Carboplatin, Paclitaxel, Bevacizumab, and Veliparib in Treating Patients with Newly Diagnosed Stage II-IV Ovarian Epithelial, Fallopian Tube, or Primary Peritoneal Cancer

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Basic Trial Information

PhaseTypeAgeTrial IDs
Phase IBiomarker/Laboratory analysis, Treatment18 and overGOG-9923
NCI-2011-03730, CDR0000656038, NCT00989651

Trial Description

Summary

This phase I trial studies the side effects and best dose of veliparib when given together with carboplatin, paclitaxel, and bevacizumab in treating patients with newly diagnosed stage II-IV ovarian epithelial, fallopian tube, or primary peritoneal cancer. Veliparib may stop the growth of tumor cells by blocking some of the enzymes needed for cells to repair themselves from damage and survive. Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Bevacizumab, a type of drug called a monoclonal antibody, blocks tumor growth by targeting certain cells and preventing the growth of tumor blood vessels. Giving veliparib together with carboplatin, paclitaxel, and bevacizumab may kill more tumor cells.

Further Study Information

PRIMARY OBJECTIVES:

I. To determine the maximum tolerated dose (MTD) and dose-limiting toxicities of ABT-888 (veliparib) when administered using continuous versus intermittent dosing schedules with intravenous carboplatin, paclitaxel and bevacizumab using two different treatment regimens; or with intraperitoneal cisplatin and intravenous and intraperitoneal paclitaxel and bevacizumab in women with newly diagnosed, previously untreated, epithelial ovarian, fallopian tube, or primary peritoneal cancer.

II. To determine the feasibility of these treatment regimens over four cycles in a 2-stage group sequential design once the MTD is established.

III. To assess the toxicity of these regimens using Cancer Therapy Evaluation Program (CTEP) National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.

SECONDARY OBJECTIVES:

I. To estimate the response rate (in measurable disease patients) and progression-free survival in patients treated with these treatment regimens.

TERTIARY OBJECTIVES:

I. To assess the extent of poly-ADP-ribose polymerase (PARP) inhibition in peripheral blood mononuclear cells on day 1 of cycles 1 and 2.

II. To assess genomic breast cancer, early onset (BRCA) mutation status in all patients in regimens I and II with continuous ABT-888 dosing and descriptively correlate with toxicity and efficacy.

OUTLINE: This is a dose-escalation study of veliparib followed by a feasibility study. Patients are sequentially assigned to 1 of 3 treatment regimens.

REGIMEN I: Patients receive paclitaxel intravenously (IV) over 3 hours, carboplatin IV over 30 minutes, and bevacizumab IV over 30-90 minutes (beginning in course 2) on day 1. Patients also receive veliparib orally (PO) twice daily (BID) on days 1-21. Treatment repeats every 21 days for 6 courses. Patients then receive bevacizumab alone on day 1. Treatment with bevacizumab repeats every 21 days for 16 courses in the absence of disease progression or unacceptable toxicity.

REGIMEN II: Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15. Patients also receive carboplatin, bevacizumab, and veliparib as in Regimen I. Treatment repeats every 21 days for 6 courses. Patients then receive bevacizumab alone on day 1. Treatment with bevacizumab repeats every 21 days for 16 courses in the absence of disease progression or unacceptable toxicity.

REGIMEN III: Patients receive paclitaxel IV over 3 hour on day 1 and intraperitoneally (IP) on day 8, and cisplatin IP on day 1 or 2. Patients also receive bevacizumab and veliparib as in Regimen I. Treatment repeats every 21 days for 6 courses. Patients then receive bevacizumab alone on day 1. Treatment repeats every 21 days for 16 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up periodically.

Eligibility Criteria

Inclusion Criteria:

Patients must have signed an approved informed consent and authorization permitting release of personal health information

Patients who have met the pre-entry requirements specified

Patients must be entered between 1 and 12 weeks after initial surgery performed for the combined purpose of diagnosis, staging and cytoreduction

Patients must have a Gynecologic Oncology Group (GOG) performance status of 0, 1, or 2

Prothrombin time (PT) such that international normalized ratio (INR) is =< 1.5 x ULN (or an in-range INR, usually between 2 and 3, if a patient is on a stable dose of therapeutic warfarin) and a partial thromboplastin time (PTT) < 1.5 x ULN

Neuropathy (sensory and motor) less than or equal to CTEP CTCAE version 4.0, grade 1

Alkaline phosphatase less than or equal to 2.5 x ULN (CTEP CTCAE version 4.0, grade 1)

Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) less than or equal to 3 x ULN (CTEP CTCAE version 4.0, grade 1)

Bilirubin less than or equal to 1.5 x ULN (CTEP CTCAE version 4.0, grade 1)

Regimens I and II: Creatinine =< 1.5 x institutional upper limit normal (ULN), CTCAE grade 1

Regimen III: Creatinine no greater than the institutional upper limits of normal

Platelets greater than or equal to 100,000/mm^3

Absolute neutrophil count (ANC) greater than or equal to 1,500/mm^3, equivalent to CTEP Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, grade 1; this ANC cannot have been induced or supported by granulocyte colony stimulating factors

Patients with the following histologic cell types are eligible:

Serous adenocarcinoma, endometrioid adenocarcinoma, mucinous adenocarcinoma, undifferentiated carcinoma, clear cell adenocarcinoma, mixed epithelial adenocarcinoma, transitional cell carcinoma, malignant Brenner's tumor, adenocarcinoma not otherwise specified (N.O.S.) or carcinosarcoma

All patients must have a procedure for determining diagnosis of epithelial ovarian, fallopian tube, primary peritoneal, or carcinosarcoma with appropriate tissue for histologic evaluation

Patients with a histologic diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal carcinoma, or carcinosarcoma stage II, III, or IV with either optimal (=< 1 cm residual disease) or suboptimal residual disease

Albumin greater than or equal to 3.0 g/dL

Exclusion Criteria:

Patients with clinical symptoms or signs of gastrointestinal obstruction and who require parenteral hydration or nutrition

Patients with clinically significant proteinuria (urine protein creatinine ratio greater or equal to 1.0)

Patients with known hypersensitivity to Chinese hamster ovary cell products or other recombinant human or humanized antibodies

CTEP CTCAE version 4.0, grade 2 or higher peripheral ischemia (brief [< 24 hrs] episode of ischemia managed non-surgically and without permanent deficit)

Serious cardiac arrhythmia requiring medication

Patients with active bleeding or pathologic conditions that carry high risk of bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major vessels

Patients with serious non-healing wound, ulcer, or bone fracture; this includes history of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess within 28 days; patients with granulating incisions healing by secondary intention with no evidence of fascial dehiscence or infection are eligible but require weekly wound examinations

Patients with acute hepatitis or active infection that requires parenteral antibiotics

Patients who have received prior chemotherapy for any abdominal or pelvic tumor within the last five years are excluded; patients may have received prior adjuvant chemotherapy for localized breast cancer, provided that it was completed more than three years prior to registration, and that the patient remains free of recurrent or metastatic disease

Patients who have received prior radiotherapy to any portion of the abdominal cavity or pelvis are excluded; prior radiation for localized cancer of the breast, head and neck, or skin is permitted, provided that it was completed more than three years prior to registration, and the patient remains free of recurrent or metastatic disease

Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer and other specific malignancies as noted, are excluded if there is any evidence of other malignancy being present within the last five years; patients are also excluded if their previous cancer treatment contraindicates this protocol therapy

Patients with synchronous primary endometrial cancer or a past history of endometrial cancer, unless all of the following conditions are met:

Stage not greater than IB

No more than superficial myometrial invasion

No vascular or lymphatic invasion

No poorly differentiated subtypes, including papillary serous, clear cell, or other International Federation of Gynecology and Obstetrics (FIGO) grade 3 lesions

Patients with a current diagnosis of borderline epithelial ovarian tumor (formerly “tumors of low malignant potential”) or recurrent invasive epithelial ovarian, primary peritoneal or fallopian tube cancer treated with surgery only (such as patients with stage IA or IB low-grade epithelial ovarian or fallopian tube cancers) are not eligible

NOTE: Patients with a prior diagnosis of a borderline tumor that was surgically resected and who subsequently develop an unrelated, new invasive epithelial ovarian, peritoneal primary or fallopian tube cancer are eligible, provided that they have not received prior chemotherapy for any ovarian tumor

Patients with GOG performance status of 3 or 4

New York Heart Association (NYHA) class II or higher congestive heart failure

Myocardial infarction or unstable angina < 6 months prior to registration

Uncontrolled hypertension, defined as systolic > 150 mm Hg or diastolic > 90 mm Hg

Patients with history of cerebrovascular accident (CVA, stroke), transient ischemic attack (TIA) or subarachnoid hemorrhage within six months of the first date of treatment on this study are ineligible

Patients with history or evidence upon physical examination of central nervous system (CNS) disease, including primary brain tumor, seizures or history of seizures, and/or any CNS metastases are ineligible

Patients who are pregnant or nursing

Patients with invasive procedures or anticipation of invasive procedures within the following timeframes as defined below:

Major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to the first date of bevacizumab therapy (cycle 2)

Major surgical procedure anticipated during the course of the study

Core biopsy within 7 days prior to the first date of bevacizumab therapy (cycle 2)

Trial Contact Information

Trial Lead Organizations / Sponsors / Collaborators

National Cancer Institute

  • National Cancer Institute
Katherine Marie Bell-McGuinn, Principal Investigator

Trial Sites

U.S.A.

Colorado
Aurora

University of Colorado Cancer Center - Anschutz Cancer Pavilion

Kian Behbakht
Ph: 720-848-0650

Kian Behbakht
Principal Investigator

Georgia
Augusta

Georgia Regents University Medical Center

Sharad Anant Ghamande
Ph: 706-721-1663
Email: cancer@georgiahealth.edu

Sharad Anant Ghamande
Principal Investigator

Illinois
Chicago

University of Chicago Comprehensive Cancer Center

Meaghan Elizabeth Tenney
Ph: 773-834-7424

Meaghan Elizabeth Tenney
Principal Investigator

Iowa
Iowa City

University of Iowa/Holden Comprehensive Cancer Center

David Paul Bender
Ph: 800-237-1225

David Paul Bender
Principal Investigator

Maryland
Baltimore

Johns Hopkins University/Sidney Kimmel Cancer Center

Deborah Kay Armstrong
Ph: 410-955-8804
Email: jhcccro@jhmi.edu

Deborah Kay Armstrong
Principal Investigator

Missouri
Saint Louis

Washington University School of Medicine

David Gardner Mutch
Ph: 800-600-3606
Email: info@ccadmin.wustl.edu

David Gardner Mutch
Principal Investigator

New York
Buffalo

Roswell Park Cancer Institute

Shashikant B. Lele
Ph: 877-275-7724

Shashikant B. Lele
Principal Investigator

New York

Memorial Sloan-Kettering Cancer Center

Katherine Marie Bell-McGuinn
Ph: 212-639-7202

Katherine Marie Bell-McGuinn
Principal Investigator

Ohio
Cleveland

Cleveland Clinic Foundation

Peter G. Rose
Ph: 866-223-8100

Peter G. Rose
Principal Investigator

MetroHealth Medical Center

Peter G. Rose
Ph: 866-223-8100

Peter G. Rose
Principal Investigator

Columbus

Ohio State University Comprehensive Cancer Center

Katherine Marie Bell-McGuinn
Ph: 212-639-7202
Email: bell-mck@mskcc.org

Katherine Marie Bell-McGuinn
Principal Investigator

Mayfield Heights

Hillcrest Hospital Cancer Center

Peter G. Rose
Ph: 866-223-8100

Peter G. Rose
Principal Investigator

Oklahoma
Oklahoma City

University of Oklahoma Health Sciences Center

Robert S. Mannel
Ph: 405-271-4272
Email: julie-traylor@ouhsc.edu

Robert S. Mannel
Principal Investigator

Pennsylvania
Philadelphia

Fox Chase Cancer Center

Lainie Paula Martin
Ph: 215-728-4790

Lainie Paula Martin
Principal Investigator

Rhode Island
Providence

Women and Infants Hospital

Cara A. Mathews
Ph: 401-274-1122

Cara A. Mathews
Principal Investigator

Virginia
Charlottesville

University of Virginia Cancer Center

Linda Rosenbaum Duska
Ph: 434-243-6143

Linda Rosenbaum Duska
Principal Investigator

Richmond

Virginia Commonwealth University/Massey Cancer Center

Jori S. Carter
Ph: 804-628-1939

Jori S. Carter
Principal Investigator

Link to the current ClinicalTrials.gov record.
NLM Identifer NCT00989651

Note: Information about participating sites on pharmaceutical industry trials may be incomplete. Please visit the ClinicalTrials.gov record via the link above for more information about participating sites.