Phase II Trial of Ceralasertib (AZD6738) Alone and in Combination With Olaparib or Durvalumab in Patients With Selected Solid Tumor Malignancies

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Investigational drug late phase More information Active drug More information Moderate burden on patient More information Started >3 years ago More information

Trial Details

Sponsor: Rahul Aggarwal (other)

Phase: 2

Start date: Jan. 17, 2019

Planned enrollment: 89

Trial ID: NCT03682289
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More trial details at ClinicalTrials.gov More info

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Goal: Evaluate the antitumor activity and safety of the ATR inhibitor ceralasertib given alone or combined with olaparib or durvalumab in biomarker-selected advanced solid tumors, with a focus on ARID1A-altered tumors, ATM-deficient tumors, and endometrial cancer.

Patients: Adults (ECOG 0–1) with locally advanced or metastatic solid tumors after at least one prior systemic therapy. Three groups: ARID1A subgroup including RCC (predominant clear cell), urothelial, all pancreatic cancers, ovarian and endometrial, and other solid tumors excluding clear cell ovarian and endometrial cancers; ATM-loss subgroup including mCRPC and other solid tumors with pathogenic ATM mutation and/or loss of ATM by IHC; and an endometrial cancer cohort previously treated with and progressed on checkpoint inhibitor and with archival tissue available. Measurable disease required (RECIST 1.1; mCRPC may be evaluable per PCWG3). Key exclusions include prior ATR inhibitor, uncontrolled comorbidities, active CNS disease, significant cardiac risk, strong CYP3A interactions, active autoimmune disease for the durvalumab cohort, and inadequate organ function.

Design: Phase II, multicohort, nonrandomized, biomarker- and histology-directed study. Allocation to one of three arms is based on IHC/CLIA results and disease type. Treatment continues until progression, unacceptable toxicity, or withdrawal, with allowance for treatment beyond first progression in select cases. Planned enrollment is 89.

Treatments: Arm I: Ceralasertib monotherapy 160 mg BID days 1–14 of 28-day cycles (for BAF250a-negative ARID1A subgroup or ATM-deficient tumors including mCRPC). Arm II: Ceralasertib 160 mg daily days 1–7 plus olaparib 300 mg BID days 1–28, 28-day cycles (for BAF250a-positive ARID1A subgroup). Arm III: Ceralasertib 240 mg BID days 1–7 plus durvalumab 1500 mg IV day 8 every 28 days (endometrial cohort). Ceralasertib is an oral ATR kinase inhibitor that impairs DNA damage response, promoting cell death in tumors with DNA repair defects and potentially synergizing with PARP inhibition and immunotherapy. Early-phase studies have shown activity across solid tumors, including responses with olaparib in ovarian cancer and disease control with durvalumab in pretreated NSCLC, with a safety profile primarily marked by hematologic toxicities (anemia, neutropenia, thrombocytopenia). Olaparib is a PARP inhibitor standard in HRD/BRCA-altered cancers; durvalumab is an anti–PD-L1 antibody used in multiple malignancies.

Outcomes: Primary: ORR by RECIST 1.1 in ARID1A cohorts receiving ceralasertib or ceralasertib+olaparib; composite response (RECIST ORR and/or PSA50) in ATM-mutant/ATM-loss mCRPC on ceralasertib; ORR by RECIST in other ATM-loss solid tumors on ceralasertib; ORR by RECIST in the endometrial cohort on ceralasertib+durvalumab. Secondary: DOR, PFS at 6 and 12 months and over time by arm and disease group, OS in the endometrial cohort, safety per CTCAE v4.0, percent change in tumor size, PSA50 and rPFS by PCWG3 in mCRPC.

Burden on patient: Moderate. Oral ceralasertib schedules are intermittent, but require adherence and routine hematologic and chemistry monitoring due to myelosuppression risk. Combination arms add either continuous oral olaparib or monthly IV durvalumab, increasing clinic visits. Imaging at standard RECIST intervals, ECG and labs per protocol, and mandatory archival tissue with possible optional biopsy add procedural burden. Travel is periodic, with more frequent visits early in treatment and monthly thereafter for the durvalumab cohort; there are no intensive pharmacokinetic schedules typical of phase I trials.

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Sites (3)

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City of Hope Comprehensive Cancer Center

Duarte, California, 91010, United States

[email protected] / No phone

Status: Recruiting

University of California, San Francisco

San Francisco, California, 94143, United States

[email protected] / 877-827-3222

Status: Recruiting

University of Chicago Comprehensive Cancer Center

Chicago, Illinois, 60637, United States

[email protected] / 773-834-6413

Status: Recruiting

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