Relacorilant in Combination With Nab-Paclitaxel in Advanced, Platinum-Resistant, High-Grade Epithelial Ovarian, Primary Peritoneal, or Fallopian-Tube Cancer

NCT05257408Active, Not RecruitingPHASE3INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

Corcept Therapeutics

Enrollment

381

Start Date

2022-06-29

Completion Date

2025-03-24

Study Type

INTERVENTIONAL

Official Title

A Phase 3 Study of Relacorilant in Combination With Nab-Paclitaxel Versus Nab-Paclitaxel Monotherapy in Advanced, Platinum-Resistant, High-Grade Epithelial Ovarian, Primary Peritoneal, or Fallopian-Tube Cancer (ROSELLA)

Interventions

Nab-paclitaxel 80 mg/m^2Relacorilant 150 mg once daily (QD)Nab-paclitaxel 100 mg/m^2

Conditions

Ovarian NeoplasmFallopian Tube NeoplasmsPeritoneal Neoplasms

Eligibility

Age Range

18 Years+

Sex

FEMALE

Inclusion Criteria:

* Signed and dated Institutional Review Board/Independent Ethics Committee-approved informed consent form prior to study-specific screening procedures.
* Confirmed histologic diagnosis of high-grade (Grade 3) serous, epithelial ovarian, primary peritoneal, or fallopian tube carcinoma.
* Patients must have platinum-resistant disease (defined as RECIST v1.1 defined progression \<6 months from completion of a platinum-containing therapy).
* Must consent to provide archival tumor-tissue block or slides. Patients may consent to an optional tumor biopsy if archival tumor is unavailable.
* Has a life expectancy of ≥3 months.
* At least one lesion that meets the definition of measurable disease by RECIST v1.1
* Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1.
* Able to comply with protocol requirements.
* Able to swallow and retain oral medication and does not have uncontrolled emesis.
* Received at least 1 but ≤3 lines of prior systemic anticancer therapy and at least 1 prior line of platinum therapy and prior treatment with bevacizumab is required.
* Has adequate organ function meeting the following laboratory-test criteria: Absolute neutrophil count (ANC) ≥1500 cells/mm\^3, Platelet count ≥100,000/mm\^3, Hemoglobin ≥9 g/dL, Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≤2.5 × upper limit of normal (ULN), or ≤5 × ULN in context of liver metastases, Total bilirubin ≤1.5 × ULN, and Albumin ≥3 g/dL, and creatinine clearance \>40 mL/min/1.73 m\^2 (measured or estimated).
* Negative pregnancy test for patients of childbearing potential; patients of childbearing potential must agree to use highly effective contraceptive method(s); hormonal contraceptives are not allowed.
* Coronavirus disease (COVID-19) approved vaccines are accepted concomitant medications when recommended by the Investigator.

Exclusion Criteria:

* Has clinically relevant toxicity from prior systemic anticancer therapies or radiotherapy that has not resolved to ≤Grade 1 prior to randomization.
* Has had any major surgery within 4 weeks prior to randomization.
* Has low-grade endometrioid, clear cell, mucinous, or sarcomatous histology, or mixed tumors containing any of these histologies, or low-grade or borderline ovarian tumor.
* Has primary platinum-refractory disease, defined as disease that did not respond to or has progressed ≤1 month of the last dose of first-line platinum-containing chemotherapy.
* Has not received prior bevacizumab treatment.
* Has been treated with the following prior to randomization: chemotherapy, immunotherapy, investigational agent treatments for disease under study within 28 days before first dose of study drug, radiotherapy not completed at least 2 weeks prior to first dose of study drug, hormonal anticancer therapies within 7 days of first dose of study drug, and systemic, inhaled, or prescription strength topical corticosteroids within 21 days of first dose of study drug.
* Has received wide-field radiation to more than 25% of marrow-bearing areas.
* Has toxicities of prior therapies that have not resolved the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0, ≤Grade 1.
* Requires treatment with chronic or frequently used oral corticosteroids for medical conditions or illnesses.
* Has a history of severe hypersensitivity or severe reaction to any of the study drugs.
* Is receiving concurrent treatment with mifepristone or other glucocorticoid receptor (GR) modulators.
* Has peripheral neuropathy from any cause \>Grade 1.
* Pregnant or lactating patients or patients expecting to conceive children within the projected duration of the trial, starting with the screening visit through at least 1 month after the last dose of relacorilant, or 6 months after the last dose of nab-paclitaxel whichever is the longest.
* Has clinically significant uncontrolled condition(s) or condition which, in the opinion of the Investigator, may confound the results of the trial or interfere with the patient's safety or participation.
* Has current chronic/active infection with human immunodeficiency virus or current chronic/active infection with hepatitis C virus or hepatitis B virus.
* Has any untreated or symptomatic central nervous system (CNS) metastases.
* Patients with a history of other malignancy within 3 years prior to randomization
* Is taking a concomitant medication that is a strong cytochrome P450 (CYP)3A inhibitor or strong CYP3A inducer, or that is a substrate of CYP3A with a narrow therapeutic window.
* Concurrent treatment on other investigational treatment studies for the treatment of ovarian, fallopian tube, or primary peritoneal cancer.
* Has received a live vaccine within 30 days of prior to the study start date.

Outcome Measures

Primary Outcomes

Progression-free Survival as Assessed by BICR

Time from randomization until the time of first documented progressive disease (PD) by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, or death due to any cause, whichever occurs first

Time frame: Up to 24 months from enrollment of the last patient

Overall survival

Time from randomization to death by any cause

Time frame: Up to 24 months from enrollment of the last patient

Secondary Outcomes

PFS as Assessed by the Investigator

Time from randomization until the time of first documented progressive disease (PD) by RECIST v1.1, or death due to any cause, whichever occurs first

Time frame: Up to 24 months from enrollment of the last patient

Objective Response as Assessed by BICR

Proportion of patients with measurable disease at baseline who attain CR or PR by RECIST v1.1.

Time frame: Up to 24 months from enrollment of the last patient

Best Overall Response as Assessed by BICR

Proportion of patients with measurable disease at baseline who attain CR or PR as best response by RECIST v1.1.

Time frame: Up to 24 months from enrollment of the last patient

Duration of Response as Assessed by BICR

Time from when response (CR or PR per RECIST v1.1) is first documented to first objectively documented PD or death (whichever occurs first)

Time frame: Up to 24 months from enrollment of the last patient

Clinical benefit rate as assessed by BICR

Proportion of patients who attain CR, PR, or stable disease (SD) per RECIST v1.1.

Time frame: 24 weeks

Cancer Antigen (CA)-125 Response

Cancer antigen (CA)-125 response will be assessed per Gynecologic Cancer Intergroup (GCIG) criteria defined as ≥50% reduction in CA-125 from a pre-treatment sample and maintained for ≥28 days in patients with a pretreatment sample that is at least twice the upper limit of the reference range within 2 weeks before starting the treatment. In addition, patients who have a CA-125 response and whose CA-125 level falls to within the reference range will be classified as CA-125 complete responders.

Time frame: Up to 24 months from enrollment of the last patient

Combined Response According to RECIST v1.1 and GCIG Criteria

Combined response will be assessed for PD per RECIST v1.1 and for CA-125 response per GCIG criteria

Time frame: Up to 24 months from enrollment of the last patient

Locations

Site 318, Phoenix, United States

Site 277, Tucson, United States

Site 350, Irvine, United States

Site 364, La Jolla, United States

Site 150, Palo Alto, United States

Site 278, San Francisco, United States

Site 014, San Francisco, United States

Site 316, Solvang, United States

Site 032, Aurora, United States

Site 335, Miami Beach, United States

Site 042, Weston, United States

Site 009, Atlanta, United States

Site 272, Atlanta, United States

Site 372, Gainesville, United States

Site 291, Savannah, United States

Site 315, Evanston, United States

Site 314, Hinsdale, United States

Site 346, Urbana, United States

Site 339, Indianapolis, United States

Site 200, Overland Park, United States

Site 334, Overland Park, United States

Site 279, Louisville, United States

Site 128, Boston, United States

Site 288, New Brunswick, United States

Site 292, Albuquerque, United States

Site 275, Flushing, United States

Site 298, Cincinnati, United States

Site 304, Cincinnati, United States

Site 280, Portland, United States

Site 317, Portland, United States

Site 049, Portland, United States

Site 337, Bethlehem, United States

Site 127, Pittsburgh, United States

Site 276, Rapid City, United States

Site 368, Germantown, United States

Site 281, Nashville, United States

Site 229, Austin, United States

Site 312, Bedford, United States

Site 297, Fort Worth, United States

Site 392, San Antonio, United States

Site 301, The Woodlands, United States

Site 300, Norfolk, United States

Site 365, Richmond, United States

Site 121, Milwaukee, United States

Site 393, CABA, Argentina

Site 381, Ciudad Autonoma de Buenos Aire, Argentina

Site 415, Córdoba, Argentina

Site 401, Córdoba, Argentina

Site 395, Córdoba, Argentina

Site 404, Mendoza, Argentina

Site 391, Rosario, Argentina

Site 412, Rosario, Argentina

Site 426, St Leonards, Australia

Site 417, Benowa, Australia

Site 414, Melbourne, Australia

Site 419, Melbourne, Australia

Site 328, Aalst, Belgium

Site 109, Brussels, Belgium

Site 326, Charleroi, Belgium

Site 325, Hasselt, Belgium

Site 108, Leuven, Belgium

Site 327, Liège, Belgium

Site 424, Brasília, Brazil

Site 382, Fortaleza, Brazil

Site 384, Salvador, Brazil

Site 383, Belo Horizonte, Brazil

Site 390, Natal, Brazil

Site 413, São Paulo, Brazil

Site 421, Porto Alegre, Brazil

Site 380, Rio de Janeiro, Brazil

Site 376, São Paulo, Brazil

Site 389, São Paulo, Brazil

Site 413, São Paulo, Brazil

Site 374, São Paulo, Brazil

Site 001, São Paulo, Brazil

Site 117, Toronto, Canada

Site 273, Montreal, Canada

Site 306, Lille, France

Site 347, Montpellier, France

Site 307, Nancy, France

Site 310, Nice, France

Site 289, Paris, France

Site 323, Plérin, France

Site 322, Budapest, Hungary

Site 290, Debrecen, Hungary

Site 348, Győr, Hungary

Site 309, Haifa, Israel

Site 080, Jerusalem, Israel

Site 203, Tel Aviv, Israel

Site 321, Catania, Italy

Site 320, Legnago, Italy

Site 122, Milan, Italy

Site 295, Pavia, Italy

Site 161, Roma, Italy

Site 124, Rome, Italy

Site 293, Torino, Italy

Site 319, Treviso, Italy

Site 341, Gdynia, Poland

Site 331, Poznan, Poland

Site 329, Siedlce, Poland

Site 397, Gyeonggi-do, South Korea

Site 399, Seoul, South Korea

Site 398, Seoul, South Korea

Site 403, Seoul, South Korea

Site 400, Seoul, South Korea

Site 396, Seoul, South Korea

Site 402, Seoul, South Korea

Site 409, Seoul, South Korea

Site 349, Badalona, Spain

Site 311, San Sebastián, Spain

Site 330, Valencia, Spain

Site 367, Brighton, United Kingdom

Site 351, Taunton, United Kingdom

Site 366, Cheltenham, United Kingdom

Site 055, London, United Kingdom

Site 344, Manchester, United Kingdom

Site 345, Northwood, United Kingdom

Linked Papers

2025-06-02

Relacorilant and nab-paclitaxel in patients with platinum-resistant ovarian cancer (ROSELLA): an open-label, randomised, controlled, phase 3 trial

Relacorilant, a first-in-class selective glucocorticoid receptor antagonist, increases a tumour's sensitivity to chemotherapy by reducing cortisol signalling. This study aimed to show whether the addition of relacorilant to nab-paclitaxel improves progression-free and overall survival in females with platinum-resistant ovarian cancer. This randomised, controlled, open-label phase 3 trial (ROSELLA [GOG-3073/ENGOT-ov72]) was done at 117 hospitals and community oncology treatment centres in 14 countries across Australia, Europe, Latin America, North America, and South Korea. Patients had to be aged 18 years or older and had to have a confirmed diagnosis of platinum-resistant, epithelial (ie, high-grade serous, endometrioid, or carcinosarcoma with a ≥30% epithelial component) ovarian, primary peritoneal, or fallopian tube cancer; up to three previous lines of anticancer therapy and previous bevacizumab and disease progression or intolerance to the most recent therapy; measurable disease according to the Response Evaluation Criteria in Solid Tumours (RECIST; version 1.1); an Eastern Cooperative Oncology Group performance status of 0 or 1; and adequate organ function. Patients were assigned (1:1) to relacorilant (150 mg orally the day before, of, and after nab-paclitaxel infusion) plus nab-paclitaxel (80 mg/m Between Jan 5, 2023, and April 8, 2024, 381 patients were randomly assigned to the combination group (n=188) or to the nab-paclitaxel monotherapy group (n=193). Patients receiving relacorilant plus nab-paclitaxel had a statistically significant improvement in progression-free survival assessed by blinded independent central review compared with those receiving nab-paclitaxel monotherapy (hazard ratio 0·70 [95% CI 0·54-0·91]; median 6·54 months [95% CI 5·55-7·43] vs 5·52 months [3·94-5·88]; stratified log-rank p=0·0076). At the planned interim analysis, there was a clinically meaningful difference in overall survival with the addition of relacorilant to nab-paclitaxel (0·69 [95% CI 0·52-0·92]; 15·97 months [95% CI 13·47-not reached] vs 11·50 months [10·02-13·57]; log-rank p=0·0121). Adverse events were similar across study groups when adjusted for nab-paclitaxel exposure; no new safety signals were observed. The addition of relacorilant to nab-paclitaxel prolonged progression-free survival and interim results also showed an improvement in overall survival. Together, the results position the combination of relacorilant and nab-paclitaxel as a potential new standard treatment for patients with platinum-resistant ovarian cancer. Corcept Therapeutics.

2023-06-26

Relacorilant + Nab-Paclitaxel in Patients With Recurrent, Platinum-Resistant Ovarian Cancer: A Three-Arm, Randomized, Controlled, Open-Label Phase II Study

PURPOSE Despite therapeutic advances, outcomes for patients with platinum-resistant/refractory ovarian cancer remain poor. Selective glucocorticoid receptor modulation with relacorilant may restore chemosensitivity and enhance chemotherapy efficacy. METHODS This three-arm, randomized, controlled, open-label phase II study (ClinicalTrials.gov identifier: NCT03776812 ) enrolled women with recurrent, platinum-resistant/refractory, high-grade serous or endometrioid epithelial ovarian, primary peritoneal, or fallopian tube cancer, or ovarian carcinosarcoma treated with ≤4 prior chemotherapeutic regimens. Patients were randomly assigned 1:1:1 to (1) nab-paclitaxel (80 mg/m2) + intermittent relacorilant (150 mg the day before, of, and after nab-paclitaxel); (2) nab-paclitaxel (80 mg/m2) + continuous relacorilant (100 mg once daily); or (3) nab-paclitaxel monotherapy (100 mg/m2). Nab-paclitaxel was administered on days 1, 8, and 15 of each 28-day cycle. The primary end point was progression-free survival (PFS) by investigator assessment; objective response rate (ORR), duration of response (DOR), overall survival (OS), and safety were secondary end points. RESULTS A total of 178 women were randomly assigned. Intermittent relacorilant + nab-paclitaxel improved PFS (hazard ratio [HR], 0.66; log-rank test P = .038; median follow-up, 11.1 months) and DOR (HR, 0.36; P = .006) versus nab-paclitaxel monotherapy, while ORR was similar across arms. At the preplanned OS analysis (median follow-up, 22.5 months), the OS HR was 0.67 ( P = .066) for the intermittent arm versus nab-paclitaxel monotherapy. Continuous relacorilant + nab-paclitaxel showed numerically improved median PFS but did not result in significant improvement over nab-paclitaxel monotherapy. Adverse events were comparable across study arms, with neutropenia, anemia, peripheral neuropathy, and fatigue/asthenia being the most common grade ≥3 adverse events. CONCLUSION Intermittent relacorilant + nab-paclitaxel improved PFS, DOR, and OS compared with nab-paclitaxel monotherapy. On the basis of protocol-prespecified Hochberg step-up multiplicity adjustment, the primary end point did not reach statistical significance ( P &lt; .025). A phase III evaluation of this regimen is underway (ClinicalTrials.gov identifier: NCT05257408 ).

Relacorilant in Combination With Nab-Paclitaxel in Advanced, Platinum-Resistant, High-Grade Epithelial Ovarian, Primary Peritoneal, or Fallopian-Tube Cancer