Combination Rucaparib With Nivolumab in Small Cell Lung Carcinoma

Sponsor

Aman Chauhan (Other)

Overall Status

Recruiting

CT.gov ID

NCT03958045

Collaborator

Clovis Oncology, Inc. (Industry)

Enrollment

Location

Arm

57.9

Anticipated Duration (Months)

0.6

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose of this study is to evaluate survival and response rate of the combination rucaparib and nivolumab as maintenance therapy in platinum-sensitive small cell lung carcinoma.

Condition or Disease	Intervention/Treatment	Phase
Small Cell Lung Cancer	Combination Product: Rucaparib and Nivolumab	Phase 2

Detailed Description

Small cell lung cancer (SCLC) is one of the most aggressive malignancies with a 5-year survival rate of less than 7%. SCLC is characterized by rapid doubling time, high growth fraction and early development of widespread metastases. SCLC accounts for roughly 93% of all high-grade neuroendocrine carcinomas. The prognosis for SCLC is extremely poor with a median survival less than a year for extensive-stage disease. Therapeutic options have not advanced significantly in over two decades, with frontline treatment consisting of platinum doublet therapy for 3-6 cycles. While most patients show an initial favorable response to Carboplatin/cisplatin + etoposide, this response is usually short-lived. Most patients relapse with resistant disease between 3 to 6 months after completion of initial chemotherapy.

Based on preclinical data supporting the role of immune checkpoint and PARP (poly ADP ribose polymerase ) inhibitors in SCLC, combining nivolumab and rucaparib has the potential to prolong progression-free survival and overall survival. These two classes of drugs have non-overlapping toxicities. This novel combination has not been tried in a front-line maintenance setting for SCLC.

Eligible patients will have pathological (biopsy) or cytologically confirmed stage IV SCLC, and have achieved either partial or complete response post frontline chemotherapy with platinum doublet. Patients will be treated with combination rucaparib and nivolumab. The recommended starting dose of rucaparib as a continuously administered oral monotherapy is 600 mg BID. Nivolumab will be administered as an intravenous infusion once every 4 weeks at a fixed dose of 480 mg. In the absence of treatment delays due to adverse event(s), treatment may continue for 24 months.

Progression-free survival, overall survival, disease control rates, objective response rate, quality of life, and tumor mutation burden will be evaluated during this study (up to 3 years).

Study Design

Study Type:

Interventional

Anticipated Enrollment :

36 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Phase II Study of Combination Rucaparib With Nivolumab in Platinum-Sensitive Small Cell Lung Carcinoma Patients as Maintenance After Induction Therapy With Platinum Doublet

Actual Study Start Date :

Sep 4, 2019

Anticipated Primary Completion Date :

Jul 1, 2023

Anticipated Study Completion Date :

Jul 1, 2024

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Patients with Stage IV SCLC Patients with extensive stage (IV) SCLC (small cell lung cancer)	Combination Product: Rucaparib and Nivolumab Rucaparib (600mg BID) and Nivolumab (480mg IV q4 wk)

Arm

Intervention/Treatment

Experimental: Patients with Stage IV SCLC

Patients with extensive stage (IV) SCLC (small cell lung cancer)

Combination Product: Rucaparib and Nivolumab

Rucaparib (600mg BID) and Nivolumab (480mg IV q4 wk)

Outcome Measures

Primary Outcome Measures

Progression Free Survival [0-3 years]
Duration (time) of progression-free survival after response to initial platinum-based therapy.

Secondary Outcome Measures

Disease Control Rate [8 weeks, 16 weeks and 24 weeks post-treatment]
Disease control rate is the percentage of subjects who had a partial response post-initial chemotherapy and who have a confirmed reduction in tumor size compared to post-induction chemotherapy baseline or fulfilling the criteria for stable disease.
Overall Survival [0-2 years]
The time from first dose of trial medication to date of death due to any cause.
Objective Response Rate [8 weeks, 16 weeks and 24 weeks post-treatment]
Objective response rate (ORR) is the proportion of patients with complete response or partial response according to RECIST v1.1. Patients with complete response at baseline will be excluded from ORR analysis.
Quality of Life Scale [0-2 years]
Quality of life is assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) questionnaire, which probes function and symptoms. Scores range from 0-100. High scores on functional scales represent a high/healthy level of functioning; high scores symptom scales represent a high level of symptomology.

Other Outcome Measures

Tumor Mutation Burden [0-3 years]
Correlate tumor mutation burden with treatment response.
PD-L1 CPS [0-3 years]
A combined positive score (CPS) for Programmed Death Ligand 1 (PD-L1) will be derived from immunohistochemical analysis of tumor tissue.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria

Patients with histologically or cytologically confirmed stage IV, extensive stage, small cell lung cancer who achieved either partial or complete remission per RECIST 1.1 post frontline chemotherapy with platinum doublet (Cisplatin or Carboplatin/etoposide).
Enrollment is within 6 weeks of last (4th cycle) of chemotherapy.
Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
Adequate Bone Marrow Function
Adequate Hepatic Function

Exclusion Criteria

Prior therapy with any antibody/drug targeting T-cell co-regulatory proteins (immune checkpoints)
Major surgery within 4 weeks of initiation of study medication.
Current use of (some) immunosuppressants
Active infection requiring systemic therapy
HIV/AIDS
Hepatitis B virus or hepatitis C virus infection at screening
Autoimmune disease
Persisting toxicity related to prior therapy
Pregnancy
Vaccination (except inactive) within 4 weeks of the first dose of nivolumab
Hypersensitivity to the study drugs
Cardiovascular disease
Untreated central nervous system (CNS) metastases or leptomeningeal carcinomatosis
(Some) active secondary malignancy
Active pneumonitis or interstitial lung disease