Overview

Tri Association in Patient With Advanced Epithelial Ovarian Cancer in Relapse

Status:
Active, not recruiting
Trial end date:
2024-04-30
Target enrollment:
0
Participant gender:
Female
Summary
Assessing the safety and efficacy of the bevacizumab (FKB238), Olaparib and Durvalumab (MEDI 4736) combination in patient with high grade serous or high grade endometrioid or other high grade epithelial non mucinous ovarian tumor, with at least one previous line of platinum-taxane chemotherapy, and present with platinum resistant disease (PRR) or platinum-sensitive relapse (PSR), whatever the line of chemotherapy given at relapse.
Phase:
Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
ARCAGY/ GINECO GROUP
Treatments:
Antibodies, Monoclonal
Bevacizumab
Durvalumab
Olaparib
Criteria
Inclusion Criteria:

Patients with platinum resistant relapse

- Female Patient must be ≥18 years of age.

- Signed informed consent and ability to comply with treatment and follow-up.

- Patient with Ovarian cancer, primary peritoneal cancer and/or fallopian-tube cancer,
histologically confirmed (based on local histopathological findings): high grade
serous or high grade endometrioid or other high grade epithelial non mucinous ovarian
tumor.

- Patient who has completed at least one line of platinum-taxane chemotherapy, and
presents with platinum resistant relapse (resistant disease defined by a tumor
progression less than six months after the last dose of platinum) [Note: the patient
may have received one or even more line of platinum based chemotherapy] OR Patient who
is in platinum-sensitive relapse, whatever the line of chemotherapy given at relapse
[Note: any chemotherapy previously administered must have contained a platinum
compound]. The platinum sensitive relapse is defined by a tumor progression occurring
more than six months after the last dose of platinum chemotherapy.

- Patient who didn't receive any of the tested drugs, or previously received either
bevacizumab or olaparib BUT NOT the combination of both drugs.

- At least one measurable or evaluable lesion that can be accurately assessed at
baseline by computed tomography (CT) (or magnetic resonance imaging [MRI] where CT is
contraindicated) and is suitable for repeated assessment as per irRC. The baseline
scan must be obtained within 28 days of first dose.

- Availability of a pre-treatment tumor sample (archival FFPE block or fresh biopsy if
feasible) lasting of less than 3 months before inclusion into the study and performed
AFTER the last chemotherapy administration.

- Patient not amenable to cytoreductive surgery at the time of relapse (surgery is not
allowed during the protocole treatment).

- Patient must have normal organ and bone marrow function:

- Hemoglobin ≥ 10.0 g/dL. (Transfusions is not allowed within 28 days before
randomization)

- Absolute neutrophil count (ANC) ≥ 1.5 x 109/L.

- Platelet count ≥ 100 x 109/L. (Platelet transfusion or G-CSF administration is
not allowed within 28 days before randomization)

- Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN).

- Aspartate aminotransferase / Serum Glutamic Oxaloacetic Transaminase (ASAT/SGOT))
and Alanine aminotransferase / Serum Glutamic Pyruvate Transaminase (ALAT/SGPT))
≤ 2.5 x ULN, unless liver metastases are present in which case they must be ≤ 5 x
ULN.

- Creatinine clearance ≥ 60 mL/min by Cockcroft and Gault formula.

- Patient not receiving anticoagulant medication who has an International
Normalized Ratio (INR) ≤ 1.5 and an Activated ProThrombin Time (aPTT) ≤ 1.5 x
ULN. The use of full-dose oral or parenteral anticoagulants is permitted as long
as the INR or APTT is within therapeutic limits (according to site medical
standard). If the patient is on oral anticoagulants, dose has to be stable for at
least two weeks at the time of inclusion.

- Urine dipstick for proteinuria < 2+. If urine dipstick is ≥ 2+, 24-hour urine
must demonstrate < 1 g of protein in 24 hours.

- Normal blood pressure or adequately treated and controlled hypertension (systolic
BP ≤ 150 mmHg and/or diastolic BP ≤ 90 mmHg).

- Expectancy of at least 12 weeks

- Eastern Cooperative Oncology Group (ECOG) performance status 0-1.

- Postmenopausal or evidence of non-childbearing status for women of childbearing
potential prior to the first dose of study treatment (see protocol appendix 1).

- As this study will include patients in France, a subject will be eligible for
inclusion in this study only if either affiliated to, or a beneficiary of, a social
category.

Patients with platinum sensitive relapse

- Female Patient must be ≥18 years of age.

- Signed informed consent and ability to comply with treatment and follow-up.

- Patient with :

- Ovarian cancer, primary peritoneal cancer and/or fallopian-tube cancer, histologically
confirmed (based on local histopathological findings): high grade serous or high grade
endometrioid or other high grade epithelial non mucinous ovarian tumor.

- Patient who is in platinum-sensitive relapse, whatever the line of chemotherapy given
at relapse [Note: any chemotherapy previously administered must have contained a
platinum compound]. The platinum sensitive relapse is defined by a tumor progression
occurring more than six months after the last dose of platinum chemotherapy.

- Patient who didn't receive any of the tested drugs, or previously received either
bevacizumab or olaparib BUT NOT the combination of both drugs.

- At least one measurable or evaluable lesion that can be accurately assessed at
baseline by computed tomography (CT) (or magnetic resonance imaging [MRI] where CT is
contraindicated) and is suitable for repeated assessment as per irRC. The baseline
scan must be obtained within 28 days of first dose.

- Availability of a pre-treatment tumor sample (archival FFPE block or fresh biopsy if
feasible) lasting of less than 3 month before inclusion into the study and performed
AFTER the last chemotherapy administration.

- Patient not amenable to cytoreductive surgery at the time of relapse (surgery is not
allowed during the protocole treatment).

- Patient must have normal organ and bone marrow function:

- Hemoglobin ≥ 10.0 g/dL. (Transfusions is not allowed within 28 before
randomization)

- Absolute neutrophil count (ANC) ≥ 1.5 x 109/L.

- Platelet count ≥ 100 x 109/L. (Platelet transfusion or G-CSF administration is
not allowed within 28 days before randomization).

- Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN).

- Aspartate aminotransferase / Serum Glutamic Oxaloacetic Transaminase (ASAT/SGOT))
and Alanine aminotransferase / Serum Glutamic Pyruvate Transaminase (ALAT/SGPT))
≤ 2.5 x ULN, unless liver metastases are present in which case they must be ≤ 5 x
ULN.

- Creatinine clearance ≥ 60 mL/min by Cockcroft and Gault formula.

- Patient not receiving anticoagulant medication who has an International
Normalized Ratio (INR) ≤ 1.5 and an Activated ProThrombin Time (aPTT) ≤ 1.5 x
ULN. The use of full-dose oral or parenteral anticoagulants is permitted as long
as the INR or APTT is within therapeutic limits (according to site medical
standard). If the patient is on oral anticoagulants, dose has to be stable for at
least two weeks at the time of incusion.

- Urine dipstick for proteinuria < 2+. If urine dipstick is ≥ 2+, 24-hour urine
must demonstrate < 1 g of protein in 24 hours.

- Normal blood pressure or adequately treated and controlled hypertension (systolic
BP ≤ 150 mmHg and/or diastolic BP ≤ 90 mmHg).

- Expectancy of at least 12 weeks

- Eastern Cooperative Oncology Group (ECOG) performance status 0-1.

- Postmenopausal or evidence of non-childbearing status for women of childbearing
potential prior to the first dose of study treatment.

- As this study will include patients in France, a subject will be eligible for
inclusion in this study only if either affiliated to, or a beneficiary of, a social
category.

Exclusion Criteria:

- Non-epithelial origin of the tumor (i.e. germ cell tumor).

- Ovarian tumors of low malignant potential (e.g. borderline tumors), or mucinous
carcinoma.

- Carcinosarcoma (Mixed Mullerian Tumor)

- Patient with synchronous primary endometrial cancer unless both of the following
criteria are met:

- Stage < II,

- Less than 60 years old at the time of diagnosis of endometrial cancer with stage
IA or IB grade 1 or 2, or stage IA grade III endometrial carcinoma,OR ≥ 60 years
old at the time of diagnosis of endometrial cancer with stage IA grade 1 or 2
endometrioid adenocarcinoma.

Patient with serous or clear cell adenocarcinoma or carcinosarcoma of the endometrium is
not eligible.

- Other malignancy within the last 5 years except: adequately treated non-melanoma skin
cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ
(DCIS). Patient with a history of localized malignancy diagnosed over 5 years ago may
be eligible provided she completed her adjuvant systemic therapy and remains free of
recurrent or metastatic disease. Patient with history of primary triple negative
breast cancer may be eligible provided she completed her definitive anticancer
treatment more than 3 years ago and she remains breast cancer disease free prior to
start of study treatment.

- Patient with myelodysplastic syndrome/acute myeloid leukemia history.

- Current or prior use of immunosuppressive medication within 14 days (use 28 days if
combining durvalumab with a novel agent) before the first dose of durvalumab, with the
exceptions of intranasal and inhaled corticosteroids or systemic corticosteroids at
physiological doses, which are not to exceed 10 mg/day of prednisone, or an equivalent
corticosteroid. (...)

- Any unresolved toxicity NCI CTCAE Grade ≥2 from previous anticancer therapy with the
exception of alopecia, vitiligo, and the laboratory values defined in the inclusion
criteria

- Patients with Grade ≥2 neuropathy will be evaluated on a case-by-case basis after
consultation with the Study Physician.

- Patients with irreversible toxicity not reasonably expected to be exacerbated by
treatment with durvalumab may be included only after consultation with the Study
Physician.

- Active or prior documented autoimmune or inflammatory disorders (including
inflammatory bowel disease [e.g., colitis or Crohn's disease], diverticulitis [with
the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome,
or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid
arthritis, hypophysitis, uveitis, etc]). (...)

- Patient receiving radiotherapy within 6 weeks prior to study treatment.

- Major surgery within 4 weeks of starting study treatment and patient must have
recovered from any effects of any major surgery.

- Previous allogenic bone marrow transplant.

- Any previous treatment with Anti PD(L)-1 immunotherapy, including durvalumab

- Any previous treatment with a PARP inhibitor in combination with an anti-VEGF
(previous treatment with PARP inhibitor alone or anti-VEGF alone is allowed).

- Past medical history of interstitial lung disease, drug-induced pneumonitis, radiation
pneumonitis that required steroid treatment, or any evidence of clinically active
interstitial lung disease

- Administration of other simultaneous chemotherapy drugs, any other anticancer therapy
or anti-neoplastic hormonal therapy, or simultaneous radiotherapy during the trial
treatment period (hormonal replacement therapy is permitted as are steroidal
antiemetics).

- Current or recent (within 10 days prior to inclusion) chronic use of aspirin > 325
mg/day.

- Concomitant use of known potent CYP3A4 inhibitors such as ketoconazole, itraconazole,
ritonavir, indinavir, saquinavir, telithromycin, clarithromycin and nelfinavir. The
required washout period prior to starting study treatment is 2 weeks.

- Concomitant use of known strong (e.g. phenobarbital, enzalutamide, phenytoin,
rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John's Wort) or
moderate CYP3A inducers (e.g. bosentan, efavirenz, modafinil). The required washout
period prior to starting study treatment is 5 weeks for enzalutamide or phenobarbital
and 3 weeks for other agents. Patients should stop using herbal remedies 7 days prior
to the first dose of study medication and for the duration of the trial.

- Prior history of hypertensive crisis (CTC-AE grade 4) or hypertensive encephalopathy.

- Clinically significant (e.g. active) cardiovascular disease, Previous Cerebro-Vascular
Accident (CVA), Transient Ischemic Attack (TIA) or Sub- Arachnoids Hemorrhage (SAH)
within 6 months prior to inclusion.

- History Clinically significant (e.g. active) cardiovascular disease (...)

- Evidence of bleeding diathesis or significant coagulopathy (in the absence of
coagulation).

- History or clinical suspicion of brain metastases or spinal cord compression. CT/MRI
of the brain is mandatory (within 4 weeks prior to inclusion) in case of suspected
brain metastases. Spinal MRI is mandatory (within 4 weeks prior to inclusion) in case
of suspected spinal cord compression.

- Significant traumatic injury during 4 weeks prior to inclusion.

- Non-healing wound, active ulcer or bone fracture. Patient with granulating incisions
healing by secondary intention with no evidence of facial dehiscence or infection is
eligible but require 3 weekly wound examinations.

- History of VEGF therapy related abdominal fistula or gastrointestinal perforation or
active gastrointestinal bleeding within 6 months prior to the first study treatment.

- Current, clinically relevant bowel obstruction, including sub-occlusive and occlusive
disease.

- Patient with evidence of abdominal free air not explained by paracentesis or recent
surgical procedure.

- Evidence of any other disease, metabolic dysfunction, physical examination finding or
laboratory finding giving reasonable suspicion of a disease or condition that
contraindicates the use of an investigational drug or puts the patient at high risk
for treatment related complications.

- Pregnant or lactating women.

- Participation in another clinical study with an investigational product during her
chemotherapy course immediately prior to inclusion.

- Patient unable to swallow orally administered medication and patient with
gastrointestinal disorders likely to interfere with absorption of the study
medication.

- Patient with a known hypersensitivity to olaparib, durvalumab or bevacizumab or any of
the recipients of those products.

- Immunocompromised patient, e.g., with known active hepatitis (i.e. Hepatitis B or C)
due to risk of transmitting the infection through blood or other body fluids or
patient who is known to be serologically positive for human immunodeficiency virus
(HIV).