Talazoparib and Low-Dose Temozolomide in Treating Participants With Relapsed or Refractory Extensive-Stage Small Cell Lung Cancer

A Phase 2 Study of Continuous Talazoparib Plus Intermittent Low-Dose Temozolomide in Patients With Relapsed or Refractory Extensive-Stage Small Cell Lung Cancer (TRIO-US L-07)

This phase II trial studies how effective talazoparib and temozolomide are for treating participants with extensive-stage small cell lung cancer that has come back after an initial chemotherapy treatment. Talazoparib, a PARP inhibitor, may stop the growth of tumor cells by preventing them from repairing their DNA. Chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving talazoparib and temozolomide may work better in treating participants with extensive-stage small cell lung cancer than either one alone.

Study Overview

• Status: Recruiting
• Conditions: Recurrent Extensive Stage Small Cell Lung Carcinoma; Refractory Extensive Stage Small Cell Lung Carcinoma
• Intervention / Treatment: Drug: Temozolomide; Drug: Talazoparib

Detailed Description

PRIMARY OBJECTIVES:

I. Evaluate the efficacy of talazoparib in combination with temozolomide as measured by objective response rate (ORR).

SECONDARY OBJECTIVES:

I. To evaluate the efficacy of talazoparib plus temozolomide as measured by progression-free survival (PFS), overall survival, duration of response, and time to response.

II. To evaluate the safety, tolerability of talazoparib plus temozolomide. III. To evaluate the pharmacokinetics of talazoparib when given in combination with temozolomide.

IV. To evaluate patient reported outcomes per the Patient Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE).

EXPLORATORY OBJECTIVES:

I. To identify potential biomarkers associated with response to study drug treatment.

OUTLINE:

Participants receive temozolomide orally (PO) on days 1-5 and talazoparib PO once daily (QD) on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, participants are followed up at 30 days and then up to 1 year.

• Study Type: Interventional
• Enrollment (Estimated): 28
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: TRIO-US IST Team; Phone Number: 888-798-0719; Email: ISTTeam@mednet.ucla.edu

Study Locations

• United States
  • California
    • Bakersfield, California, United States, 93309
      • Recruiting
      • CBCC Global Research, Inc. at Comprehensive Blood and Cancer Center
      • Contact: David Kanamori, MD; Phone Number: 661-622-2206
      • Principal Investigator: David Kanamori, MD
    • Fullerton, California, United States, 92835
      • Recruiting
      • St. Joseph Heritage Healthcare
      • Contact: William E. Lawler, MD; Phone Number: 714-446-5841
      • Principal Investigator: William E. Lawler, MD
    • Los Angeles, California, United States, 90095
      • Recruiting
      • UCLA / Jonsson Comprehensive Cancer Center
      • Contact: TRIO-US IST Team; Phone Number: 888-798-0719
      • Principal Investigator: Jonathan W. Goldman
  • Florida
    • Orlando, Florida, United States, 32806
      • Recruiting
      • Orlando Health, Inc. d/b/a Orlando Health UF Health Center
      • Contact: Tirrell Tremayne Johnson, MD; Phone Number: 401-648-3800
      • Principal Investigator: Tirrell Tremayne Johnson, MD
  • Indiana
    • Fort Wayne, Indiana, United States, 46804
      • Recruiting
      • Ft. Wayne Medical Oncology and Hematology, Inc.
      • Principal Investigator: Sunil Babu, MD
      • Contact: Sunil Babu, MD; Phone Number: 260-484-8830
  • Kansas
    • Wichita, Kansas, United States, 67214
      • Recruiting
      • Cancer Center of Kansas
      • Principal Investigator: Shaker Dakhil, MD
      • Contact: Shaker Dakhil, MD; Phone Number: 316-262-4467

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Able to provide informed consent.
• Cytologically or histologically confirmed small cell lung cancer (SCLC) with extensive-stage disease.
• Relapsed (progressed within 6 months) or refractory (progressed during or within 4 weeks of completing 1st line platinum based regimen).
• Measurable disease, as per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.
• Archival or fresh tissue biopsy available for exploratory analyses.
• Eastern Cooperative Oncology Group (ECOG) performance status of =< 1.
• Able to swallow the study drugs, has no known intolerance to study drugs or excipients, and able to comply with study requirements.
• Female participants of childbearing potential must have a negative pregnancy test at screening and must agree to use a highly effective birth control method (defined in protocol) from the time of the first study drug treatment through 45 days after the last study drug treatment.
• Male participants must use a condom when having sex from the time of the first study drug treatment through 105 days after the last study drug treatment. Contraception should be considered for a non-pregnant female partner of childbearing potential.
• Male and female participants must agree not to donate sperm or eggs, respectively, from the first study drug treatment through 105 days and 45 days after the last study drug treatment, respectively.
• Female participants may not be breastfeeding at baseline through 45 days after the last study drug treatment.
• Absolute neutrophil count (ANC) >= 1,500/mcL
• Platelets >= 100,000/mcL
• Hemoglobin >= 9 g/dL or >= 5.6 mmol/L without transfusion or erythropoietin (EPO) dependency (within 7 days of assessment)
• Glomerular filtration rate (by Cockroft-Gault or equivalent estimation) >= 30 mL/min
• Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 X ULN OR =< 5 X ULN for participants with liver metastases
• Serum total bilirubin =< 1.5 X upper limit or normal (ULN) OR direct bilirubin =< ULN for participants with total bilirubin levels > 1.5 ULN
• International normalized ratio (INR) or prothrombin time (PT) =< 1.5 X ULN unless participant is receiving anticoagulant therapy, as long as PT or partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants
• Activated partial thromboplastin time (aPTT) =< 1.5 X ULN unless participant is receiving anticoagulant therapy, as long as PT or PTT is within therapeutic range of intended use of anticoagulants

Exclusion Criteria:

• Has not recovered (recovery is defined as Common Terminology Criteria for Adverse Events (CTCAE) version (v)4 grade =< 1 or return to baseline) from the acute toxicities of previous therapy, except treatment-related alopecia or laboratory abnormalities otherwise meeting eligibility requirements.
• Best response of progressive disease per RECIST 1.1 to first-line platinum doublet chemotherapy.

• Has received more than 1 line of cytotoxic therapy

  • Prior immunotherapy and targeted therapies (including rovalpituzumab tesirine) are allowed.
• Prior treatment with a PARP inhibitor (not including iniparib) or temozolomide.
• Use of antineoplastic therapies within 14 days before study treatment initiation.
• Use of any other investigational agent within 14 days before study treatment initiation.

• Received radiation therapy within 14 day before study treatment initiation (single fraction palliative radiotherapy is allowed without a washout).

  • Prior thoracic irradiation and prophylactic cranial irradiation are allowed.
• Major surgery within 14 days before study treatment initiation.
• Diagnosis of myelodysplastic syndrome (MDS).
• Gastrointestinal disorder affecting absorption.
• Current or anticipated use of a prohibited P-gp inhibitor or P-gp inducer or BCRP inhibitors.
• History of another cancer within 2 years before study treatment initiation, with the exception of fully treated cancers unlikely to affect the assessment of the study treatment safety or efficacy including early stage breast, prostate, nonmelanomatous skin, thyroid, cervix and endometrial cancer.
• Any condition (concurrent disease, infection, or comorbidity) that interferes with ability to participate in the study, causes undue risk, or complicates the interpretation of safety data, in the opinion of the investigator.

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: Treatment (temozolomide, talazoparib); Participants receive temozolomide PO on days 1-5 and talazoparib PO QD on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.	Drug: Temozolomide; Given PO; Other Names: Temodar; SCH 52365; Temodal; Temcad; Methazolastone; RP-46161; Temomedac; CCRG-81045; Imidazo[5,1-d]-1,2,3,5-tetrazine-8-carboxamide, 3, 4-dihydro-3-methyl-4-oxo-; M & B 39831; M and B 39831; Drug: Talazoparib; Given PO; Other Names: BMN 673; BMN-673

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective response rate defined as the proportion of participants with a confirmed complete response (CR) or partial response (PR) per Response Evaluation Criteria in Solid Tumors (RECIS)T 1.1	Will be provided along with the corresponding exact 2-sided 95% confidence interval calculated using a method based on the F distribution.	Up to 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression-Free Survival (PFS) assessed by RECIST 1.1	Will be summarized for the safety analysis (SA) set. Will be summarized using the Kaplan-Meier method and displayed graphically when appropriate.	From treatment initiation to time of first documentation of objective tumor progression or death on study due to any cause, whichever occurs first, assessed up to 1 year
PFS assessed by RECIST 1.1	Will be summarized for the SA set. Will be summarized using the Kaplan-Meier method and displayed graphically when appropriate. Median event times and 2-sided 95% confidence interval for each median will be provided.	From treatment initiation to time of first documentation of objective tumor progression or death on study due to any cause, whichever occurs first, assessed up to 1 year
Overall survival	Will be summarized using the Kaplan-Meier method and displayed graphically when appropriate.	From treatment initiation to death by any cause, assessed up to 1 year
Duration of response (CR or PR) per RECIST 1.1	Will be summarized using the Kaplan-Meier method and displayed graphically when appropriate.	From the first documentation of objective tumor response, assessed up to 1 year
Time to response (CR or PR) per RECIST 1.1	Will be summarized using the Kaplan-Meier method and displayed graphically when appropriate.	From treatment initiation to the first documentation of objective tumor response, assessed up to 1 year
Pharmacokinetics of talazoparib - steady state trough plasma concentrations	To evaluate the pharmacokinetics (steady state trough plasma concentrations) of talazoparib when given in combination with temozolomide	Up to 1 year

Collaborators and Investigators

• Sponsor: Jonsson Comprehensive Cancer Center
• Collaborators: Pfizer; Translational Research in Oncology
• Investigators: Principal Investigator: Jonathan Goldman, MD, UCLA / Jonsson Comprehensive Cancer Center

Study record dates

Study Major Dates

• Study Start (Actual): October 31, 2018
• Primary Completion (Estimated): October 1, 2024
• Study Completion (Estimated): October 1, 2025

Study Registration Dates

• First Submitted: August 14, 2018
• First Submitted That Met QC Criteria: September 13, 2018
• First Posted (Actual): September 14, 2018

Study Record Updates

• Last Update Posted (Actual): November 18, 2023
• Last Update Submitted That Met QC Criteria: November 16, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: PARP Inhibitor; Small Cell Lung Cancer
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Neoplasms by Histologic Type; Neoplasms; Lung Diseases; Neoplasms by Site; Neoplasms, Glandular and Epithelial; Respiratory Tract Neoplasms; Thoracic Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Carcinoma; Small Cell Lung Carcinoma; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Alkylating Agents; Poly(ADP-ribose) Polymerase Inhibitors; Temozolomide; Talazoparib
• Other Study ID Numbers: 18-001387; NCI-2018-01409 (Registry Identifier: CTRP (Clinical Trial Reporting Program)); TRIO-US L-07 (Other Identifier: UCLA / Jonsson Comprehensive Cancer Center)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes