Phase II Trial of Talazoparib in BRCA1/2 Wild-type HER2-negative Breast Cancer and Other Solid Tumors

  • STATUS
    Recruiting
  • End date
    Dec 8, 2023
  • participants needed
    40
  • sponsor
    Melinda Telli
Updated on 8 September 2021
platelet count
cancer
hysterectomy
estrogen
serum pregnancy test
measurable disease
breast cancer
gilbert's syndrome
progesterone
metastasis
neutrophil count
carboplatin
advanced breast cancer
immunohistochemistry
HER2
blood transfusion
chemotherapy regimen
solid tumour
solid tumor
PTEN
progesterone receptor
erbb2
estrogen receptor
fanca
her2-negative breast cancer
BRCA1/2
BRCA1
BRCA2
triple-negative breast cancer
serum total bilirubin
palb2
brca2 mutation
talazoparib
CHEK2
mammogram
her2/neu-negative breast cancer

Summary

The aim of this single-arm phase 2 clinical trial is to evaluate the anti-cancer activity of Talazoparib (also known as BMN 673) in patients with advanced breast cancer with specific genetic or tumor genomic alterations. Patients with either triple-negative or HER2-negative breast cancer are eligible.

Description

Talazoparib (BMN 673) is a novel, dual-mechanism PARP inhibitor that potently inhibits the PARP enzyme and effectively traps PARP on DNA. Talazoparib has shown promising single-agent anti-tumor efficacy in several BRCA1/2 mutation-associated advanced cancers. The efficacy of PARP inhibition in BRCA1/2 wild-type TNBC with homologous recombination (HR) defects and in breast tumors with mutations in other non-BRCA1/2 HR pathway genes is currently unknown.

This phase 2 trial explores the activity of single agent talazoparib in BRCA1/2 wild-type BC patients using an optimal Simon two-stage design. Eligible subjects will be assigned to one of two parallel cohorts: 1) Cohort A: Subjects (n=29) with advanced TNBC with underlying HR defects as assessed by the HRD assay and, 2) Cohort B: Subjects (n=29) with advanced HER2-negative BC with a somatic or germline mutation in a non-BRCA1/2 HR pathway gene. Gene mutations of interest are: PTEN, PALB2, CHEK2, ATM, NBN, BARD1, BRIP1, RAD50, RAD51C, RAD51D, MRE11, ATR, Fanconi anemia complementation group of genes (FANCA, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCL).

Details
Condition Primary Immunodeficiency, Near-Sighted Corrective Surgery, Breast Cancer, Triple Negative Breast Cancer, Injection Port, Chronic Diarrhea, Skin Wounds, Recurrent Respiratory Papillomatosis, Diet and Nutrition, Peripheral Arterial Occlusive Disease, Metastatic Triple-Negative Breast Cancer, Vaginal Atrophy, Breast Cancer - HER2 Positive, Pediatric Health, Brain Function, HER2/Neu Negative, Chronic Shoulder Pain, Anal Dysplasia, Advanced Breast Cancer, Adverse Effects, Drugs, Razor Bumps (Pseudofolliculitis Barbae)
Treatment Talazoparib Tosylate
Clinical Study IdentifierNCT02401347
SponsorMelinda Telli
Last Modified on8 September 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

No deleterious germline BRCA1 or BRCA2 mutation based on full sequencing and comprehensive rearrangement testing at an external reference laboratory; patients with variants of unknown significance will be eligible
Measurable disease per Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1
Must have progressed on at least 1 prior chemotherapy regimen for the treatment of advanced breast cancer; there is no upper limit on the number of prior therapies
If prior platinum agent (eg, carboplatin or cisplatin) has been administered, no evidence of progression, or within 8 weeks of stopping platinum treatment
Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2
Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) 2.5 x upper limit of normal (ULN); if liver function abnormalities are due to hepatic metastasis, then AST and ALT 5 x ULN
Total serum bilirubin 1.5 x ULN ( 3 x ULN for Gilbert's syndrome)
Calculated creatinine clearance 30 mL/min or serum creatinine 1.5 mg/dL
Hemoglobin 9.0 g/dL with last transfusion at least 14 days before day 1 of study drug
Absolute neutrophil count (ANC) 1500/mm^3
Platelet count 100,000/mm^3
Able to take oral medications
Willing and able to provide written, signed informed consent after the nature of the study has been explained, and prior to any research-related procedures
Sexually active patients of childbearing potential must be willing to use an acceptable method of contraception such as an intrauterine device or double barrier contraception during treatment and for 30 days after the last dose of study drug
Females of childbearing potential must have a negative serum pregnancy test at screening and be willing to have additional serum pregnancy tests during the study; females considered not of childbearing potential include those who have been in menopause at least 2 years, or had tubal ligation at least 1 year prior to screening, or who have had total hysterectomy
Willing and able to comply with all study procedures
COHORT A SPECIFIC ELIGIBILITY CRITERIA
Histologically-confirmed metastatic or recurrent triple-negative breast cancer (defined as estrogen receptor 5%, progesterone receptor 5%, HER2-negative via immunohistochemistry [IHC] or fluorescent in situ hybridization [FISH])
An homologous recombination deficiency (HRD) score 42 on the HRD Assay as assessed on a tumor biopsy sample; in the case that obtaining an adequate metastatic tumor biopsy is not possible, we will assess the HRD score from the primary breast tumor
COHORT B SPECIFIC ELIGIBILITY CRITERIA
Histologically-confirmed metastatic or recurrent HER2-negative (via IHC or FISH) breast cancer or other histologically-confirmed metastatic solid tumor
Deleterious germline or somatic mutation implicated in the homologous recombination (HR) pathway, excluding BRCA1 or BRCA2, based on germline multiplex gene testing or direct tumor next generation DNA sequencing. Genes of interest include: PTEN, PALB2, CHEK2, ATM, NBN, BARD1, BRIP1, RAD50, Rad51c, Rad51d, MRE11, ATR, FANCA, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCL, plus other HR-related genes at the discretion of the primary investigators

Exclusion Criteria

Any patient with a deleterious mutation in BRCA1 or BRCA2
Hormone receptor positive and/or HER2 positive breast cancer (Cohort A only)
HER2 positive breast cancer (Cohort B only)
Prior treatment with a PARP inhibitor
Non-measurable disease only
Pregnant or nursing patients
Any anti-cancer therapy within the past 21 days of the first day of treatment
Brain or central nervous system (CNS) metastases
Exception: Adequately treated brain metastases documented by baseline computed tomography (CT) or magnetic resonance imaging (MRI) scan that have not progressed since previous scans and do not require corticosteroids (except prednisone 5 mg/day or equivalent) for management of CNS symptoms. A repeated CT or MRI following the identification of CNS metastases (obtained at least 2 weeks after definitive therapy) must document adequately treated brain metastases
Subjects with leptomeningeal carcinomatosis are not permitted
Other malignancy that is either active or for which patient has received treatment in the last five years excluding non-melanoma skin cancer and carcinoma in situ of the cervix
Radiation therapy in the last 14 days
Known to be human immunodeficiency virus positive
Known active hepatitis C virus
Known active hepatitis B virus
Use of any investigational product or investigational medical device within 28 days before day 1 of study drug
Major surgery requiring a prolonged hospitalization or recovery within 21 days before day 1 of study drug
Concurrent disease or condition that would interfere with study participation or safety, such as any of the following
Active, clinically significant infection either grade > 2 by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 or requiring the use of parenteral anti-microbial agents within 7 days before day 1 of study drug
Clinically significant bleeding diathesis or coagulopathy, including known platelet function disorders
Known hypersensitivity to any of the components of BMN 673
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