Efficacy and Safety of Niraparib Combined With Oral Etoposide in Platinum Resistant/Refractory Recurrent Ovarian Cancer

NCT04217798UNKNOWNPHASE2INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

Peking Union Medical College Hospital

Enrollment

36

Start Date

2020-05-21

Completion Date

2022-03-01

Study Type

INTERVENTIONAL

Official Title

A Single Arm, Prospective, Multicenter, Phase II Study to Evaluate the Efficacy and Safety of Niraparib Combined With Oral Etoposide in Platinum Resistant/ Refractory Recurrent Ovarian Cancer

Interventions

Niraparib

Conditions

Ovarian Cancer

Eligibility

Age Range

18 Years – 70 Years

Sex

FEMALE

Inclusion Criteria:

* Signed informed consent before undertaking any study procedure.
* Female, age 18-70.
* Histologically confirmed FIGO stage III or IV non-mucinous epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer.
* No limitation of the BRCA mutation and HRD status.
* Platinum resistant or refractory recurrent disease.
* Subjects must have received at least 1 prior line of platinum-based chemotherapy regimen and no more than twice.
* Subjects must have measurable lesions with imaging evidence of disease progression (according to RECIST1.1 criteria); or without measurable/evaluable lesion (RECIST 1.1 criteria), but two consecutive cases of elevated CA125 \> 2 times the upper limit of normal (\> 70 U/ml) were detected.
* Life expectancy of more than 6 months.
* ECOG 0-1.
* Good organ function, including:

  * Bone marrow function: neutrophil count ≥1,500/µL, platelets ≥100,000/µL, hemoglobin ≥10 g/dL;
  * Hepatic function: total bilirubin ≤ 1.5 x upper limit of normal (ULN) or direct bilirubin ≤1.0 x ULN, AST and ALT ≤2.5 x ULN unless liver metastases are present, in which case they must be ≤5 x ULN;
  * Renal function: serum creatinine ≤1.5 x upper limit of normal (ULN) or calculated creatinine clearance ≥60 mL/min using the Cockcroft-Gault equation.
* Has a negative serum pregnancy test within 3 days prior to taking study treatment if of childbearing potential and agrees to abstain from activities that could result in pregnancy from screening through 3 months after the last dose of study treatment, or is of non-childbearing potential. Non-childbearing potential is defined as follows (by other than medical reasons):

  * ≥45 years and \<60 years of age and has not had menses for \>1 year
  * ≥60 years of age
  * Post-hysterectomy, post-bilateral oophorectomy, or post-tubal ligation.
* Is able to adhere to the protocol.
* Has recovered from previous chemotherapy induced toxic side effects to ≤ grade 1 CTCAE or basal level, apart from ≤ grade 2 CTCAE peripheral neuropathy or hair loss symptoms at steady state.

Exclusion Criteria:

* Has a known hypersensitivity to the active or inactive ingredients of niraparib or compound which has similar chemical structure to niraparib.
* Has a known hypersensitivity to the active or inactive ingredients of etoposide or compound which has similar chemical structure to etoposide.
* prior PARP inhibitor therapy.
* Has symptomatic uncontrolled brain or leptomeningeal metastasis.
* Major surgery or chemotherapy within 3 weeks of starting the study or patient has not recovered from any effects of the surgery.
* Receive palliative radiotherapy encompassing \> 20% of the bone marrow within 1 week of entering the study.
* Be diagnosed any invasive cancer other than ovarian cancer (apart from cured basal cell carcinoma and squamous cell carcinoma) within 2 years prior to study enrolment.
* Previously or currently diagnosed of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML).
* Has other serious or uncontrolled disease.
* Has any disease, treatment and laboratory abnormality that may interfere the study results and affect the fully attendance of study. Or the subject is considered to be not suitable for the study by the investigator. Cannot receive platelet or red blood cell transfusion within 4 weeks of study drug administration.
* Pregnant, breastfeeding or expecting to conceive children during the study treatment period.
* Adjusted for QT interval (QTc) \>470 msec.

Outcome Measures

Primary Outcomes

Progression Free Survival (PFS)

PFS is defined as the time from randomization to first disease progression by investigator assessment using RECIST 1.1 or death, from any cause, whichever comes first.

Time frame: Through study completion, an average of 1 year

Secondary Outcomes

Objective Response Rate (ORR)

ORR is defined as the proportion of subjects who have a partial response (PR) or complete response (CR) to therapy according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.

Time frame: Through study completion, an average of 1 year

Duration of Response (DOR)

DOR is defined as the time from the first date of response until the date of first documented progression.

Time frame: Through study completion, an average of 1 year

Disease Control Rate (DCR)

DCR is defined as the proportion of subjects who have a complete response (CR), partial response (PR) and stable disease (SD) to therapy according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.

Time frame: Through study completion, an average of 1 year

CA125 Response Rate

The proportion of subjects with a minimum 50% reduction in CA-125 serum levels lasting for ≥28 days relative to baseline CA-125 serum levels.

Time frame: Through study completion, an average of 1 year

The frequency and severity of adverse events

The frequency and severity of adverse events evaluated according to NCI CTCAE version 5.0 during subjects receiving the study treatment.

Time frame: Through study completion, an average of 1 year

Locations

Peking Union Medical College Hospital, Beijing, China

Shandong Cancer Hospital, Jinan, China

Linked Papers

2024-11-04

Efficacy and safety of an oral combination therapy of niraparib and etoposide in platinum resistant/refractory ovarian cancer: a single arm, prospective, phase II study

Non-platinum chemotherapy is used in platinum resistant/refractory ovarian cancer patients but offers limited efficacy, especially in those who develop platinum resistance after ≤2 lines of platinum based chemotherapy. This phase II study aimed to evaluate the efficacy and safety of oral niraparib plus etoposide in platinum resistant/refractory ovarian cancer. Platinum resistant/refractory ovarian cancer patients after ≤2 lines of platinum based chemotherapy, histologically confirmed as non-mucinous epithelial ovarian cancer, regardless of biomarker status, were eligible. Patients received niraparib with a starting dose of 200 mg/100 mg alternate once a day, and oral etoposide of 50 mg once a day, on days 1-20 of 30 days per cycle for a maximum of 6-8 cycles, followed by niraparib until disease progression or intolerable toxicity. The primary endpoint was investigator assessed progression free survival. 29 patients were enrolled from 22 May 2020 to 3 February 2023; 26 patients were included in the efficacy analysis set as per protocol. Median progression free survival was 4.2 months (95% confidence interval (CI) 3.9 to 4.4). Overall response rate was 26.9% (95% CI 8.7 to 45.2). Disease control rate was 57.7% (95% CI 37.3 to 78.0). Overall response rate in patients with a BRCA mutation and homologous recombination deficiency was 50% and 41.7%, respectively. Median progression free survival in patients with primary platinum resistance was 4.5 months (95% CI 3.6 to 5.3). 29 patients were included in the safety analysis set, and 8 (28%) patients experienced treatment related adverse events of grade ≥3. There was no treatment related discontinuation. Niraparib combined with etoposide showed evidence of antitumor activity in platinum resistant/refractory ovarian cancer after ≤2 lines of platinum based chemotherapy, particularly in patients with a BRCA mutation, homologous recombination deficiency, or primary platinum resistance. This once-a-day oral combination was a convenient option. NCT04217798.

Linked Investigators