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試驗計畫名稱
一項第II期開放性、隨機分配、多中心試驗,評估DNA損壞修復標靶藥物併用Olaparib相較於Olaparib單一療法,用於治療以同源重組修復(HRR)相關基因(包括BRCA1/2)不同變異組別之轉移性三陰性乳癌病患的療效與安全性(VIOLETTE)
試驗申請者: |
百瑞精鼎國際股份有限公司 |
試驗委託/贊助單位名稱: |
AstraZeneca AB |
試驗計畫書編號: |
D5336C00001 |
核准執行文號: |
1066067021 |
登錄日期: |
2017-12-29 |
試驗預計執行期間: |
2017-07-01 至 2020-03-31 |
試驗目的
針對下列病患族群定出試驗目標:
「乳癌易感性基因突變(BRCAm)」 = 分層A之病患
「同源重組修復基因突變(HRRm)」 = 分層A和分層B之病患
「非BRCAm HRRm」 = 分層B之病患
「全部」 = 任一分層之病患
「非HRRm」 = 分層C之病患
試驗階段分級
Phase Ⅱ
藥品名稱
Olaparib (AZD2281), AZD6738 and AZD1775
主成分,劑型,劑量
AZD1775
AZD6738
Olaparib (AZD2281),film-coated tablet
film-coated tablet
dry-filled capsules,100 or 150
20, 80 or 100
25 or 100
宣稱適應症
Metastatic Triple Negative Breast Cancer Patients Stratified by
Alterations in Homologous Recombinant Repair (HRR)-related Genes
(including
試驗醫院 / 受試者 召募狀態
試驗醫院 |
受試者召募狀態 |
國立臺灣大學醫學院附設醫院 |
N/A |
召募中 |
評估指標(endpoint)
PFS由盲性獨立中央評估委員會(BICR)依據實體腫瘤反應評估標準(RECIST 1.1)進行評估
利用試驗主持人依據RECIST 1.1所做出的評估進行PFS敏感性分析
PFS由盲性獨立中央評估委員會(BICR)依據實體腫瘤反應評估標準(RECIST 1.1)進行評估
利用試驗主持人依據RECIST 1.1所做出的評估進行PFS敏感性分析
利用BICR依據RECIST 1.1評估客觀反應
利用試驗主持人依據RECIST 1.1所做的評估對客觀反應進行敏感性分析
利用BICR依據RECIST 1.1評估DoR和腫瘤變化
利用試驗主持人依據RECIST 1.1所做的評估對DoR和腫瘤變化進行敏感性分析
至任何原因死亡的時間
利用BICR依據RECIST 1.1評估PFS和客觀反應率
利用試驗主持人依據RECIST 1.1所做的評估對PFS和客觀反應率進行敏感性分析
利用BICR依據RECIST 1.1評估DoR和腫瘤變化
利用試驗主持人依據RECIST 1.1所做的評估對DoR和腫瘤變化進行敏感性分析
15種基因的突變狀態
穩定狀態的最低濃度(Cmin ss)
�P 不良事件(AE,嚴重程度依據不良事件常用術語標準[CTCAE] 第4版分級)
�P 實驗室檢測(臨床化學、血液學及尿液分析)
�P 生命徵象(脈搏和血壓[BP])
�P 心電圖(ECG)數據
�P 美國東岸癌症臨床研究合作組織體能狀態(ECOG PS) (參見附錄F)
ctDNA濃度
以歐洲癌症研究與治療組織生活品質問卷-核心問卷(EORTC QLQ-30)進行結果評量
得包括但不限於定量化蛋白、訊息核醣核酸(mRNA)、去氧核醣核酸(DNA)和/或水溶性循環因子(如細胞激素)。得額外評估這類標記彼此間的生物資訊關聯性。
主要納入/排除條件
For inclusion in the study patients should fulfil the following criteria:
1. * Provision of informed consent prior to any study specific procedures
2. * Patients must be male or female ≥18 years of age
3. * Progressive cancer at the time of study entry
4. * Histologically or cytologically confirmed TNBC with evidence of metastatic
disease (defined as ER and PgR negative [IHC nuclear staining <1% positive] and
HER2 negative [IHC 0, 1+ or IHC 2+ with corresponding ISH non-amplified of
ratio less than 2.0 or ISH non-amplified ratio less than 2.0] as per ASCO-CAP
HER2 guideline recommendations 2013 (ASCO-CAP)
5. * Patients must have received at least 1 and no more than 2 prior lines of treatment
for metastatic disease with an anthracycline (eg, doxorubicin, epirubicin) and/or a
taxane (eg, paclitaxel, docetaxel) unless contraindicated, in either the neo-adjuvant,
adjuvant or metastatic setting..
* Patients who have received platinum (cisplatin or carboplatin, either as
monotherapy or in combination) for advanced breast cancer are eligible to enter the
study provided there has been no evidence of disease progression during the
platinum chemotherapy.
* Patients who have received prior platinum based chemotherapy are eligible if
platinum was given either as potentially curative treatment for a prior non breast
cancer (eg, ovarian cancer) with no evidence of disease for ≥5 years prior to study
entry or as adjuvant/neoadjuvant treatment for breast cancer provided at least
12 months have elapsed between the last dose of platinum-based treatment and
randomisation
6. Confirmed presence of qualifying HRR mutation or absence of any HRR mutation
in tumour tissue by the Lynparza HRR assay.
�{ FFPE tumour tissue blocks are required for each patient, but if not
available, tissue sections are accepted. At least twenty (20) (thirty [30]
preferable) unstained sections without cover slips must be submitted to
ensure sufficient material for the prospective Lynparza HRR testing to
determine study eligibility and research that will aid understanding of the
patient population relative to treatment with DDR and other cancer agents.
�{ If a patient has a previously known qualifying BRCA1/2 mutation (in blood
or tumour tissue), then the patient can be invited to consent to the full
study. The patient will need to consent to provide an archival tumour
block or tissue sections for central assessment of the HRR mutation status.
�{ If patients have a mutation in one of the 13 other non BRCA HRR genes
based on prior breast cancer tissue specimen testing by the commercially
available FoundationOne® assay, they must have the mutation confirmed
as a qualifying mutation by FMI. Similarly, if patients have no detected
mutation in any of the 15 HRR genes based on prior breast cancer tissue
specimen testing by the FoundationOne® assay, they must have the lack of
HRR mutation confirmed by FMI. The patient will need to consent to
provide an archival tumour sample (tissue block or sections) and a blood
sample.
7. *At least one measurable lesion that can be accurately assessed at baseline by
computed tomography (CT) (magnetic resonance imaging [MRI] where CT is
contraindicated) and is suitable for repeated assessment as per RECIST 1.1.
8. Patients must have normal organ and bone marrow function measured within
28 days prior to randomisation as defined below:
(a) Haemoglobin (Hb) ≥10.0 g/dL with no blood transfusions (packed red
blood cells) in the past 28 days
(b) Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
(c) Platelet count ≥100 x 109/L with no platelet transfusions in the
past 28 days
(d) Total bilirubin ≤1.5 x institutional upper limit of normal (ULN) unless
the patient has documented Gilbert’s Syndrome
(e) Aspartate aminotransferase (AST)/alanine aminotransferase (ALT)
≤2.5 x institutional ULN unless liver metastases are present in which case
they must be ≤5 x ULN
(f) Patients must have creatinine clearance (CrCl) estimated using the
Cockcroft-Gault equation of ≥51 mL/min:
Estimated CrCl = (140-age [years]) x weight (kg) (x F)a
serum creatinine (mg/dL) x 72
a where F=0.85 for females and F=1 for males
9. * ECOG PS 0-1 within 28 days of randomisation.
10. * Postmenopausal or evidence of non childbearing status for women of childbearing
potential: negative urine or serum pregnancy test within 28 days of study treatment
and confirmed prior to treatment on Day 1.
Postmenopausal is defined as:
�{ Amenorrheic for 1 year or more following cessation of exogenous
hormonal treatments
�{ Luteinizing hormone and Follicle stimulating hormone levels in the
postmenopausal range for women under 50
�{ radiation-induced oophorectomy with last menses >1 year ago
�{ chemotherapy-induced menopause with >1 year interval since last menses
�{ surgical sterilisation (bilateral oophorectomy or hysterectomy).
11. Women of childbearing potential and their partners, who are sexually active, must
agree to the use of 2 highly effective forms of contraception in combination (as
described in Appendix E) from the signing of the informed consent, throughout the
period of taking study treatment and for at least 1 month after last dose of study
drug(s), or they must totally/truly abstain from any form of sexual intercourse (as
described in Appendix E).
12. Male patients must use a condom during treatment and for 6 months after the last
dose of study drug(s) when having sexual intercourse with a pregnant woman or
with a woman of childbearing potential. Female partners of male patients should
also use a highly effective form of contraception (see Appendix E for acceptable
methods) for 6 months after the last dose of study drug(s) if they are of childbearing
potential.
13. Patient is willing and able to comply with the protocol for the duration of the study
including undergoing treatment and scheduled visits and examinations.
14. * Patients must have a life expectancy of ≥16 weeks.
Patients should not enter the study if any of the following exclusion criteria are fulfilled:
1. * Involvement in the planning and/or conduct of the study (applies to AstraZeneca
staff and/or staff at the study site).
2. Cytotoxic chemotherapy, hormonal or non hormonal targeted therapy within
21 days of Cycle 1 Day 1 is not permitted. Palliative radiotherapy must have been
completed 21 or more days before Cycle 1 Day 1. The patient can receive a stable
dose of bisphosphonates or denosumab for bone metastases, before and during the
study as long as these were started at least 5 days prior to study treatment.
3. * More than 2 prior lines of cytotoxic chemotherapy for metastatic disease.
�{ Prior treatments with hormonal therapy and non hormonal targeted therapy
are allowed and not counted as a prior line of cytotoxic chemotherapy.
�{ For the purposes of this protocol, the combination of an aromatase
inhibitor and everolimus is not considered cytotoxic chemotherapy.
�{ Treatment with biologics will not be considered as prior line of therapy.
4. * Previous randomisation in the present study.
5. * Previous treatment with a PARP inhibitor (including olaparib) or other DDR
inhibitor (unless treatment was for less than 3 weeks duration and at least 12 months
have elapsed between the last dose and randomisation. Patients that did not tolerate
prior treatment are excluded).
6. * Exposure to a small molecule IP within 30 days or 5 half-lives (whichever is
longer) prior to randomisation. The minimum washout period for immunotherapy
shall be 42 days.
7. * Patients with MDS/AML or with features suggestive of MDS/AML.
8. * Patients with second primary cancer, EXCEPTIONS: adequately treated
non melanoma skin cancer, curatively treated in-situ cancer of the cervix, Ductal
Carcinoma in Situ (DCIS), stage 1 grade 1 endometrial carcinoma, or other solid
tumours curatively treated with no evidence of disease for ≥ 5 years prior to study
entry (including lymphomas [without bone marrow involvement]).
9. Mean resting corrected QTc interval using the Fridericia formula (QTcF)
>470 msec/female patients and >450 msec for male patients (as calculated per
institutional standards) obtained from 3 ECGs performed 2-5 minutes apart at study
entry, or congenital long QT syndrome.
AZD1775 should not be given to patients who have a history of Torsades de pointes
unless all risk factors that contributed to Torsades have been corrected. AZD1775
has not been studied in patients with ventricular arrhythmias or recent myocardial
infarction.
10. Any of the following cardiac diseases currently or within the last 6 months defined
by New York Heart Association (NYHA) ≥ Class 2:
�{ Unstable angina pectoris
�{ Congestive heart failure
�{ Acute myocardial infarction
�{ Conduction abnormality not controlled with pacemaker or medication
�{ Significant ventricular or supraventricular arrhythmias (patients with
chronic rate-controlled atrial fibrillation in the absence of other cardiac
abnormalities are eligible)
11. Concomitant use of known strong cytochrome P (CYP) 3A inhibitors (eg.
itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with
ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or
moderate CYP3A inhibitors (eg. ciprofloxacin, erythromycin, diltiazem,
fluconazole, verapamil). The required washout period prior to starting study
treatment is 2 weeks.
Patient has had prescription or non-prescription drugs or other products known to be
sensitive CYP3A4 substrates or CYP3A4 substrates with a narrow therapeutic
index, or to be moderate to strong inhibitors/inducers of CYP3A4 which cannot be
discontinued 2 weeks prior to Day 1 of dosing and withheld throughout the study
until 2 weeks after the last dose of study drug (see Appendix H).
Transporter studies (in vitro) have shown that AZD1775 is an inhibitor of breast
cancer resistance protein (BCRP). Please refer to Appendix H for use with BCRP
substrates.
Patients should stop using herbal medications 7 days prior to first dose of study
treatment. Please see Appendix H for further details.
12. Concomitant use of known strong (eg. phenobarbital, enzalutamide, phenytoin,
rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John’s Wort) or
moderate CYP3A inducers (eg. 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.
13. Persistent toxicities (≥ CTCAE grade 2) caused by previous cancer therapy,
excluding alopecia and CTCAE grade 2 peripheral neuropathy.
14. Major surgery within 2 weeks of starting study treatment: patients must have
recovered from any effects of any major surgery.
15. * Immunocompromised patients, eg, patients who are known to be serologically
positive for human immunodeficiency virus (HIV).
16. * Patients with known active hepatitis (ie, hepatitis B or C).
17. * Patients considered a poor medical risk due to a serious, uncontrolled medical
disorder, non malignant systemic disease or active, uncontrolled infection.
�{ Examples include, but are not limited to, uncontrolled ventricular
arrhythmia, recent (within 3 months) myocardial infarction, uncontrolled
major seizure disorder, unstable spinal cord compression, superior vena
cava syndrome, extensive interstitial bilateral lung disease on High
Resolution CT scan or any psychiatric disorder that prohibits obtaining
18. * Patients with symptomatic uncontrolled brain metastases.
�{ A scan to confirm the absence of brain metastases is not required. Patients
with spinal cord compression unless considered to have received definitive
treatment for this and evidence of clinically stable disease (SD) for
28 days.
�{ * Patients with a history of treated central nervous system (CNS)
metastases are eligible, provided they meet all of the following criteria:
Disease outside the CNS is present. No clinical evidence of progression
since completion of CNS-directed therapy. Minimum of 3 weeks between
completion of radiotherapy and Cycle 1 Day 1 and recovery from
significant (Grade ≥3) acute toxicity with no ongoing requirement for
>10 mg of prednisone per day or an equivalent dose of other
corticosteroid. If on corticosteroids, the patient should be receiving a
stable dose of corticosteroids, started at least 4 weeks prior to treatment.
19. * Patients unable to swallow orally administered medication and patients with
gastrointestinal disorders likely to interfere with absorption of the study medication.
20. * Patients with a known hypersensitivity to olaparib, AZD1775, AZD6738, or any
of the excipients of the products.
21. Pregnant or breast feeding women.
Procedures for withdrawal of incorrectly enrolled patients see Section 3.4.
試驗計畫聯絡資訊
郭佳茹
02-8722-3258
試驗計畫受試者收納人數
本計畫預計收納受試者人數:台灣人數 26 人,全球人數 450 人
本計畫資料最近更新日期:2018-01-29
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