Phase I of Carboplatin-Olaparib Followed by Olaparib Monotherapy in Advanced Cancer (REVIVAL)

A Phase I Followed by a Randomized Phase II Trial of Two Cycles Carboplatin-Olaparib Followed by Olaparib Monotherapy Versus Capecitabine in BRCA-1 or -2 Mutated Her2 Negative Advanced Breast Cancer as First Line Treatment

A phase I trial to determine the recommended phase two dose of the combination of carboplatin and olaparib.

Study Overview

• Status: Completed
• Conditions: Breast Cancer; Ovarian Cancer; Advanced Cancer
• Intervention / Treatment: Drug: carboplatin, olaparib

Detailed Description

A 3+3 dose escalation trial of 2 cycles (21 days) carboplatin and olaparib combination therapy, followed by olaparib monotherapy until progression or unacceptable toxicity in patients with advanced cancer.

• Study Type: Interventional
• Enrollment (Actual): 25
• Phase: Phase 1

Contacts and Locations

Study Locations

• Netherlands
  • Amsterdam, Netherlands, 1066CX
    • Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion criteria:

1. Histological or cytological proof of advanced cancer pre-treated with maximally one line of systemic chemotherapy in the advanced setting and any line of hormonal therapy for advanced disease, and potentially benefitting from olaparib-carboplatin combination therapy (prior (neo-)adjuvant chemotherapy is accepted and does not count as one line, since administered in early stage disease);
2. Age ≥ 18 years;
3. Able and willing to give written informed consent;
4. WHO performance status of 0, 1 or 2;
5. Able and willing to undergo blood sampling for PK and PD analysis;
6. Life expectancy ≥ 3 months, allowing adequate follow up of toxicity evaluation and antitumor activity;
7. Evaluable disease according to RECIST 1.1 criteria;

8. Minimal acceptable safety laboratory values

   1. ANC of ≥ 1.5 x 10^9 /L
   2. Hemoglobin of at least 6.2 mM and no transfusions in the last 28 days.
   3. Platelet count of ≥ 100 x 10^9 /L
   4. Hepatic function as defined by serum bilirubin ≤ 1.5 x ULN (or < 3 x ULN in case of known Gilbert syndrome), ASAT and ALAT 2.5 x ULN (or <5 x ULN in case of liver metastasis)
   5. Renal function as defined by serum creatinine ≤1.5 x ULN or creatinine clearance ≥ 50 mL/min (by Cockcroft-Gault formula);
9. Negative pregnancy test (urine/serum) for female patients with childbearing potential;

Exclusion criteria

1. Any treatment with investigational drugs within 28 days prior to receiving the first dose of investigational treatment; or 21 days for standard (neo-)adjuvant chemotherapy, hormonal and immunotherapy;
2. Patients who have received high dose alkylating agents, a PARP1 inhibitor or carboplatin pretreatment; unless no progression on carboplatin had been observed during earlier treatment and the last carboplatin administration had been longer than 6 months ago;
3. Any current treatment with drugs that induce or inhibit the CYP3A4 system : http://www.fda.gov/drugs/developmentapprovalprocess/developmentresources/druginteractionslabeling/ucm093664.htm#inVivo or APPENDIX IX
4. Women who have a positive pregnancy test (urine/serum) and/or who are breast feeding;
5. Unreliable contraceptive methods. Women and men enrolled in this trial must agree to use a reliable contraceptive method throughout the study (adequate contraceptive methods are: oral, injected or implanted hormonal methods, intra-uterine devices or systems, condom or other barrier contraceptive measures, sterilization and true abstinence)
6. Radiotherapy within the last four weeks prior to receiving the first dose of investigational treatment; except 1x8 Gy for pain palliation then a seven days interval should be maintained;
7. Uncontrolled infectious disease or known Human Immunodeficiency Virus HIV-1 or HIV-2 type patients;
8. Patients with known active hepatitis B or C;
9. Recent myocardial infarction (< six months) or unstable angina;
10. Symptomatic brain metastases. If adequately treated with resection and/or irradiation and patients are at least four weeks completely free of symptoms of these metastases and without medication related to these metastases patients could be eligible if all other in- and exclusion criteria are obeyed.
11. Known leptomeningeal metastases.
12. Patients with myelodysplastic syndrome or acute myeloid leukemia
13. Any medical condition not yet specified above that is considered to possibly, probably or definitely interfere with study procedures, including adequate follow-up and compliance and/or would jeopardize safe treatment.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dose escalation; carboplatin, olaparib	Drug: carboplatin, olaparib; 2 cycles of carboplatin and olaparib combination therapy followed by olaparib monotherapy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximum Tolerated Dose	The dose level at which more than 1/6 patients develop a dose limiting toxicity	per doselevel of 3 to 6 patients (when 3-6 patients have completed DLT period of 3 weeks)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pharmacokinetics (area under time-concentration curve (AUC))	Pharmacokinetics (PK) measurements of olaparib alone and olaparib in combination with carboplatin	1 year
Pharmacodynamics (PAR (Poly(ADP) ribose) activation measured with the PAR assay)	PAR (Poly(ADP) ribose) activation measured with the PAR assay	1 year
Objective Response Rate	Objective Response Rate according to Response Evaluation Criteria in Solid Tumors (RECIST)	1 year

Collaborators and Investigators

• Sponsor: The Netherlands Cancer Institute
• Investigators: Principal Investigator: Sabine Linn, MD, PhD, The Netherlands Cancer Institute

Publications and helpful links

General Publications

• Schouten PC, Dackus GM, Marchetti S, van Tinteren H, Sonke GS, Schellens JH, Linn SC. A phase I followed by a randomized phase II trial of two cycles carboplatin-olaparib followed by olaparib monotherapy versus capecitabine in BRCA1- or BRCA2-mutated HER2-negative advanced breast cancer as first line treatment (REVIVAL): study protocol for a randomized controlled trial. Trials. 2016 Jun 21;17(1):293. doi: 10.1186/s13063-016-1423-0.

Study record dates

Study Major Dates

• Study Start: May 1, 2015
• Primary Completion (Actual): January 1, 2019
• Study Completion (Actual): January 1, 2019

Study Registration Dates

• First Submitted: March 9, 2015
• First Submitted That Met QC Criteria: April 13, 2015
• First Posted (Estimate): April 16, 2015

Study Record Updates

• Last Update Posted (Actual): January 16, 2019
• Last Update Submitted That Met QC Criteria: January 14, 2019
• Last Verified: January 1, 2019

More Information

Terms related to this study

• Keywords: olaparib; carboplatin; homologous recombination deficiency; breast cancer 1, early onset (BRCA1); breast cancer 2, early onset (BRCA2)
• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Poly(ADP-ribose) Polymerase Inhibitors; Carboplatin; Olaparib
• Other Study ID Numbers: M14REV; NL50610.031.14 (Other Identifier: Netherlands CCMO); 2013-005590-41 (EudraCT Number)