Sponsor: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (other)
Phase: 2
Start date: Feb. 6, 2025
Planned enrollment: 18
Senaparib (IMP4297; Chinese trade name: Paishuning) is an oral PARP1/2 inhibitor discovered by IMPACT Therapeutics. In January 2025, China’s NMPA approved senaparib monotherapy for first-line maintenance treatment of adults with advanced epithelial high‑grade ovarian, fallopian tube, or primary peritoneal cancer who respond to platinum-based chemotherapy. Outside China, senaparib remains investigational. The FDA granted orphan drug designation to a fixed‑dose combination of senaparib plus temozolomide for small cell lung cancer (SCLC). (onclive.com, prnewswire.com)
Senaparib inhibits PARP1 and PARP2, impairing base‑excision repair and causing synthetic lethality in tumors with homologous recombination repair defects (e.g., BRCA1/2). Preclinical and early clinical work describe high potency and selectivity, with in vivo antitumor activity and a wide therapeutic window; first‑in‑human studies identified 100 mg once daily as a recommended phase 2 dose. (pmc.ncbi.nlm.nih.gov, aacrjournals.org)
First‑line ovarian cancer maintenance (phase 3, FLAMES; NCT04169997): In a randomized, double‑blind trial of 404 patients, senaparib 100 mg daily significantly prolonged progression‑free survival (PFS) versus placebo (median PFS not reached vs 13.6 months; HR 0.43, 95% CI 0.32–0.58; P<0.0001). Benefit was consistent regardless of BRCA mutation or homologous recombination deficiency status. Twelve‑ and 24‑month PFS rates favored senaparib (72.2% vs 53.7% and 63.0% vs 31.3%, respectively). (europepmc.org, onclive.com)
Advanced solid tumors (phase 1, single‑agent): In Chinese patients (n=57), objective response rate (ORR) was 22.7% overall and 26.9% among BRCA1/2‑mutated patients; disease control rates were 63.6% and 73.1%, respectively. (pmc.ncbi.nlm.nih.gov)
Relapsed extensive‑stage SCLC (senaparib + low‑dose temozolomide, phase Ib/II): Dose‑escalation (n=14) established the RP2D (senaparib 80 mg QD + temozolomide 20 mg D1–21 q28d) with an ORR of 25.0% among 12 evaluable patients. In dose‑expansion (interim, n=45; 42 evaluable), confirmed ORR was 14.3%, disease control rate 64.3%, median PFS 3.8 months, and median OS 13.1 months. (ascopubs.org, ace.asco.org, jto.org)
Phase 3 FLAMES: Grade ≥3 treatment‑emergent adverse events occurred in 66.3% with senaparib vs 20.3% with placebo; the most common were anemia, thrombocytopenia, and neutropenia. Dose reductions occurred in 63.3% with a low permanent discontinuation rate (4.4%); no treatment‑related deaths were reported. (europepmc.org, ajmc.com)
Phase 1 single‑agent: No dose‑limiting toxicities were observed up to 120 mg QD; common treatment‑related events included anemia, leukopenia, thrombocytopenia, and asthenia. (pmc.ncbi.nlm.nih.gov)
Combination with temozolomide in relapsed ES‑SCLC: Hematologic toxicities (neutropenia, thrombocytopenia, anemia) were the most frequent grade ≥3 events; no treatment‑related deaths were reported. (jto.org)
Notes: Senaparib is approved in China (January 2025) for first‑line maintenance in advanced ovarian cancer; development continues internationally, including combination strategies such as with temozolomide in SCLC. (onclive.com)
Last updated: Sep 2025
Goal: Evaluate the antitumor activity of senaparib plus temozolomide in ARID1A-mutated clear cell or endometrioid ovarian cancers, using objective response rate by RECIST v1.1 as the primary endpoint, and characterize safety and tolerability.
Patients: Adult females (≥18 years) with recurrent or persistent clear cell or endometrioid ovarian, fallopian tube, or primary peritoneal carcinoma, with ≥50% clear cell or endometrioid histology, measurable disease by RECIST v1.1, and a pathogenic/likely pathogenic ARID1A alteration confirmed by qualified NGS. Patients must have received ≥2 prior cytotoxic regimens or have platinum-resistant/refractory disease, with no more than 3 prior cytotoxic lines; prior hormonal, targeted, immunotherapy, or antiangiogenic agents are allowed. Key exclusions include prior PARP inhibitor or temozolomide, active significant comorbidities, unresolved ≥grade 2 toxicities, myeloid malignancy history or MDS/MPN-associated abnormalities, untreated brain metastases, bowel obstruction, pregnancy/lactation, and HIV infection.
Design: Single-arm, two-stage, non-randomized, multicenter phase 2 study. Up to 18 participants will be treated and followed for response and safety. Imaging every 8 weeks for the first 3 cycles, then every 12 weeks until progression is confirmed; treatment continues until progression, unacceptable toxicity, or withdrawal.
Treatments: Senaparib 80 mg orally daily on days 1–28 plus temozolomide 20 mg orally daily on days 1–21 of a 28-day cycle. Senaparib is an oral PARP1/2 inhibitor that impairs base-excision repair, exploiting synthetic lethality in tumors with homologous recombination repair defects and potentially in ARID1A-deficient tumors. It has shown significant progression-free survival benefit as first-line maintenance in advanced ovarian cancer in a randomized phase 3 study and demonstrated manageable hematologic toxicity. In combination with low-dose temozolomide, a recommended phase 2 dose similar to this regimen has been defined in relapsed small cell lung cancer with modest response rates and expected myelosuppression. Temozolomide is an oral alkylating agent with established DNA-damaging activity; at low doses it may synergize with PARP inhibition.
Outcomes: Primary: Objective response rate (CR+PR) by RECIST v1.1 with binomial estimates and 95% CIs. Secondary: Incidence, nature, and severity of adverse events and serious adverse events by CTCAE v5.0, including frequency of grade 3–4 treatment-related events.
Burden on patient: Moderate. The regimen is entirely oral, minimizing infusion visits, but requires adherence to daily dosing and monitoring for myelosuppression. Imaging is relatively frequent early (every 8 weeks for three cycles) then every 12 weeks, similar to standard practice in recurrent disease. Routine clinic visits and labs for counts and chemistry are expected each cycle given PARP inhibitor and temozolomide hematologic risks; no protocol-mandated biopsies or intensive pharmacokinetic sampling are described. Travel burden centers on periodic clinic and imaging appointments; toxicity management may necessitate additional visits for transfusions or dose modifications if cytopenias occur.
Inclusion Criteria:
* Ability to understand and the willingness to sign a written informed consent document. Legally authorized representatives may sign and give informed consent on behalf of study participants.
* Pathologically (histologically or cytologically) confirmed diagnosis of recurrent or persistent clear cell or endometrioid ovarian, fallopian tube, or primary peritoneal carcinoma. Histologic documentation (via the pathology report) indicating at least 50% endometrioid or clear cell morphology is required.
* Presence of an ARID1A pathologic variant or likely pathogenic variant identified by next generation sequencing (NGS) tests (per criteria below)
* Pathogenic or likely pathogenic ARID1A variant identified NGS tests performed by the labs listed on https://ecog-acrin.org/nci-match-eay131-designated-labs will be considered confirmed for the purposes of this study.
* Pathogenic ARID1A mutation identified by other NGS tests will need to be confirmed by the study PI prior to enrollment.
* All patients must have measurable disease, according to RECIST v1.1. Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions) as ≥20 mm with conventional techniques or as ≥10 mm with spiral CT scan, MRI, or calipers by clinical exam. To be considered pathologically enlarged and measurable, a lymph node must be ≥15 mm in short axis when assessed by CT scan or MRI (CT scan slice thickness recommended to be no greater than 5 mm). See Section 12 for the evaluation of measurable disease.
* Patients who have received radiation must have evidence of measurable disease outside of the radiation field or have documented progression after radiation at the time of enrollment.
* Patients must have received at least two prior cytotoxic regimens or have platinum-resistant (defined as having progressed within 6 months of last platinum therapy) or platinum-refractory (having progressed during primary platinum therapy) disease.
* Participants can have received no more than 3 prior lines of cytotoxic therapy (any agent that targets the genetic and/or mitotic apparatus of dividing cells, resulting in dose-limiting toxicity to the bone marrow).
* Unlimited prior hormonal therapy, targeted therapy (including immunotherapy) or antiangiogenic therapy will be permitted.
* Patients must have completed prior therapy as detailed below:
* Prior Therapy Time from last prior therapy to study treatment start date Chemotherapy (except nitrosoureas or mitomycin C) ≥ 28 days; Nitrosoureas or mitomycin C ≥ 42 days; Small molecule inhibitors ≥ 28 days; Monoclonal antibodies ≥ 28 days; Immunotherapy ≥ 28 days; Radiotherapy (RT) ≥ 28 days from last local site RT ≥ 28 days from stereotactic radiosurgery; ≥ 12 weeks from craniospinal ≥50% radiation of pelvis or total body irradiation Radiation related side effects must have resolved prior to study enrollment Endocrine therapy ≥ 7 days
* Ability to take oral medications and not have gastrointestinal illnesses that would preclude absorption of senaparib or TMZ as judged by the treating physician.
* Patients assigned female at birth, age ≥18 years. Because no dosing or adverse event data are currently available on the use of senaparib and TMZ in patients \<18 years of age, children are excluded from this study, but will be eligible for future pediatric trials.
* Eastern Cooperative Oncology Group (ECOG) performance status ≤2 (Karnofsky ≥60%, see Appendix A).
* Patients must have adequate organ and marrow function as defined below:
* Absolute Neutrophil Count ≥1,000/microliter (mcL);
* Differential Differential with no clinically significant morphologic abnormalities on complete blood count (CBC) testing.
* Manual differential is encouraged, if clinically indicated, and in cases where an automated differential is abnormal.
* Hemoglobin ≥9 g/dL;
* Platelets ≥100,000/mcL;
* aspartate transferase (AST) (SGOT) or Alanine Transaminase (ALT) (SGPT) ≤3 × institutional ULN;
* Total Bilirubin ≤1.5 × institutional ULN; Direct bilirubin ≤ ULN for subjects with total bilirubin \> 1.5 x ULN (patients with isolated indirect bilirubin elevations and a history of Gilbert's Syndrome are eligible)
* Creatinine -OR- Glomerular Filtration Rate ≤ institutional upper limit normal (ULN) -OR- ≥50 mL/min/1.73 m2 for patients with creatinine levels above institutional ULN
* Because of the potential DNA damaging effects in a developing human fetus with the study treatment, participants of childbearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation including for one month after last dose of senaparib or temozolomide. Should a woman become pregnant or suspect she is pregnant while she is participating in this study, she should inform her treating physician immediately. Theoretically, CYP3A induction with senaparib use may result in the loss of efficacy in hormonal contraceptives, thus a barrier method of contraception must be used in addition to hormonal contraceptives due to the potential drug-drug interaction with senaparib. Note: All females will be considered to be of childbearing potential unless postmenopausal (amenorrheic for at least 12 consecutive months, in the appropriate age group, and without other known or suspected cause) or have been sterilized surgically (ie, bilateral tubal ligation, total hysterectomy, or bilateral oophorectomy, all with surgery at least 1 month before dosing).
* For patients with known history of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated and the suppressive therapy must not be an excluded concurrent medication.
* Patients with a known history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, the patients are eligible if the patient has an undetectable HCV viral load and the HCV therapy is not an excluded concurrent medication.
* Patients with treated brain metastases are eligible if follow-up brain imaging ≥ 12 weeks after central nervous system (CNS)-directed therapy shows no evidence of progression.
* Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial, with permission of the protocol chair.
* Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better.
Exclusion Criteria:
* Prior treatment with a poly ADP ribose polymerase (PARP) inhibitor or temozolomide.
* Patients who are currently receiving or have previously received any other investigational agents within 3 weeks prior to entering the study.
* Patients who have not recovered (CTCAE v5 grade ≤1) from adverse events due to agents administered more than 4 weeks earlier, unless those events are deemed to have returned to baseline, are irreversible, or are unlikely to develop into a life-threatening condition at the permission of the Protocol Chair (e.g., alopecia).
* Patients who have any of the following:
* A prior history of myeloid malignancies, including myelodysplastic syndrome (MDS).
* Abnormalities known to be associated with MDS (e.g. del 5q, chr 7 abn) and myeloproliferative neoplasms (MPN) (e.g. JAK2 V617F) observed in cytogenetic testing and DNA sequencing.
* A prior history of T-cell lymphoblastic lymphoma/lymphoblastic leukemia (T-ALL).
* Patients with clinical or radiographic evidence of bowel obstruction.
* Severe, active comorbidity per the treating investigator's clinical discretion.
* Pregnant or lactating patients.
* Patients with known human immunodeficiency virus (HIV) infection are ineligible because the treatments involved in this protocol may be immunosuppressive, increasing the risk of lethal infections in this patient population.
* Patients with known, untreated brain metastases, as progressive neurologic dysfunction may develop that would confound the evaluation of neurologic and other adverse events.
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to senaparib or temozolomide.
* Strong CYP3A4 inhibitors or inducers should not be used within 3 days of Day 1 dosing until the end of study. Moderate CYP3A4 inhibitors or inducers should be used with caution.
Because the lists of these agents are constantly changing, it is important to regularly consult a frequently updated list such as http://medicine.iupui.edu/ clinpharm/ddis/table.aspx; medical reference texts such as the Physicians' Desk Reference may also provide this information. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product.
* Uncontrolled intercurrent illness including, but not limited to, the following:
* ongoing or active infection, including latent tuberculosis infection,
* clinically significant GI disease (such as active Crohn's disease or ulcerative colitis),
* recent or significant cardiovascular disease (defined as any major CV event within the previous 6 months including myocardial infarction, unstable angina, cardiac arrhythmia, stroke, Pulmonary Embolism (PE), or New York Heart Association Class III or IV heart failure),
* history of liver function abnormality requiring investigation, drug induced liver injury, chronic liver disease, excessive alcohol consumption or chronic alcohol-induced disease,
* psychiatric illness/social situations that would limit compliance with study requirements, or
* any other severe acute or chronic medical condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study
* Pregnant women are excluded from this study because of the potential for teratogenic or abortifacient effects of senaparib and temozolomide. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with these agents, breastfeeding should be discontinued if the mother is treated on study. These potential risks may also apply to other agents used in this study.
Baltimore, Maryland, 21231-2410, United States
[email protected] / 410-955-8804
Status: Recruiting