent.

7. Estimated life expectancy of <6 months, as estimated by the investigator in consultation with participating oncologists.

8. Participants with symptomatic cardiac conditions (i.e. NYHA class III/IV or uncompensated angina).

9. Enrollment in another clinical study that precludes allowing the oncologist to select chemotherapy regimens.

10. Previously participated in this study.

11. Any condition that would, in the opinion of the investigator, place the participant at an unacceptable risk, or render the participant unable to meet the requirements of the protocol (including long-term study follow-up).

12. CA-125 only disease without RECIST 1.1 measurable or otherwise evaluable disease.

13. Patients with third space fluid (for example pleural effusions) as only site of disease.

14. Participant may not use any complementary or alternative medicines including natural herbal products or folk remedies as they may interfere with the effectiveness of the study treatments.

Related Conditions & MeSH terms

• Carcinoma, Ovarian Epithelial
• Ovarian Neoplasms
• Platinum-resistant Ovarian Cancer
• Recurrence
• Recurrent Ovarian Carcinoma

Intervention

Diagnostic Test:
• ChemoID Assay
The ChemoID test is a CLIA-certified and CAP-accredited drug response assay performed by a hospital clinical pathology laboratory that uses patient's live tumor cells to indicate which chemotherapy agent (or combinations) will kill bulk of tumor cells, and cancer stem cells (CSCs) that are known to cause cancer to recur. During the assay, cancer stem cells and bulk tumor cells from an individual patient are exposed to FDA-approved chemotherapy drugs. The test measures the cytotoxic effect of actual doses of standard-of-care chemotherapies. The ChemoID drug response assay reports a prioritized list of effective and ineffective chemotherapies. The test is designed to target cancer stem cells to mitigate tumor relapse.

Drug:
• Standard Chemotherapy
Control chemotherapy treatment will be chosen from any of the following standard-of-care chemotherapy drugs or combinations: Liposomal Doxorubicin; Docetaxel; Paclitaxel; Carboplatin; Cisplatin; Gemcitabine; Topotecan; Carboplatin, Gemcitabine; Cisplatin, Gemcitabine; Carboplatin, Liposomal Doxorubicin; Carboplatin, Paclitaxel; Carboplatin, Docetaxel. The treating physician will NOT receive the ChemoID assay results from the ChemoID lab.

Locations

Country	Name	City	State
United States	Charleston Area Medical Center (CAMC)	Charleston	West Virginia
United States	University of Cincinnati Cancer Institute	Cincinnati	Ohio
United States	Edwards Comprehensive Cancer Center - Cabell Huntington Hospital	Huntington	West Virginia
United States	Kaiser Permanente	Los Angeles	California
United States	Miami Cancer Institute/Baptist Health South Florida	Miami	Florida
United States	LSU Health Sciences Center	New Orleans	Louisiana
United States	University of Oklahoma Health Sciences Center	Oklahoma City	Oklahoma
United States	West Penn Hospital, Allegheny Health Network	Pittsburgh	Pennsylvania

Sponsors (1)

Lead Sponsor	Collaborator
Cordgenics, LLC

Country where clinical trial is conducted

United States, 

References & Publications (2)

Howard CM, Bush S 2nd, Zgheib NB, Lirette ST, Cortese A, Mollo A, Valluri J, Claudio PP. Cancer Stem Cell Assay for the Treatment of Platinum-Resistant Recurrent Ovarian Cancer. HSOA J Stem Cells Res Dev Ther. 2021;7(3):076. doi: 10.24966/srdt-2060/100076. Epub 2021 Sep 9. — View Citation

Howard CM, Zgheib NB, Bush S 2nd, DeEulis T, Cortese A, Mollo A, Lirette ST, Denning K, Valluri J, Claudio PP. Clinical relevance of cancer stem cell chemotherapeutic assay for recurrent ovarian cancer. Transl Oncol. 2020 Dec;13(12):100860. doi: 10.1016/j.tranon.2020.100860. Epub 2020 Aug 28. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Objective response rate	Objective response rate (ORR) as measured by RECIST version 1.1 criteria in recurrent EOC patients who have had ChemoID-guided treatment versus physician choice control treatment (chemotherapy chosen by the physician from the provided list).	24 months
Secondary	Progression Free Survival (PFS)	Progression free survival (PFS) in patients with recurrent epithelial ovarian cancer (EOC) who receive standard of care treatment (chemotherapy chosen by the physician from the provided list) versus ChemoID drug response assay-directed chemotherapy.	24 months
Secondary	Duration of Response	Duration of Response (DOR) in patients with recurrent epithelial ovarian cancer (EOC) who receive standard of care treatment (chemotherapy chosen by the physician from the provided list) versus ChemoID drug response assay-directed chemotherapy.	24 months
Secondary	CA125 levels	Levels of CA125 in patients with recurrent epithelial ovarian cancer (EOC) who receive standard of care treatment (chemotherapy chosen by the physician from the provided list) versus ChemoID drug response assay-directed chemotherapy.	24 months
Secondary	Health-Related Quality of Life (HRQOL)	Health-Related Quality of Life (HRQOL) measured to ChemoID-guided treatment selection vs. standard chemotherapy chosen by the physician using self-reported and validated questionnaires, addressing physical, psychological, emotional, and social issues.	24 months