Signal TrAnsduction Pathway Activity Analysis in OVarian cancER (STAPOVER)

April 13, 2023 updated by: Jurgen M.J. Piek, Gynaecologisch Oncologisch Centrum Zuid
The purpose of this prospective, parallel-group, cohort study is to implement phenotype-guided targeted therapy based on functional signal transduction pathway (STP) activity in recurrent ovarian cancer patients using a novel mRNA-based assay. Existing targeted drugs with tolerable toxicity profiles are used to investigate the therapeutic value beyond their approved indication, which are deemed beneficial in the select group of patients with a relevant predominantly active functional STP, in order to improve survival and maintain quality of life.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Rationale: Ovarian cancer is one of the most lethal cancers in the world. Standard therapy consists of debulking surgery and chemotherapy. However, despite this aggressive treatment, recurrent disease almost invariably occurs resulting in a five-year survival rate of approximately 30%. Tumour growth is driven by several signal transduction pathways (STPs), and twelve major STPs have been identified as important for carcinogenesis. Currently, several targeted therapy drugs are available and new targeted drugs are being developed. With a newly developed technique, Signal Transduction Activation (STA) analysis, it is possible to assess which pathway is predominant in a specific (ovarian) cancer sample. Therefore, we hypothesize that specifically targeting the predominant STP might impair tumour growth and improve survival.

Objective: This study aims to investigate the progression-free survival (PFS) according to RECIST 1.1 criteria on matched targeted therapy by STA-analysis (PFS2) in comparison to the PFS recorded on the therapy administered immediately prior to enrolment (PFS1) in women with recurrent ovarian cancer.

Study design: A multi-centre prospective, parallel-group, cohort study. Study population: Recurrent ovarian cancer patients with platinum-resistant disease, patients who refrain from standard therapy and patients who are not yet eligible for standard palliative chemotherapy, including all histological subtypes.

Intervention: STA-analysis will be performed on a biopsy taken from the recurrent tumour. Patients will be included if a predominant pathway is identified for which a matched targeted drug is available and deemed adequate by the multidisciplinary tumour board. We will start with targeted therapy in patients with oestrogen receptor, androgen receptor, phosphoinositide 3-kinase and Hedgehog pathway active tumours, since targeted therapy interceding these pathways are easily available with tolerable side effects.

Main study parameters/endpoints: The primary outcome is therapy response defined as PFS2/PFS1 ratio according to RECIST 1.1 criteria. Secondary outcomes include the proportion of patients with an actionable active pathway and the proportion of patients receiving matched targeted therapy, best overall response (according to RECIST 1.1 criteria), one-year survival, overall survival, predictive value of STA-analysis results, side effects, quality of life, cost-effectiveness and change in STP activity score comparing the score before treatment and after disease progression.

Study Type

Interventional

Enrollment (Anticipated)

148

Phase

  • Phase 2
  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Netherlands
      • Breda, Netherlands, 4818 CK
        • Not yet recruiting
        • Amphia Hospital
        • Contact:
        • Principal Investigator:
          • H.P.M. Smedts
      • Maastricht, Netherlands, 6229 HX
      • Rotterdam, Netherlands
      • Tilburg, Netherlands, 5022 GC
        • Not yet recruiting
        • Elisabeth-TweeSteden hospital
        • Contact:
          • M.C. Vos, MD, PhD
    • Brabant
      • Eindhoven, Brabant, Netherlands, 5623EJ
        • Recruiting
        • Catharina Ziekenhuis
        • Contact:
        • Sub-Investigator:
          • A.M.J. Thijs, MD, PhD
    • Gelderland
      • Nijmegen, Gelderland, Netherlands
        • Not yet recruiting
        • Radboudumc
        • Contact:
        • Principal Investigator:
          • N. Ottevanger, Prof

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Female, age > 18 years
  • Patients with recurrent ovarian cancer who meet one of the following criteria:
  • Platinum-resistant disease, defined as disease recurrence or progression within six months of last platinum-based chemotherapy or;
  • Patient refrains from standard therapy or;
  • Asymptomatic patient who is not yet eligible for standard palliative chemotherapy but has an increase of CA125 tumour marker at two consecutive time points 28 days apart with a value of two times nadir above 35 U/ml.
  • Progressive disease after at least one prior line of systemic treatment for recurrent disease.
  • Radiologically evaluable disease according to RECIST 1.1 criteria (36).
  • Ability and willingness to obtain a tumour biopsy after the last course of standard treatment and before start of the study.
  • Ability and willingness to provide written and oral consent.
  • Able to speak and understand the Dutch language.
  • WHO performance status 0-II.
  • Adequate renal and liver function to start matched targeted therapy (according to the local clinician).
  • Adequate use of contraceptives in case of patients with childbearing potential.

Exclusion Criteria:

  • Age < 18 years.
  • Patient is receiving any other anti-cancer therapy (e.g. cytotoxic or targeted drug or radiation) or is chemotherapy naïve. The required wash out period prior to start of matched targeted therapy is at least three weeks.
  • Patient is diagnosed with or treated for a second primary tumour (except non-melanoma skin tumour) one year prior to study inclusion.
  • Inability to obtain (sufficient) tumour material.
  • Previous use of the selected targeted drug as anti-cancer agent.
  • Physical condition WHO III-IV.
  • Pregnant or lactating women.
  • Simultaneous participation in another treatment-related clinical trial.
  • Patients with any other clinically significant medical condition which, in the opinion of the local clinician, makes it undesirable for the patient to participate in this study or which could jeopardize compliance with study requirements including, but not limited to: ongoing or active infection, severe psychiatric illness, or complicated social situations.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: A - ER active tumors
In case of an aberrantly active Estrogen Receptor (ER) pathway, patients will be treated with Letrozole 2.5mg daily orally until progression of disease.
Drug: Letrozole Oral Product
Letrozole 2.5mg tablet - 2.5mg once dailty until progression of disease.
Experimental: B - AR active tumors
In case of an aberrantly active androgen receptor (AR) pathway, patients will be treated with Bicalutamide 150mg daily orally until progression of disease.
Drug: Bicalutamide Oral Product
Bicalutatmide 150mg tablet - 150mg once daily until progression of disease.
Experimental: C - PI3K active tumors
In case of an aberrantly active phosphoinositide 3-kinase (PI3K) pathway, patients will be treated with Everolimus 10mg daily orally until progression of disease.
Drug: Everolimus Oral Product
Everolimus 10mg tablet - 10mg once daily until progression of disease.
Experimental: D - HH and/or PI3K active tumors
In case of an aberrantly active Hedgehog (HH) or PI3K pathway, patients will be treated with Itraconazole 300mg twice daily orally until progression of disease.
Drug: Itraconazole Oral Product
Itraconazole 100mg capsule - 300mg twice daily until progression of disease.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progression free survival on matched targeted therapy determined by STP-activity (PFS2) in comparison to the PFS recorded on the therapy administered immediately prior to enrolment (PFS1).
Time Frame: From baseline until the date of documented disease progression or 12 months after the start of targeted therapy.
PFS on matched targeted therapy (PFS2) is defined as the time from start of matched targeted therapy to disease progression, defined by RECIST 1.1 criteria, or death from any cause. PFS on prior therapy (PFS1) is defined as the time from start of the prior treatment to disease progression defined by RECIST 1.1 criteria
From baseline until the date of documented disease progression or 12 months after the start of targeted therapy.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Proportion of patients with an actionable active pathway for which targeted therapy is recommended in relation to the number of patients who underwent a biopsy.
Time Frame: From date of biopsy until the date of the result from Multi-disciplinary Tumor Board Meeting, up 14 days after biopsy date.
From date of biopsy until the date of the result from Multi-disciplinary Tumor Board Meeting, up 14 days after biopsy date.
Proportion of patients who receive matched targeted therapy in relation to the number of patients included in each study arm.
Time Frame: From start date matched targeted therapy until the end of the study enrollment, up to 36 months.
Proportion of patients included in arm A, B, C, D.
From start date matched targeted therapy until the end of the study enrollment, up to 36 months.
Best overall response defined by RECIST 1.1 criteria based on radiological imaging.
Time Frame: From baseline, radiological evaluation every 12 weeks after the start of targeted therapy until the date of documented disease progression or death, whichever comes first, assessed up to 12 months.
From baseline, radiological evaluation every 12 weeks after the start of targeted therapy until the date of documented disease progression or death, whichever comes first, assessed up to 12 months.
One-year survival
Time Frame: From start date of targeted therapy until date of death or one year follow-up, whichever comes first.
One-year survival is defined as the time from start matched targeted therapy till death or the end of the one-year follow-up period.
From start date of targeted therapy until date of death or one year follow-up, whichever comes first.
Overall survival
Time Frame: From start date of targeted therapy until the date of death, assessed up to 36 months.
Defined as the time from start matched targeted therapy till death.
From start date of targeted therapy until the date of death, assessed up to 36 months.
Predictive value of STA-analysis results on matched targeted therapy response.
Time Frame: From start date targeted therapy until response evaluation at 12 weeks after start of targeted therapy.
From start date targeted therapy until response evaluation at 12 weeks after start of targeted therapy.
Side effects
Time Frame: From start date of targeted therapy after two weeks, every 12 weeks from targeted therapy start date, until 12 weeks after end of treatment.
Assessed according to the PRO-CTCAE and NCI CTCAE 5.0
From start date of targeted therapy after two weeks, every 12 weeks from targeted therapy start date, until 12 weeks after end of treatment.
Health Related Quality of Life
Time Frame: From baseline, every 12 weeks after start date of treatment until 12 weeks after end of treatment.
HRQoL is assessed using standardized questionnaires from the EORTC QLQ-C30 and QLQ-OV28.
From baseline, every 12 weeks after start date of treatment until 12 weeks after end of treatment.
Cost-effectiveness
Time Frame: From baseline, every 12 weeks after start date of targeted therapy until 12 weeks after end of treatment.
Standardized EuroQol 5D (EQ-5D-5L) questionnaire is used to calculated the cost-effectiveness.
From baseline, every 12 weeks after start date of targeted therapy until 12 weeks after end of treatment.
Change in pathway activity score after disease progression compared to pathway activity score before start of matched therapy.
Time Frame: From date of biopsy until 4 weeks after date of documented progression of disease.
If pathway activity scores are available from a second (voluntary) biopsy for after treatment has ended and before standard (palliative) treatment has started, change in pathway scores are assessed.
From date of biopsy until 4 weeks after date of documented progression of disease.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Gynaecologisch Oncologisch Centrum Zuid

Collaborators

Radboud University Medical Center
Maastricht University Medical Center
Erasmus Medical Center
Eurofins
InnoSIGN

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 31, 2023

Primary Completion (Anticipated)

October 1, 2026

Study Completion (Anticipated)

October 1, 2026

Study Registration Dates

First Submitted

February 23, 2018

First Submitted That Met QC Criteria

March 1, 2018

First Posted (Actual)

March 8, 2018

Study Record Updates

Last Update Posted (Actual)

April 18, 2023

Last Update Submitted That Met QC Criteria

April 13, 2023

Last Verified

April 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • STAPOVER
  • 2020-005091-36 (EudraCT Number)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Recurrent Ovarian Cancer

Clinical Trials on Letrozole Oral Product

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Denmark

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

3
Subscribe