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Testing the Addition of Ipatasertib to the Usual Chemotherapy Treatment (Paclitaxel and Carboplatin) for Stage III or IV Epithelial Ovarian Cancer

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ClinicalTrials.gov Identifier: NCT05276973
Recruitment Status : Recruiting
First Posted : March 14, 2022
Last Update Posted : September 26, 2022
Sponsor:
Collaborator:
NRG Oncology
Information provided by (Responsible Party):
National Cancer Institute (NCI)

Brief Summary:
This phase I/IB trial tests the safety, side effects, and best dose of ipatasertib in combination with paclitaxel and carboplatin in treating patients with stage III or IV epithelial ovarian cancer. Ipatasertib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Paclitaxel is in a class of medications called taxanes. It stops tumor cells from growing and dividing and may kill them. Carboplatin is in a class of medications known as platinum-containing compounds. It works in a way similar to the anticancer drug cisplatin, but may be better tolerated than cisplatin. Carboplatin works by killing, stopping or slowing the growth of tumor cells. Giving ipatasertib in combination with paclitaxel and carboplatin may lower the chance of the tumor growing or spreading for longer than the paclitaxel and carboplatin alone.

Condition or disease Intervention/treatment Phase
Fallopian Tube Endometrioid Adenocarcinoma Fallopian Tube High Grade Serous Adenocarcinoma Ovarian Endometrioid Adenocarcinoma Ovarian High Grade Serous Adenocarcinoma Primary Peritoneal Endometrioid Adenocarcinoma Primary Peritoneal High Grade Serous Adenocarcinoma Stage III Fallopian Tube Cancer AJCC v8 Stage III Ovarian Cancer AJCC v8 Stage III Primary Peritoneal Cancer AJCC v8 Stage IV Fallopian Tube Cancer AJCC v8 Stage IV Ovarian Cancer AJCC v8 Stage IV Primary Peritoneal Cancer AJCC v8 Unresectable Fallopian Tube Endometrioid Adenocarcinoma Unresectable Fallopian Tube High Grade Serous Adenocarcinoma Unresectable Ovarian Endometrioid Adenocarcinoma Unresectable Ovarian High Grade Serous Adenocarcinoma Unresectable Primary Peritoneal Endometrioid Adenocarcinoma Unresectable Primary Peritoneal High Grade Serous Adenocarcinoma Procedure: Biopsy Drug: Carboplatin Drug: Ipatasertib Drug: Paclitaxel Phase 1

Detailed Description:

PRIMARY OBJECTIVES:

I. To estimate the maximum tolerated dose (MTD) and the dose limiting toxicities (DLTs) of ipatasertib in combination with paclitaxel and carboplatin as neoadjuvant chemotherapy for ovarian cancer.

II. To determine the feasibility of the treatment regimen once the MTD is estimated.

III. To assess the toxicities of ipatasertib in combination with paclitaxel and carboplatin by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

SECONDARY OBJECTIVE:

I. Objective response rate by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 prior to interval debulking surgery (IDS).

TRANSLATIONAL RESEARCH OBJECTIVES:

I. To evaluate the change of phosphorylated (p)PRAS40 expression in the pre-treatment tumor versus (vs.) on-treatment tumor.

II. To identify the pharmacokinetics of ipatasertib in the tissue and blood. III. To correlate antitumor response with genomic alterations in PI3K pathway genes (PTEN, PIK3CA, PIK3R1, AKT1, p53 loss, KRAS, NF1, TSC1/TSC1).

IV. To correlate antitumor response with transcriptomic alterations in PI3K pathway genes (PTEN, PIK3CA, PIK3R1, AKT1, p53 loss, KRAS, NF1, TSC1/TSC1).

V. To correlate response with PTEN loss.

OUTLINE: This is a dose-escalation study of ipatasertib followed by a dose-expansion study.

Patients receive paclitaxel intravenously (IV) over 3 hours and carboplatin IV over 30-60 minutes on day 1. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients also receive ipatasertib orally (PO) once daily (QD) until 24 hours before surgery in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 30 and 90 days.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I/IB Safety and Pharmacodynamic Study of Neoadjuvant (NACT) Paclitaxel and Carboplatin With Ipatasertib as Initial Therapy of Ovarian Cancer PTMA 100805
Actual Study Start Date : June 27, 2022
Estimated Primary Completion Date : June 30, 2024
Estimated Study Completion Date : June 30, 2024


Arm Intervention/treatment
Experimental: Treatment (paclitaxel, carboplatin, ipatasertib)
Patients receive paclitaxel IV over 3 hours and carboplatin IV over 30-60 minutes on day 1. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients also receive ipatasertib PO QD until 24 hours before surgery in the absence of disease progression or unacceptable toxicity.
Procedure: Biopsy
Undergo biopsy
Other Names:
  • BIOPSY_TYPE
  • Bx

Drug: Carboplatin
Given IV
Other Names:
  • Blastocarb
  • Carboplat
  • Carboplatin Hexal
  • Carboplatino
  • Carboplatinum
  • Carbosin
  • Carbosol
  • Carbotec
  • CBDCA
  • Displata
  • Ercar
  • JM-8
  • Nealorin
  • Novoplatinum
  • Paraplatin
  • Paraplatin AQ
  • Paraplatine
  • Platinwas
  • Ribocarbo

Drug: Ipatasertib
Given PO
Other Names:
  • GDC-0068
  • RG-7440

Drug: Paclitaxel
Given IV
Other Names:
  • Anzatax
  • Asotax
  • Bristaxol
  • Praxel
  • Taxol
  • Taxol Konzentrat




Primary Outcome Measures :
  1. Incidence of dose limiting toxicities (dose escalation phase) [ Time Frame: Within the first cycle of neoadjuvant chemotherapy (1 cycle = 21 days) ]
    The number of patients with dose limiting toxicities will be summarized by dose level.

  2. Incidence of dose limiting toxicities (dose expansion phase) [ Time Frame: Within the first cycle of neoadjuvant chemotherapy (1 cycle = 21 days) ]
  3. Incidence of adverse events [ Time Frame: Up to 90 days after last dose of study drug ]
    Frequency and severity of adverse events as assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5 will be tabulated as descriptive statistics.


Secondary Outcome Measures :
  1. Tumor response [ Time Frame: Up to day of surgery ]
    Tumor response is assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, and will be summarized by dose level. The proportion of patients with objective tumor response will be estimated with their corresponding 90% confidence interval for expansion phase.


Other Outcome Measures:
  1. Phosphorylated (p)PRAS40 expression in tumor [ Time Frame: Up to 90 days ]
    Will be summarized by collection time point and dose level. Wilcoxon signed rank test will be used to explore the change of pPRAS40 expression in the pre-treatment versus on-treatment tumor in the patients who have been treated at the maximum tolerated dose and have evaluable biopsy specimen.

  2. Measurements of tissue and blood pharmacokinetics for ipatasertib [ Time Frame: Up to day of surgery ]
    Descriptive statistics (e.g., mean, standard deviation) will be given for the ipatasertib pharmacokinetics measured in the tissue and blood. Graphs and non-linear model techniques will be used to describe and identify the maximum plasma concentration (Cmax) and the time to observed Cmax (Tmax) for ipatasertib whenever these are applied.

  3. Tumor response [ Time Frame: Up to 90 days ]
    Assessed by RECIST 1.1, and measurements for genomic alterations in PI3K Pathway genes (PTEN, PI3KCA, PIK3R1, AKT1, p53 loss, KRAS, NF1, TSC1/TSC1). Summary statistics (or graphs) for PTEN loss, genomic alterations in PI3K pathway genes (PTEN, PI3KCA, PIK3R1, AKT1, p53 loss, KRAS, NF1, TSC1/TSC1), transcriptomic alterations in PI3K Pathway genes (PTEN, PI3KCA, PIK3R1, AKT1, p53 loss, KRAS, NF1, TSC1/TSC1) will be given. The association of objective tumor response with each of these biomarkers will be explored by appropriate statistical methods, e.g., Spearman's rank correlation coefficient for ordinal or interval type of biomarker data, chi-squared test for nominal type of biomarker data.

  4. Tumor response [ Time Frame: Up to 90 days ]
    Assessed by RECIST 1.1, and measurements for transcriptomic alterations in PI3K Pathway genes (PTEN, PI3KCA, PIK3R1, AKT1, p53 loss, KRAS, NF1, TSC1/TSC1). Summary statistics (or graphs) for PTEN loss, genomic alterations in PI3K pathway genes (PTEN, PI3KCA, PIK3R1, AKT1, p53 loss, KRAS, NF1, TSC1/TSC1), transcriptomic alterations in PI3K Pathway genes (PTEN, PI3KCA, PIK3R1, AKT1, p53 loss, KRAS, NF1, TSC1/TSC1) will be given. The association of objective tumor response with each of these biomarkers will be explored by appropriate statistical methods, e.g., Spearman's rank correlation coefficient for ordinal or interval type of biomarker data, chi-squared test for nominal type of biomarker data.

  5. Tumor response [ Time Frame: Up to 90 days ]
    Assessed by RECIST 1.1, and measurement for PTEN loss. Summary statistics (or graphs) for PTEN loss, genomic alterations in PI3K pathway genes (PTEN, PI3KCA, PIK3R1, AKT1, p53 loss, KRAS, NF1, TSC1/TSC1), transcriptomic alterations in PI3K Pathway genes (PTEN, PI3KCA, PIK3R1, AKT1, p53 loss, KRAS, NF1, TSC1/TSC1) will be given. The association of objective tumor response with each of these biomarkers will be explored by appropriate statistical methods, e.g., Spearman's rank correlation coefficient for ordinal or interval type of biomarker data, chi-squared test for nominal type of biomarker data.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Pathologically proven diagnosis of ovarian cancer (ovarian cancer = fallopian tube cancer, ovarian cancer, primary peritoneal cancer). Required data element: submission of pathology report. Patients with the following histologic cell types are eligible:

    • High grade serous
    • Endometrioid adenocarcinoma, grade 3 Genomic/genetic testing results will be a data collection element if performed as part of usual care (germline genetic testing, tumor genomic testing, homologous recombination deficiency [HRD] testing). Genetic/genomic testing results should be uploaded if they become available anytime during conduct of the study
  • Appropriate stage for study entry defined as stage III or stage IV based on the following diagnostic workup:

    • History/physical examination within 14 days prior to registration
    • Imaging with computed tomography (CT) chest/abdomen/pelvis (C/A/P) within 28 days prior to registration
  • Patients must have evaluable disease or measurable disease defined by RECIST version (v) 1.1. Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded). Each lesion must be >= 10 mm when measured by CT or magnetic resonance imaging (MRI). Lymph nodes must be >= 15 mm in short axis when measured by CT or MRI
  • Pre-treatment formalin-fixed, paraffin-embedded (FFPE) tumor block collected from laparoscopy (preferred) or five 18G cores by radiology/interventional radiology (acceptable) must be available for submission
  • Disease must be considered unresectable via primary debulking surgery and in need of neoadjuvant chemotherapy (NACT) prior to debulking surgery. This assessment of unresectability can be made via imaging or laparoscopic scoring
  • No prior therapy directed at ovarian cancer
  • Age >= 18 years
  • Eastern Cooperative Oncology Group (ECOG) performance status =< 2 within 14 days prior to registration
  • Absolute neutrophil count >= 1,000/mcl (within 14 days prior to registration)
  • Platelets >= 100,000/mcl (within 14 days prior to registration)
  • Creatinine =< institutional/laboratory upper limit of normal (ULN) or creatinine clearance (CrCL) or estimated glomerular filtration rate (eGFR) of >= 60 mL/min estimated using either the Cockcroft-Gault equation, the Modification of Diet in Renal Disease Study, or as reported in the comprehensive metabolic panel/basic metabolic panel (eGFR) (within 14 days prior to registration)
  • Total bilirubin =< 1.5 x ULN (patients with known Gilbert's disease who have bilirubin level =< 3 x ULN may be enrolled) (within 14 days prior to registration)
  • Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 3 x ULN (within 14 days prior to registration)
  • Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better
  • Women of childbearing potential (WOCBP) must agree to use two forms of birth control (hormonal or barrier method of birth control; abstinence) agree to remain abstinent (refrain from heterosexual intercourse) or use contraceptive methods with a failure rate of < 1% per year during the treatment period and for at least 28 days after the last dose of ipatasertib and agreement to refrain from donating eggs during this same period
  • Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
  • Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial
  • For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
  • Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
  • The patient or a legally authorized representative must provide study-specific informed consent prior to study entry and, for patients treated in the United States (U.S.), authorization permitting release of personal health information
  • Ability to understand and willingness to sign an institutional review board (IRB) approved written informed consent document (or that of legally authorized representative, if applicable)

Exclusion Criteria:

  • Prior treatment with agent(s) targeting PI3K/AKT/mTor pathway
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to ipatasertib, paclitaxel or carboplatin
  • Currently receiving any other investigational agents or has received an investigational agent within 4 weeks of study registration
  • Abnormal gastrointestinal function. This includes gastrointestinal (GI) obstruction or bleeding or signs/symptoms thereof within 3 months of study registration
  • Patients with a history of abdominal fistula will be considered eligible if the fistula was surgically repaired or has healed, there has been no evidence of fistula for at least 6 months, and patient is deemed to be at low risk of recurrent fistula
  • Received prior radiotherapy to any portion of the abdominal cavity or pelvis
  • Patients with uncontrolled intercurrent illness
  • Patients with psychiatric illness/social situations that would limit compliance with study requirements
  • Patients with active infections requiring intravenous antibiotics
  • Patients with diabetes either requiring insulin therapy or with a baseline fasting glucose >= 160 mg/dL and/or high glycosylated hemoglobin (HbA1c) (> 8), suggesting poorly controlled diabetes. Fasting is defined as abstaining from food and drink (with the exception of water) for at least 8 hours
  • Patients with grade >= 2 uncontrolled or untreated hypercholesterolemia (> 300 mg/dL) or hypertriglyceridemia (> 300 mg/dL) would be an ineligible
  • History of or active inflammatory bowel disease (e.g., Crohn's disease and/or ulcerative colitis) or active bowel inflammation (e.g., diverticulitis)
  • Lung disease: Pneumonitis, interstitial lung disease, idiopathic pulmonary fibrosis, cystic fibrosis, Aspergillosis, active tuberculosis, or history of opportunistic infections (pneumocystis pneumonia or cytomegalovirus pneumonia)
  • Patients with known brain metastases or leptomeningeal disease are not eligible, as prior treatment directed at ovarian cancer is not allowed
  • Treatment with strong CYP3A inhibitors or strong CYP3A inducers within 2 weeks or 5 drug-elimination half-lives, whichever is longer, prior to registration

    • Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product
  • Known clinically significant history of liver disease consistent with Child Pugh class B or C, including active viral or other hepatitis, current drug or alcohol abuse, or cirrhosis
  • Pregnant women are excluded from this study because ipatasertib is an oral AKT inhibitor with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with ipatasertib, breastfeeding should be discontinued if the mother is treated with ipatasertib. These potential risks may also apply to other agents used in this study

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05276973


Locations
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United States, Georgia
Augusta University Medical Center Recruiting
Augusta, Georgia, United States, 30912
Contact: Site Public Contact    706-721-2388    ga_cares@augusta.edu   
Principal Investigator: Sharad A. Ghamande         
United States, Oklahoma
University of Oklahoma Health Sciences Center Recruiting
Oklahoma City, Oklahoma, United States, 73104
Contact: Site Public Contact    405-271-8777    ou-clinical-trials@ouhsc.edu   
Principal Investigator: Lauren E. Dockery         
United States, Rhode Island
Women and Infants Hospital Recruiting
Providence, Rhode Island, United States, 02905
Contact: Site Public Contact    401-274-1122      
Principal Investigator: Cara A. Mathews         
Sponsors and Collaborators
National Cancer Institute (NCI)
NRG Oncology
Investigators
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Principal Investigator: Katherine C Fuh NRG Oncology
Layout table for additonal information
Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT05276973    
Other Study ID Numbers: NCI-2022-01930
NCI-2022-01930 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
NRG-GY027 ( Other Identifier: NRG Oncology )
NRG-GY027 ( Other Identifier: CTEP )
U10CA180868 ( U.S. NIH Grant/Contract )
First Posted: March 14, 2022    Key Record Dates
Last Update Posted: September 26, 2022
Last Verified: July 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page.
URL: https://grants.nih.gov/policy/sharing.htm

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Adenocarcinoma
Ovarian Neoplasms
Carcinoma, Ovarian Epithelial
Fallopian Tube Neoplasms
Peritoneal Neoplasms
Cystadenocarcinoma, Serous
Carcinoma, Endometrioid
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Endocrine Gland Neoplasms
Neoplasms by Site
Ovarian Diseases
Adnexal Diseases
Genital Neoplasms, Female
Urogenital Neoplasms
Endocrine System Diseases
Gonadal Disorders
Fallopian Tube Diseases
Abdominal Neoplasms
Digestive System Neoplasms
Digestive System Diseases
Peritoneal Diseases
Cystadenocarcinoma
Neoplasms, Cystic, Mucinous, and Serous
Endometrial Neoplasms
Uterine Neoplasms
Paclitaxel
Carboplatin