This phase II trial studies how well niraparib and dostarlimab work in treating patients with
germline or somatic BRCA1/2 and PALB2 mutated pancreatic cancer that has spread to other
places in the body (metastatic). Niraparib may stop the growth of tumor cells by blocking
some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as
dostarlimab, may help the body's immune system attack the cancer, and may interfere with the
ability of tumor cells to grow and spread. Giving niraparib and dostarlimab may kill more
I. To determine antitumor activity as measured by disease control rate at 12 weeks (DCR12) as
assessed using immune-modified Response Evaluation Criteria in Solid Tumors (iRECIST) in
select homologous recombination repair (HRR) deficient pancreatic cancer patients with HRR
deficiency (defined as mutations in BRCA 1/ 2, or PALB2).
I. To assess adverse events according to the current National Cancer Institute (NCI) Common
Terminology Criteria for Adverse Events (CTCAE) and other safety parameters.
II. To assess the time to next treatment (TTNT), objective response rate (ORR), time to and
duration of response and duration of confirmed stable disease according to iRECIST.
III. To assess progression-free survival. IV. To assess overall survival.
CORRELATIVE RESEARCH OBJECTIVES:
I. To assess germline deoxyribonucleic acid (DNA) and serum markers of immune response.
II. To determine changes in circulating tumor DNA (ctDNA) profile after therapy with a PARP
inhibitor (i) and a PD-1 inhibitor.
III. To study mechanisms of resistance in ctDNA profile after therapy with a PARPi and a PD-1
IV. To assess the tumor microenvironment for immune related changes (immune infiltration,
PD-L1 and PD-1 expression, tumor-infiltrating lymphocytes [TIL]).
V. To assess genetic profile of the tumor pre- and post-treatment. VI. To determine changes
in the cytokine profile pre- and post-treatment.
Patients receive niraparib orally (PO) once daily (QD) on days 1-21. Patients also receive
dostarlimab intravenously (IV) over 30 minutes on day 1 every 3 weeks (Q3W) for cycles 1-4
and every 6 weeks (Q6W) for subsequent cycles. Cycles repeat every 21 days for up to 2 years
in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 days, every 3 months
until progressive disease (PD), and then every 6 months for up to 5 years after registration.
Metastatic Pancreatic Ductal Adenocarcinoma, Stage IV Pancreatic Cancer AJCC v8
If you are confirmed eligible after full screening, you will be required to understand and sign the informed consent if you decide to enroll in the study. Once enrolled you may be asked to make scheduled visits over a period of time.
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