Phase II Study of Olaparib in Subjects With Advanced Pancreatic Acinar Cell Carcinoma

• Status: Not yet recruiting
• Trial end date: 2025-06-01
• Target enrollment: 0
• Participant gender: All

Summary

Background:

• Pancreatic Acinar Cell Carcinoma (PACC) is a rare pancreatic tumor, representing 0.5-1% of all pancreatic malignancies.

• PACC is commonly advanced at presentation and median overall survival in this population is poor.

• PACC is pathologically and biochemically distinct from pancreatic adenocarcinoma.

• No clinical trials for PACC have ever been reported.

• Patients are most commonly treated with combination regimens used for either pancreatic or colon adenocarcinoma with poor (~30%) response rates in the first-line setting.

• PACC pathological specimens demonstrate evidence of high chromosomal instability, a hallmark of DNA repair deficiency.

• Data derived from ovarian and prostate cancer patients has demonstrated that mutations in DNA repair genes can define subgroups of cancer patients with distinct vulnerabilities to DNA damage response inhibitors.

• Olaparib is a Poly-ADP ribose polymerase (PARP)-1 inhibitor that has been FDA approved for the treatment of BRCA-mutant homologous recombination repair (HRR) deficient cancers.

• As PACC has multiple hallmarks of HRR deficiency, we hypothesize that PACC will be sensitive to PARP inhibition with olaparib.

• Pre-clinical modeling of PACC has been very limited with no currently available animal models or cell lines, which precludes testing this hypothesis in the laboratory setting.

Objective:

• To assess the anti-tumor activity of single agent olaparib, a PARP inhibitor, in participants with platinum-sensitive advanced pancreatic acinar cell carcinoma (PACC)

Eligibility:

• Participants must have advanced previously treated PACC

• Participants must not have platinum-resistant disease

• Age >=18 years

• Adequate organ and bone marrow function

Design:

• This is a phase II, single arm, single center study of olaparib in subjects with advanced previously treated PACC.

• All subjects will take olaparib by mouth twice daily for up to two years or until disease progression or intolerable side effects.

• Subjects will be assessed for safety (continuously) and efficacy (every 8 weeks).

• Up to 13 evaluable participants will be enrolled.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: National Cancer Institute (NCI)
• Treatments: Olaparib

Criteria

-INCLUSION CRITERIA:

1. Histological or cytological diagnosis of Pancreatic Acinar Cell Carcinoma (PACC) as confirmed by NIH Laboratory of Pathology.

2. Participants must have received one prior line of combination chemotherapy (or be ineligible to receive combination chemotherapy) with tumor still not amenable for potentially curative resection or be ineligible to receive combination chemotherapy. There is no limit on the number of prior therapies.

3. Access to medical records from past treatment

4. Measurable disease, per RECIST 1.1.

5. Age >=18 years.

6. ECOG performance status <=1.

7. At least 3 weeks from previous chemotherapy or radiation therapy prior to planned start of treatment.

8. At least 30 days or 5 half-lives (whichever is greater) since receipt of any investigational therapy prior to planned start of treatment.

9. Fully recovered from all reversible sequalae and >=2 weeks from major surgery or from minor surgical procedure such as biliary or duodenal stenting prior to planned start of treatment.

10. At least 2 weeks since last 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).

11. At least 5 weeks since last use of phenobarbital, enzalutamide, and at least 3 weeks since last use of other strong (e.g., phenytoin, rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John s Wort) or moderate (e.g., bosentan, efavirenz, modafinil) CYP3A inducers.

12. Adequate organ and marrow function as measured within 28 days prior to study treatment as defined below:

• leukocytes >=3,000/mcL

• absolute neutrophil count >=1,500/mcL

• hemoglobin >= 10 g/dL with no blood transfusion within the last 28 days

• platelets >=100,000/mcL

• total bilirubin within 1.5x normal institutional upper limit of normal (ULN)

• AST(SGOT)/ALT(SGPT) <= institutional ULN unless liver metastases are present in which case they may be <=5x ULN

• Creatinine clearance must be >51 mL/min as estimated using the Cockroft-Gault equation* or measured by 24- hour urine test

• Estimated creatinine clearance = (140-age [years]) x weight (kg) (x F) serum/ creatinine (mg/dL) x 72a, where F=0.85 for females and F=1 for males

This list includes eligibility-defining laboratory value requirements for treatment; laboratory value requirements should be adapted according to local regulations and guidelines for the administration of specific chemotherapies.

13. The effects of olaparib on the developing human fetus are unknown. For this reason and because PARP inhibitor agents are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception prior to study entry and for the duration of study participation.

14. Participants must agree to abstain from consuming grapefruit juice throughout the duration of study treatment with olaparib.

15. Ability of subject to understand and the willingness to sign a written informed consent document.

EXCLUSION CRITERIA:

1. History of allergic reactions attributed to compounds of similar chemical or biologic composition to olaparib.

2. Participants unable to swallow orally administered medication or suffering from GI disorders likely to interfere with absorption of study medication.

3. Participants with HIV are excluded even if viral load is undetectable

4. Active hepatitis B or C

5. Resting ECG indicating uncontrolled, potentially reversible cardiac conditions, as judged by the investigator (e.g., unstable ischemia, uncontrolled symptomatic arrhythmia, congestive heart failure, QTcF prolongation >500 ms, electrolyte disturbances, etc.), or participants with congenital long QT syndrome.

6. Recent (within 3 months) myocardial infarction

7. Unstable angina pectoris.

8. Symptomatic congestive heart failure

9. Uncontrolled major seizure disorder

10. Superior vena cava syndrome

11. Extensive interstitial bilateral lung disease on High Resolution Computed Tomography (HRCT) scan

12. Psychiatric illness/social situations (within the last 3 months) that would limit compliance with study requirements or prohibits obtaining informed consent

13. Uncontrolled intercurrent illness or participants considered a poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease or active uncontrolled infection as documented in prior records or suggested by medical history, physical examination or standard clinical assessments such as imaging and laboratory studies

14. Participants with myelodysplastic syndrome/acute myeloid leukemia or with features suggestive of MDS/AML.

15. Solid or liquid malignancy other than PACC unless curatively treated with no evidence of disease for >=5 years, 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.

16. Previous allogenic bone marrow transplant or double umbilical cord blood transplantation (dUCBT).

17. Women who are breastfeeding and unwilling to stop.

18. Participants with symptomatic uncontrolled brain metastases. A scan to confirm the absence of brain metastases is not required. Brain metastases are considered uncontrolled if the dose of corticosteroid being provided for control of brain metastases has been titrated in the 4 weeks prior to start of treatment.

19. Participants with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for >=28 days. Participants with unstable spinal cord compression are ineligible even if previously treated.

20. Participants known to have disease resistant to platinum chemotherapy will be excluded. A patient has platinum-resistant disease if: a) develop progression of disease during prior platinum-based chemotherapy (including cisplatin, carboplatin, and/or oxaliplatin), and/ or b) develop recurrence/ progressive disease within 3 months after completion of platinum-containing adjuvant therapy. If the platinum component of a combination regimen is dropped prior to progression of disease, the patient does NOT have platinum- resistant disease. Disease will be considered progressive if there was radiologic evidence of progression as reported by prior CT evidence or physician assessment, or >= 25% composite increase in relevant tumor marker on two sequential measurements at least 1 week apart. Completion of adjuvant therapy is defined as receiving the intended number of cycles.

21. Participants with large volume ascites, serum albumin < 2.5 mg/dL, or having received paracentesis within the last 4 weeks

22. Participants with persistent toxicities > grade 2 or with new grade 2 events within the last 2 weeks per Common Terminology Criteria for Adverse Event (CTCAE) version 5 caused by previous cancer therapy.