Olaparib Dose Escalating Trial in Patients Treated With Radiotherapy With or Without Daily Dose Cisplatin for Locally Advanced Non-small Cell Lung Carcinoma
试验速览
- 阶段
- 1 期
- 状态
- 已完成
- 入组人数
- 28
- 试验地点
- 1
- 主要终点
- The incidence of dose limiting toxicities (DLTs)
研究概览
简要总结
Phase I dose escalating trial. Primary objective of this study is to define the maximal tolerated dose (MTD)of Olaparib in combination with high dose radiotherapy with or without daily dose Cisplatin in locally advanced NSCLC. Secondary objectives include to define safety profile, determine PK/Pd variables and document preliminary evidence of objective tumor response.
详细描述
Concurrent chemoradiotherapy (CCRT) is the treatment of choice for patients with locally advanced NSCLC. The cure rates however need to be improved. The main mechanism by which both radiation and Cisplatin kill tumor cells is by an accumulation of un- or misrepaired DNA damage.PARP inhibitors increase radiation and chemotherapy (Cisplatin) response in preclinical studies including lung cancer models.
This open label dose escalating trial consists of a screening phase, a treatment phase and a follow up phase.
The screening phase: patients who can tolerate concurrent cisplatin will receive Olaparib, RT and Cisplatin. Patients who can not tolerate concurrent cisplatin will receive Olaparib and RT with or without prior sequential chemotherapy.
The treatment phase:dose escalation of Olaparib will be performed in cohorts of 3 subjects. The decision to escalate to the next dose level will be based on the occurrence of DLTs during the DLT evaluation period (i.e. 3 months following the last day of irradiation) and will be made after all patients within the cohort have completed their third month of follow up.
Active follow-up phase: frequent follow up will take place during the first 3 months (acute toxicity). Thereafter patients will be monitored for late toxicity and for disease activity 3-monthly throughout the first year and thereafter 6-monthly until 5 years, when patients are deemed to be cured and follow up is no longer warranted.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •≥18 years of age
- •Histologically or cytologically confirmed diagnosis of NSCLC
- •Stage II/III non-operable disease, without malignant pleural effusion
- •Presence of at least one measurable target lesion
- •Acceptable pulmonary function as defined by a Fev1 of ≥30% and a DLCO of ≥ 40% of predicted,
- •NYHA I-II functional status
- •Expected risk of radiation-induced pulmonary toxicity is modest: MLD ≤ 20 and maximum cord dose 50 Gy
- •WHO performance 0-1
- •Life expectancy of at least 6 months
- •Adequate hematological, renal and hepatic functions
- •Hemoglobin ≥ 5.5 mmol/l
- •Leucocytes > 3.0 x 109/l
- •Absolute neutrophil count > 1.5x109/l
- •Platelet count > 100 x 109/l
- •Total bilirubin < 1.5 x UNL
- •ASAT/ALAT < 2.5 x UNL
- •Alkaline phosphatase < 5 x UNL
- •Creatinine < 130 mmol/l or creatinine clearance > 50 ml/min; measured or calculated
- •Urine dipstick for proteinuria < 2+. If urine dipstick is ≥ 2, 24 hour urine must demonstrate < 500 mg of protein in 24 hours
- •No pre-existing sensory neurotoxicity grade ≥ 1 (CTCAE)
- •Patients of reproductive potential must agree to practice two effective medically approved contraceptive method during the trial and 3 months afterwards
- •Signed written informed consent.
排除标准
- •Concurrent active malignancy other than localized, non-melanoma skin cancer or carcinoma-in-situ of the cervix (unless definitive treatment was completed 5 years or more before study entry and the patient has remained disease free)
- •Anti-cancer therapy including chemotherapy, radiotherapy, endocrine therapy, immunotherapy or use of other investigational agents within the 3 weeks prior to start of therapy (or a longer period depending on the defined characteristics of the agents used e.g. 6 weeks for mitomycin or nitrosourea). Patients may continue the use of LHRH agonists for cancer; bisphosphonates for bone disease and corticosteroids.
- •Patients, selected for sequential chemoradiotherapy, are excluded if no disease control (all responses except progression) is obtained after induction chemotherapy.
- •Ipsilateral radiotherapy to the chest;
- •Chemotherapy for other indications than NSCLC within the last 5 years
- •History of interstitial pneumonitis (to include diffuse alveolar damage, non-malignant causes of pneumonitis, ARDS, alveolitis, cryptogenic organising pneumonia, obliterative bronchiolitis, non-malignant causes of pulmonary fibrosis, eligibility based on the judgement of the primary investigator), active infection on day of enrolment
- •Significant cardiovascular disease as defined by:
- •History of congestive heart failure requiring therapy;
- •History of unstable angina pectoris or myocardial infarction up to 6 months prior to trial entry;
- •Presence of severe valvular heart disease;
- •Presence of a ventricular arrhythmia requiring treatment;
- •Uncontrolled hypertension
- •Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be assessed with the patient before registration in the trial.
- •Participation in other trial with investigational drug or treatment modality
- •Co-existing serious active infection requiring parenteral antibiotics
- •Patients with hepatic disease e.g. patients with known serologically positive Hepatitis B or Hepatitis C as they may be more at risk of toxicity from Olaparib
- •Immunocompromised patients e.g. human immunodeficiency virus (HIV)
- •Myelodysplastic syndrome/acute myeloid leukaemia or features suggestive of MDS/AML on peripheral blood smear.
- •Any co-existing medical condition that in the investigator's judgement will substantially increase the risk associated with the patient's participation in the study
- •Gastrointestinal disorders that may interfere with absorption of the study drug or patients who are not able to take oral medication
- •Concomitant medications:
- •Any previous treatment with a PARP inhibitor, including Olaparib
- •Patients receiving the following classes of inhibitors of CYP3A4 (see Section 7.4 for guidelines and wash out periods)
- •Azole antifungals
- •Macrolide antibiotics
- •Protease inhibitors
- •Persistent grade 2 or greater toxicities, from any cause
- •Pregnant or breast-feeding women
研究组 & 干预措施
Olaparib, radiation +/- Cisplatin
Olaparib and radiotherapy with or without Cisplatin
干预措施: Olaparib (Drug)
Olaparib, radiation +/- Cisplatin
Olaparib and radiotherapy with or without Cisplatin
干预措施: Cisplatin (Drug)
Olaparib, radiation +/- Cisplatin
Olaparib and radiotherapy with or without Cisplatin
干预措施: Radiation (Radiation)
结局指标
主要结局
The incidence of dose limiting toxicities (DLTs)
时间窗: from start until 3 months after the last RT day
The incidence of dose limiting toxicities occuring during the DLT evaluation period (from start of study treatment until 3 months after the last radiation day). This endpoint will be used to determine the maximal tolerated dose of Olaparib in combination with radiotherapy with and without low dose Cisplatin.
次要结局
- Locoregional control rate (LRCR)(at one year)
- Progression free survival(until 5 years after treatment)
- Additional safety variables(until 5 years after treatment)
- Objective tumor response(until 5 years after treatment)
- Pharmacokinetic variables(week -1 (baseline) until week 11)
- Pharmacodynamic variables(week -1 (baseline) until week 8)
- Surrogate biomarkers for antitumor response(until 5 years after treatment)