A Comparison of Platinum-based Therapy With TSR-042 and Niraparib Versus Standard of Care (SOC) Platinum-based Therapy as First-line Treatment of Stage III or IV Nonmucinous Epithelial Ovarian Cancer (FIRST)

A Randomized, Double-blind, Phase 3 Comparison of Platinum-based Therapy With TSR-042 and Niraparib Versus Standard of Care Platinum-based Therapy as First-line Treatment of Stage III or IV Nonmucinous Epithelial Ovarian Cancer

Ovarian cancer is a heterogeneous disease, characterized by complex molecular and genetic changes. The high expression of vascular endothelial growth factor (VEGF) receptor, programmed death receptor ligands 1 (PD-L1) expression, and deoxyribonucleic acid (DNA) damage in ovarian tumors provide several targets for treatment and maintenance of disease response. Given the unmet medical need of participants with advanced or metastatic ovarian cancer, this study design will enable investigators to provide participants with current SOC for ovarian cancer for the duration of the study. This is a global, multicenter, randomized, double-blind, controlled Phase 3 study that will primarily compare the progression-free survival (PFS) for participants receiving dostarlimab with SOC chemotherapy +/- bevacizumab followed by niraparib and dostarlimab maintenance +/- bevacizumab versus participants receiving SOC with chemotherapy followed by niraparib maintenance. This comparison will be investigated both in the PD-L1 positive and overall population of newly diagnosed stage III or IV advanced non-mucinous epithelial ovarian cancer participants and also to compare PFS of all participants with Stage III or IV high-grade non-mucinous epithelial ovarian cancer treated with platinum-based combination therapy, dostarlimab (TSR-042), and niraparib to SOC platinum-based combination therapy. The currently recommended SOC therapy for the first line treatment of Stage III or IV ovarian cancer is the combination of paclitaxel and carboplatin, with or without concurrent and maintenance bevacizumab. Participants will receive SOC during the chemotherapy Run-In period (cycle 1) before randomization to study treatment (cycle 2). Concurrent bevacizumab use must be determined prior to randomization at cycle 2.

Study Overview

• Status: Active, not recruiting
• Conditions: Ovarian Neoplasms; Ovarian, Fallopian Tube and Primary Peritoneal Carcinoma
• Intervention / Treatment: Drug: Dostarlimab (TSR-042); Drug: Standard of care; Drug: Dostarlimab-Placebo; Drug: Niraparib-Placebo; Drug: Niraparib

• Study Type: Interventional
• Enrollment (Actual): 1402
• Phase: Phase 3

Contacts and Locations

Study Locations

• Belarus
  • Minsk, Belarus, 223040
    • GSK Investigational Site
• Belgium
  • Brasschaat, Belgium, 2930
    • GSK Investigational Site
  • Brugge, Belgium, 8000
    • GSK Investigational Site
  • Brussels, Belgium, 1000
    • GSK Investigational Site
• Canada
  • British Columbia
    • Vancouver, British Columbia, Canada, V5Z 4E6
      • GSK Investigational Site
  • Ontario
    • London, Ontario, Canada, N6A 4L6
      • GSK Investigational Site
    • Toronto, Ontario, Canada, M4N 3M5
      • GSK Investigational Site
  • Quebec
    • Montreal, Quebec, Canada, H4A 3J1
      • GSK Investigational Site
    • Montreal, Quebec, Canada, H2X 3E4
      • GSK Investigational Site
    • Sherbrooke, Quebec, Canada, J1H 5N4
      • GSK Investigational Site
• Czechia
  • Prague, Czechia, 128 51
    • GSK Investigational Site
  • Praha 8 - Liben, Czechia, 180 81
    • GSK Investigational Site
• Denmark
  • Copenhagen, Denmark, DK- 2100
    • GSK Investigational Site
  • Dk-2730 Herlev, Denmark, 2730
    • GSK Investigational Site
  • Roskilde, Denmark, 4000
    • GSK Investigational Site
• Finland
  • Helsinki, Finland, 00029
    • GSK Investigational Site
  • Kuopio, Finland, 70210
    • GSK Investigational Site
  • Tampere, Finland, 33520
    • GSK Investigational Site
  • Turku, Finland, 20520
    • GSK Investigational Site
• France
  • Angers Cedex 02, France, 49055
    • GSK Investigational Site
  • Avignon Cedex 9, France, 84918
    • GSK Investigational Site
  • Besançon Cedex, France, 25030
    • GSK Investigational Site
  • Bordeaux, France, 33000
    • GSK Investigational Site
  • Caen, France, 14000
    • GSK Investigational Site
  • Clermont-Ferrand cedex, France, 63011
    • GSK Investigational Site
  • Dijon Cedex, France, 21079
    • GSK Investigational Site
  • Grenoble Cedex, France, 38000
    • GSK Investigational Site
  • La Tronche, France, 38700
    • GSK Investigational Site
  • Le Mans, France, 72000
    • GSK Investigational Site
  • Lille, France, 59000
    • GSK Investigational Site
  • Lyon, France, 69008
    • GSK Investigational Site
  • Lyon cedex 08, France, 69373
    • GSK Investigational Site
  • Marseille Cedex 9, France, 13273
    • GSK Investigational Site
  • Montpellier, France, 34070
    • GSK Investigational Site
  • Montpellier Cedex 5, France, 34298
    • GSK Investigational Site
  • Nancy, France, 54100
    • GSK Investigational Site
  • Nantes, France, 44227
    • GSK Investigational Site
  • Nice Cedex 2, France, 06189
    • GSK Investigational Site
  • Nîmes cedex 9, France, 30029
    • GSK Investigational Site
  • Paris, France, 75014
    • GSK Investigational Site
  • Paris, France, 75020
    • GSK Investigational Site
  • Paris Cedex 05, France, 75248
    • GSK Investigational Site
  • Paris Cedex 14, France, 75014
    • GSK Investigational Site
  • Paris Cedex 15, France, 75908
    • GSK Investigational Site
  • Paris Cedex 20, France, 75970
    • GSK Investigational Site
  • Pierre-Benite Cedex, France, 69495
    • GSK Investigational Site
  • Pierre-Bénite cedex, France, 69495
    • GSK Investigational Site
  • Plerin-sur-mer, France, 22190
    • GSK Investigational Site
  • Poitiers cedex, France, 86021
    • GSK Investigational Site
  • Reims Cedex, France, 51056
    • GSK Investigational Site
  • Rennes Cedex, France, 35042
    • GSK Investigational Site
  • Saint-Priest en Jarez, France, 42271
    • GSK Investigational Site
  • Strasbourg Cedex, France, 67091
    • GSK Investigational Site
  • Toulouse Cedex 9, France, 31059
    • GSK Investigational Site
  • Tours Cedex 1, France, 37044
    • GSK Investigational Site
  • Villejuif, France, 94805
    • GSK Investigational Site
• Germany
  • Berlin, Germany, 13125
    • GSK Investigational Site
  • Hamburg, Germany, 22457
    • GSK Investigational Site
  • Baden-Wuerttemberg
    • Ravensburg, Baden-Wuerttemberg, Germany, 88212
      • GSK Investigational Site
  • Niedersachsen
    • Wolfsburg, Niedersachsen, Germany, 38440
      • GSK Investigational Site
  • Nordrhein-Westfalen
    • Muenster, Nordrhein-Westfalen, Germany, 48149
      • GSK Investigational Site
  • Schleswig-Holstein
    • Kiel, Schleswig-Holstein, Germany, 24103
      • GSK Investigational Site
• Greece
  • Athens, Greece, 115 28
    • GSK Investigational Site
  • Athens, Greece, 11528
    • GSK Investigational Site
  • Athens, Greece, 12462
    • GSK Investigational Site
  • Haidari, Athens, Greece, 12462
    • GSK Investigational Site
  • Maroussi, Greece, 15123
    • GSK Investigational Site
• Israel
  • Beer Sheva, Israel, 8410101
    • GSK Investigational Site
  • Haifa, Israel, 3109601
    • GSK Investigational Site
  • Haifa, Israel, 3436212
    • GSK Investigational Site
  • Holon, Israel, 5822012
    • GSK Investigational Site
  • Petach Tikva, Israel, 4941492
    • GSK Investigational Site
  • Rehovot, Israel, 76100
    • GSK Investigational Site
• Italy
  • Bologna, Italy, 40138
    • GSK Investigational Site
  • Meldola, Italy, 47014
    • GSK Investigational Site
  • Campania
    • Napoli, Campania, Italy, 80131
      • GSK Investigational Site
  • Emilia-Romagna
    • Faenza (RA), Emilia-Romagna, Italy, 48018
      • GSK Investigational Site
    • Ravenna, Emilia-Romagna, Italy, 48100
      • GSK Investigational Site
• Netherlands
  • Amsterdam, Netherlands, 1105 AZ
    • GSK Investigational Site
  • Groningen, Netherlands, 9700 RB
    • GSK Investigational Site
  • Maastricht, Netherlands, 6229 HX
    • GSK Investigational Site
  • Nijmegen, Netherlands, 6525 GA
    • GSK Investigational Site
  • Rotterdam, Netherlands, 3015 GD
    • GSK Investigational Site
  • Utrecht, Netherlands, 3584 CX
    • GSK Investigational Site
• Norway
  • Kristiansand, Norway, 4632
    • GSK Investigational Site
  • Oslo, Norway, 0310
    • GSK Investigational Site
  • Tromso, Norway, 9019
    • GSK Investigational Site
• Poland
  • Olsztyn, Poland, 10-228
    • GSK Investigational Site
  • Szczecin, Poland, 70-111
    • GSK Investigational Site
  • Warszawa, Poland, 02-781
    • GSK Investigational Site
• Romania
  • Bucuresti, Romania, 022328
    • GSK Investigational Site
  • Cluj-Napoca, Romania, 400015
    • GSK Investigational Site
  • Cluj-Napoca, Romania, 400051
    • GSK Investigational Site
  • Constanta, Romania, 900591
    • GSK Investigational Site
  • Craiova, Romania, 200347
    • GSK Investigational Site
  • Timisoara, Romania, 300239
    • GSK Investigational Site
• Spain
  • Avila, Spain, 05071
    • GSK Investigational Site
  • Badalona, Spain, 08916
    • GSK Investigational Site
  • Barcelona, Spain, 08036
    • GSK Investigational Site
  • Girona, Spain, 17007
    • GSK Investigational Site
  • Jaén, Spain, 23007
    • GSK Investigational Site
  • Madrid, Spain, 28046
    • GSK Investigational Site
  • San Sebastian de los Reyes, Spain, 28702
    • GSK Investigational Site
  • Santiago de Compostela, Spain, 15706
    • GSK Investigational Site
  • Toledo, Spain, 45007
    • GSK Investigational Site
  • Valencia, Spain, 46010
    • GSK Investigational Site
  • Zaragoza, Spain, 50009
    • GSK Investigational Site
• Ukraine
  • Chernihiv, Ukraine, 14029
    • GSK Investigational Site
  • Kharkiv, Ukraine, 61024
    • GSK Investigational Site
  • Lviv, Ukraine, 79031
    • GSK Investigational Site
• United Kingdom
  • Bebington, Wirral, United Kingdom, CH63 4JY
    • GSK Investigational Site
  • Glasgow, United Kingdom, G12 0YN
    • GSK Investigational Site
  • London, United Kingdom, SW36JJ
    • GSK Investigational Site
  • Truro, United Kingdom, TR1 3LJ
    • GSK Investigational Site
  • Hampshire
    • Portsmouth, Hampshire, United Kingdom, PO6 3LY
      • GSK Investigational Site
  • Surrey
    • Sutton, Surrey, United Kingdom, SM2 5PT
      • GSK Investigational Site
• United States
  • Alaska
    • Anchorage, Alaska, United States, 99508
      • GSK Investigational Site
  • Arizona
    • Phoenix, Arizona, United States, 85016
      • GSK Investigational Site
    • Tucson, Arizona, United States, 85704
      • GSK Investigational Site
    • Tucson, Arizona, United States, 85710
      • GSK Investigational Site
    • Tucson, Arizona, United States, 85711
      • GSK Investigational Site
  • California
    • Los Angeles, California, United States, 90027
      • GSK Investigational Site
    • Los Angeles, California, United States, 90048
      • GSK Investigational Site
    • Newport Beach, California, United States, 92663
      • GSK Investigational Site
    • Orange, California, United States, 92868
      • GSK Investigational Site
  • Connecticut
    • Farmington, Connecticut, United States, 06030
      • GSK Investigational Site
    • Hartford, Connecticut, United States, 06102
      • GSK Investigational Site
  • Florida
    • Gainesville, Florida, United States, 32608
      • GSK Investigational Site
    • Jacksonville, Florida, United States, 32256
      • GSK Investigational Site
  • Illinois
    • Warrenville, Illinois, United States, 60555
      • GSK Investigational Site
    • Zion, Illinois, United States, 60099
      • GSK Investigational Site
  • Louisiana
    • Covington, Louisiana, United States, 70433
      • GSK Investigational Site
    • New Orleans, Louisiana, United States, 70121
      • GSK Investigational Site
    • Shreveport, Louisiana, United States, 71103
      • GSK Investigational Site
  • Maine
    • Scarborough, Maine, United States, 04074
      • GSK Investigational Site
  • Maryland
    • Baltimore, Maryland, United States, 21201
      • GSK Investigational Site
    • Silver Spring, Maryland, United States, 20910
      • GSK Investigational Site
    • Silver Spring, Maryland, United States, 20902
      • GSK Investigational Site
  • Massachusetts
    • Boston, Massachusetts, United States, 02215
      • GSK Investigational Site
    • Springfield, Massachusetts, United States, 01199
      • GSK Investigational Site
    • Worcester, Massachusetts, United States, 01605
      • GSK Investigational Site
  • Minnesota
    • Maplewood, Minnesota, United States, 55109
      • GSK Investigational Site
    • Minneapolis, Minnesota, United States, 55404
      • GSK Investigational Site
    • Minneapolis, Minnesota, United States, 55455
      • GSK Investigational Site
  • Montana
    • Billings, Montana, United States, 59101
      • GSK Investigational Site
  • New Jersey
    • Neptune, New Jersey, United States, 07753
      • GSK Investigational Site
    • Teaneck, New Jersey, United States, 07666
      • GSK Investigational Site
  • New York
    • Hawthorne, New York, United States, 10532
      • GSK Investigational Site
    • New York, New York, United States, 10032
      • GSK Investigational Site
    • New York, New York, United States, 10065
      • GSK Investigational Site
    • New York, New York, United States, 10016
      • GSK Investigational Site
    • New York, New York, United States, 10029
      • GSK Investigational Site
    • Rochester, New York, United States, 14620-4159
      • GSK Investigational Site
    • Stony Brook, New York, United States, 11794
      • GSK Investigational Site
    • Syracuse, New York, United States, 13210
      • GSK Investigational Site
  • North Carolina
    • Charlotte, North Carolina, United States, 28204
      • GSK Investigational Site
  • Ohio
    • Canton, Ohio, United States, 44710
      • GSK Investigational Site
    • Cincinnati, Ohio, United States, 45219
      • GSK Investigational Site
  • Oklahoma
    • Oklahoma City, Oklahoma, United States, 73104
      • GSK Investigational Site
  • Oregon
    • Eugene, Oregon, United States, 97401
      • GSK Investigational Site
    • Portland, Oregon, United States, 97227
      • GSK Investigational Site
    • Tualatin, Oregon, United States, 97062
      • GSK Investigational Site
  • Pennsylvania
    • Abington, Pennsylvania, United States, 19001-3788
      • GSK Investigational Site
    • Paoli, Pennsylvania, United States, 19301
      • GSK Investigational Site
    • Philadelphia, Pennsylvania, United States, 19111
      • GSK Investigational Site
    • Pittsburgh, Pennsylvania, United States, 15232
      • GSK Investigational Site
    • Pittsburgh, Pennsylvania, United States, 15224
      • GSK Investigational Site
    • Wynnewood, Pennsylvania, United States, 19096
      • GSK Investigational Site
  • Rhode Island
    • Providence, Rhode Island, United States, 02905
      • GSK Investigational Site
  • South Carolina
    • Charleston, South Carolina, United States, 29425
      • GSK Investigational Site
  • South Dakota
    • Sioux Falls, South Dakota, United States, 57105
      • GSK Investigational Site
  • Tennessee
    • Knoxville, Tennessee, United States, 37920
      • GSK Investigational Site
    • Nashville, Tennessee, United States, 37203
      • GSK Investigational Site
    • Nashville, Tennessee, United States, 37205
      • GSK Investigational Site
  • Texas
    • Austin, Texas, United States, 78731
      • GSK Investigational Site
    • Dallas, Texas, United States, 75246
      • GSK Investigational Site
    • Fort Worth, Texas, United States, 76104
      • GSK Investigational Site
    • Houston, Texas, United States, 77030
      • GSK Investigational Site
    • San Antonio, Texas, United States, 78240
      • GSK Investigational Site
    • The Woodlands, Texas, United States, 77380
      • GSK Investigational Site
    • Tyler, Texas, United States, 75702
      • GSK Investigational Site
  • Utah
    • Ogden, Utah, United States, 84405
      • GSK Investigational Site
  • Virginia
    • Charlottesville, Virginia, United States, 22903
      • GSK Investigational Site
    • Hampton, Virginia, United States, 23666
      • GSK Investigational Site
    • Newport News, Virginia, United States, 23606
      • GSK Investigational Site
    • Norfolk, Virginia, United States, 23502
      • GSK Investigational Site
  • Washington
    • Kennewick, Washington, United States, 99336
      • GSK Investigational Site
    • Seattle, Washington, United States, 98104
      • GSK Investigational Site
    • Seattle, Washington, United States, 98109
      • GSK Investigational Site
    • Vancouver, Washington, United States, 98684
      • GSK Investigational Site

Participation Criteria

Eligibility Criteria

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

Description

Inclusion criteria:

• Participants must be female, >=18 years of age, able to understand the study procedures, and agree to participate in the study by providing written informed consent.
• Participants with a histologically confirmed diagnosis of high-grade nonmucinous epithelial ovarian (serous, endometrioid, clear cell, carcinosarcoma, and mixed pathologies), fallopian tube, or peritoneal cancer that is Stage III or IV according to the International Federation of Gynecology and Obstetrics (FIGO) or tumor, node and metastasis staging criteria.
• All participants with Stage IV disease are eligible. This includes those with inoperable disease, those who undergo primary debulking surgery (PDS) (R0 or macroscopic disease), or those for whom neoadjuvant chemotherapy (NACT) is planned.
• Participants with Stage III are eligible if they meet protocol defined criteria.
• Participants must provide a blood sample for circulating tumor deoxyribonucleic acid (ctDNA) homologous recombinant repair (HRR) testing at pre-screening or screening.
• Participant must provide a minimum of 1 formalin-fixed paraffin embedded (FFPE) block slide at pre-screening or screening for PD-L1, homologous recombinant deficiency (HRD) testing.
• Participants of childbearing potential must have a negative serum or urine pregnancy test (beta human chorionic gonadotropin) within 3 days prior to receiving the first dose of study treatment.
• Participants must be postmenopausal, free from menses for >1 year, surgically sterilized, or willing to use highly effective contraception to prevent pregnancy or must agree to abstain from activities that could result in pregnancy throughout the study, starting with enrollment through 180 days after the last dose of study treatment.
• Participants must have adequate organ function: Absolute neutrophil count (ANC) >=1500/micro liter (μL;) Platelet count >=100000/μL; Hemoglobin >=9 grams per deciliter (g/dL); Serum creatinine <=1.5 × upper limit of normal (ULN) or calculated creatinine clearance >=60 milliliters per minute (mL/min) using the Cockcroft-Gault equation; total bilirubin <=1.5 × ULN or direct bilirubin <=1.5 × ULN; AST and ALT <=2.5 × ULN unless liver metastases are present, in which case they must be <=5 × ULN.
• Participants must have an ECOG score of 0 or 1.
• Participants must have normal blood pressure (BP) or adequately treated and controlled hypertension (systolic BP <=140 millimeters of mercury (mmHg) and/or diastolic BP <=90 mmHg).
• Participants must agree to complete health related quality of life (HRQoL) questionnaires throughout the study.
• Participants must be able to take oral medication.

Exclusion Criteria:

• Participant has mucinous, germ cell, transitional cell, or undifferentiated tumor.
• Participant has low-grade or Grade 1 epithelial ovarian cancer.
• Participant has not adequately recovered from prior major surgery.
• Participant is pregnant or is expecting to conceive children while receiving study drug or for up to 180 days after the last dose of study drug. Participant is breastfeeding or is expecting to breastfeed within 30 days of receiving the final dose of study drug (women should not breastfeed or store breastmilk for use, during niraparib treatment and for 30 days after receiving the final dose of study treatment).
• Participant has known active central nervous system metastases, carcinomatous meningitis, or both.
• Participant has clinically significant cardiovascular disease.
• Participant has a bowel obstruction by clinical symptoms or computed tomography (CT) scan, subocclusive mesenteric disease, abdominal or gastrointestinal fistula, gastrointestinal perforation, or intra-abdominal abscess.
• Participant has any known history or current diagnosis of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML).
• Participant has been diagnosed and/or treated with any therapy for invasive cancer <5 years from study enrollment, completed adjuvant chemotherapy and/or targeted therapy (example, trastuzumab) less than 3 years from enrollment, or completed adjuvant hormonal therapy less than 4 weeks from enrollment.
• Participants with definitively treated non-invasive malignancies such as cervical carcinoma in situ, ductal carcinoma in situ, Grade 1 or 2, Stage I endometrial cancer, or non-melanomatous skin cancer are allowed.
• Participant is at increased bleeding risk due to concurrent conditions (example, major injuries or major surgery within the past 28 days prior to start of study treatment and/or history of hemorrhagic stroke, transient ischemic attack, subarachnoid hemorrhage, or clinically significant hemorrhage within the past 3 months).
• Participant is immunocompromised.
• Participant has known active hepatitis B (example, hepatitis B surface antigen reactive) or hepatitis C (example, hepatitis C virus ribonucleic acid [qualitative] is detected).
• Participant is considered a poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease, or uncontrolled infection.
• Participant has had investigational therapy administered within 4 weeks or within a time interval less than at least 5 half-lives of the investigational agent, whichever is longer, prior to the first scheduled day of dosing in this study.
• Participant has received a live vaccine within 14 days of planned start of study therapy. Seasonal influenza vaccines that do not contain live viruses are allowed.
• Participant has a known contraindication or uncontrolled hypersensitivity to the components of paclitaxel, carboplatin, niraparib, bevacizumab, dostarlimab, or their excipients.
• Prior treatment for high-grade nonmucinous epithelial ovarian, fallopian tube, or peritoneal cancer (immunotherapy, anti-cancer therapy, radiation therapy).
• Participant has an active autoimmune disease that has required systemic treatment in the past 2 years. Replacement therapy is not considered a form of systemic therapy (example, thyroid hormone or insulin).
• Participant has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of systemic immunosuppressive therapy within 7 days prior to the first dose of study treatment.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Participants receiving SOC+placebo; Participants in this arm will receive SOC (carboplatin+paclitaxel+/-bevacizumab) in cycle 1 (each cycle is of 21 days) followed by SOC with chemotherapy treatment with dostarlimab placebo from cycles 2 to 6 and maintenance treatment of +/-bevacizumab along with niraparib placebo and dostarlimab placebo.	Drug: Standard of care; Participants will receive SOC that includes paclitaxel 175 milligrams per square meter (mg/m^2) on day 1 every 21 days + carboplatin area under the curve (AUC) of 5 to 6 milligrams per milliliter per minute (mg/mL/min) on day 1 every 21 days +/- bevacizumab 7.5 milligrams per kilograms (mg/kg) every 21 days or 15 mg/kg every 21 days for a total of 15 months.; Drug: Dostarlimab-Placebo; Participants will receive 1000 mg of dostarlimab-placebo on day 1 every 6 weeks to continue up to 3 years in the absence of disease progression, unacceptable toxicity, participant withdrawal, or investigator decision; Drug: Niraparib-Placebo; Participants will receive oral capsules of niraparib-placebo as a unit dosage strength of 100 mg.
Active Comparator: Participants receiving SOC+niraparib; Participants in this arm will receive SOC in cycle 1 (each cycle is of 21 days) followed by SOC with chemotherapy treatment dostarlimab placebo from cycles 2 to 6 and maintenance treatment of +/- bevacizumab with niraparib and dostarlimab placebo.	Drug: Standard of care; Participants will receive SOC that includes paclitaxel 175 milligrams per square meter (mg/m^2) on day 1 every 21 days + carboplatin area under the curve (AUC) of 5 to 6 milligrams per milliliter per minute (mg/mL/min) on day 1 every 21 days +/- bevacizumab 7.5 milligrams per kilograms (mg/kg) every 21 days or 15 mg/kg every 21 days for a total of 15 months.; Drug: Dostarlimab-Placebo; Participants will receive 1000 mg of dostarlimab-placebo on day 1 every 6 weeks to continue up to 3 years in the absence of disease progression, unacceptable toxicity, participant withdrawal, or investigator decision; Drug: Niraparib; Participants will receive oral capsules of niraparib as a unit dosage strength of 100 milligrams (mg).; Other Names: ZEJULA
Experimental: Participants receiving SOC+dostarlimab+niraparib; Participants in this arm will receive SOC in cycle 1 (each cycle is of 21 days) followed by SOC with chemotherapy treatment dostarlimab, and maintenance treatment of +/-bevacizumab with niraparib and dostarlimab.	Drug: Dostarlimab (TSR-042); Participants will receive 30 minutes intravenous (IV) infusions of 1000 mg dostarlimab on Day 1 every 6 weeks.; Drug: Standard of care; Participants will receive SOC that includes paclitaxel 175 milligrams per square meter (mg/m^2) on day 1 every 21 days + carboplatin area under the curve (AUC) of 5 to 6 milligrams per milliliter per minute (mg/mL/min) on day 1 every 21 days +/- bevacizumab 7.5 milligrams per kilograms (mg/kg) every 21 days or 15 mg/kg every 21 days for a total of 15 months.; Drug: Niraparib; Participants will receive oral capsules of niraparib as a unit dosage strength of 100 milligrams (mg).; Other Names: ZEJULA

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PFS for PD-L1 positive participants	To compare the PFS of PD-L1 positive participants with Stage III or IV non-mucinous epithelial ovarian cancer given first-line treatment with the combination of dostarlimab with SOC chemotherapy +/- bevacizumab followed by niraparib and dostarlimab maintenance +/- bevacizumab versus SOC chemotherapy +/- bevacizumab followed by niraparib maintenance +/- bevacizumab. PFS is defined as the time from treatment randomization to the earlier date of assessment of progression or death by any cause in the absence of progression. PFS will be evaluated by investigator assessment per Response Evaluation Criteria in Solid Tumors (RECIST) version (v.) 1.1 criteria.	Up to 5 years
PFS for all participants	To compare the PFS of all participants with Stage III or IV high-grade nonmucinous epithelial ovarian cancer given first-line treatment with the combination of dostarlimab with SOC chemotherapy +/- bevacizumab followed by niraparib and dostarlimab maintenance +/- bevacizumab versus SOC chemotherapy +/- bevacizumab followed by niraparib maintenance +/- bevacizumab. PFS is defined as the time from treatment randomization to the earlier date of assessment of progression or death by any cause in the absence of progression. PFS will be evaluated by investigator assessment per RECIST v.1.1 criteria.	Up to 5 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of PD-L1 positive participants with treatment-emergent adverse events (TEAEs)	TEAEs are defined as, any event that was not present prior to the initiation of study treatment or any event already present that worsens in either intensity or frequency following exposure to study treatment.	Up to 5 years
Number of overall participants with TEAEs	TEAEs are defined as, any event that was not present prior to the initiation of study treatment or any event already present that worsens in either intensity or frequency following exposure to study treatment.	Up to 5 years
Number of PD-L1 positive participants with serious adverse events (SAEs)	SAEs are any adverse event that may result in death, is life threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability or incapacity, is a congenital abnormality or birth defect, is an important medical event.	Up to 5 years
Number of overall participants with SAEs	SAEs are any adverse event that may result in death, is life threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability or incapacity, is a congenital abnormality or birth defect, is an important medical event.	Up to 5 years
Number of PD-L1 positive participants with treatment discontinuations or dose delays or dose reductions due to adverse events	Adverse events are any untoward medical occurrence that occurs in a participant or clinical investigation participant administered a medicinal product and which does not necessarily have to have a causal relationship with this treatment.	Up to 5 years
Number of PD-L1 positive participants with abnormal hematology results	Blood samples will be collected for the analysis of hematologic parameters including: hemoglobin, platelet count, white blood cell count, differential white blood cell count, coagulation factors-International normalized ratio (INR) and activated partial thromboplastin time.	Up to 5 years
Number of all the participants with abnormal hematology results	Blood samples will be collected for the analysis of hematologic parameters including: hemoglobin, platelet count, white blood cell count, differential white blood cell count, coagulation factors-INR and activated partial thromboplastin time.	Up to 5 years
Pathologic complete response (pCR) rate among PD-L1 positive participants	pCR rate, per investigator assessment, defined as the rate of pathologic complete responseas assessed by the evaluation of residual microscopic disease at the time of surgery in neoadjuvant participants.	Up to 5 years
pCR rate among all the participants	pCR rate, per investigator assessment, defined as the rate of pathologic complete responseas assessed by the evaluation of residual microscopic disease at the time of surgery in neoadjuvant participants.	Up to 5 years
PFS by Blinded Independent Central Review (BICR) per investigator-assessed Response Evaluation Criteria in Solid Tumors (RECIST) criteria for PD-L1 positive participants	BICR determined PFS will be assessed as per RECIST criteria.	Up to 5 years
Overall Survival (OS) of PD-L1 positive participants	OS is defined as the date of randomization to the date of death by any cause.	Up to 5 years
OS of all the participants	OS is defined as the date of randomization to the date of death by any cause.	Up to 5 years
Number of overall participants with treatment discontinuations or dose delays or dose reductions due to adverse events	Adverse events are any untoward medical occurrence that occurs in a participant or clinical investigation participant administered a medicinal product and which does not necessarily have to have a causal relationship with this treatment.	Up to 5 years
Number of PD-L1 positive participants with immune-related adverse events (irAEs)	Following events are categorized as irAEs: Diarrhea/colitis, aspartate aminotransferase (AST) or alanine aminotransferase (ALT; >3 and <=5 X upper limit of normal [ULN]), or increased bilirubin, type 1 diabetes mellitus (T1DM) or hyperglycemia, immune-related encephalitis, uveitis, myositis, hypophysitis, adrenal insufficiency, hypo- and hyperthyroidism, infusion-related reaction, pneumonitis, immune-related rash, renal failure or nephritis and recurrence of adverse events after resolution to Grade <=1.	Up to 5 years
Number of overall participants with irAEs	Following events are categorized as irAEs: Diarrhea/colitis, AST or ALT (>3 and <=5 X ULN), or increased bilirubin, T1DM or hyperglycemia, immune-related encephalitis, uveitis, myositis, hypophysitis, adrenal insufficiency, hypo- and hyperthyroidism, infusion-related reaction, pneumonitis, immune-related rash, renal failure or nephritis and recurrence of AEs after resolution to Grade <=1.	Up to 5 years
Number of PD-L1 positive participants with changes in Eastern Cooperative Oncology Group (ECOG) performance status	Performance status will be assessed using the ECOG performance status scale: ranging from Grade 0 to 5, Grade 0 denoting fully active and Grade 5 denoting death.	Up to 5 years
Number of overall participants with changes in ECOG performance status	Performance status will be assessed using the ECOG performance status scale: ranging from Grade 0 to 5, Grade 0 denoting fully active and Grade 5 denoting death.	Up to 5 years
Number of PD-L1 positive participants with abnormal clinical chemistry results	Blood samples will be collected for the analysis of clinical chemistry parameters including: amylase, thyroid function (thyroid stimulating hormone [TSH]), urea or blood urea nitrogen, creatinine, albumin, total protein, ALT, AST, total bilirubin, Glucose, Magnesium, Calcium, Chloride, Potassium and Sodium.	Up to 5 years
Number of all the participants with abnormal clinical chemistry results	Blood samples will be collected for the analysis of clinical chemistry parameters including: amylase, thyroid function (TSH), urea or blood urea nitrogen, creatinine, albumin, total protein, ALT, AST, total bilirubin, Glucose, Magnesium, Calcium, Chloride, Potassium and Sodium.	Up to 5 years
Change from Baseline in the European Quality of Life 5-Dimension 5-Level Scale (EQ-5D-5L) assessment among PD-L1 positive participants	EQ-5D-5L is a validated questionnaire to assess the overall health-related quality of life in participants across diseases. EQ-5D-5L consists of a descriptive section of 5 questions/dimensions, one related to each of: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension is measured by 5-point Likert scale (no problems, slight problems, moderate problems, severe problems and extreme problems).	Baseline and up to 5 years
Change from Baseline in the EQ-5D-5L assessment among all participants	EQ-5D-5L is a validated questionnaire to assess the overall health-related quality of life in participants across diseases. EQ-5D-5L consists of a descriptive section of 5 questions/dimensions, one related to each of: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension is measured by 5-point Likert scale (no problems, slight problems, moderate problems, severe problems and extreme problems).	Baseline and up to 5 years
Change from Baseline in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC-QLQ-C30) assessment among PD-L1 positive participants	EORTC QLQ-C30 is a validated questionnaire to assess the overall health-related quality of life in participants with cancer and is composed of 30 questions including multi-item scales and single item measures. These include five functional scales (physical, role, emotional, cognitive and social), three symptom scales (fatigue, nausea/vomiting, and pain), a global health status/quality of life scale (GHS/QOL), and six single items (dyspnoea, insomnia, appetite loss, constipation, diarrhea and financial difficulties). Response options are 1 to 4. Higher score indicates better health-related quality of life.	Baseline and Up to 5 years
Change from Baseline in the EORTC-QLQ-C30 assessment among all the participants	EORTC QLQ-C30 is a validated questionnaire to assess the overall health-related quality of life in participants with cancer and is composed of 30 questions including multi-item scales and single item measures. These include five functional scales (physical, role, emotional, cognitive and social), three symptom scales (fatigue, nausea/vomiting, and pain), a GHS/QOL, and six single items (dyspnoea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Response options are 1 to 4. Higher score indicates better health-related quality of life.	Baseline and up to 5 years
Change from Baseline in the EORTC-QLQ Ovarian Cancer Module OV28 (EORTC-QLQ-OV28) assessment among PD-L1 positive participants	EORTC QLQ-OV28 is a validated questionnaire to assess the overall health-related quality of life in participants with local or advanced ovarian cancer. EORTC QLQ-OV28 consists of 28 questions evaluated across eight multi-item and 4 single item scales: abdominal/ gastrointestinal (GI) symptoms, peripheral neuropathy, hormonal symptoms, body image, attitude to disease/treatment, chemotherapy side effects, and sexuality, and single items scales for indigestion/heartburn, hair loss, upset due to hair loss, and taste. All questions are rated on a 4 point verbal rating scale: "Not at all," "A little," "Quite a bit," and "Very much."	Baseline and up to 5 years
Change from Baseline in the EORTC-QLQ-OV28 assessment among all the participants	EORTC QLQ-OV28 is a validated questionnaire to assess the overall health-related quality of life in all the participants with local or advanced ovarian cancer. EORTC QLQ-OV28 consists of 28 questions evaluated across eight multi-item and 4 single item scales: abdominal/GI symptoms, peripheral neuropathy, hormonal symptoms, body image, attitude to disease/treatment, chemotherapy side effects, and sexuality, and single items scales for indigestion/heartburn, hair loss, upset due to hair loss, and taste. All questions are rated on a 4 point verbal rating scale: "Not at all," "A little," "Quite a bit," and "Very much."	Baseline and up to 5 years
Time to symptom worsening in the EQ-5D-5L assessment among the PD-L1 positive participants	EQ-5D-5L is a validated questionnaire to assess the overall health-related quality of life in participants across diseases. EQ-5D-5L consists of a descriptive section of 5 questions/dimensions, one related to each of: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension is measured by 5-point Likert scale (no problems, slight problems, moderate problems, severe problems and extreme problems).	Up to 5 years
Time to symptom worsening in the EQ-5D-5L assessment among all the participants	EQ-5D-5L is a validated questionnaire to assess the overall health-related quality of life in participants across diseases. EQ-5D-5L consists of a descriptive section of 5 questions/dimensions, one related to each of: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension is measured by 5-point Likert scale (no problems, slight problems, moderate problems, severe problems and extreme problems).	Up to 5 years
Time to symptom worsening in the EORTC-QLQ-C30 assessment among the PD-L1 positive participants	EORTC QLQ-C30 is a validated questionnaire to assess the overall health-related quality of life in participants with cancer and is composed of 30 questions including multi-item scales and single item measures. These include five functional scales (physical, role, emotional, cognitive and social), three symptom scales (fatigue, nausea/vomiting, and pain), a GHS/QOL, and six single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Response options are 1 to 4. Higher score indicates better health-related quality of life.	Up to 5 years
Time to symptom worsening in the EORTC QLQ-C30 assessment among all the participants	EORTC QLQ-C30 is a validated questionnaire to assess the overall health-related quality of life in participants with cancer and is composed of 30 questions including multi-item scales and single item measures. These include five functional scales (physical, role, emotional, cognitive and social), three symptom scales (fatigue, nausea/vomiting, and pain), a GHS/QOL, and six single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Response options are 1 to 4. Higher score indicates better health-related quality of life.	Up to 5 years
Time to symptom worsening in the EORTC-QLQ-OV28 assessment among the PD-L1 positive participants	EORTC QLQ-OV28 is a validated questionnaire to assess the overall he PFS2, health-related quality of life in participants with local or advanced ovarian cancer. EORTC QLQ-OV28 consists of 28 questions evaluated across eight multi-item and 4 single item scales: abdominal/GI symptoms, peripheral neuropathy, hormonal symptoms, body image, attitude to disease/treatment, chemotherapy side effects, and sexuality, and single items scales for indigestion/heartburn, hair loss, upset due to hair loss, and taste. All questions are rated on a 4 point verbal rating scale: "Not at all," "A little," "Quite a bit," and "Very much."	Up to 5 years
Time to symptom worsening in the EORTC-QLQ-OV28 assessment among all the participants	EORTC QLQ-OV28 is a validated questionnaire to assess the overall he PFS2, health-related quality of life in participants with local or advanced ovarian cancer. EORTC QLQ-OV28 consists of 28 questions evaluated across eight multi-item and 4 single item scales: abdominal/GI symptoms, peripheral neuropathy, hormonal symptoms, body image, attitude to disease/treatment, chemotherapy side effects, and sexuality, and single items scales for indigestion/heartburn, hair loss, upset due to hair loss, and taste. All questions are rated on a 4 point verbal rating scale: "Not at all," "A little," "Quite a bit," and "Very much."	Up to 5 years
Time to first subsequent therapy (TFST) in PD-L1 positive participants	TFST is defined as the time from randomization until the start date of the first subsequent anti-cancer therapy or death, whichever occurs first.	Up to 5 years
TFST in all the participants	TFST is defined as the time from randomization until the start date of the first subsequent anti-cancer therapy or death, whichever occurs first.	Up to 5 years
Time to second subsequent therapy (TSST) in PD-L1 positive participants	TSST is defined as the time from randomization until the start date of the second subsequent anti-cancer therapy or death, whichever occurs first.	Up to 5 years
TSST in all the participants	TSST is defined as the time from randomization until the start date of the second subsequent anti-cancer therapy or death, whichever occurs first.	Up to 5 years
Time to progression on next-line therapy (PFS2,) in PD-L1 positive participants	PFS2 is defined as the time from randomization until PD per investigator's assessment after starting follow-up anti-cancer therapy or death due to any cause, whichever occurs first.	Up to 5 years
PFS2 in all the participants	PFS2 is defined as the time from randomization until PD per investigator's assessment after starting follow-up anti-cancer therapy or death due to any cause, whichever occurs first.	Up to 5 years
Objective Response Rate (ORR) among PD-L1 positive participants	ORR, defined as the percentage of participants with complete response (CR) or partial response (PR) on study treatment as assessed by RECIST v.1.1 criteria for participants with measurable disease.	Up to 5 years
ORR among all the participants	ORR, defined as the percentage of participants with complete response (CR) or partial response (PR) on study treatment as assessed by RECIST v.1.1 criteria for participants with measurable disease.	Up to 5 years
Duration of response (DOR) in PD-L1 positive participants	DOR, defined as the time from first documentation of CR or PR until the time of first documentation of PD as assessed by RECIST v.1.1, or death by any cause in the absence of progression, whichever occurs first.	Up to 5 years
DOR in all the participants	DOR, defined as the time from first documentation of CR or PR until the time of first documentation of PD as assessed by RECIST v.1.1, or death by any cause in the absence of progression, whichever occurs first.	Up to 5 years
Disease control rate (DCR) in PD-L1 positive participants	DCR, defined as the proportion of participants with a best overall response of CR, PR, or stable disease (SD), as assessed by RECIST v.1.1 criteria.	Up to 5 years
DCR in all the participants	DCR, defined as the proportion of participants with a best overall response of CR, PR, or SD, as assessed by RECIST v.1.1 criteria.	Up to 5 years
Maintenance progression-free survival (MPFS) in PD-L1 positive participants	MPFS, defined as the time from the date of the first maintenance period dose to the date of first documentation of progression or death by any cause in the absence of progression, whichever occurs first, as determined by the investigator. Progression will be assessed by RECIST v.1.1 criteria.	Up to 5 years
MPFS in all the participants	MPFS, defined as the time from the date of the first maintenance period dose to the date of first documentation of progression or death by any cause in the absence of progression, whichever occurs first, as determined by the investigator. Progression will be assessed by RECIST v.1.1 criteria.	Up to 5 years
Plasma concentration of dostarlimab in PD-L1 positive participants	Blood samples will be collected for pharmacokinetic analysis of dostarlimab.	Up to 5 years
Plasma concentration of dostarlimab in all the participants	Blood samples will be collected for pharmacokinetic analysis of dostarlimab.	Up to 5 years
Number of participants with positive antidrug antibodies (ADAs) against dostarlimab in PD-L1 positive participants	Serum samples will be collected for the analysis of the presence of ADAs using validated immunoassays.	Up to 5 years
Number of participants with positive ADAs against dostarlimab in all the participants	Serum samples will be collected for the analysis of the presence of ADAs using validated immunoassays.	Up to 5 years
Plasma concentration of niraparib in PD-L1 positive participants	Blood samples will be collected for pharmacokinetic analysis of niraparib.	Up to 5 years
Plasma concentration of niraparib in all the participants	Blood samples will be collected for pharmacokinetic analysis of niraparib.	Up to 5 years

Collaborators and Investigators

• Sponsor: Tesaro, Inc.
• Collaborators: European Network of Gynaecological Oncological Trial Groups (ENGOT)
• Investigators: Study Director: GSK Clinical Trials, GlaxoSmithKline

Study record dates

Study Major Dates

• Study Start (Actual): October 11, 2018
• Primary Completion (Estimated): March 29, 2024
• Study Completion (Estimated): June 22, 2026

Study Registration Dates

• First Submitted: June 28, 2018
• First Submitted That Met QC Criteria: July 18, 2018
• First Posted (Actual): July 27, 2018

Study Record Updates

• Last Update Posted (Actual): August 2, 2023
• Last Update Submitted That Met QC Criteria: July 31, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Keywords: Ovarian cancer; Niraparib; FIRST; FIRST trial; Dostarlimab (TSR-042)
• Additional Relevant MeSH Terms: Neoplasms by Histologic Type; Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Carcinoma; Neoplasms, Glandular and Epithelial; Genital Neoplasms, Female; Endocrine System Diseases; Ovarian Diseases; Adnexal Diseases; Gonadal Disorders; Endocrine Gland Neoplasms; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Diseases; Genital Diseases, Female; Ovarian Neoplasms; Carcinoma, Ovarian Epithelial; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Poly(ADP-ribose) Polymerase Inhibitors; Niraparib; Dostarlimab
• Other Study ID Numbers: 213350; 3000-03-005 (Other Identifier: Tesaro)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No