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Lampert EJ, Hays JL, Kohn EC, Annunziata CM, Minasian L, Yu M, Gordon N, Sissung TM, Chiou VL, Figg WD, Houston N, Lee JM. Phase I/Ib study of olaparib and carboplatin in heavily pretreated recurrent high-grade serous ovarian cancer at low genetic risk. Oncotarget 2019; 10:2855-2868. [PMID: 31080557 PMCID: PMC6499601 DOI: 10.18632/oncotarget.26869] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/04/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose: To investigate maximum tolerated dose (MTD), activity and predictive biomarkers of olaparib with carboplatin in BRCA wild-type (BRCAwt) high grade serous ovarian carcinoma (HGSOC) patients. Methods: A 3+3 dose escalation study examined olaparib capsules (400 mg twice daily [BID], days 1-7) with carboplatin (AUC3-5 on day 1) every 21 days for 8 cycles, followed by olaparib 400 mg BID maintenance. Blood and tumor biopsy samples were collected pre- and on-treatment in the expansion cohort for PAR levels and proteomic endpoints. Results: 30 patients (median 7 prior regimens [2-12], 63% (19/30) platinum-resistant) were enrolled. Dose-limiting toxicity was thrombocytopenia/neutropenia, and infection with carboplatin AUC5 (2/6 patients). MTD was olaparib 400 mg BID + carboplatin AUC4. Grade 3/4 adverse events (>10%) included neutropenia (23%), thrombocytopenia (20%), and anemia (13%). Five of 25 (20%) evaluable patients had partial response (PR; median 4.5 months [3.3-9.5]). Clinical benefit rate (PR + stable disease ≥4 months) was 64% (16/25). A greater decrease in tissue PAR levels was seen in the clinical benefit group versus no benefit (median normalized linear change -1.84 [-3.39- -0.28] vs 0.51 [-0.27- 1.29], p = 0.001) and a DNA repair score by proteomics did not correlate with response. Conclusions: The olaparib and carboplatin combination is tolerable and has clinical benefit in subsets of heavily pretreated BRCAwt HGSOC, independent of platinum sensitivity.
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Affiliation(s)
- Erika J. Lampert
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | | | - Elise C. Kohn
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Christina M. Annunziata
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Lori Minasian
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Minshu Yu
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nicolas Gordon
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Tristan M. Sissung
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Victoria L. Chiou
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - William D. Figg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nicole Houston
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Jung-Min Lee
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Lee JM, Hays JL, Chiou VL, Annunziata CM, Swisher EM, Harrell MI, Yu M, Gordon N, Sissung TM, Ji J, Figg WD, Minasian L, Lipkowitz S, Wood BJ, Doroshow J, Kohn EC. Phase I/Ib study of olaparib and carboplatin in women with triple negative breast cancer. Oncotarget 2017; 8:79175-79187. [PMID: 29108297 PMCID: PMC5668030 DOI: 10.18632/oncotarget.16577] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 03/13/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To investigate the safety, activity, and potential biomarkers of response to olaparib and carboplatin combination in sporadic triple negative breast cancer (TNBC). EXPERIMENTAL DESIGN: Metastatic or recurrent TNBC patients with no germline BRCA mutation or with BRCAPro scores <10% and a negative family history were eligible. A 3+3 dose escalation tested olaparib capsules (400mg bid, days1-7) with carboplatin AUC3-5 on day1 or 2 every 21 days, ≤ 8 cycles, with olaparib 400mg bid maintenance. Peripheral blood mononuclear cells were collected for polymorphisms and PAR levels, and paired tumor biopsies (pre-/post-cycle 1) for proteomics and apoptosis endpoints. RESULTS 28 women were treated (median 5 prior regimens [0-12]). Dose-limiting toxicity was thrombocytopenia, and symptomatic hyponatremia with carboplatin AUC5. The maximum tolerated dose was olaparib 400mg bid+carboplatin AUC4. Grade 3 and 4 adverse events included neutropenia (36%), thrombocytopenia (11%), and anemia (11%). Responses included 1 complete response (CR; 69+months) and 5/27 partial responses (19%; median 4months [4-7]), for a response rate of 22%. Biomarker findings did not correlate with response. The long-term CR patient with prior negative BRCA testing was found to have deletion of BRCA1 exons1-2. CONCLUSIONS The olaparib/carboplatin combination is tolerable and has modest activity in sporadic TNBC patients. Further evaluation of predictive biomarkers to identify those with BRCA wild type who had response is warranted.
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Affiliation(s)
- Jung-Min Lee
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - John L Hays
- Division of Medical Oncology, Department of Internal Medicine, The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Victoria L Chiou
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Christina M Annunziata
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Elizabeth M Swisher
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Maria I Harrell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Minshu Yu
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nicolas Gordon
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Tristan M Sissung
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Jiuping Ji
- National Clinical Target Validation Laboratory, Leidos Biomedical Research Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - William D Figg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Lori Minasian
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Stanley Lipkowitz
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute, NIH, Bethesda, MD, USA
| | - James Doroshow
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Elise C Kohn
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Lee JM, Trepel JB, Choyke P, Cao L, Sissung T, Houston N, Yu M, Figg WD, Turkbey IB, Steinberg SM, Lee MJ, Ivy SP, Liu JF, Matulonis UA, Kohn EC. CECs and IL-8 Have Prognostic and Predictive Utility in Patients with Recurrent Platinum-Sensitive Ovarian Cancer: Biomarker Correlates from the Randomized Phase-2 Trial of Olaparib and Cediranib Compared with Olaparib in Recurrent Platinum-Sensitive Ovarian Cancer. Front Oncol 2015; 5:123. [PMID: 26082895 PMCID: PMC4450585 DOI: 10.3389/fonc.2015.00123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/17/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Olaparib (O), a polyADPribose polymerase (PARP) inhibitor, and cediranib (C), a VEGF receptor (VEGFR)1-3 inhibitor together had greater activity than O alone in women with recurrent platinum-sensitive ovarian cancer (OvCa). The objective of this study is to identify potential lead biomarker candidates for response to O + C in the setting of a multi-institutional phase II study of O with and without C in recurrent platinum-sensitive OvCa. METHODS A self-selected group of patients participated in a prospectively planned exploratory biomarker substudy of the randomized phase II study of O versus O + C. Whole blood for peripheral blood mononuclear cell (PBMC) and plasma isolation was collected prior to and on day 3 of treatment. Quantitation of circulating endothelial cells (CEC), IL-6, IL-8, VEGF, and soluble VEGFR-2 plasma concentrations, and polyADPribose (PAR) incorporation were performed. Single nucleotide polymorphism analysis of XRCC1 280H, R194W, and Q399R was done. Dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) was performed at baseline and day 3 of treatment. Parameter changes were compared between the two arms using an exact Wilcoxon rank sum test. Kaplan-Meier and log-rank tests were used to examine survival outcome. RESULTS Thirteen patients elected to participate in the translational substudy, seven patients on O and six patients on O + C. Patients on O + C had a greater decrease in IL-8 concentration and larger CEC fold increase compared with those on O alone (p = 0.026, p = 0.032). The fold increase in CEC on day 3 was associated with duration of progression-free survival (PFS) (R (2) = 0.77, 95% CI 0.55-0.97, p < 0.001). IL-8 post-pretreatment changes correlate with PFS (p = 0.028). XRCC1 DNA polymorphisms were not related to PFS. All patients had reduction in PAR incorporation, and all except one had reduction in vascular flow on DCE-MRI. CONCLUSION Our exploratory correlative studies indicate that CEC and IL-8 changes may be predictive for response to O + C and prognostic in recurrent platinum-sensitive OvCa, requiring prospective validation.
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Affiliation(s)
| | | | | | - Liang Cao
- Center for Cancer Research , Bethesda, MD , USA
| | | | | | - Minshu Yu
- Center for Cancer Research , Bethesda, MD , USA
| | | | | | | | | | - S Percy Ivy
- Cancer Therapy Evaluation Program, National Cancer Institute , Bethesda, MD , USA
| | - Joyce F Liu
- Dana-Farber Cancer Institute , Boston, MA , USA
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Lee JM, Hays JL, Annunziata CM, Noonan AM, Minasian L, Zujewski JA, Yu M, Gordon N, Ji J, Sissung TM, Figg WD, Azad N, Wood BJ, Doroshow J, Kohn EC. Phase I/Ib study of olaparib and carboplatin in BRCA1 or BRCA2 mutation-associated breast or ovarian cancer with biomarker analyses. J Natl Cancer Inst 2014; 106:dju089. [PMID: 24842883 DOI: 10.1093/jnci/dju089] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Olaparib has single-agent activity against breast/ovarian cancer (BrCa/OvCa) in germline BRCA1 or BRCA2 mutation carriers (gBRCAm). We hypothesized addition of olaparib to carboplatin can be administered safely and yield preliminary clinical activity. METHODS Eligible patients had measurable or evaluable disease, gBRCAm, and good end-organ function. A 3 + 3 dose escalation tested daily oral capsule olaparib (100 or 200mg every 12 hours; dose level1 or 2) with carboplatin area under the curve (AUC) on day 8 (AUC3 day 8), then every 21 days. For dose levels 3 to 6, patients were given olaparib days 1 to 7 at 200 and 400 mg every 12 hours, with carboplatin AUC3 to 5 on day 1 or 2 every 21 days; a maximum of eight combination cycles were permitted, after which daily maintenance of olaparib 400mg every12 hours continued until progression. Dose-limiting toxicity was defined in the first two cycles. Peripheral blood mononuclear cells were collected for polymorphism analysis and polyADP-ribose incorporation. Paired tumor biopsies (before/after cycle 1) were obtained for biomarker proteomics and apoptosis endpoints. RESULTS Forty-five women (37 OvCa/8 BrCa) were treated. Dose-limiting toxicity was not reached on the intermittent schedule. Expansion proceeded with olaparib 400mg every 12 hours on days 1 to 7/carboplatin AUC5. Grade 3/4 adverse events included neutropenia (42.2%), thrombocytopenia (20.0%), and anemia (15.6%). Responses included 1 complete response (1 BrCa; 23 months) and 21 partial responses (50.0%; 15 OvCa; 6 BrCa; median = 16 [4 to >45] in OvCa and 10 [6 to >40] months in BrCa). Proteomic analysis suggests high pretreatment pS209-eIF4E and FOXO3a correlated with duration of response (two-sided P < .001; Pearson's R (2) = 0.94). CONCLUSIONS Olaparib capsules 400mg every 12 hours on days 1 to 7/carboplatin AUC5 is safe and has activity in gBRCAm BrCa/OvCa patients. Exploratory translational studies indicate pretreatment tissue FOXO3a expression may be predictive for response to therapy, requiring prospective validation.
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Affiliation(s)
- Jung-Min Lee
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD.
| | - John L Hays
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Christina M Annunziata
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Anne M Noonan
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Lori Minasian
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Jo Anne Zujewski
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Minshu Yu
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Nicolas Gordon
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Jiuping Ji
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Tristan M Sissung
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - William D Figg
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Nilofer Azad
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - James Doroshow
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
| | - Elise C Kohn
- Affiliations of authors: Medical Oncology Branch, Center for Cancer Research (J-ML, JLH, CMA, AMN, LM, JAZ, MY, NG, TMS, WDF, NA, ECK), National Clinical Target Validation Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research (JJ), Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center and National Cancer Institute (BJW), and Division of Cancer Treatment and Diagnosis, National Cancer Institute (JD), National Institutes of Health, Bethesda, MD
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