Olaparib in Treating Patients With Metastatic Biliary Tract Cancer With Aberrant DNA Repair Gene Mutations

  • STATUS
    Recruiting
  • End date
    Sep 30, 2024
  • participants needed
    36
  • sponsor
    Academic and Community Cancer Research United
Updated on 16 May 2022
platelet count
cancer
hysterectomy
absolute neutrophil count
serum pregnancy test
measurable disease
anticoagulants
oophorectomy
tumor cells
blood transfusion
follicle stimulating hormone
olaparib
palb2
metastatic biliary tract cancer
luteinizing hormone (lh)

Summary

This phase II trial studies how well olaparib works in treating patients with biliary tract cancer that has spread to other places in the body (metastatic) and with aberrant DNA repair gene mutations. Olaparib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

Description

PRIMARY OBJECTIVES:

I. To determine the efficacy (objective response rate) of olaparib monotherapy in advanced biliary tract cancer (BTC) with mutations in deoxyribonucleic acid (DNA) repair genes.

SECONDARY OBJECTIVES:

I. To determine the overall survival of patients with advanced biliary tract cancer with mutations in DNA repair genes treated with olaparib.

II. To determine the progression free survival of patients with advanced biliary tract cancer with mutations in DNA repair genes treated with olaparib.

III. To assess the frequency and severity of adverse events in advanced biliary tract cancer patients treated with olaparib.

IV. To assess the duration of response for patients with advanced biliary tract cancer with mutations in DNA repair genes treated with olaparib who experience an objective response.

CORRELATIVE RESEARCH OBJECTIVES:

I. Determine the prevalence of mutations including those targeting DNA repair pathways.

II. Identify mutational signatures associated with pathogenic process in advanced biliary tract cancer samples.

III. Correlate the presence of mutations and mutational signatures linked to mutations in DNA repair genes and homologous recombinant repair with clinical responses to olaparib.

IV. To evaluate putative biomarkers related to:

Iva. De novo sensitivity. IVb. Tumor evolution and resistance, to PARP inhibition from olaparib in BTC.

OUTLINE

Patients receive olaparib orally (PO) twice daily (BID) on days 1-28. Treatment repeats every 28 days for up to 36 cycles in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 30 days and then every 3 months for up to 3 years.

Details
Condition ARID1A Gene Mutation, ATM Gene Mutation, ATR Gene Mutation, Bile Duct Adenocarcinoma, BRCA1 Gene Mutation, BRCA2 Gene Mutation, BRIP1 Gene Mutation, CHEK2 Gene Mutation, EMSY Gene Mutation, Fanconi Anemia Complementation Group Gene Mutation, Metastatic Bile Duct Carcinoma, MRE11 Gene Mutation, NBN Gene Mutation, PALB2 Gene Mutation, PTEN Gene Deletion, RAD51 Gene Mutation
Treatment olaparib
Clinical Study IdentifierNCT04042831
SponsorAcademic and Community Cancer Research United
Last Modified on16 May 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Histological or cytological documentation of metastatic adenocarcinoma of the biliary tract
Patients with previously identified genetic aberrations that are associated with homologous recombinant repair pathway will be eligible [e.g. somatic mutations in ATM, ATR, CHEK2, BRCA 1/2, RAD51, BRIP1, PALB2, PTEN, FANC, NBN, EMSY, MRE11, ARID1A] or germline mutations in the above genes. Clinical Laboratory Improvement Act (CLIA)-certified assays including commercial tests (Foundation Medicine, Caris, Tempus) will be allowed
Measurable disease
Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1. (Form is available on the Academic and Community Cancer Research United [ACCRU] web site)
Life expectancy of >= 16 weeks per estimation of investigator
Absolute neutrophil count (ANC) >= 1500/mm^3 (obtained =< 7 days prior to registration)
Platelet count >= 75,000/mm^3 (obtained =< 7 days prior to registration)
Hemoglobin >= 9.0 g/dL with no blood transfusion in the past 28 days (obtained =< 7 days prior to registration)
Total bilirubin =< 1.5 x upper limit of normal (ULN) (obtained =< 7 days prior to registration)
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 x ULN (=< 5 x ULN for subjects with liver involvement of their cancer) (obtained =< 7 days prior to registration)
Serum creatinine =< 1.5 x ULN (obtained =< 7 days prior to registration)
Institutional normalized ratio (INR)/partial thromboplastin time (PTT) =< 1.5 x ULN (obtained =< 7 days prior to registration)
Exception: Patients who are therapeutically treated with anticoagulant agents (excluding warfarin) will be allowed to participate provided that no prior evidence of underlying abnormality in coagulation parameters exists. Close monitoring of at least weekly evaluations will be performed until INR/PTT is stable based on a measurement that is pre-dose as defined by the local standard of care
Alkaline phosphatase limit =< 2.5 x ULN (=< 5 x ULN for patients with liver
Creatinine clearance estimated of >= 51 mL/min using the Cockcroft-Gault equation (obtained =< 7 days prior to registration)
involvement of their cancer) (obtained =< 7 days prior to registration)
Negative serum pregnancy test done =< 28 days prior to registration and confirmed prior to treatment on day 1, for women of childbearing potential, postmenopausal women or women of childbearing potential with evidence of non-childbearing status
Postmenopausal is defined as
Amenorrheic for 1 year or more following cessation of exogenous hormonal treatments
Luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels in the post-menopausal range for women under 50
Radiation-induced oophorectomy with last menses > 1 year ago
Chemotherapy-induced menopause with > 1 year interval since last menses
Surgical sterilization (bilateral oophorectomy or hysterectomy)
Provide informed written consent
Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)
Willing to provide blood and tissue for correlative purposes
Prior exposure or completion of platinum based chemotherapy

Exclusion Criteria

Platinum refractory disease (evidence disease progression on platinum based chemotherapy regimen or =< 6 months of completion of platinum based chemotherapy regimen)
Patient has received prior systemic anti-cancer therapy, tumor embolization or radiotherapy =< 4 weeks prior to registration
Major surgical procedure, open biopsy, or significant traumatic injury =< 28 days prior to registration
NOTE: Patients must have recovered from any effects of any major surgery
Congestive heart failure - New York Heart Association (NYHA) >= class II
Resting electrocardiogram (ECG) indicating uncontrolled, potentially reversible cardiac conditions, as judged by the investigator (eg. unstable ischemia, uncontrolled symptomatic arrhythmia, corrected QT interval by Fridericia's correction formula [QTcF] prolongation > 500 ms, electrolyte disturbances, etc.), or patients with congenital long QT syndrome. Cardiac arrhythmias requiring anti-arrhythmic therapy
NOTE: Pacemaker, beta blockers or digoxin are permitted
History of or current pheochromocytoma
Uncontrolled hypertension. (Systolic blood pressure > 140 mmHg or diastolic pressure >
Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism =< 6 months prior to registration
mmHg despite optimal medical management)
Ongoing infection > grade 2 National Cancer Institute (NCI)-Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0
Known active hepatitis B or C
Seizure disorder requiring medication
Symptomatic metastatic brain or meningeal tumors unless the patient is > 6 months from definitive therapy, has a negative imaging study =< 4 weeks of registration and is clinically stable with respect to the tumor at the time of registration. Patients with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days prior to registration
NOTE: The patient can receive a stable dose of corticosteroids before and during the study as long as these were started =< 4 weeks prior to registration
Evidence or history of bleeding diathesis or any hemorrhage or bleeding event > CTCAE v5.0 grade 3, =< 4 weeks prior to registration
Non-healing wound, ulcer, or bone fracture
History of organ allograft (including corneal transplant) or allogenic bone marrow
Renal failure requiring hemo-or peritoneal dialysis
transplant or double umbilical cord blood transplantation (dUCBT)
Dehydration CTCAE v5.0 grade >= 1
Substance abuse, medical, psychological or social conditions that may interfere with the patient?s participation in the study or evaluation of the study results
Known hypersensitivity to any of the study drugs, study drug classes, or excipients in the formulation
Interstitial lung disease with ongoing signs and symptoms at the time of informed consent
Persistent proteinuria of CTCAE v5.0 grade 3 or higher (>= 3.5 g/24 hours [hrs])
Unable to swallow orally administered medications
Any malabsorption condition and/or patients with gastrointestinal disorders likely to interfere with absorption of the study medication
Unresolved toxicity greater than CTCAE v5.0 grade 2 attributed to any prior therapy/procedure excluding alopecia and oxaliplatin induced neurotoxicity =< grade 2
Albumin levels < 2.5 g/dl
Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown
Pregnant women
Nursing women
Men or women of childbearing potential who are unwilling to employ adequate contraception
NOTE: Women of childbearing potential and their partners, who are sexually active, must agree to the use of TWO highly effective forms of contraception in combination. This should be started from the time of registration and continue throughout the period of taking study treatment and for at least 1 month after last dose of study drug(s), or they must totally/truly abstain from any form of sexual intercourse
Male patients must use a condom during treatment and for 3 months after the last dose of olaparib when having sexual intercourse with a pregnant woman or with a woman of childbearing potential. Female partners of male patients should also use a highly effective form of contraception if they are of childbearing potential. Male patients should not donate sperm throughout the period of taking olaparib and for 3 months following the last dose of olaparib
Immunocompromised patients and patients known to be human immunodeficiency virus (HIV) serologically positive and currently receiving antiretroviral therapy
NOTE: Patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial
Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment
Other malignancy unless curatively treated with no evidence of disease for >= 5 years prior to registration, except: adequately treated non-melanoma skin cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ (DCIS), stage 1, grade 1 endometrial carcinoma
of the investigator, would make the patient inappropriate for entry into this
NOTE: All cancer treatments for cancers that were distinct in a primary site other than biliary tract cancer must be completed >= 5 years prior to registration
study or interfere significantly with the proper assessment of safety and
toxicity of the prescribed regimens. Patients considered a poor medical risk
Previous enrollment in the present study
due to a serious, uncontrolled medical disorder, non-malignant systemic
Prior exposure to any PARP inhibitor including olaparib
disease or active, uncontrolled infection. Examples include, but are not
Known hypersensitivity reaction to olaparib or any of the excipients of the product
limited to, uncontrolled ventricular arrhythmia, recent (within 3 months)
Myelodysplastic syndrome/acute myeloid leukemia or with features suggestive of myelodysplastic syndrome/acute myeloid leukemia (MDS/AML)
myocardial infarction, uncontrolled major seizure disorder, unstable spinal
Concomitant use of known strong CYP3A inhibitors (eg. itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or moderate CYP3A inhibitors (eg. ciprofloxacin, erythromycin, diltiazem, fluconazole, verapamil)
cord compression, superior vena cava syndrome, extensive interstitial
NOTE: The required washout period prior to registration is 2 weeks
bilateral lung disease on high resolution computed tomography (HRCT) scan or
any psychiatric disorder that prohibits obtaining informed consent
NOTE: The required washout period prior to registration is 5 weeks for enzalutamide or phenobarbital and 3 weeks for other agents
Patient taking medications with a known risk to prolong the QTc interval and/or cause Torsades de Pointes. Note: Patients must be discontinued >= 7 days of registration. Treating physicians may wish to replace the drug(s) that do not carry this risk with safe alternative(s)
Receiving any other investigational agent which would be considered as a treatment for
Concurrent use of warfarin or other warfarin-derived anticoagulant
the primary neoplasm
NOTE: Concurrent use of heparin, direct oral anticoagulants, low molecular weight heparin (LMWH), or fondaparinux is allowed
Involvement in the planning and/or conduct of the study
Pleural effusion or ascites that causes respiratory compromise (>= CTCAE v5.0 grade 2
Judgment by the investigator that the patient should not participate in the study if the patient is unlikely to comply with study procedures, restrictions and requirements
dyspnea)
Concomitant use of known strong (eg. phenobarbital, enzalutamide, phenytoin
rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John?s
Wort) or moderate CYP3A inducers (eg. bosentan, efavirenz, modafinil)
Patient taking medications or herbal products including grapefruits, grapefruit
hybrids, pomelos, star fruits, Seville oranges, pomegranates, or the juice
from any of these. Note: Patients must discontinue the drug/product >= 7 days
prior to registration
Whole blood transfusions in the last 120 days prior to entry to the study (packed red
blood cells and platelet transfusions are acceptable outside of 28 days prior
to treatment)
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