Personalized Maintenance Therapy for m-PDAC Using Olaparib or Selumetinib + Durvalumab, Based on BRCAness and KRAS Status. (MAZEPPA)

MAZEPPA: Phase II PRODIGE-GERCOR Study to Evaluate MAintenance Therapy With Olaparib or Selumetinib Plus Durvalumab According to BRCAness and KRAS Somatic Status Personalized in Metastatic Pancreatic Adenocarcinoma Patients

MAZEPPA is open-label, phase II study to assess the efficacy of a genomic-driven maintenance therapy in terms of PFS in Pancreatic ductal adenocarcinoma (PDAC) patients with disease controlled after 4 months of mFOLFIRINOX chemotherapy as following:

Patients with a BRCAness somatic profile: olaparib Arm A. Patients with no BRCAness profile and with KRAS mutation randomization between durvalumab plus selumetinib Arm B, versus FOLFIRI Arm C.

Study Overview

• Status: Active, not recruiting
• Conditions: Metastatic Pancreatic Adenocarcinoma
• Intervention / Treatment: Drug: Arm A - Olaparib; Drug: ARM B - durvalumab plus selumetinib; Drug: ARM C FOLFIRI

Detailed Description

Searching for efficient maintenance therapies in metastatic PDAC patients whose disease has been controlled using an induction chemotherapy is crucial for two main reasons:

1. Patients may stop IV toxic chemotherapy while their tumor remains under control. Although up to 70% of PDAC patients achieve tumor control when treated during induction with mFOLFIRINOX, toxicity of this regimen, particularly neuropathy and fatigue, remains a key concern.
2. Tumor control may be extended, which might improve quality of life (QoL) and survival.

Patients are included in MAZEPPA study based on the genetic profile of their tumor.

• If a BRCA gene mutation is present in the tumor, treatment with the drug olaparib will be proposed (arm A), regardless of the status of the other genes analyzed.
• In the absence of a mutation in the BRCA gene and in the presence of a mutation in the KRAS gene, a treatment combining immunotherapy and targeted therapy (durvalumab and selumetinib - Arm B) or chemotherapy by FOLFIRI (arm C) will be proposed.

• Study Type: Interventional
• Enrollment (Estimated): 307
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Pascal HAMMEL, MD; Phone Number: 01 40 29 85 00; Email: pascal.hammel@aphp.fr
• Study Contact Backup: Name: Marie-Line GARCIA LARNICOL, MD; Phone Number: 01 40 29 85 00; Email: marie-line.garcia-larnicol@gercor.com.fr

Study Locations

• France
  • Avignon, France
    • Institut Sainte Catherine
  • Besançon, France
    • CHRU Jean Minjoz
  • Bordeaux, France
    • Polyclinique Bordeaux Nord Aquitaine
  • Caen, France
    • Centre François Baclesse
  • Clichy, France
    • Hopital Beaujon
  • Creil, France
    • GHPSO Site de Creil
  • Dijon, France
    • CHU Dijon
  • Dijon, France
    • Centre Georges Francois Leclerc
  • Grenoble, France
    • CHU Grenoble Alpes Hôpital Michallon
  • Levallois-Perret, France
    • Hopital Franco-Britannique
  • Lille, France
    • CHRU Lille
  • Lyon, France
    • Centre Léon Bérard
  • Lyon, France
    • Hopital Prive Jean Mermoz
  • Lyon, France
    • hôpital Saint Joseph Saint Luc
  • Marseille, France
    • Institut Paoli Calmette
  • Marseille, France
    • CHU La Timone
  • Marseille, France
    • Hôpital Européen
  • Montbéliard, France
    • Hopital Nord Franche Comte
  • Paris, France
    • Institut Mutualiste Montsouris
  • Paris, France
    • Hopital Pitie Salpetriere
  • Paris, France
    • Hopital Saint Antoine
  • Paris, France
    • Hôpital Européen Georges Pompidou
  • Paris, France
    • GH Diaconesses Croix Saint Simon
  • Poitiers, France
    • CHU Poitiers
  • Reims, France
    • CHU Robert Debré
  • Saint-Herblain, France
    • ICO Site de Saint Herblain
  • Strasbourg, France
    • Centre Paul Strauss
  • Toulouse, France
    • CHU Toulouse IUCT Rangueil
  • Tours, France
    • Hôpital Trousseau

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

1. Signed and dated informed consent,
2. Age ≥18 years
3. Body weight >30 kg,
4. Patient is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up,
5. Life expectancy of at least 4 months,
6. Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1,
7. Pathologically confirmed pancreatic adenocarcinoma with distant metastases (stage IV disease),
8. No prior therapy for metastatic disease other than mFOLFIRINOX (in case of previous adjuvant therapy, the interval between the end of adjuvant chemotherapy and relapse must be >6 months),
9. Stability or tumor response (Response evaluation criteria in solid tumors [RECIST] 1.1) after 4 months of mFOLFIRINOX (8 cycles) for metastatic disease,
10. Have tissue from archival tissue sample from surgery or biopsy identified and confirmed as available for study
11. Availability of tumor somatic genetic analyses data, performed during the first 4 months of mFOLFIRINOX (specific informed consent),
12. In case of germinal BRCA gene mutation identified before inclusion the patient can be included until olaparib receives a marketing authorization for the treatment indication of the patients in the study and the treatment is available in the retail pharmacy; it will be prescribed according to the summary product characteristics (SmPC),
13. At least one measurable or evaluable lesion as assessed by CT-scan or MRI according to RECIST 1.1 and feasibility of repeated radiological assessments,

14. Normal organ and bone marrow function prior to administration of study treatment as defined below:

    • Hemoglobin ≥ 10.0 g/dL with no blood transfusion in the past 28 days,
    • Absolute neutrophil count (ANC) ≥ 1.5 x 109/L,
    • Platelet count ≥ 100 x 109/L,
    • Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN),

    • Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ≤ 2.5 x institutional ULN unless liver metastases are present in which case

      ≤ 5x ULN,

    • Creatinine clearance (CrCl) ≥ 50 mL/min estimated using the Cockcroft-Gault equation, Estimated CrCl =(140-age [years]) x weight (kg) (x F)a serum creatinine (mg/dL) x 72 a F=0.85 for females and F=1 for males.
15. Absence of known dihydropyrimidine dehydrogenase (DPD) deficiency,

16. Female patients must be surgically sterile, or be post-menopausal, or have negative serum pregnancy test if pre-menopausal at inclusion and must commit to using reliable and appropriate methods of contraception during the study and during at least 6 months after the end of studytreatment (when applicable).

    Women will be considered post-menopausal if they have been amenorrhoeic for 12 months without an alternative medical cause. The following age-specific requirements apply:

    • Women < 50 years of age would be considered post-menopausal if they have been amenorrhoeic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the postmenopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy).
    • Women ≥ 50 years of age would be considered post-menopausal if they have been amenorrhoeic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses > 1 year ago, had chemotherapy-induced menopause with last menses > 1 year ago, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy). All female patients with reproductive potential must have a negative pregnancy test (beta human chorionic gonadotropin [β-HCG]) within 72 hours prior to starting the protocol treatment. Breastfeeding is not allowed. Male patients must agree to use effective contraception in addition to having their partner use a contraceptive method as well during the trial and during at least 6 months after the end of the study treatment. Men and women with childhood potential are required to use adequate birth control during the study,
17. Registration in a national health care system (PUMa; Couverture Maladie Universelle included).

Exclusion Criteria:

1. Histology other than PDAC
2. Toxicities after mFOLFIRINOX treatment not resolved to ≥ grade 1 prior to maintenance treatment, except for oxaliplatin induced neuropathy, alopecia, or grade ≥ 2 are permitted
3. Patients with known brain metastases at inclusion,
4. Enrollment in another therapeutic trial
5. Evidence of interstitial lung disease, any active non-infectious pneumonitis, or known active infection including active tuberculosis
6. Hepatitis B virus (HBV; known positive HBV surface antigen (HbsAg) result), hepatitis C virus (HCV), or human immunodeficiency virus (positive HIV ½ antibodies).
7. Active uncontrolled infection, current unstable, or uncompensated respiratory or cardiac conditions, or active digestive hemorrhages less than 3 months,
8. Patient has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the study,
9. Live vaccine administration within 30 days prior to the first dose of study treatment,
10. Treatment with any other investigational medicinal product within 28 days prior to study entry,
11. Other malignancy unless curatively treated with no evidence of disease for ≥ 5 years except: adequately treated non-melanoma skin cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ (DCIS), and stage 1, grade 1 endometrial carcinoma,
12. Uncontrolled intercurrent illness, including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, acute coronary syndrome within 6 months prior to starting treatment, prior or current cardiomyopathy, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs or compromise the ability of the patient to give written informed consent,
13. Resting electrocardiogram (ECG) indicating uncontrolled, potentially reversible cardiac conditions, as judged by the Investigator or patients with congenital long QT syndrome. Mean corrected QT interval (QTc) for heart rate using the QTcF formula ≥ must be <470 ms,
14. Pregnancy/lactation,
15. Uncontrolled massive pleural effusion or massive ascites,
16. Tutelage or guardianship.

Arm A: Specific exclusion criteria for patients with the BRCAness profile in order to receive olaparib

1. Myelodysplastic syndrome/acute myeloid leukemia or with features suggestive of myelodysplastic syndrome (MDS)/ DS)/acute myeloid leukemia (AML),
2. Unable to swallow orally administered medication and gastrointestinal disorders likely to interfere with absorption of the study medication,
3. Any previous treatment with PARP inhibitor, including olaparib,
4. Concomitant use of known strong cytochrome P450, family 3, subfamily A (CYP3A) inhibitors (e.g. itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or moderate CYP3A inhibitors. The required washout period prior to starting olaparib is 2 weeks,
5. Concomitant use of known strong or moderate CYP3A inducers.
6. Major surgery within 2 weeks of starting study treatment and patients must have recovered from any effects of any major surgery.
7. Previous allogenic bone marrow transplant or double umbilical cord blood transplantation (dUCBT),
8. Whole blood transfusions in the last 120 days prior to entry to the study (packed red blood cells and platelet transfusions are acceptable outside of 28 days prior to study treatment,
9. Known hypersensitivity to the excipients of the olaparib

Arm B/C: Specific criteria for patients without the BRCAness profile and with KRAS mutation in order to receive durvalumab:

1. Prior treatment with any of the following immune checkpoint inhibitor:

   anti-PD-1, anti-PD-L1, anti-PD-L2, or anti-cytotoxic T lymphocyte antigen 4 (CTLA-4) antibody,

2. Active autoimmune disease that has required systemic treatment in the past 2 years; replacement therapy is considered a form of systemic treatment and is not a criterion of exclusion,
3. Any systemic steroid therapy whatever the duration of this corticotherapy,
4. Active or prior documented autoimmune or inflammatory disorders

Arm B/C: Specific exclusion criteria for patients without BRCAness profile and with KRAS-mutated tumors in order to receive selumetinib:

1. Cardiac conditions
2. Documented antecedent history of retinopathy or retinal disorders as known ophthalmologic conditions
3. Patients with any other significant abnormality on ophthalmic examination (performed by an ophthalmologist) should be discussed for potential ineligibility
4. The last palliative radiotherapy seance within 7 days of the first dose of study treatment

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ARM A - olaparib; Olaparib tablets at 300 mg orally twice daily until PD (RECIST 1.1) or unacceptable toxicity.	Drug: Arm A - Olaparib; 300 mg orally twice daily, for a total daily dose of 600mg Study treatment can be dose-reduced to : First step : 250 mg twice daily , for a total daily dose of 500 mg Second step: 200 mg twice daily taken twice daily, for a total daily dose of 400 mg No further dose reduction is allowed, and study treatment should be discontinued.; Other Names: AZD-2281
Experimental: ARM B - durvalumab plus selumetinib; Durvalumab plus selumetinib until PD (RECIST 1.1 and/or iRECIST), unacceptable toxicity, withdrawal of consent, or death. Durvalumab administered IV at a flat dose of 1500 mg on day 1 of every 28-day cycle, Selumetinib administered as 75 mg twice daily dose for 21 days on and 7 days off (a 28-day cycle).	Drug: ARM B - durvalumab plus selumetinib; Durvalumab administered IV at a flat dose of 1500 mg on day 1 of every 28-day cycle, Selumetinib Starting Dose : 75 mg twice daily Study treatment can be dose-reduced to : Dose Level -1 : 75 mg once daily Dose Level -2 : 50 mg twice daily Dose Level -3 : 50 mg once daily; Other Names: MEDI-4736 plus AZD-6244
Active Comparator: ARM C - FOLFIRI; FOLFIRI FOLFIRI (irinotecan 180 mg/m2 IV on day 1, folinic acid 400 mg/m2 IV on day 1, 5-FU 400 mg/m2 IV bolus on day 1 and 2, and 46h IV infusion of 5-FU 2400 mg/m2 every 2 weeks) until PD (RECIST 1.1) unacceptable toxicity, withdrawal of consent, or death.	Drug: ARM C FOLFIRI; FOLFIRI every two weeks Irinotecan 180 mg/m2 Intravenous (IV) on day 1 Folinic acid 400 mg/m2 IV on day 1, 5-FU 400 mg/m2 IV bolus on day 1 and 2, and 46h IV infusion of 5-FU 2400 mg/m2; Other Names: folinic acid, fluorouracil, and irinotecan

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ARM A - Progression free survival (PFS)	PFS rate at 4 months is defined by the number of patients alive at 4 months from inclusion without PD divided by the total number of patients evaluable at 4 months (dead during 4 months or alive at 4 months with a progressive status available).	at 4 months
ARM B/ C - PFS	PFS is defined as time from randomization into arm B/C to the date of first documented PD RECIST 1.1 and/or iRECIST for arm B and PD RECIST1.1 for arm C or death.	Assessed up to 36 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Disease control rate (DCR)	DCR is the percentage of patients who achieve CR, PR, or SD to study treatment (according to RECIST 1.1).	Measured at 16 weeks of maintenance therapy.
Overall response rate (ORR)	ORR is the number of patients with a best overall response of CR or PR divided by the number of all treated (at least 1 dose of study treatment) patients.	Assessed up to 36 months
Overall survival (OS)	OS is the time between the date of inclusion into Arm A or Arms B/C and death	Assessed up to 36 months
Number of participants with treatment-related adverse events	All grade and severe toxicities, according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v5.0	Assessed up to 36 months
Time to HRQoL score definitive deterioration (TUDD)	TUDD is defined as the time interval between inclusion into Arm A and randomization into Arms B/C and the first occurrence of a decrease in QLQ-C30 score for dimension ⩾5 points compared to baseline HRQoL score without any further improvement in QoL score ⩾5 points or any further available QoL data.	At baseline, at every 2 months during treatment, and at the end of treatment visit. Assessed up to 36 months

Collaborators and Investigators

• Sponsor: GERCOR - Multidisciplinary Oncology Cooperative Group
• Collaborators: AstraZeneca
• Investigators: Principal Investigator: Pascal HAMMEL, MD, Hopital Beaujon

Study record dates

Study Major Dates

• Study Start (Actual): December 7, 2020
• Primary Completion (Actual): July 12, 2023
• Study Completion (Estimated): December 1, 2024

Study Registration Dates

• First Submitted: April 8, 2020
• First Submitted That Met QC Criteria: April 14, 2020
• First Posted (Actual): April 15, 2020

Study Record Updates

• Last Update Posted (Actual): January 5, 2024
• Last Update Submitted That Met QC Criteria: January 3, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: BRCAness status; KRAS somatic status
• Additional Relevant MeSH Terms: Neoplasms by Histologic Type; Neoplasms; Carcinoma; Neoplasms, Glandular and Epithelial; Adenocarcinoma; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Topoisomerase Inhibitors; Antineoplastic Agents, Immunological; Poly(ADP-ribose) Polymerase Inhibitors; Topoisomerase I Inhibitors; Fluorouracil; Olaparib; Durvalumab; Irinotecan
• Other Study ID Numbers: MAZEPPA D19-02 PRODIGE-72

Drug and device information, study documents

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