A Study of Niraparib in Patients With Ovarian Cancer Who Have Received Three or Four Previous Chemotherapy Regimens

NCT02354586CompletedPHASE2INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

Tesaro, Inc.

Enrollment

463

Start Date

2015-03-23

Completion Date

2018-02-28

Study Type

INTERVENTIONAL

Official Title

A Phase 2, Open-Label, Single-Arm Study to Evaluate the Safety and Efficacy of Niraparib in Patients With Advanced, Relapsed, High-Grade Serous Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer Who Have Received Three or Four Previous Chemotherapy Regimens

Interventions

Niraparib

Conditions

Ovarian NeoplasmsOvarian Cancer

Eligibility

Age Range

18 Years+

Sex

FEMALE

Inclusion Criteria:

* Patients must agree to undergo tumor HRD testing and blood gBRCAmut status testing.
* Patients of childbearing potential must have negative pregnancy serum test within 72 hours of being dosed
* Patients must have histologically diagnosed high-grade (Grade 2 or 3) serous epithelial ovarian, fallopian tube, or primary peritoneal cancer with recurrent disease and must have been previously treated with chemotherapy and experienced a response lasting at least 6 months to first-line platinum based therapy.
* Patients Must have completed 3 or 4 previous chemotherapy regimens.
* Patients must have completed their last chemotherapy regimen \> 4 weeks prior to treatment initiation.
* Patients must have measurable disease according to RECIST (v.1.1).
* Patients must have formalin-fixed, paraffin-embedded tumor samples available from the primary or recurrent cancer or agree to undergo fresh biopsy prior to study treatment initiation.
* Patients must agree to blood samples during screening and at the end of treatment for cytogenetic analysis.

Exclusion Criteria:

* Patients must not have any known, persistent (\> 4 weeks), ≥Grade 3 hematologic toxicity during the last cancer therapy. Patients must not have any known, persistent (\>4 weeks), ≥ Grade 3 fatigue during the last cancer therapy.
* Patients must not have received pelvic radiotherapy as treatment for primary or recurrent disease within 1 year of the first dose of study treatment.
* Patients must not have symptomatic uncontrolled brain or leptomeningeal metastases.
* Patients must not be considered a poor medical risk due to a serious, uncontrolled medical disorder, nonmalignant systemic disease or active, uncontrolled infection.
* Patients must not have received a transfusion (platelets or red blood cells) within 4 weeks of the first dose of study treatment.
* Patients must not have known history or current diagnosis of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML).

Outcome Measures

Primary Outcomes

Objective Response Rate (ORR)

The ORR was defined as the percentage of participants achieving complete response (CR) or partial response (PR) as assessed by the Investigator per Response Evaluation Criteria in Solid Tumors (RECIST) (version1.1), where CR=Disappearance of all target lesions. Any pathological lymph nodes must be \<10 millimeters (mm) in the short axis, PR=At least a 30 percent (%) decrease in the sum of the diameters of target lesions, taking as a reference, the Baseline sum of the diameters. Primary Analysis Population comprised of participants who received 3 or 4 prior lines of therapy (LOT), had homologous recombination deficiency positive (HRDpos) tumors, had platinum-sensitive disease, and were poly(adenosine 5'-diphosphate \[ADP\]-ribose) polymerase inhibitors (PARPi) naïve.

Time frame: Up to 3 years

Secondary Outcomes

Duration of Response (DoR)

DoR was defined as the time from first documentation of CR or PR until the time of first documentation of disease progression (PD) as assessed by the Investigator per RECIST (version1.1). DoR was analyzed using Kaplan-Meier (KM) method.

Time frame: Up to 3 years

ORR by HRD Status and Breast Cancer Gene (BRCA) Status

The ORR was defined as the percentage of participants achieving CR or PR as assessed by the Investigator per RECIST (version1.1), where CR=Disappearance of all target lesions. Any pathological lymph nodes must be \<10 mm in the short axis. PR=At least a 30% decrease in the sum of the diameters of target lesions, taking as a reference, the Baseline sum of the diameters. ORR was evaluated for participants with following characteristics: HRD status (positive, negative and unknown) and BRCA status (mutation positive, wild-type and unknown).

Time frame: Up to 3 years

Disease Control Rate (DCR)

Disease control rate was defined as the percentage of participants achieving CR, PR, or stable disease (SD) as assessed by the Investigator per RECIST (version1.1). The exact (Clopper-Pearson) method was used to calculate 95% confidence interval.

Time frame: Up to 3 years

Progression Free Survival

Progression-free survival was defined as the time from the date of first dose to the earlier date of assessment of progression or death by any cause in the absence of progression as assessed by the Investigator per RECIST (version 1.1) or clinical criteria. Progression is defined using RECIST version1.1 as at least a 20% increase in the sum of the diameter of target lesions or unequivocal progression of existing non-target lesions or the appearance of one or more new lesions.

Time frame: Up to 3 years

Overall Survival

Overall Survival was defined as the time from the date of the first dose to the date of death by any cause. It was calculated as (Date of Death minus First dose date plus 1) divided by 30.4375.

Time frame: Up to 3 years

Time to First Subsequent Therapy (TFST)

Time to first subsequent therapy (TFST) was defined as the time from the date of first dose to the date of first subsequent therapy or death, whichever occurs first. It was calculated as (Earlier of \[First dose of first subsequent therapy or death\] minus First dose date plus 1) divided by 30.4375.

Time frame: Up to 3 years

Locations

GSK Investigational Site, Chandler, United States

GSK Investigational Site, Phoenix, United States

GSK Investigational Site, Tucson, United States

GSK Investigational Site, Burbank, United States

GSK Investigational Site, Duarte, United States

GSK Investigational Site, Los Angeles, United States

GSK Investigational Site, Los Angeles, United States

GSK Investigational Site, San Francisco, United States

GSK Investigational Site, Santa Barbara, United States

GSK Investigational Site, Stanford, United States

GSK Investigational Site, New Haven, United States

GSK Investigational Site, Tampa, United States

GSK Investigational Site, West Palm Beach, United States

GSK Investigational Site, Atlanta, United States

GSK Investigational Site, Chicago, United States

GSK Investigational Site, Chicago, United States

GSK Investigational Site, Indianapolis, United States

GSK Investigational Site, Indianapolis, United States

GSK Investigational Site, Covington, United States

GSK Investigational Site, New Orleans, United States

GSK Investigational Site, Baltimore, United States

GSK Investigational Site, Boston, United States

GSK Investigational Site, Boston, United States

GSK Investigational Site, Burlington, United States

GSK Investigational Site, Ann Arbor, United States

GSK Investigational Site, Minneapolis, United States

GSK Investigational Site, Rochester, United States

GSK Investigational Site, Springfield, United States

GSK Investigational Site, Hackensack, United States

GSK Investigational Site, Morristown, United States

GSK Investigational Site, East Setauket, United States

GSK Investigational Site, Jamaica, United States

GSK Investigational Site, Lake Success, United States

GSK Investigational Site, New York, United States

GSK Investigational Site, Durham, United States

GSK Investigational Site, Oklahoma City, United States

GSK Investigational Site, Medford, United States

GSK Investigational Site, Wynnewood, United States

GSK Investigational Site, Providence, United States

GSK Investigational Site, Nashville, United States

GSK Investigational Site, Austin, United States

GSK Investigational Site, Dallas, United States

GSK Investigational Site, Fort Worth, United States

GSK Investigational Site, San Antonio, United States

GSK Investigational Site, The Woodlands, United States

GSK Investigational Site, Tyler, United States

GSK Investigational Site, Spokane, United States

GSK Investigational Site, Tacoma, United States

GSK Investigational Site, Calgary, Canada

GSK Investigational Site, Toronto, Canada

GSK Investigational Site, Montreal, Canada

GSK Investigational Site, Montreal, Canada

GSK Investigational Site, Montreal, Canada

GSK Investigational Site, Montreal, Canada

GSK Investigational Site, Sherbrooke, Canada

Linked Papers

2024-07-16

Niraparib Population Pharmacokinetics and Exposure-Response Relationships in Patients With Newly Diagnosed Advanced Ovarian Cancer

Niraparib is a poly(adenosine diphosphate [ADP]-ribose) polymerase inhibitor approved for the maintenance treatment of advanced ovarian cancer (OC). Niraparib was originally approved in recurrent OC at a fixed starting dose (FSD) of 300 mg once daily (QD). This analysis characterized the population pharmacokinetics (PK) of niraparib and evaluated the relationships between exposure, efficacy, and safety to support clinical use of an individualized dosing strategy, in which the starting dose of niraparib was adjusted based on patient characteristics to improve the benefit-risk profile. A population PK model was developed by pooling data from four niraparib clinical trials (PN001 [n = 104], QUADRA [n = 455], NOVA [n = 403], and PRIMA [n = 480]) in patients with solid tumors, including OC. Exposure-response analyses were conducted to explore the relationships of niraparib exposure with progression-free survival (PFS) and adverse events in the PRIMA study. A multivariate logistic regression model was also developed to estimate the probability of grade ≥3 thrombocytopenia, using data from patients enrolled in PRIMA and NOVA. The impact of an individualized starting dose (ISD) regimen (200 mg QD in patients with body weight [BW] <77 kg or platelet count [PLT] <150,000/µL, or 300 mg QD in patients with BW ≥77 kg and PLT ≥150,000/µL) on systemic exposure, efficacy, and safety was assessed. Niraparib disposition was best described by a 3-compartment model with linear elimination. Key covariates included baseline creatinine clearance, BW, albumin, and age, all of which had minor effects on niraparib exposure. Comparable model-predicted exposure up to the time of disease progression/death or censoring in the 300-mg FSD and 200-/300-mg ISD groups was consistent with the lower rate of dose reduction in the ISD groups. No consistent niraparib exposure-response relationship was observed for efficacy in all PRIMA patients (first-line OC), and no statistically significant difference was seen in PFS curves for patients receiving a niraparib dose of 200 mg versus 300 mg. In the multivariate regression model, performed using combined data from PRIMA and NOVA, higher niraparib exposure (area under the concentration-time curve at steady-state [AUC Population PK and exposure-response analyses support use of an ISD to improve the safety profile of niraparib, including reducing the rate of grade ≥3 thrombocytopenia, without compromising efficacy. ClinicalTrials.gov, NCT01847274 (NOVA), NCT00749502 (PN001), NCT02655016 (PRIMA), NCT02354586 (QUADRA), www. gov.