Veliparib, ATR Kinase Inhibitor M6620, and Cisplatin in Treating Patients with Refractory Solid Tumors
This phase I trial studies the side effects and best dose of veliparib and ATR kinase inhibitor M6620 when given together with cisplatin in treating patients with solid tumors that have not responded to treatment (refractory). Veliparib and ATR kinase inhibitor M6620 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cisplatin, 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. Giving veliparib, ATR kinase inhibitor M6620, and cisplatin may be safe, tolerable and/or effective in treating patients with refractory solid tumors.
Inclusion Criteria
- Patients must have histologically confirmed solid tumors for which standard therapy known to prolong survival has failed in the metastatic setting or for which standard therapies do not exist
- Tumor amenable to biopsy and willingness to undergo tumor biopsies before and after M6620 (VX-970) treatment during the expansion phase of the trial (biopsies optional during the escalation phase)
- Patients must have completed any chemotherapy, radiation therapy, surgery, or biologic therapy >= 3 weeks (or >= 5 half-lives, whichever is shorter) prior to entering the study; patients must be >= 2 weeks since any prior administration of a study drug in an exploratory investigational new drug (IND)/phase 0 study and >= 1 week since any palliative radiation therapy; patients must have recovered to eligibility levels from prior toxicity or adverse events
- Age >= 18 years of age
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2
- Life expectancy > 3 months
- Absolute neutrophil count >= 1,500/mcL
- Hemoglobin >= 10 g/dL
- Platelets >= 100,000/mcL
- Total bilirubin =< 1.5 X institutional upper limit of normal
- Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT)(serum glutamic pyruvic transaminase [SGPT]) =< 1.5 X institutional upper limit of normal (or =< 3 X upper limit of normal [ULN] in the setting of liver metastases)
- Creatinine =< 1.5 X institutional upper limit of normal or creatinine clearance >= 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal
- The effects of M6620 (VX-970) and veliparib on the developing human fetus are unknown; for this reason and because cisplatin is known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 6 months after completing study treatment; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately; men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and for 6 months after completion of administration of study agents
- Human immunodeficiency virus (HIV)-positive subjects on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with M6620 (VX-970); in addition, these subjects are at increased risk of lethal infections when treated with marrow-suppressive therapy
- Patients must be able to swallow whole tablets or capsules; nasogastric or g-tube administration is not allowed; any gastrointestinal disease which would impair ability to swallow, retain, or absorb drug is not allowed
- Ability to understand and the willingness to sign a written informed consent document
- During the expansion phase of the protocol, patients must have disease amenable to biopsy and be willing to undergo pre- and post-treatment biopsies
- Patients must have >= 10.0 g/dL hemoglobin (Hb) and no blood transfusion in the past 28 days to receive veliparib
Exclusion Criteria
- Patients who are receiving any other investigational agents
- Patients with known active brain metastases or carcinomatous meningitis are excluded from this clinical trial; patients whose brain metastatic disease status has remained stable for >= 4 weeks following treatment of brain metastases are eligible to participate at the discretion of the principal investigator
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active untreated infection, or psychiatric illness/social situations that would limit compliance with study requirements
- Patients required to be on any of the concomitant medications are excluded
- Pregnant women and women who are breastfeeding are excluded from this study because the effects of the study drugs on the developing fetus are unknown
- Patients who have had prior platinum-based therapy who have > grade 1 neurotoxicity or ototoxicity at the time of enrollment will not be permitted on study
- Patients with a seizure history will not be permitted on protocol due to association of veliparib with seizure activity in animal toxicology studies at higher doses; patients on anticonvulsant medications will not be permitted on study due to the potential to lower plasma levels of anticonvulsants and risk for seizure activity
- Patients with treatment-related acute myeloid leukemia (AML) (t-AML)/myelodysplastic syndrome (MDS), or with features suggestive of AML/MDS, or who have had prior allogeneic bone marrow transplant or double umbilical cord blood transplantation, should not receive veliparib due to reports of MDS and leukemia secondary to oncology therapy on Cancer Therapy Evaluation Program (CTEP)-sponsored studies utilizing veliparib
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT02723864.
PRIMARY OBJECTIVE:
I. To establish the safety, tolerability, and the maximum tolerated dose (MTD) of the combination of berzosertib (M6620 [VX-970]), an ATR inhibitor and veliparib, an oral PARP 1/2 inhibitor, in combination with cisplatin in patients with advanced refractory solid tumors.
SECONDARY OBJECTIVES:
I. To assess the effect of the combination of M6620 (VX-970), veliparib, and cisplatin on markers of deoxyribonucleic acid (DNA) damage and apoptosis.
II. To assess the antitumor activity of the combination.
EXPLORATORY OBJECTIVE:
I. To investigate tumor genomic alterations potentially associated with acquired resistance to the combination of M6620 (VX-970), veliparib, and cisplatin.
OUTLINE: This is a dose escalation study of veliparib and berzosertib.
Patients receive veliparib orally (PO) every 12 hours on days 1-3 and 8-10, berzosertib intravenously (IV) over 1 hour on days 2 and 9 or 1 and 8 of cycles when cisplatin is not administered, and cisplatin IV over 60 minutes on day 1 or days 1 and 8 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients that have completed 6 cycles may have cisplatin administration held or discontinued at the discretion of the principal investigator. Patients undergo computed tomography (CT) or magnetic resonance imaging (MRI) at baseline, every 2 cycles for 1 year, every 3 cycles for 3 years, and then every 4 cycles while on study. Patients in the expansion cohort also undergo tumor biopsies on days 1 and 9 of cycle 1, and may undergo biopsy at restaging or disease progression.
After completion of study treatment, patients are followed up for 30 days.
Trial PhasePhase I
Trial Typetreatment
Lead OrganizationNational Cancer Institute Developmental Therapeutics Clinic
Principal InvestigatorA P Chen
- Primary ID9771
- Secondary IDsNCI-2016-00355, 16-C-0087, 160087, P141582
- ClinicalTrials.gov IDNCT02723864