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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Withdrawn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
Ospedale Policlinico San Martino
About
Eligibility
Locations
Arms
Outcomes
Full info

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

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

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

    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)
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    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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