The phase I trial aims to determine the recommended phase II dose (RP2D) and schedule of olaparib in combination with standard cisplatin-based chemoradiotherapy, in patients with high-risk locally advanced squamous cell carcinoma of the head and neck (HNSCC), by assessing the safety and tolerability of the treatment combination.
ORCA-2 is a phase I trial in patients with locally advanced, with or without metastatic nodal disease. Patients will receive olaparib (a PARP inhibitor) in combination with standard cisplatin-based chemotherapy and intensity modulated radiotherapy (IMRT). Olaparib, cisplatin and radiotherapy will be given in combination every week for a maximum of 7 weeks. Prior to starting combination treatment, olaparib will be started 7 days before the first week of combination treatment. Olaparib will be given twice daily on days 1-3 of each week of treatment (either alone during week 0 or in combination with chemotherapy and radiotherapy during weeks 1-7). Cisplatin will be started on day 1 of each week, and given once a week during radiotherapy treatment for a total of 7 weeks. Radiotherapy will be delivered on days 1-5 of each week using IMRT, for a total of 7 weeks. The phase I trial aims to determine the recommended phase II dose of olaparib (50mg, 100mg, 150mg or 200mg bd) - the dose of olaparib patients receive will depend on the dose under investigation at the time of patient registration. Dose escalation will be guided by the two-dimensional dose escalation design called Product of Independent Beta Probabilities escalation (PIPE). It will recommend the choice of dose/duration combination cohort of olaparib for subsequent patients by estimating the contour that divides dose/duration combination cohorts to be those above the target toxicity rate (equal to 33%) and those below. The recommended phase II cohort(s) are those that have been experimented on during the trial and are also closest to (but not above) the estimated contour calculated using all trial data.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
70
50 mg, 100 mg, 150 mg or 200 mg taken twice daily (depending on dose under investigation at time of registration) on days 1-3, 1-4 or 1-5 (depending on allocation of treatment schedule) of each week of treatment.
35 mg/m\^2 IV on day 1 of each week of treatment during radiotherapy for a total of 7 weeks (total overall dose 245 mg/m\^2)
2 Gy delivered in 35 fractions, on days 1-3, 1-4 or 1-5 each week for up to 7 weeks (total overall dose delivered 70 Gy)
Guy's and St Thomas' NHS Foundation Trust
London, United Kingdom
University College London Hospitals NHS Foundation Trust
London, United Kingdom
Velindre Cancer Centre
Wales, United Kingdom
Occurrence of Dose Limiting Toxicity
Detailed adverse event monitoring will be conducted according to CTCAE v4.03. Dose Limiting Toxicity (DLT) is defined as any adverse event or laboratory abnormality detailed in the trial protocol, that is considered to be trial treatment related and commencing anytime during the DLT evaluation period (from start of week 1 of olaparib + CRT until 6 weeks after end of olaparib + CRT).
Time frame: From start of week 1 to 6 weeks after end of combination treatment (combination treatment = 7 weeks)
Occurrence and Severity of Adverse Events
Will include all grade 1-5 adverse events
Time frame: From date of registration until 12 weeks after completion of trial treatment
Best Overall Response
Response will be assessed according to RECIST v1.1. Confirmation of complete or partial response is not required.
Time frame: Determined from imaging/scans performed pre-registration, during treatment and follow-up until disease progression or up to 2 years from date of registration
Time to Loco-Regional Progression
Time to loco-regional progression will be evaluated from the date of trial entry to date of documented disease progression according to RECIST v1.1 or histological/cytological confirmation.
Time frame: From date of registration to date of documented disease progression, assessed up to 2 years from date of registration
Time to Progression
Time to progression will be determined from the date of patient registration to objective disease progression according to RECIST v1.1
Time frame: From date of registration to date of documented objective disease progression
Progression Free Survival
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Progression-free survival will be calculated from the date of trial entry to the date of documented disease progression, or death from any cause. Where progression is suspected and subsequently confirmed by scans, the date of documented suspected progression will be used.
Time frame: From date of registration to date of documented disease progression or death from any cause, whichever comes first. Assessed up to 2 years from date of registration.
Overall Survival
Overall survival time will be calculated from the date of trial entry to the date of death from any cause or end of trial follow-up.
Time frame: From date of registration until date of death or date of last follow-up assessment (up to 2 years from date of registration)