This phase II trial studies the side effects of ONC201 and paclitaxel and how well they work in treating patients with platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer that has come back (recurrent), or that does not respond to treatment (refractory). ONC201 is the first in its class of drugs that antagonize some specific cell receptors on cancer cells, leading to their destruction. Drugs used in chemotherapy, such as paclitaxel, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving ONC201 and paclitaxel may work better in treating patients with platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer compared to paclitaxel alone.
PRIMARY OBJECTIVES: I. To evaluate the safety and tolerability of the combination of Akt/ERK inhibitor ONC 201 (ONC201) and paclitaxel in patients with platinum refractory or resistant epithelial ovarian, fallopian tube or primary peritoneal cancer. (Part 1) II. To evaluate the objective response rate (ORR) of ONC201 in combination with paclitaxel in patients with platinum refractory or resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer. (Part 2) III. To evaluate progression free survival (PFS) of ONC201 in combination with weekly paclitaxel in patients with platinum refractory or resistant epithelial ovarian, fallopian tube or primary peritoneal cancer. (Part 2) SECONDARY OBJECTIVES: I. To evaluate the durability/duration of response (DOR) of ONC201 in combination with paclitaxel. II. To evaluate the safety and patient reported tolerability of ONC201 in combination with paclitaxel. (Part 2) III. To evaluate the disease control rate (DCR) of ONC201 in combination with paclitaxel. IV. To evaluate the cancer antigen-125 (CA-125) and/or human epididymis factor 4 (HE-4) response of ONC201 in combination with paclitaxel in those patients with one or both of these tumor markers upregulated. V. To characterize the pharmacokinetics (PK) and pharmacodynamics (PD) of ONC201 in combination with paclitaxel. VI. To obtain preliminary estimates of overall survival (OS) of ONC201 in combination with weekly paclitaxel. EXPLORATORY OBJECTIVES: I. To evaluate the immune response (specifically natural killer \[NK\] cell and cytokine profile) of ONC201 in combination with paclitaxel in patients with platinum refractory or resistant epithelial ovarian, fallopian tube or primary peritoneal cancer. OUTLINE: Patients receive ONC201 orally (PO) on days 1, 8, and 15, and paclitaxel intravenously (IV) over 1 hour on days 2, 9, and 16. Cycles repeat every 28 days in the absence disease progression or unacceptable toxicity. If paclitaxel must be stopped for any reason, patients may continue on ONC201 alone. After completion of study treatment, patients are followed up for 1 year.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
62
Barbara Ann Karmanos Cancer Institute
Detroit, Michigan, United States
RECRUITINGKarmanos Cancer Institute at McLaren Flint
Flint, Michigan, United States
RECRUITINGIncidence of treatment related adverse events (AEs) (Part 1)
Graded according to National Cancer Institute (NCI) Common Terminology Criteria in Adverse Events (CTCAE) version (v)5.0.
Time frame: Up to 28 days
Incidence of dose limiting toxicities (DLT's) (Part 1)
Graded according to NCI CTCAE v5.0.
Time frame: Up to 28 days
Objective response rate (ORR) (Part 2)
Defined as the proportion of patients achieving a complete (CR) or partial tumor response (PR) by computed tomography (CT) evaluation according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Will be calculated as the proportion of patients achieving a complete or partial tumor response according to RECIST v1.1 criteria and its associated 1-sided 92% confidence interval (CI) will be also estimated using Pearson-Klopper's exact method.
Time frame: Up to 1 year
Progression free survival (PFS) (Part 2)
Will be summarized using Kaplan-Meier (KM) curves and their median and confidence intervals (CI's) will be further estimated.
Time frame: From study treatment initiation to objective tumor progression or death, assessed up to 1 year
Duration of response (DOR)
The distributions of additional time-to-event endpoints will be summarized using KM curves and their median and CI's will be further estimated using KM estimates.
Time frame: From first documented tumor response until the date of documented progression or death from any cause, assessed up to 1 year
Incidence of treatment related AEs
Treatment emergent AEs and serious adverse events (SAEs) will be summarized by count and percentage per CTCAE v5.0.
Time frame: Up to 1 year
Incidence of patient reported symptoms
Will be summarized by count and percentage from the Functional Assessment of Cancer Therapy (FACT)-Taxane questionnaire. Repeated measured analysis of variance (ANOVA) will be conducted to assess for any changes in these symptoms by time. If a significant association with time is identified, pairwise comparisons between various time-points will be assessed using paired t-tests with a Tukey adjustment for multiple comparisons.
Time frame: Up to 1 year
Disease clinical response (DCR)
Defined as the proportion of patients achieving a complete response (CR), partial response (PR), or stable disease (SD) according to RECIST v1.1 criteria.
Time frame: At 6 months
CA-125 response rate
Defined as the proportion of patients achieving a 50% reduction in CA-125 levels from baseline, if baseline level is \>= 2 x the upper limit of normal (ULN) within 2 weeks prior to starting treatment. Differences in these markers by response will be assessed by Fisher's exact tests, and difference in these markers over time will be assessed using McNemar's tests.
Time frame: Up to 1 year
HE-4 response rate
Defined as proportion of patients achieving a 50% reduction in HE-4 levels from baseline over time, if baseline level is \>= 2 x ULN within 2 weeks prior to starting treatment, respectively. Differences in these markers by response will be assessed by Fisher's exact tests, and difference in these markers over time will be assessed using McNemar's tests.
Time frame: Up to 1 year
Plasma concentrations of ONC201
Examined to assess drug interactions with paclitaxel and characterize the pharmacokinetics (PK). PK parameters will be estimated using non-compartment or compartment models and summarized in mean and CIs under the assumption of log-normal distribution.
Time frame: Up to 1 year
Pharmacodynamic studies
As a biomarker of apoptosis, the serum cCK18 (M30 assay) and CK18 (M65 assay) will be used to quantify serum caspase-cleaved and total cytokeratin 18 levels. Prolactin levels will be assayed from the collected serum specimens. Repeated measured ANOVA will be conducted to assess for any changes in apoptosis and prolactin by time. If a significant association with time is identified, pairwise comparisons between various time-points will be assessed using paired t-tests with a Tukey adjustment for multiple comparisons. Tissue based biomarkers will be evaluated based on archival (pretreatment) and on-study biopsy tissue and compared via pre/post treatment H-score both within each individual patient and among the group of patients. Wilcoxon signed rank test will be used for pre/post comparisons.
Time frame: Up to 1 year
Overall survival
The distributions of additional time-to-event endpoints will be summarized using KM curves and their median and CI's will be further estimated using KM estimates.
Time frame: From study treatment initiation to death, assessed up to 1 year
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