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The Efficacy and Safety of Niraparib vs Placebo to Treat Breast Cancer in Participants Who Have Tumour DNA in Their Blood After Completing Treatment (ZEST)

Phase 1
Conditions
Breast Cancer
MedDRA version: 23.0Level: PTClassification code 10083232Term: HER2 negative breast cancerSystem Organ Class: 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Therapeutic area: Diseases [C] - Cancer [C04]
Registration Number
EUCTR2020-003973-23-NL
Lead Sponsor
GlaxoSmithKline Research and Development Ltd.
Brief Summary

Not available

Detailed Description

Not available

Recruitment & Eligibility

Status
Authorised-recruitment may be ongoing or finished
Sex
All
Target Recruitment
800
Inclusion Criteria

Participants are eligible to be included in Cohorts 1 and 2 of the study only if all of the following criteria are met:
1.Stage I to III breast cancer per AJCC for breast cancer staging criteria 8th edition with surgical resection of the primary tumor that is confirmed to be either:
•TNBC
•HR+/HER2- breast cancer with a known and documented deleterious or suspected deleterious tBRCA mutation (either sBRCA or gBRCA positive)
2.Completed prior standard therapy for curative intent, including all of the following, if indicated: neoadjuvant treatment, surgery, adjuvant radiotherapy, and adjuvant chemotherapy
3.Participants with HR+ breast cancer must be on a stable regimen of endocrine therapy, if indicated, for at least 3 months prior to randomization. Ovarian suppression, if indicated, must also have been started at least 3 months prior to randomization.
4.Detectable ctDNA as measured by central Signatera testing
5.An archival tumour tissue specimen of the primary tumor sufficient in quality and quantity for ctDNA assay design and tBRCA and HRD testing is required. Sponsor requirements for tissue sufficiency are outlined in the Study Reference Manual.
6.An Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
7.Must be =18 years of age.
8.Must have adequate organ and bone marrow function, as defined below.
Absolute neutrophil count:=1,500/µL
Platelets:=100,000/µL
Hemoglobin:=9 g/dL or 5.6?mmol/L
Renal function Calculated creatinine clearance =30 mL/min
Total bilirubin:=3×ULN
ALT: =2.5×ULN
9.Participants with toxicity from prior cancer therapy must have recovered to Grade 1. (A participant with Grade?2 neuropathy or any grade of alopecia is an exception to this criterion and may qualify for this study.)
10.Must be able to swallow and retain orally administered study treatment.
11.A female participant is eligible if she is not pregnant or breastfeeding, and at least 1 of the following conditions applies:
•Is not a woman of childbearing potential (WOCBP), as defined in Appendix 4.
OR
•Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), as described in Appendix 4, during the Treatment Period and for at least 180 days after the last dose of study treatment and agrees not to donate eggs (ova, oocytes) for the purpose of reproduction during this period. The Investigator should evaluate the effectiveness of the contraceptive method in relationship to the first dose of study treatment.
•A WOCBP must have a negative pregnancy test (highly sensitive urine test or serum test as required by local regulations) within 72 hours before the first dose of study treatment.
•If a urine test cannot be confirmed as negative (eg, an ambiguous result), a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive.
•Additional requirements for pregnancy testing during and after study treatment are described in Section 8.4.6 of the protocol.
•The Investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy.
See Appendix 4 for a list of acceptable birth control methods. Information must be captured appropriately within the site’s source documents.
12.Male participants are eligible if they agree to the following during the Treatment Period and for at least 90 days after the last d

Exclusion Criteria

Participants are excluded from Cohorts 1 and 2 of the study if any of the following criteria are met:
1.Prior treatment with a PARP inhibitor.
2.Current treatment with a CDK4/6 inhibitor or endocrine therapy other than anastrozole, letrozole, exemestane, and tamoxifen with or without ovarian
suppression.
3.Participants have any sign of metastasis or local recurrence after comprehensive assessment conducted per protocol.
4.Participants have shown no definitive response to preoperative chemotherapy by pathologic, radiological, or clinical evaluation, in cases where preoperative chemotherapy was administered (see Appendix 1).
5.Participants have systolic BP >140 mmHg or diastolic BP >90 mmHg that has not been adequately treated or controlled.
6.Participants have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach and/or bowels.
7.Participants have received colony-stimulating factors (eg, granulocyte macrophage colony-stimulating factor or recombinant erythropoietin) within 4?weeks prior to the first dose of study treatment.
8.Participants have previously or are currently participating in a treatment study of an investigational agent within 4?weeks of the first dose of therapy preceding the study.
9.Participants have received live vaccine within 30 days of planned start of study randomization. Study participants can be vaccinated against Corona virus disease 2019 (COVID-19) using vaccines authorized via the appropriate regulatory mechanisms (i.e. Emergency Use Authorization, Conditional Marketing Authorization or Marketing Authorization Application).
10.Participants have known hypersensitivity to the components of niraparib, placebo, or their formulation excipients.
11.Participants have undergone major surgery within 4?weeks of starting the first dose of study treatment or have not recovered from any effects of any major surgery.
12.Participants have a second primary malignancy. Exceptions are the following:
•Adequately treated nonmelanoma skin cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ (DCIS) of the breast, Stage I Grade 1 endometrial carcinoma
•Other solid tumors and lymphomas (without bone marrow involvement) diagnosed =5 years prior to randomization and treated with no evidence of disease recurrence and for whom no more than 1 line of chemotherapy was applied
13.Participants have current active pneumonitis or any history of pneumonitis requiring steroids (any dose) or immunomodulatory treatment within 90 days of planned start of the study.
14.Participants have any clinically significant concomitant disease or condition (such as transfusion-dependent anemia or thrombocytopenia) that could interfere with, or for which the treatment might interfere with, the conduct of the study or that would, in the opinion of the Investigator, pose an unacceptable risk to the participants in this study.
15.Participants have any psychological, familial, sociological, or geographical condition potentially hampering compliance with the study requirements and/or follow up procedures. Those conditions should be discussed with the participants before study entry.
16.Participants have high medical risk due to a serious, uncontrolled medical disorder; nonmalignant systemic disease; or active, uncontrolled infection (including COVID-19). Examples include, but are not limited to, uncontrolled ventricular arrhythmia, recent (wi

Study & Design

Study Type
Interventional clinical trial of medicinal product
Study Design
Not specified
Primary Outcome Measures
NameTimeMethod
Main Objective: -Evaluation of the efficacy of niraparib relative to placebo as measured by disease-free survival (DFS);Secondary Objective: -Evaluation of overall survival (OS)<br>-Evaluation of time to progression on next anticancer therapy<br>-Evaluation of distant recurrence-free survival (DRFS)<br>-Evaluation of the safety and tolerability of niraparib <br>-Evaluation of disease-related symptoms that impact health-related <br>quality of life<br>-Evaluation of patient-reported treatment-related symptoms;Primary end point(s): -DFS is defined as the time until disease recurrence, measured from the time of randomization to the earliest date of assessment of disease recurrence or death by any cause, as assessed by Investigator using RECIST v1.1.;Timepoint(s) of evaluation of this end point: -Median DFS for the placebo arm is expected to be ~9 months from randomization.
Secondary Outcome Measures
NameTimeMethod
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