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Study of Gemcitabine, Carboplatin and VELIPARIB (ABT-888) in Refractory Testicular Germ Cell Cancer

Primary Purpose

Testicular Cancer

Status
Completed
Phase
Phase 2
Locations
Slovakia
Study Type
Interventional
Intervention
Veliparib
Gemcitabine
Carboplatin
Sponsored by
National Cancer Institute, Slovakia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Testicular Cancer focused on measuring Multiple relapsed/refractory testicular germ cell tumors, PARP inhibition, Chemotherapy, Gemcitabine, Carboplatin

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Signed written informed consent
  2. Men aged 18 years or older
  3. ECOG performance status: 0-1,
  4. Histologically confirmed extracranial primary germ cell cancer, seminoma, or nonseminoma
  5. Rising serum markers (i.e., alpha-fetoprotein and human chorionic gonadotropin) on sequential measurement or biopsy-proven unresectable germ cell cancer
  6. Refractory GCTs e.g. patients relapsing after high-dose chemotherapy or for patients non fit enough for high-dose chemotherapy
  7. Primary mediastinal GCTs in first relapse
  8. Patient's disease must not be amenable to cure with either surgery or chemotherapy in the opinion of investigator,
  9. Measurable disease radiologically
  10. Adequate hematologic function defined by ANC > 1500/mm3, platelet count > 100 000/mm3 and hemoglobin level > 9g/dl.
  11. Adequate liver function defined by a total bilirubin level < 1.5 ULN, and ALT, AST < 3 ULN or < 5 in case of liver metastases. For subjects with Gilbert's syndrome bilirubin > 1.5 × ULN is allowed if no symptoms of compromised liver function are present
  12. Adequate renal function: measured or calculated (by Cockcroft formula) creatinine clearance > 50 ml/min. Cockcroft formula: CLcr = [(140-age) x weight(Kg)]/[72 x creatinine (mg/dl)]
  13. At least 4 weeks must have elapsed since the last radiotherapy and/or chemotherapy before study entry,
  14. At least 4 weeks must have elapsed since the last major surgery
  15. Complete recovery from prior surgery, and/or reduction of all adverse events from previous systemic therapy or radiotherapy to grade 1,
  16. Absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule

Exclusion Criteria:

  1. Patients who do not fit inclusion criteria
  2. Other prior malignancy except successfully treated nonmelanoma skin cancer
  3. Prior PARP1 inhibitor
  4. Other concurrent approved or investigational anticancer treatment, including surgery, radiotherapy, chemotherapy, biologic-response modifiers, hormone therapy, or immunotherapy
  5. Female patients
  6. Patients infected by the Human Immunodeficiency Virus (HIV)
  7. Patients with other severe acute or chronic medical condition, or laboratory abnormality that would impair, in the judgment of investigator, excess risk associated with study treatment, or which, in judgment of the investigator, would make the patient inappropriate for entry into this study
  8. Inability of oral intake, or drug absorption (e.g. malabsorption syndrome)
  9. Hypersensitivity to any compound of the drug
  10. Sexually active men not using highly effective birth control if their partners are women of child-bearing potential
  11. Patients with history of or current CNS metastasis
  12. Patients with history of seizures

Sites / Locations

  • National Cancer Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Gemcitabine, Carboplatin, Veliparib

Arm Description

Gemcitabine 800mg/m2 day 1 and 8 every 3 weeks; Carboplatin AUC = 4, day 1, every 3 weeks, Veliparib 250mg bid day continuously.

Outcomes

Primary Outcome Measures

Percentage of patients that will be free of disease progression according to RECIST criteria 12-months after the first administration of the treatment.
Percentage of patients that will be free of disease progression according to RECIST criteria 12-months after the first administration of the treatment.

Secondary Outcome Measures

Response rate
Response rate as measured by RECIST 1.1
Median overall survival
Median overall survival. Overall survival will be measured from the date of first administration of the treatment until death or date of last follow-up.
Median progression-free survival
Median progression-free survival. Progression-free survival will be measured from the date of first administration of the treatment until progression, death or date of last follow-up.
Frequency of grade III and IV adverse events
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0

Full Information

First Posted
July 14, 2016
Last Updated
March 2, 2021
Sponsor
National Cancer Institute, Slovakia
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1. Study Identification

Unique Protocol Identification Number
NCT02860819
Brief Title
Study of Gemcitabine, Carboplatin and VELIPARIB (ABT-888) in Refractory Testicular Germ Cell Cancer
Official Title
Phase II Study of Gemcitabine, Carboplatin and VELIPARIB (ABT-888) in Refractory Testicular Germ Cell Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
December 2020
Overall Recruitment Status
Completed
Study Start Date
August 1, 2016 (Actual)
Primary Completion Date
November 30, 2020 (Actual)
Study Completion Date
February 15, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute, Slovakia

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a proof-of-concept study to define efficacy of gemcitabine, carboplatin and VELIPARIB (ABT-888) in patients with refractory germ cell tumors (GCTs). PARP proteins are involved in base excision repair (BER), one of the major DNA repair system in cells and PARP is overexpressed in testicular GCTs (TGCTs) compared to normal testis and data suggest that PARP overexpression is early event in TGCTs development. Patients with low PARP expression in primary tumour had non-significantly better OS compared to patients with high PARP expression (5-year OS 89.2% vs 78.7%; HR=0.50, 95% CI 0.21 to 1.17, p=0.12). The aim of this study is to evaluate PARP inhibitor VELIPARIB in combination with gemcitabine, carboplatin in patients with refractory germ cell tumors (GCTs).
Detailed Description
PARP proteins are involved in base excision repair (BER), one of the major DNA repair system in cells. Recently, it was showed that PARP inhibitors have striking efficacy in patients with BRCA1 deficient or triple negative breast cancer in monotherapy or in combination with cisplatin based chemotherapy, without increased systemic toxicity. Pertubations affecting homologous recombination (HR) involved in DNA repair are associated with higher probability of response to PARP inhibitors. Inactivation of PTEN, tumor suppressor protein, is associated with defects in HR and response to PARP inhibitors. Recently, PARP expression was evaluated in TGCTs. It was showed that PARP is overexpressed in testicular germ cell tumours compared to normal testis and PARP overexpression is early event in TGCTs development. Patients with low PARP expression in primary tumour had non-significantly better OS compared to patients with high PARP expression (5-year OS 89.2% vs 78.7%; HR=0.50, 95% CI 0.21 to 1.17, p=0.12).Loss of the tumor suppressor gene PTEN marks the transition from intratubular germ cell neoplasias (ITGCN) to invasive germ cell tumors. In the testis, PTEN was abundantly expressed in germ cells whereas it was virtually absent from 56% of seminomas as well as from 86% of embryonal carcinomas and virtually all teratomas. On the contrary, ITGCN intensely expressed PTEN, indicating that loss of PTEN expression is not in early event in testicular tumor development, but is associated with progression of disease. Previously, it was showed, that testicular germ cell tumors cell lines have low activity of proteins involved in nuclear excision repair (NER) and it is assumed that low NER activity is related to the favorable response of testis tumors to cisplatin-based chemotherapy. Gemcitabine and carboplatin showed activity in refractory TGCTs. Recently, maximal tolerated dose of Veliparib (ABT-888) with gemcitabine and carboplatin was established. Based on aforementioned data, there is strong rationale to inhibit PARP in TGCT. Inactivation of PARP by Veliparib along with defects of homologous recombination due to PTEN inactivation in GCTs and low activity of nucleotide excision repair system will dramatically increase antitumor effect gemcitabine and carboplatin in patients with progressing or relapsing germ cell cancer.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Testicular Cancer
Keywords
Multiple relapsed/refractory testicular germ cell tumors, PARP inhibition, Chemotherapy, Gemcitabine, Carboplatin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Gemcitabine, Carboplatin, Veliparib
Arm Type
Experimental
Arm Description
Gemcitabine 800mg/m2 day 1 and 8 every 3 weeks; Carboplatin AUC = 4, day 1, every 3 weeks, Veliparib 250mg bid day continuously.
Intervention Type
Drug
Intervention Name(s)
Veliparib
Other Intervention Name(s)
ABT-888
Intervention Description
Veliparib 250mg BID, continuously
Intervention Type
Drug
Intervention Name(s)
Gemcitabine
Intervention Description
Gemcitabine 800mg/m2, day 1 and 8
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Intervention Description
Carboplatin AUC = 4, day 1
Primary Outcome Measure Information:
Title
Percentage of patients that will be free of disease progression according to RECIST criteria 12-months after the first administration of the treatment.
Description
Percentage of patients that will be free of disease progression according to RECIST criteria 12-months after the first administration of the treatment.
Time Frame
12-months
Secondary Outcome Measure Information:
Title
Response rate
Description
Response rate as measured by RECIST 1.1
Time Frame
6-weeks
Title
Median overall survival
Description
Median overall survival. Overall survival will be measured from the date of first administration of the treatment until death or date of last follow-up.
Time Frame
12 months
Title
Median progression-free survival
Description
Median progression-free survival. Progression-free survival will be measured from the date of first administration of the treatment until progression, death or date of last follow-up.
Time Frame
12-months
Title
Frequency of grade III and IV adverse events
Description
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Time Frame
3-weeks

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed written informed consent Men aged 18 years or older ECOG performance status: 0-1, Histologically confirmed extracranial primary germ cell cancer, seminoma, or nonseminoma Rising serum markers (i.e., alpha-fetoprotein and human chorionic gonadotropin) on sequential measurement or biopsy-proven unresectable germ cell cancer Refractory GCTs e.g. patients relapsing after high-dose chemotherapy or for patients non fit enough for high-dose chemotherapy Primary mediastinal GCTs in first relapse Patient's disease must not be amenable to cure with either surgery or chemotherapy in the opinion of investigator, Measurable disease radiologically Adequate hematologic function defined by ANC > 1500/mm3, platelet count > 100 000/mm3 and hemoglobin level > 9g/dl. Adequate liver function defined by a total bilirubin level < 1.5 ULN, and ALT, AST < 3 ULN or < 5 in case of liver metastases. For subjects with Gilbert's syndrome bilirubin > 1.5 × ULN is allowed if no symptoms of compromised liver function are present Adequate renal function: measured or calculated (by Cockcroft formula) creatinine clearance > 50 ml/min. Cockcroft formula: CLcr = [(140-age) x weight(Kg)]/[72 x creatinine (mg/dl)] At least 4 weeks must have elapsed since the last radiotherapy and/or chemotherapy before study entry, At least 4 weeks must have elapsed since the last major surgery Complete recovery from prior surgery, and/or reduction of all adverse events from previous systemic therapy or radiotherapy to grade 1, Absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule Exclusion Criteria: Patients who do not fit inclusion criteria Other prior malignancy except successfully treated nonmelanoma skin cancer Prior PARP1 inhibitor Other concurrent approved or investigational anticancer treatment, including surgery, radiotherapy, chemotherapy, biologic-response modifiers, hormone therapy, or immunotherapy Female patients Patients infected by the Human Immunodeficiency Virus (HIV) Patients with other severe acute or chronic medical condition, or laboratory abnormality that would impair, in the judgment of investigator, excess risk associated with study treatment, or which, in judgment of the investigator, would make the patient inappropriate for entry into this study Inability of oral intake, or drug absorption (e.g. malabsorption syndrome) Hypersensitivity to any compound of the drug Sexually active men not using highly effective birth control if their partners are women of child-bearing potential Patients with history of or current CNS metastasis Patients with history of seizures
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michal Mego, Assoc.Prof
Organizational Affiliation
National Cancer Institute (NCI)
Official's Role
Study Chair
Facility Information:
Facility Name
National Cancer Institute
City
Bratislava
ZIP/Postal Code
83310
Country
Slovakia

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
34052929
Citation
Mego M, Svetlovska D, Reckova M, Angelis D, Kalavska K, Obertova J, Palacka P, Rejlekova K, Sycova-Mila Z, Chovanec M, Mardiak J. Gemcitabine, carboplatin and veliparib in multiple relapsed/refractory germ cell tumours: The GCT-SK-004 phase II trial. Invest New Drugs. 2021 Dec;39(6):1664-1670. doi: 10.1007/s10637-021-01130-5. Epub 2021 May 29.
Results Reference
derived

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Study of Gemcitabine, Carboplatin and VELIPARIB (ABT-888) in Refractory Testicular Germ Cell Cancer

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