E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
platinum sensitive serous ovarian cancer |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10033128 |
E.1.2 | Term | Ovarian cancer |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of this study is: · To determine the efficacy (assessed by Progression Free Survival [PFS]) of AZD2281 compared to placebo in the overall population, and in patients with Homologous Recombination Deficient (HRD) tumours |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives of this study are: · To determine the efficacy of AZD2281 compared to placebo by assessment of overall survival (OS), best overall response, duration of response, Cancer Antigen (CA)-125 response (Gynecologic Cancer InterGroup [GCIG] criteria), time to progression by CA-125 (GCIG criteria), or RECIST. · To obtain archival tumour samples for analyses of candidate biomarkers to identify the Homologous Recombination Deficient (HRD) subset of tumours for which increased sensitivity to AZD2281 is expected. · To determine the safety and tolerability of AZD2281 compared to placebo. · To determine the effects of AZD2281 compared to placebo on disease related symptoms. · To determine the quality of life of patients treated with AZD2281 compared to placebo.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Provision of fully informed consent prior to any study specific procedures. 2. Patients must be > 18 years of age. 3. Female patients with histologically diagnosed serous ovarian cancer or recurrent serous ovarian cancer (including primary peritoneal and fallopian tube cancer). This includes patients who have developed recurrent ovarian cancer with macroscopic peritoneal metastases outside the pelvis or distant metastases. Patients with spinal cord compression may be considered if they have received definitive treatment for this and evidence of clinically stable disease for 28 days. 4. Patients must have completed at least 2 previous courses of platinum containing therapy: a. For the penultimate chemotherapy course prior to enrolment on the study: - A patient’s treatment must have contained a platinum agent (carboplatin or cisplatin per normal clinical practice; there are no other specific requirements). - A patient must have been defined as platinum sensitive after this treatment; defined as disease progression greater than 6 months after completion of their last dose of platinum chemotherapy. b. For the last chemotherapy course prior to enrolment on the study: - Patients must have received a platinum containing regimen (carboplatin or cisplatin). - Patients must have demonstrated an objective stable maintained response (partial or complete response) and this response needs to be maintained to permit entry into the study. • This response can be confirmed as per RECIST, (note the assessment does not need to be confirmed >4 weeks later) and/or a CA-125 GCIG confirmed response (at least a 50% reduction in CA-125 levels from the last pre-treatment sample, confirmed 28 days later). - Patients must be treated on the study within 8 wks of completion of their final dose of the platinum containing regimen. - Chemotherapy course must have consisted of a minimum of 4 treatment cycles. 5. Formalin fixed, paraffin embedded tumour sample from the primary or recurrent cancer must be available for central testing. If there is not written confirmation of the availability of an archived tumour sample prior to enrolment the patient is not eligible for the study. 6. Pre-treatment CA-125 measurements (taken at least 7 days apart, at the same local lab as specified in Table 4) must meet criterion specified below: - If the 2nd value is within ULN a patient is eligible to enter the study - If the 2nd value is greater than ULN, it must no more than 15% greater than the 1st. 7. Patients must have normal organ and bone marrow function measured within 7 days prior to administration of study treatment as defined below: - Haemoglobin ≥ 9.0 g/dL - Absolute neutrophil count (ANC) ≥ 1.5 x 109/L - White blood cells (WBC) > 3x109/L - Platelet count ≥ 100 x 109/L - Total bilirubin ≤ 1.5 x institutional upper limit of normal - AST (SGOT)/ALT (SGPT) ≤ 2.5 x institutional upper limit of normal unless liver metastases are present in which case it must be ≤ 5x ULN - Serum creatinine ≤ 1.5 x institutional upper limit of normal (ULN) 8. ECOG performance status ≤ 2 (see Appendix F) 9. Patients must have a life expectancy ≥ 16 weeks. 10. Evidence of non-childbearing status: negative urine or serum pregnancy test within 7 days of study treatment for women of childbearing potential, or postmenopausal status Postmenopausal is defined by any one of the following: § natural menopause with last menses >1 year ago; § radiation-induced oophorectomy with last menses >1 year ago, § chemotherapy-induced menopause with >1 year interval since last menses, § serum follicle stimulating hormone, lutenising hormone and plasma oestradiol levels in the post menopausal range for the institution, § or surgical sterilisation (bilateral oophorectomy or hysterectomy). 11. Patient is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations. For inclusion in genetic research, patients must fulfil the following criterion: 1. Provision of informed consent for genetic research If a patient declines to participate in the genetic research, there will be no penalty or loss of benefit to the patient. The patient will not be excluded from other aspects of the study described in this Clinical Study Protocol, so long as they consent to that part.
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E.4 | Principal exclusion criteria |
1. Patients with low grade ovarian carcinoma. (Grade 1) 2. Patients who have had drainage of their ascites during the final 2 cycles of their last chemotherapy regimen prior to enrolment on the study. 3. Previous treatment with PARP inhibitors including AZD2281. 4. Patients with second primary cancer, except: 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 including lymphomas (without bone marrow involvement) curatively treated with no evidence of disease for ≥ 5 years. 5. Patients receiving any chemotherapy, radiotherapy (except for palliative reasons), within 2 weeks from the last dose prior to study entry (or a longer period depending on the defined characteristics of the agents used). Patients may continue the use of corticosteroids, provided the dose is stable during the study and has been started at least 4 weeks prior to enrolment. 6. Patients with symptomatic uncontrolled brain metastases. A scan to confirm the absence of brain metastases is not required. 7. Major surgery within 2 weeks of starting the study and patients must have recovered from any effects of any major surgery. 8. 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, or any psychiatric disorder that prohibits obtaining informed consent. 9. Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the study medication (eg, partial bowel obstruction or malabsorption). 10. Patients requiring treatment with potent inhibitors or inducers of CYP3A4 (see Section 6.4.1 for guidelines and wash out periods). 11. Pregnant or breast feeding women. 12. Immunocompromised patients, eg, patients who are known to be serologically positive for human immunodeficiency virus (HIV). 13. Patients with known hepatic disease (ie, Hepatitis B or C). 14. Persistent toxicities (grade 2 or greater) caused by previous cancer therapy (excluding alopecia). 15. Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site). 16. Previous randomisation to treatment in the present study. 17. Treatment with any investigational product during the last 28 days (or a longer period depending on the defined characteristics of the agents used). 18. Patients with a known hypersensitivity to AZD2281 or any of the excipients of the product. 19. Patients currently experiencing seizures or who were currently being treated with only anti-epileptics for seizures (use of anti-epileptic drugs to control pain is allowed in patients not suffering from seizures unless drug is excluded due to CYP3A4 induction - phenytoin, carbamazepine, phenobarbitone, see Section 6.4.1. 20. Optional pharmacogenetics sample only: · previous allogeneic bone marrow transplant · blood transfusion in the last 120 days prior to entry to the study
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E.5 End points |
E.5.1 | Primary end point(s) |
Primary outcome variable - PFS as evaluated by RECIST Secondary outcome variables - Efficacy: OS, best overall response, duration of response, CA-125 response (GCIG criteria), time to progression by CA-125 (GCIG criteria) or RECIST, Quality of Life (QoL) and disease related symptoms. - Measurement of candidate biomarkers (including but not limited to ATM, MRE-11, MDC1, BRCA1/2) to identify the Homologous Recombination Deficient subset of tumours for correlation with benefit/risk of treatment with AZD2281. - Safety: AEs, physical examination, vital signs including BP, pulse, ECG and laboratory findings including clinical chemistry, haematology and urinalysis.
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | Information not present in EudraCT |
E.7.1.2 | Bioequivalence study | Information not present in EudraCT |
E.7.1.3 | Other | Information not present in EudraCT |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | Information not present in EudraCT |
E.7.4 | Therapeutic use (Phase IV) | Information not present in EudraCT |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.3 |
The trial involves single site in the Member State concerned
| Information not present in EudraCT |
E.8.4 | The trial involves multiple sites in the Member State concerned | Information not present in EudraCT |
E.8.4.1 | Number of sites anticipated in Member State concerned | 7 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 21 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The end of the entire study is defined as when the final database lock is performed and no patients are receiving ongoing treatment with AZD2281. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 3 |