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Functional Analysis of BRCAness (FAB)

Primary Purpose

Ovarian Neoplasm Epithelial, Homologous Recombination Deficiency, BRCA1 Mutation

Status
Unknown status
Phase
Phase 2
Locations
Netherlands
Study Type
Interventional
Intervention
Functional RAD51 assay
Olaparib Oral Product
Sponsored by
Leiden University Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Ovarian Neoplasm Epithelial

Eligibility Criteria

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

Inclusion Criteria:

  • Patients with recurrent high grade serous or endometrioid EOC (more than 3 months after platinum containing chemotherapy and unwilling or ineligible for platinum based therapy) with a tumor lesion that is amendable for biopsy or who can undergo ascites drainage prior to treatment.
  • Diagnosis of high grade serous or endometrioid EOC confirmed by histology .
  • Provision of informed consent prior to any study specific procedures
  • Female aged equal or above 18 years
  • Patients must have normal organ and bone marrow function measured within 28 days prior to administration olaparib
  • Eastern Cooperative Oncology Group performance status 0 to 2
  • Patients must have a life expectancy equal or above 16 weeks.
  • Postmenopausal or evidence of nonchildbearing status for women of childbearing potential, negative urine or serum pregnancy test within 28 days of study treatment and confirmed prior to treatment on day 1.
  • Patients willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations.
  • Evaluable disease, measurable and, or nonmeasurable, that can be accurately assessed at baseline using RECIST by CT or MRI and is suitable for repeated assessment.
  • For inclusion in the optional exploratory genetic research and the optional biomarker research, patients must fulfil informed consent for genetic research and informed consent for biomarker research

Exclusion Criteria:

  • Participation in another clinical study with an investigational product during the last month.
  • Any previous treatment with PARP inhibitor, including olaparib.
  • Other malignancy within the last 5 years, except, adequately treated nonmelanoma skin cancer, curatively treated in situ cancer, stage 1 and grade 1 endometrial carcinoma, or other solid tumours including breast cancer and lymphomas curatively treated with no evidence of disease for equal or above 3 years.
  • Patients receiving radiotherapy within 3 weeks prior to study treatment.
  • Concomitant use of known strong CYP3A inhibitors or moderate CYP3A inhibitors
  • Concomitant use of known strong or moderate CYP3A inducers.
  • Persistent toxicities , Common Terminology Criteria for Adverse Event equal or above grade 2, caused by previous cancer therapy, excluding alopecia.
  • Patients with symptomatic uncontrolled brain metastases. Patients with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days.
  • Major surgery within 2 weeks of starting study treatment and patients must have recovered from any effects of any major surgery.
  • Patients considered a poor medical risk due to a serious, uncontrolled medical disorder, nonmalignant systemic disease or active, uncontrolled infection.
  • Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the study medication.
  • Breast feeding women.
  • Immunocompromised patients, for example, patients who are known to be serologically positive for human immunodeficiency virus.
  • Patients with a known hypersensitivity to olaparib or any of the excipients of the product.
  • Patients with known active hepatitis due to risk of transmitting the infection through blood or other body fluids
  • Previous allogenic bone marrow transplant or double umbilical cord blood transplantation.
  • Patients with myelodysplastic syndrome, acute myeloid leukaemia or with features suggestive of MDS, AML.
  • Whole blood transfusions in the last 120 days prior to entry to the study .
  • Resting ECG with QTc equal or above 470 msec on 2 or more time points within a 24 hour period or family history of long QT syndrome.

Sites / Locations

  • University Medical Center GroningenRecruiting
  • Leiden University Medical CenterRecruiting
  • Erasmus Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Olaparib monotherapy

Arm Description

Patients, irrespective of BRCA status, will be treated with olaparib tablet 300 mg bid

Outcomes

Primary Outcome Measures

Response Rate
The primary endpoint is the RR, defined as the best overall response (partial response and/or complete response) according to RECIST1.1 for both the HR proficient and HR deficient group as determined by the RAD51 assay.

Secondary Outcome Measures

Progression free survival (PFS)
time from start of maintenance olaparib to the date of first documented disease progression or death from any cause, whichever occurs first, of olaparib for the BRCA1 or BRCA2 mutant (germline or somatic) HR deficient group, the non BRCA mutant HR deficient group and the HR proficient group
Overall Survival (OS)
time from start olaparib to death (any cause).
RAD51 test
Percentage of informative RAD51 test results in tumor biopsies and/or ascites
Loss of function mutation
Identify loss of function mutations in genes involved in HR as part of the molecular analysis in the HR proficient and HR deficient group as determined by the RAD51 assay.
NCT-CTC toxicity criteria
Safety and adverse events (AE) of Common Terminology Criteria for Adverse Events version 4.03 (CTCAE) grade 3>5.

Full Information

First Posted
August 27, 2019
Last Updated
March 30, 2021
Sponsor
Leiden University Medical Center
Collaborators
Erasmus Medical Center, University Medical Center Groningen
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1. Study Identification

Unique Protocol Identification Number
NCT04780945
Brief Title
Functional Analysis of BRCAness
Acronym
FAB
Official Title
Correlation Between Homologous Recombination Deficiency and Response to Olaparib in Patients With Recurrent Epithelial Ovarian Cancer (EOC)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2021
Overall Recruitment Status
Unknown status
Study Start Date
January 21, 2019 (Actual)
Primary Completion Date
December 21, 2022 (Anticipated)
Study Completion Date
June 21, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Leiden University Medical Center
Collaborators
Erasmus Medical Center, University Medical Center Groningen

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
PARP inhibitors are most effective in homologous recombinant (HR) deficient tumors. There are clear indications that besides BRCA1 or BRCA2 mutated EOC, there is an additional group of EOC having deficiencies in HR (i.e. BRCAness) that might benefit from treatment with PARP inhibitors. Assessment of HR in high grade EOC might therefore serve as a better predictive biomarker and allow the identification of a larger group of patients that could benefit most from platinum based chemotherapy and maintenance treatment with a PARP inhibitor. We recently developed a robust ex vivo functional assay (RAD51 assay;) to test HR in viable tumor tissue. In the proposed study, we will evaluate whether the RAD51 assay predicts sensitivity to therapy with olaparib, in patients with recurrent EOC. With the RAD51 assay we aim to identify a larger number of patients who will benefit from treatment with the PARP inhibitor olaparib than patients with a germline or somatic BRCA mutation only. Furthermore, we aim to identify molecular markers (including genomic markers) that are associated with the outcome of the RAD51 assay. Finally, we will explore whether these molecular markers can be measured in liquid biopsies by analysing ctDNA.
Detailed Description
Epithelial ovarian cancer (EOC) often presents at an advanced stage, and harbours an unfavourable prognosis. Standard of care includes complete or optimal debulking surgery and chemotherapy, however, most patients experience recurrent disease. Recurrences are often treated with additional chemotherapy, and for selected patients, treatment with PARP inhibitors may be an option. Patients with platinum sensitive recurrent epithelial ovarian cancer (EOC) and a germ-line or somatic BRCA1 or BRCA2 mutation, who are in response to platinum based chemotherapy are currently eligible for maintenance treatment with the Poly (ADP-ribose) polymerase (PARP) inhibitor olaparib after chemotherapy. Germline (11-15%) or somatically acquired (6-7%) BRCA1 and BRCA2 mutations lead to deficiency in homologous recombination (HR) and subsequent less effective DNA repair. PARP inhibitors are most effective in HR deficient tumors. There are clear indications that besides BRCA1 or BRCA2 mutated EOC, there is an additional group of EOC (~15-30%) having deficiencies in HR (i.e. BRCAness) that might benefit from treatment with PARP inhibitors (Mukhopadhyay, Cancer Res 2012; Konstantinopolos, Cancer Discovery 2015; Telli, Clin Cancer Res 2016). Assessment of HR in high grade EOC might therefore serve as a better predictive biomarker and allow the identification of a larger group of patients that could benefit most from platinum based chemotherapy and maintenance treatment with a PARP inhibitor. We recently developed a robust ex vivo functional assay (RAD51 assay;) to test HR in viable tumor tissue (Naipal, Clin. Cancer Res., 2014). It is still unknown however, whether the outcome of the RAD51 assay reliably predicts the sensitivity to platinum-based chemotherapy or PARP inhibitors. In the proposed study, we will therefore evaluate whether the RAD51 assay predicts sensitivity to therapy with olaparib, in patients with recurrent EOC. With the RAD51 assay we aim to identify a larger number of patients who will benefit from treatment with the PARP inhibitor olaparib than patients with a germline or somatic BRCA mutation only. Furthermore, we aim to identify molecular markers (including genomic markers) that are associated with the outcome of the RAD51 assay. Finally, we will explore whether these molecular markers can be measured in liquid biopsies by analysing ctDNA.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ovarian Neoplasm Epithelial, Homologous Recombination Deficiency, BRCA1 Mutation, BRCA2 Mutation

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
prospective, Dutch, multicenter, single arm phase II study
Masking
None (Open Label)
Allocation
N/A
Enrollment
55 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Olaparib monotherapy
Arm Type
Experimental
Arm Description
Patients, irrespective of BRCA status, will be treated with olaparib tablet 300 mg bid
Intervention Type
Diagnostic Test
Intervention Name(s)
Functional RAD51 assay
Other Intervention Name(s)
RECAP assay
Intervention Description
ex vivo functional assay (RAD51 assay also known as Repair Capacity (RECAP) assay ) to test homologous recombination deficiencie (HRD) in viable tumor tissue
Intervention Type
Drug
Intervention Name(s)
Olaparib Oral Product
Other Intervention Name(s)
Olaparib tablet
Intervention Description
300 mg bid
Primary Outcome Measure Information:
Title
Response Rate
Description
The primary endpoint is the RR, defined as the best overall response (partial response and/or complete response) according to RECIST1.1 for both the HR proficient and HR deficient group as determined by the RAD51 assay.
Time Frame
3 years
Secondary Outcome Measure Information:
Title
Progression free survival (PFS)
Description
time from start of maintenance olaparib to the date of first documented disease progression or death from any cause, whichever occurs first, of olaparib for the BRCA1 or BRCA2 mutant (germline or somatic) HR deficient group, the non BRCA mutant HR deficient group and the HR proficient group
Time Frame
3 years
Title
Overall Survival (OS)
Description
time from start olaparib to death (any cause).
Time Frame
3 years
Title
RAD51 test
Description
Percentage of informative RAD51 test results in tumor biopsies and/or ascites
Time Frame
3 years
Title
Loss of function mutation
Description
Identify loss of function mutations in genes involved in HR as part of the molecular analysis in the HR proficient and HR deficient group as determined by the RAD51 assay.
Time Frame
3 years
Title
NCT-CTC toxicity criteria
Description
Safety and adverse events (AE) of Common Terminology Criteria for Adverse Events version 4.03 (CTCAE) grade 3>5.
Time Frame
3 years
Other Pre-specified Outcome Measures:
Title
molecular marker in liquid biopsies
Description
molecular marker analysis BRCA/HRD (ctDNA in blood), using NGS and digital PCR analyses
Time Frame
3 years

10. Eligibility

Sex
Female
Gender Based
Yes
Gender Eligibility Description
female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with recurrent high grade serous or endometrioid EOC (more than 3 months after platinum containing chemotherapy and unwilling or ineligible for platinum based therapy) with a tumor lesion that is amendable for biopsy or who can undergo ascites drainage prior to treatment. Diagnosis of high grade serous or endometrioid EOC confirmed by histology . Provision of informed consent prior to any study specific procedures Female aged equal or above 18 years Patients must have normal organ and bone marrow function measured within 28 days prior to administration olaparib Eastern Cooperative Oncology Group performance status 0 to 2 Patients must have a life expectancy equal or above 16 weeks. Postmenopausal or evidence of nonchildbearing status for women of childbearing potential, negative urine or serum pregnancy test within 28 days of study treatment and confirmed prior to treatment on day 1. Patients willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations. Evaluable disease, measurable and, or nonmeasurable, that can be accurately assessed at baseline using RECIST by CT or MRI and is suitable for repeated assessment. For inclusion in the optional exploratory genetic research and the optional biomarker research, patients must fulfil informed consent for genetic research and informed consent for biomarker research Exclusion Criteria: Participation in another clinical study with an investigational product during the last month. Any previous treatment with PARP inhibitor, including olaparib. Other malignancy within the last 5 years, except, adequately treated nonmelanoma skin cancer, curatively treated in situ cancer, stage 1 and grade 1 endometrial carcinoma, or other solid tumours including breast cancer and lymphomas curatively treated with no evidence of disease for equal or above 3 years. Patients receiving radiotherapy within 3 weeks prior to study treatment. Concomitant use of known strong CYP3A inhibitors or moderate CYP3A inhibitors Concomitant use of known strong or moderate CYP3A inducers. Persistent toxicities , Common Terminology Criteria for Adverse Event equal or above grade 2, caused by previous cancer therapy, excluding alopecia. Patients with symptomatic uncontrolled brain metastases. Patients with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days. Major surgery within 2 weeks of starting study treatment and patients must have recovered from any effects of any major surgery. Patients considered a poor medical risk due to a serious, uncontrolled medical disorder, nonmalignant systemic disease or active, uncontrolled infection. Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the study medication. Breast feeding women. Immunocompromised patients, for example, patients who are known to be serologically positive for human immunodeficiency virus. Patients with a known hypersensitivity to olaparib or any of the excipients of the product. Patients with known active hepatitis due to risk of transmitting the infection through blood or other body fluids Previous allogenic bone marrow transplant or double umbilical cord blood transplantation. Patients with myelodysplastic syndrome, acute myeloid leukaemia or with features suggestive of MDS, AML. Whole blood transfusions in the last 120 days prior to entry to the study . Resting ECG with QTc equal or above 470 msec on 2 or more time points within a 24 hour period or family history of long QT syndrome.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Judith Kroep, MD, PhD
Phone
0031715263464
Ext
0031
Email
j.r.kroep@lumc.nl
First Name & Middle Initial & Last Name or Official Title & Degree
Maaike Vreeswijk, PhD
Phone
0031715263464
Ext
0031
Email
vreeswijk@lumc.nl
Facility Information:
Facility Name
University Medical Center Groningen
City
Groningen
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hilde Jalving, MD PhD
Facility Name
Leiden University Medical Center
City
Leiden
ZIP/Postal Code
2300RC
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
J R Kroep, MD PhD
First Name & Middle Initial & Last Name & Degree
J R Kroep, MD PhD
First Name & Middle Initial & Last Name & Degree
M Vreeswijk, PhD
Facility Name
Erasmus Medical Center
City
Rotterdam
Country
Netherlands
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ingrid Boere, MD PhD

12. IPD Sharing Statement

Plan to Share IPD
No

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Functional Analysis of BRCAness

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