| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
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| E.1.1.1 | Medical condition in easily understood language |
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| E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
| MedDRA Classification |
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 20.0 |
| E.1.2 | Level | PT |
| E.1.2 | Classification code | 10033128 |
| E.1.2 | Term | Ovarian cancer |
| E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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| E.1.3 | Condition being studied is a rare disease | No |
| E.2 Objective of the trial |
| E.2.1 | Main objective of the trial |
| To compare the preliminary efficacy of maintenance treatment with olaparib (arm A) to that of olaparib plus durvalumab and UV1 (arm C) |
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| E.2.2 | Secondary objectives of the trial |
• To compare the preliminary efficacy of maintenance treatment with olaparib plus durvalumab (arm B) to that of olaparib plus durvalumab and UV1 (arm C)
• To compare the preliminary efficacy of maintenance treatment with olaparib to that of olaparib plus durvalumab and UV1 according to stratification factors
• To evaluate Patient Reported Outcomes (PROs) in treatment arms
• To compare the preliminary efficacy of maintenance treatment according to PD-L1 status
• To evaluate safety in treatment arms
Exploratory objectives:
• To describe genetic, molecular, and immunological mechanisms in blood and tumor of maintenance treatment.
• To explore the efficacy of maintenance treatment in the molecular subgroups based on homologous recombination deficiency (HRD) status.
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| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
1. Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.
2. Histologically diagnosed with epithelial ovarian, fallopian tube or primary peritoneal cancer, excluding mucinous or low-grade serous histology
3. Radiological or histological confirmation of relapse disease ≥ 6 month after last chemotherapy
4. Patients who are non-gBRCAmut or tBRCAwt
5. Have completed at least two lines, but no more than 4 lines, of platinum-containing chemotherapy, which means that patients at first, second or third relapse with treatment free interval of more than 6 months are eligible.
a. Subjects must have completed at least 4 cycles of the last platinum-containing chemotherapy
6. Be either:
a. PARPi naive
b. Earlier treated with PARPi and not progressed during 6 month of PARPi therapy
7. Must have, in the opinion of the investigator, CR or PR on the post-treatment scan following completion of the last chemotherapy course.
8. Patient consent to Myriad myChoice HRD test
9. Must be included in the study within 10 weeks of completion of the final dose of platinum-containing chemotherapy.
10 Age ≥18 years
11. Body weight > 30 kg
12. Eastern Cooperative Oncology Group (ECOG) performance status 0-1 (Appendix 3)
13. Must have a life expectancy ≥ 16 weeks.
14. Must have normal organ and bone marrow function measured within 28 days prior to administration of study treatment as defined below:
- Haemoglobin ≥ 10.0 g/dL (6,2 mmol/L) with no blood transfusion in the past 28 days
- Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
- Platelet count ≥ 100 x 109/L
- Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN)
- Aspartate aminotransferase (AST) (Serum Glutamic Oxaloacetic Transaminase (SGOT)) / Alanine aminotransferase (ALT) (Serum Glutamic Pyruvate Transaminase (SGPT)) ≤ 2.5 x institutional upper limit of normal unless liver metastases are present in which case, they must be ≤ 5x ULN
- Must have creatinine clearance estimated of ≥ 51 mL/min using the Cockcroft-Gault equation or based on a urine test:
o Estimated creatinine clearance = [[140 - age(yr)] x weight(kg)] / [72 x serum Cr (mg/dL)] (multiply by 0.85 for women)
15. Ability to swallow oral medications (tablets) without chewing, breaking, crushing, opening or otherwise altering the product formulation.
16. Post-menopausal 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.
Post-menopausal is defined as:
- Amenorrhoeic for 1 year or more following cessation of exogenous hormonal treatments
- Luteinizing hormone (LH) and Follicle stimulating hormone (FSH) levels in the post-menopausal range for women under 50
- radiation-induced oophorectomy with last menses > 1 year ago
- chemotherapy-induced menopause with > 1year interval since last menses
- surgical sterilisation (bilateral oophorectomy or hysterectomy)
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| E.4 | Principal exclusion criteria |
1. Previous immunotherapy (for example anti-PD-1/L1, including durvalumab).
2. Other malignancy unless curatively treated with no evidence of disease for ≥ 5 years
3. Resting ECG indicating uncontrolled, potentially reversible cardiac conditions, as judged by the investigator, or patients with congenital long QT syndrome.
4. Patients with myelodysplastic syndrome/acute myeloid leukemia or with features suggestive of MDS/AML.
5. Patients with symptomatic uncontrolled brain metastases.
6. Patients considered a poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease or active, uncontrolled infection. Disease progression during or within 4 weeks after PARPi therapy.
7. Concomitant treatment with bevacizumab within the last 3 weeks.
8. Concomitant therapy with any other anticancer therapy or chronic use of systemic corticosteroids of more than 10mg prednisolone daily.
9. Concomitant use of known strong CYP3A inhibitors (e.g. itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or moderate CYP3A inhibitors (e.g. ciprofloxacin, erythromycin, diltiazem, fluconazole, verapamil). The required washout period prior to starting study treatment is 2 weeks.
10. Concomitant use of known strong (e.g. phenobarbital, enzalutamide, phenytoin, rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John’s Wort) or moderate CYP3A inducers (e.g. 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
11. Previous allogeneic bone marrow transplant or double umbilical cord blood transplantation
12. Subjects being considered at poor medical condition due to a serious, uncontrolled medical disorder or non-malignant systemic disease.
13. Major surgery or significant traumatic injury within 28 days of run-in
14. Immunocompromised patients, e.g., patients who are known to be serologically positive for human immunodeficiency virus (HIV), patients with active hepatitis B (defined as having a positive hepatitis B surface antigen [HBsAg] test at screening) or hepatitis C.
Patients with past hepatitis B virus (HBV) infection or resolved HBV infection (defined as having a negative HBsAg test and a positive antibody to hepatitis B core antigen [anti-HBc] antibody test) are eligible. Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction (PCR) is negative for HCV RNA
15. Pregnancy, lactation or intention to become pregnant during the study or within 5 months after the last dose of olaparib. If the patient can become pregnant, the patient must be on acceptable birth control listed in Appendix 5.
16. Participation in a clinical study within 28 days or 5 half-lives of the drug, whichever is longest.
17. Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the study medication.
18. Patients with a history of allergy or hypersensitivity to any of the study drugs
19. Any unresolved toxicity NCI CTCAE Grade ≥ 2 from previous anticancer therapy except for alopecia, vitiligo, and the laboratory values defined in the inclusion criteria
a. Patients with Grade ≥ 2 neuropathy will be evaluated on a case-by-case basis after consultation with the Lead Clinician.
b. Patients with irreversible toxicity not reasonably expected to be exacerbated by treatment with durvalumab may be included only after consultation with the Lead Clinician.
20. Active or prior documented autoimmune or inflammatory disorders
21. Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhoea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs or compromise the ability of the patient to give written informed consent
22. Mean QT interval corrected for heart rate using Fridericia's formula (QTcF) ≥ 470 ms calculated from 3 ECGs (within 15 minutes at 5 minutes apart). A single ECG ≥ 470 ms is sufficient.
23. History of active primary immunodeficiency
24. Active infection including tuberculosis (TB).
25. Receipt of live attenuated vaccine within 30 days prior to the first dose of IP.
26. Has active infection with SARS-CoV-2 (antigen test).
27. Patients unable to be regularly followed for any reason
28. Subjects that are depending on the sponsor/CRO or investigational site as well as on the investigator.
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| E.5 End points |
| E.5.1 | Primary end point(s) |
| • Progression-free survival (PFS) arm A versus C |
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| E.5.1.1 | Timepoint(s) of evaluation of this end point |
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| E.5.2 | Secondary end point(s) |
• PFS arm B versus arm C
• Assessment of PROs
• PFS assessed by blinded independent central review (BICR)
• Efficacy according to stratification factors
• Efficacy according to PD-L1 status
• Overall survival (OS)
• Time to first subsequent therapy (TFST)
• Subsequent progression (PFS2)
• Time to second subsequent therapy (TSST)
• Objective Response Rate (ORR)
• Disease Control Rate (DCR)
• Safety analysis
Exploratory endpoint
• Evaluation of changes in genetic, molecular and immunological markers of response and/or resistance over time
• Correlation between changes in genetic, molecular and immunological markers and efficacy in defined subgroups
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| E.5.2.1 | Timepoint(s) of evaluation of this end point |
| 36 months for all endpoints |
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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 | Yes |
| 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 | No |
| 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 | No |
| E.7.1.2 | Bioequivalence study | No |
| E.7.1.3 | Other | No |
| E.7.1.3.1 | Other trial type description | |
| E.7.2 | Therapeutic exploratory (Phase II) | Yes |
| E.7.3 | Therapeutic confirmatory (Phase III) | No |
| E.7.4 | Therapeutic use (Phase IV) | No |
| E.8 Design of the trial |
| E.8.1 | Controlled | Yes |
| E.8.1.1 | Randomised | Yes |
| E.8.1.2 | Open | Yes |
| E.8.1.3 | Single blind | No |
| E.8.1.4 | Double blind | No |
| E.8.1.5 | Parallel group | No |
| 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) | Yes |
| E.8.2.2 | Placebo | No |
| E.8.2.3 | Other | No |
| E.8.2.4 | Number of treatment arms in the trial | 3 |
| E.8.3 |
The trial involves single site in the Member State concerned
| No |
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
| E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 36 |
| E.8.6 Trial involving sites outside the EEA |
| E.8.6.1 | Trial being conducted both within and outside the EEA | No |
| E.8.6.2 | Trial being conducted completely outside of the EEA | No |
| E.8.7 | Trial has a data monitoring committee | Yes |
| 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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36 months from the last patient entered into the trial.
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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 | 6 |
| E.8.9.1 | In the Member State concerned months | 0 |
| E.8.9.1 | In the Member State concerned days | 0 |
| E.8.9.2 | In all countries concerned by the trial years | 6 |
| E.8.9.2 | In all countries concerned by the trial months | 0 |
| E.8.9.2 | In all countries concerned by the trial days | 0 |
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