Niraparib Maintenance Treatment in mCRC With a Partial o Complete Response After Oxaliplatin-based Induction Therapy (Bohème)
Primary Purpose
Metastatic Colorectal Cancer
Status
Withdrawn
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Niraparib
Sponsored by
About this trial
This is an interventional treatment trial for Metastatic Colorectal Cancer focused on measuring Niraparib metastatic colorectal cancer PARP1 PARP2 inhibitor
Eligibility Criteria
Inclusion Criteria:
- Signed informed consent
- Age ≥ 18 years at time of study entry
- Histologically confirmed diagnosis of Stage IV colorectal adenocarcinoma
- Disease evaluation with proven Complete Response or Partial Response according to RECIST v 1.1 after 4 months of oxaliplatin-based doublets or triplets with or without anti-VEGF or anti-EGFR agents
- Availability of Formalin-Fixed Paraffin-Embedded tumor tissue
- Treatment with Niraparib must be started after at least 2 weeks the end of platinum-based induction therapy up to 6 weeks
- Eastern Cooperative Oncology Group Performance Status < 1
- Adequate normal organ and marrow function as follow: Haemoglobin≥9.0 g/dL; b. Absolute neutrophil count ≥1.5 × 109 /L; Platelet count ≥100 × 109/L; Serum bilirubin ≤1.5 x Upper Limit of Normal This will not apply to patients with Gilbert's syndrome; Calculated creatinine CL>40 mL/min by the Cockcroft-Gault formula; Aspartate aminotransferase /Alanine Aminotransferase ≤2.5 x Upper Limit of Normal o ≤ 5 x Upper Limit of Normal in the presence of liver metastases
- Willing and able to comply with all of the requirements and visits in the protocol
- Participant must agree not to donate blood during the study or for 90 days after the last dose of Niraparib
- Fertile women must have a negative urine or serum pregnancy test within 7 days prior to taking study treatment
- Fertile women must use highly effective contraception, starting with the screening visit through 6 months post last dose of Niraparib.
- Male participant agrees to use an adequate method of contraception starting with the first dose of study treatment through 90 days after the last dose of study treatment.
- Male participant must not donate sperm for 90 days after last dose of Niraparib.
Exclusion Criteria:
- Prior adjuvant treatment for stage II/III colorectal cancer ending within 12 months before the start of induction treatment
- Patients with Microsatellite instability high or DNA mismatch repair deficiency DSBs DNA double-strand breaks are not allowed
- Any systemic disease that, in the opinion of the Investigator, it is not compatible with the protocol
- Major surgery ≤ 3 weeks prior to initiating Niraparib
- Participation in another interventional clinical trial
- Radiation therapy encompassing >20% of the bone marrow within 2 weeks; or any radiation therapy < 1 week prior to taking Niraparib
- Hypersensitivity to Niraparib components or excipients
- Transfusion (platelets or red blood cells) ≤ 4 weeks prior to initiating Niraparib
- Colony stimulating factors (e.g., granulocyte colony-stimulating factor, granulocyte macrophage colony stimulating factor, or recombinant erythropoietin) within 4 weeks prior Niraparib
- Any known Grade 3 or 4 anemia, neutropenia or thrombocytopenia due to prior chemotherapy that persisted > 4 weeks
- History of myelodysplastic syndrome, acute myeloid leukemia or Prior Reversible Encephalopathy Syndrome
- Serious, uncontrolled medical disorder, nonmalignant systemic disease, or active, uncontrolled infection.
- Diagnosis, detection, or treatment of another type of cancer ≤ 2 years prior to initiating Niraparib (except basal or squamous cell carcinoma of the skin and cervical cancer in situ that has been definitively treated)
- Active infection with Human Hepatitis B Virus or Hepatitis C Virus
- Pregnancy or breastfeeding
- Any impairment of gastrointestinal function or disease that may significantly impair the absorption of oral drugs, malabsorption syndrome, bowel obstruction, or inability to swallow tablets).
Sites / Locations
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Treatment Arm
Arm Description
Treatment with Niraparib must be started after at least 2 weeks and no later than 6 weeks after the end of platinum-based induction therapy.
Outcomes
Primary Outcome Measures
Progression-Free Survival 1
Progression-Free Survival 1 is defined as the time from the patient registration to the date of first radiographic progression by RECIST guidelines (version 1.1), or death from any cause in the absence of progression, whichever occurs first.
Secondary Outcome Measures
Progression-Free Survival (2) after re-introduction of first-line treatment combination
Progression-Free Survival (2) is defined as the patient registration to progression or death from any cause in the absence of progression, whichever comes first on anticancer treatment following maintenance therapy.
Overall Survival
Overall Survival is defined as time from patient registration until death from any cause. If no event (death) has been observed, the patient is censored at the date of last follow up
Objective Response Rate
Objective Response Rate is defined as the percentage of patients with Complete Response or Partial Response, as assessed by Response Evaluation Criteria in Solid Tumors v.1.1 criteria using an independent review.
Incidence of Treatment-Emergent Adverse Events
Toxicity / adverse events classified according to NCI-Common Terminology Criteria for Adverse Events version 5.0.
Full Information
NCT ID
NCT05412706
First Posted
May 25, 2022
Last Updated
September 5, 2023
Sponsor
Ospedale Policlinico San Martino
Collaborators
CRO "Centro Clinical Trials" IRCCS Ospedale Policlinico San Martino, Laboratory Molecular Oncology Candiolo Cancer Institute IRCCS - Candiolo (Torino)
1. Study Identification
Unique Protocol Identification Number
NCT05412706
Brief Title
Niraparib Maintenance Treatment in mCRC With a Partial o Complete Response After Oxaliplatin-based Induction Therapy
Acronym
Bohème
Official Title
Niraparib Maintenance Treatment in Metastatic Colorectal Cancer Patients With a Partial or Complete Response After Oxaliplatin-based Induction Therapy: Bohème Trial
Study Type
Interventional
2. Study Status
Record Verification Date
September 2023
Overall Recruitment Status
Withdrawn
Why Stopped
The Principal Investigator has retired and has not been replaced has retired and a new one has not been identified Principal Investigator
Study Start Date
September 4, 2023 (Actual)
Primary Completion Date
September 4, 2023 (Actual)
Study Completion Date
September 4, 2023 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ospedale Policlinico San Martino
Collaborators
CRO "Centro Clinical Trials" IRCCS Ospedale Policlinico San Martino, Laboratory Molecular Oncology Candiolo Cancer Institute IRCCS - Candiolo (Torino)
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
Colorectal Cancer ranks third among the most frequent malignancies representing a leading cause of cancer-related death worldwide. The constant improvement in the "continuum of care" of metastatic colorectal cancer (mCRC) patients led to a median overall survival of about 30-36 months.
Due to the cumulative toxicities of first-line combinations of chemotherapy and biological agents, discontinuation or intermittent chemotherapy or maintenance strategies have been investigated in clinical trials. After a 4 to 6-month induction treatment with bevacizumab plus doublet or triplet regimens, a fluoropyrimidine plus bevacizumab is regarded as the optimal maintenance regimen. Little evidence is available on the role of maintenance with anti-EGFR agents.
A recent systematic review and network meta-analysis of 12 relevant randomized clinical trials comprising 5540 patients with mCRC showed that a maintenance strategy with a fluoropyrimidine, with or without the addition of bevacizumab, is preferred. However, given the lack of a clear overall survival benefit, shared decision-making should include observation as an acceptable alternative.
Poly(ADP)-ribose polymerase (PARP) inhibitors are now approved for breast, ovarian and pancreatic cancers. Evidence suggests that PARP inhibitors are more effective in tumors harboring homologous recombination DNA damage repair (HRR) deficiency and platinum sensitivity may be used a surrogate marker of HRD and therefore of PARP-inhibitors efficacy. An extensive Next Generation Sequencing analysis revealed that 15% of mCRC samples harbors mutations in genes involved in the HRR pathway. Several clinical trials are ongoing to test PARP inhibitors either alone or in combination in mCRC patients. The originality of this trial is to investigate PARPi in the maintenance setting.
Pre-clinical evidence showed that PARP blockade after initial oxaliplatin response delayed disease progression in mCRC carrying Kirsten Rat Sarcoma and BRAF mutations, suggesting that maintenance treatment with PARP inhibitors warrants further clinical investigation in mCRC patients who respond to oxaliplatin-containing induction treatment.
The main objective of this trial is to investigate the efficacy of anti-PARP inhibition as maintenance treatment in mCRC patients who obtained a complete or partial response after 4-month induction treatment with oxaliplatin-based double or triplet plus biologic agents.
Detailed Description
Multicenter phase II no profit study investigating the disease-free survival efficacy of niraparib as maintenance treatment in 46 patients with metastatic colorectal cancer with partial or complete response after oxaliplatin-based induction therapy.
The study also includes translational research objectives.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Colorectal Cancer
Keywords
Niraparib metastatic colorectal cancer PARP1 PARP2 inhibitor
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Treatment Arm
Arm Type
Experimental
Arm Description
Treatment with Niraparib must be started after at least 2 weeks and no later than 6 weeks after the end of platinum-based induction therapy.
Intervention Type
Drug
Intervention Name(s)
Niraparib
Other Intervention Name(s)
Zejula
Intervention Description
Patients will receive Niraparib 200-300 mg orally as an individualized weight and platelet-based, flat-fixed, continuous daily dose.
Niraparib will be administered orally once daily in 28-day cycles.
Primary Outcome Measure Information:
Title
Progression-Free Survival 1
Description
Progression-Free Survival 1 is defined as the time from the patient registration to the date of first radiographic progression by RECIST guidelines (version 1.1), or death from any cause in the absence of progression, whichever occurs first.
Time Frame
36 months
Secondary Outcome Measure Information:
Title
Progression-Free Survival (2) after re-introduction of first-line treatment combination
Description
Progression-Free Survival (2) is defined as the patient registration to progression or death from any cause in the absence of progression, whichever comes first on anticancer treatment following maintenance therapy.
Time Frame
36 months
Title
Overall Survival
Description
Overall Survival is defined as time from patient registration until death from any cause. If no event (death) has been observed, the patient is censored at the date of last follow up
Time Frame
36 months
Title
Objective Response Rate
Description
Objective Response Rate is defined as the percentage of patients with Complete Response or Partial Response, as assessed by Response Evaluation Criteria in Solid Tumors v.1.1 criteria using an independent review.
Time Frame
36 months
Title
Incidence of Treatment-Emergent Adverse Events
Description
Toxicity / adverse events classified according to NCI-Common Terminology Criteria for Adverse Events version 5.0.
Time Frame
36 months
Other Pre-specified Outcome Measures:
Title
Translational objectives for evaluated Association between DNA damage responseprotein expression with Progression-free survival of Niraparib maintenance
Description
Association between DNA damage responseprotein expression with Progression-free survival of Niraparib maintenance
Time Frame
36 months
Title
Translational objectives 2 for evaluated association of Colorectal Cancer-optimized mutational signatures, including HRDetect, with Progression-free survival of Niraparib maintenance
Description
Association of Colorectal Cancer-optimized mutational signatures, including HRDetect, with Progression-free survival of Niraparib maintenance
Time Frame
36 months
Title
Translational objectives 3 for evaluated association between in vitro drug screening sensitivity on Patient-derived organoids and clinical outcome
Description
Association between in vitro drug screening sensitivity on Patient-derived organoids and clinical outcome
Time Frame
36 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Signed informed consent
Age ≥ 18 years at time of study entry
Histologically confirmed diagnosis of Stage IV colorectal adenocarcinoma
Disease evaluation with proven Complete Response or Partial Response according to RECIST v 1.1 after 4 months of oxaliplatin-based doublets or triplets with or without anti-VEGF or anti-EGFR agents
Availability of Formalin-Fixed Paraffin-Embedded tumor tissue
Treatment with Niraparib must be started after at least 2 weeks the end of platinum-based induction therapy up to 6 weeks
Eastern Cooperative Oncology Group Performance Status < 1
Adequate normal organ and marrow function as follow: Haemoglobin≥9.0 g/dL; b. Absolute neutrophil count ≥1.5 × 109 /L; Platelet count ≥100 × 109/L; Serum bilirubin ≤1.5 x Upper Limit of Normal This will not apply to patients with Gilbert's syndrome; Calculated creatinine CL>40 mL/min by the Cockcroft-Gault formula; Aspartate aminotransferase /Alanine Aminotransferase ≤2.5 x Upper Limit of Normal o ≤ 5 x Upper Limit of Normal in the presence of liver metastases
Willing and able to comply with all of the requirements and visits in the protocol
Participant must agree not to donate blood during the study or for 90 days after the last dose of Niraparib
Fertile women must have a negative urine or serum pregnancy test within 7 days prior to taking study treatment
Fertile women must use highly effective contraception, starting with the screening visit through 6 months post last dose of Niraparib.
Male participant agrees to use an adequate method of contraception starting with the first dose of study treatment through 90 days after the last dose of study treatment.
Male participant must not donate sperm for 90 days after last dose of Niraparib.
Exclusion Criteria:
Prior adjuvant treatment for stage II/III colorectal cancer ending within 12 months before the start of induction treatment
Patients with Microsatellite instability high or DNA mismatch repair deficiency DSBs DNA double-strand breaks are not allowed
Any systemic disease that, in the opinion of the Investigator, it is not compatible with the protocol
Major surgery ≤ 3 weeks prior to initiating Niraparib
Participation in another interventional clinical trial
Radiation therapy encompassing >20% of the bone marrow within 2 weeks; or any radiation therapy < 1 week prior to taking Niraparib
Hypersensitivity to Niraparib components or excipients
Transfusion (platelets or red blood cells) ≤ 4 weeks prior to initiating Niraparib
Colony stimulating factors (e.g., granulocyte colony-stimulating factor, granulocyte macrophage colony stimulating factor, or recombinant erythropoietin) within 4 weeks prior Niraparib
Any known Grade 3 or 4 anemia, neutropenia or thrombocytopenia due to prior chemotherapy that persisted > 4 weeks
History of myelodysplastic syndrome, acute myeloid leukemia or Prior Reversible Encephalopathy Syndrome
Serious, uncontrolled medical disorder, nonmalignant systemic disease, or active, uncontrolled infection.
Diagnosis, detection, or treatment of another type of cancer ≤ 2 years prior to initiating Niraparib (except basal or squamous cell carcinoma of the skin and cervical cancer in situ that has been definitively treated)
Active infection with Human Hepatitis B Virus or Hepatitis C Virus
Pregnancy or breastfeeding
Any impairment of gastrointestinal function or disease that may significantly impair the absorption of oral drugs, malabsorption syndrome, bowel obstruction, or inability to swallow tablets).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alberto Sobrero
Organizational Affiliation
Ospedale Policlinico San Martino IRCCS
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Alberto Puccini
Organizational Affiliation
Ospedale Policlinico San Martino IRCCS
Official's Role
Study Chair
12. IPD Sharing Statement
Learn more about this trial
Niraparib Maintenance Treatment in mCRC With a Partial o Complete Response After Oxaliplatin-based Induction Therapy
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