Endometrial cancer ranks 11th in terms of incidence (7275 / year) and mortality (2025 deaths/ year). The 5-year overall survivals of patients at diagnosis with locally advanced and metastatic carcinomas are about 50% and 15% respectively. Beyond first line treatment with platinum-based chemotherapy, there is lack of effective drug in this disease, which explains the poor prognosis of patients. The prognosis of metastatic endometrial cancer patients is poor, and few drugs have been shown to be effective beyond first chemotherapy line. Endometrial carcinomas are characterized by frequent alterations of PI3K-AKT-mTor; IGF1R and of DNA repair pathways. Phosphatase and tensin homologue (PTEN)-phosphoinositide 3-kinase (PI3K)-mammalian target of rapamycin (mTor) and DNA repair pathways interact, and inhibition of PI3K-AKT-mTor signaling pathway may alter DNA damage repair. Metronomic cyclophosphamide regimen may increase the anti-proliferative effects of olaparib because it is an alkylating agent, and it exerts anti-angiogenic effects, with a favorable toxicity profile. Metformin may increase the anti-proliferative effects of olaparib because it downregulates IGF1R and PI3K-AKT-mTor pathways, with no additive toxicity.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
35
Olaparib tablet dose will be dose-escalated on 4 dose levels , guided by a continual reassessment method (CRM). One cycle will be 28 days (4 weeks) in duration, except for cycle 1 which will be 6 weeks.
From week 3 metformin will be gradually escalated from 500 mg/day to 1500 mg/day with weekly 500 mg dose escalation levels
from week 2 Metronomic cyclophosphamide will be given continuously on an oral daily basis at 50 mg qd
Service d'Oncologie Médicale, Centre François Baclesse
Caen, France
Département de Cancérologie Cervico-Faciale et Thoracique, Centre Oscar Lambret
Lille, France
Département d'Oncologie Médicale, Centre Antoine Lacassagne
Nice, France
Service d'Oncologie Médicale, Institut Curie
Paris, France
Centre Hospitalier Lyon Sud
Pierre-Bénite, France
Comité Gynécologique, Institut Gustave Roussy
Villejuif, France
Recommended phase 2 trial (RP2D) dose of olaparib combined to metronomic cyclophosphamide and metformin
Time frame: through the 6th week of treatment (cycle 1)
Efficacy of olaparib combined to metronomic cyclophosphamide and metformin
non-progression rate at 10 weeks, calculated as the combination of stable disease, partial response and complete response defined according to RECIST v.1.1
Time frame: at 10 weeks
Number of patients with adverse events relative to the study treatment olaparib combined to metronomic cyclophosphamide and metformin
All adverse events relative to the study treatment will be recorded (NCI- Common Terminology for Adverse Events (CTAE) v.4 criteria) during the treatment.
Time frame: through treatment completion (a median of 12 months)
Pharmacodynamic effects of the 3 drugs on circulating tumor DNA (ctDNA),
The kinetics of circulating tumor DNA (ctDNA), serially measured will be assessed using population kinetic approach and mathematical modeling
Time frame: through treatment completion (a median of 12 months)
Pharmacodynamic effects of the 3 drugs on circulating Insulin Growth Factor (IGF-1)
The kinetics of Insulin Growth Factor (IGF-1) values serially measured will be assessed using population kinetic approach and mathematical modeling
Time frame: through treatment completion (a median of 12 months)
Pharmacodynamic effects of the 3 drugs on circulating (Cancer Antigen) CA-125 values
The kinetics of (Cancer Antigen) CA-125 values serially measured will be assessed using population kinetic approach and mathematical modeling
Time frame: through treatment completion (a median of 12 months)
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