Carboplatin-Paclitaxel-Bevacizumab vs Carbo-Pacli-Beva-Rucaparib vs Carbo-Pacli-Ruca, Selected According to HRD Status, in Patients With Advanced Ovarian, Primary Peritoneal and Fallopian Tube Cancer, Preceded by a Phase I Dose Escalation Study on Ruca-Beva Combination

Last updated: August 24, 2021
Sponsor: Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Overall Status: Active - Recruiting

Phase

1/2

Condition

Fallopian Tube Cancer

Treatment

N/A

Clinical Study ID

NCT03462212
3329
  • Ages > 18
  • Female

Study Summary

This trial is a randomized, open-label Phase I-2 multi-center study designed to evaluate the effect of Carboplatin-Paclitaxel-Bevacizumab (in combination and maintenance) vs Carboplatin-Paclitaxel-Bevacizumab-Rucaparib (Rucaparib only in maintenance) vs Carboplatin-Paclitaxel-Rucaparib (Rucaparib only in maintenance) on progression-free survival in patients with advanced high grade ovarian cancer treated according to HRD status . The trial will test the hypothesis that Carboplatin-Paclitaxel-Bevacizumab-Rucaparib and the Carboplatin-Paclitaxel-Rucaparib arms will improve the progression-free survival in comparison to standard Carboplatin-Paclitaxel-Bevacizumab in HRD negative (HR proficient) patients and that Carboplatin-Paclitaxel-Bevacizumab-Rucaparib will improve PFS with respect to Carboplatin-Paclitaxel-Rucaparib in HRD positive patients. The randomized phase of the study will be preceded by a single arm Phase I study which will be conducted only in the National Cancer Institute of Milan, aiming at evaluating the MTD of the combination Rucaparib-Bevacizumab. Once the MTD has been reached, the randomized study will start.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. Women aged >=18 years at the time of study inclusion;
  2. Patients with newly diagnosed, histologically confirmed, high grade serous, high gradeendometrioid, FIGO stage IIIB-C-IV epithelial ovarian cancer, primary peritonealcancer and / or Fallopian-tube cancer. Patients with mixed histology (carcinosarcoma)are eligible providing that high grade tumor represent more than 50% of the totalhistology. Stage III patients should have had one attempt at optimal debulking surgery (upfrontor interval debulking). Stage IV patients must have had either a biopsy and/or upfrontor interval debulking surgery;
  3. Archival tumor tissue available. At progression fresh biopsy is optional for patientswilling to submit ;
  4. ECOG Performance Status of 0-1;
  5. Measurable and not measurable disease;
  6. Adequate renal and hepatic function, defined as:
  • Total serum bilirubin ≤ 1.5 institutional ULN unless patient has Gilbert'ssyndrome in which case total serum bilirubin must be <2 ULN for the institutionAST and/or ALT ≤ 2.5 x ULN for the institution. (or ≤ 5 x ULN if liver metastasesare present);
  • Alkaline phosphatase < 1.5 x ULN for the institution (if > 1.5 x ULN, thenalkaline phosphatase liver fraction must be < 1.5 ULN)
  • Serum creatinine ≤ 1.5 x ULN for the institution (or calculated creatinineclearance ≥ 45 mL/min/1.73 m2);
  1. Adequate bone marrow function, defined as:
  • Total leukocytes 2.5 x 109/L;
  • ANC 1.5 x 109/L;
  • Platelet count 100 x 109/L;
  1. Able to understand and give written informed consent;
  2. Females of childbearing potential must have a negative serum pregnancy test within 7days prior to study enrollment.

Exclusion

Exclusion Criteria:

  1. Women who are pregnant or lactating;
  2. Presence of brain or other central nervous system metastases, not adequatelycontrolled by treatment;
  3. Prior Anticancer treatment;
  4. Inadequate recovery from any prior surgical procedure or having undergone any majorsurgical procedure within 3 weeks prior to randomization;
  5. Another primary malignancy except for:
  6. Curatively treated non-melanoma skin cancer;
  7. Breast cancer treated curatively ≥5 years ago, or other solid tumor treatedcuratively ≥5 years ago, without evidence of recurrence;
  8. Synchronous endometrioid endometrial cancer (except for Stage 1A G1/G2);
  9. Known active HIV, hepatitis B or C infection;
  10. Concurrent treatment with immunosuppressive or investigational agents;
  11. History or evidence of thrombotic or hemorrhagic disorders; including cerebrovascularaccident (CVA) / stroke or transient ischemic attack (TIA) or subarachnoid haemorrhagewithin _6 months prior to the first study treatment);
  12. Clinically significant (i.e. active) cardiovascular disease, including:
  • Myocardial infarction or unstable angina within _6 months prior to the firststudy treatment;
  • New York Heart Association (NYHA) grade II or greater congestive heart failure (CHF);
  • Serious cardiac arrhythmia requiring medication (with the exception of atrialfibrillation or paroxysmal supraventricular tachycardia);
  • Peripheral vascular disease > grade 3 (i.e.symptomatic and interfering withactivities of daily living requiring repair or revision);
  1. Serious active infection requiring i.v. antibiotics at enrolment;
  2. Known hypersensitivity to any of the study drugs or excipients (including cremophorand hamster Ovary cell products);
  3. Evidence of any other medical conditions (such as psychiatric illness, peptic ulcer,etc.), physical examination or laboratory findings that may interfere with the plannedtreatment, affect patient compliance or place the patient at high risk from treatmentrelated complications;
  4. Prior gastrectomy or upper bowel removal, or any other gastrointestinal disorder ordefect that would interfere with absorption of study drug;
  5. Received administration of strong CYP1A2 or CYP3A4 inhibitors ≤7 days prior to firstdose of Rucaparib or have on-going requirements for these medications.

Study Design

Total Participants: 290
Study Start date:
March 17, 2021
Estimated Completion Date:
March 01, 2025

Study Description

Phase I study design:

This is a single-centre, Phase I, open-label, dose-escalation study to evaluate the safety and tolerability of bevacizumab-rucaparib combination and determine the MTD in patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer.

The dose of bevacizumab is fixed in cohort 1, 2 and 3 of the study at 15mg/kg, q 3 weekly.

The dose of rucaparib is evaluated in three cohorts (400 mg BID; 500 mg BID; 600 mg BID).

This trial will enroll at least 3 patients in cohort 1 with dose escalation to rucaparib 500 mg from cohort 1 to 2. Cohort 2 will enroll at least 3 patients with dose escalation to rucaparib 600 mg from cohort 2 to 3.

The standard 3+3 design will be used. Patients will be enrolled in cohort of 3 patients, if no DLT event will be reported among the first 3 patients, a second cohort will be enrolled at the upper dose level. If 1 DLT event is registered in the first cohort, other 3 patients will be enrolled at the same dose.

Phase II study design:

Eligible patients with histological documented high grade Stage IIIB-IIIC-IV ovarian cancer (regardless of residual tumor) will be randomized 1:1:1 according to a molecular driven treatment.

HRD positive patients:

  • ARM B: Carboplatin AUC 5 + Paclitaxel 175 mg/m2 q 21 for 6 cycles followed by Rucaparib 600 mg BID q 28 for 24 cycles as maintenance

  • ARM C: Carboplatin AUC 5+ Paclitaxel 175 mg/m2 q 21 + Bevacizumab 15 mg/kg for 6 cycles followed by Bevacizumab 15 mg/kg q 21 days for 16 cycles (Bevacizumab will start from Cycle 2) + Rucaparib 500 mg part BID q 28 for 24 cycles as maintenance

HRD negative patients:

  • ARM A: Carboplatin AUC 5 + Paclitaxel 175 mg/m2 q 21 + Bevacizumab 15 mg/kg for 6 cycles followed by Bevacizumab 15 mg/kg q 21 for 16 cycles (Bevacizumab will start from Cycle

  • ARM B: Carboplatin AUC 5 + Paclitaxel 175 mg/m2 q 21 for 6 cycles followed by Rucaparib 600 mg BID q 28 for 24 cycles as maintenance

Stratification factors are:

  • Residual tumor at primary surgery (RT=0 vs RT> 0)

  • Neoadiuvant chemotherapy (Yes or not)

Connect with a study center

  • Ospedale Mater Salutis

    Legnago,
    Italy

    Active - Recruiting

  • ASST Grande Ospedale Metropolitano Niguarda

    Milan,
    Italy

    Active - Recruiting

  • Istituto Nazionale Tumori IRCCS Fondazione G. Pascale

    Naples,
    Italy

    Active - Recruiting

  • Azienda Ospedaliera di Perugia

    Perugia,
    Italy

    Active - Recruiting

  • Nuovo Ospedale degli Infermi

    Ponderano,
    Italy

    Active - Recruiting

  • Fondazione Policlinico Universitario A.Gemelli IRCCS

    Rome, 00168
    Italy

    Active - Recruiting

  • Istituto di Candiolo - Fondazione del Piemonte per l'Oncologia - IRCCS

    Turin,
    Italy

    Active - Recruiting

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