This is an open-label, two-stage, multi-arm Phase 1 study designed to evaluate the safety and preliminary efficacy of combining niraparib with four standard chemotherapy regimens used to treat TNBC.
Niraparib is an oral, selective poly ADP ribose polymerase (PARP)-1 and PARP-2 inhibitor. A strategy of combining a PARP inhibitor, as a chemopotentiator, with chemotherapy is a promising approach in the treatment of triple-negative breast cancer. This study will evaluate the combination of niraparib with several standard chemotherapy regimens used to treat breast cancer to determine a recommended Stage 2 dose (RS2D) of chemotherapy regimens with niraparib. Stage 1 will be conducted in subjects with metastatic TNBC and will include 4 chemotherapy treatment arms in escalating dose levels (Arm 1: doxorubicin + cyclophosphamide (AC) every 14 days with pegfilgrastim (or biosimilar) for 4 cycles followed by AC every 21 days; Arm 2: AC every 21 days; Arm 3: weekly paclitaxel; Arm 4: weekly paclitaxel + carboplatin every 21 days), each combined with oral daily niraparib. Treatment will continue until disease progression, unacceptable toxicity, or subject withdrawal.Stage 2 will be conducted in subjects with non-metastatic TNBC. Subjects will receive neoadjuvant chemotherapy with either AC every 14 days (Arm 1A) or every 21 days (Arm 2A) at the RS2D of chemotherapy combined with oral daily niraparib from Stage 1. Treatment will continue for 4 cycles.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Stage 1 - Evaluate dose-limiting toxicities (DLT) separately for Arms 1, 2, 3, and 4 and establish recommended Stage 2 dose of chemotherapy in combination with niraparib
The DLT variable will be determined for each subject as a binary variability indicating whether or not subject experienced a protocol-defined DLT.
Time frame: up to 28 days
Stage 2 - Assess clinically significant toxicities separately for Arms 1 and 2 after RS2D of niraparib is determined.
The clinically significant toxicity variable will be determined for each subject as a binary variable indicating whether or not the subject experienced a niraparib-related dose delay of at least 28 days or a Grade 3 or higher niraparib-related non-hematologic toxicity.
Time frame: up to 84 days
Stage 1 - Objective response rate (ORR)
Objective response will be determined for each subject in Stage 1 as a binary variable indicating whether or not the subject achieved a best overall response of CR or PR
Time frame: up to 30 days post-treatment discontinuation
Stage 1 - Duration of response (DoR)
Duration of Response (DoR) will be determined for subjects in Stage 1 who experience a PR or better and is defined as the duration of time from the first assessment that determined a CR or PR to the date of the first occurrence of progressive disease or death.
Time frame: up to 5 years post-treatment discontinuation
Stage 1 - Clinical benefit rate (CBR)
Clinical benefit will be determined for each subject in Stage 1 as a binary variable indicating whether or not the subject achieved a best overall response of CR, PR, or SD
Time frame: up to 30 days post-treatment discontinuation
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IV
Injection
IV
Stage 1 - Progression free survival (PFS)
PFS will be determined for all subjects in Stage 1 and is defined as the duration of time from enrollment to the first occurrence of either progressive disease or death.
Time frame: up to 5 years post-treatment discontinuation
Stage 1 - Overall survival (OS)
Overall survival is defined as the duration of time from enrollment to the date of death from any cause.
Time frame: up to 5 years post-treatment discontinuation
Stage 1 - Cumulative incidence of secondary malignancies including MDS
Secondary malignancies (including MDS) will be defined as a time to event endpoint and will be calculated from the date of enrollment.
Time frame: up to 5 years post-treatment discontinuation
Stage 1 - Overall safety profile - Adverse Events of Special Interest (AESIs)
The AESI variable will be determined for each subject as a binary variability indicating whether or not subject experienced a protocol-defined AESI.
Time frame: up to 30 days post-treatment discontinuation
Stage 1 - Overall safety profile - Adverse Events (AEs)
The AE variable will be determined for each subject as a binary variability indicating whether or not subject experienced an AE per CTCAE V5.0.
Time frame: up to 30 days post-treatment discontinuation
Stage 1 - Overall safety profile - Death on Study Therapy
The death of study therapy variable will be determined for each subject as a binary variability indicating whether or not subject experienced a Grade 5 event.
Time frame: up to 30 days post-treatment discontinuation
Stage 1 - Overall safety profile - Complete Blood Count with Differential (CBCD)
The CBCD variable will be collected quantitatively for each subject.
Time frame: up to 30 days post-treatment discontinuation
Stage 1 - Overall safety profile - Comprehensive Metabolic Profile (CMP)
The CMP variable will be collected quantitatively for each subject.
Time frame: up to 30 days post-treatment discontinuation
Stage 2 - Pathologic complete response (pCR)
Pathologic complete response (pCR) will be determined for each subject in Stage 2 as a binary variable indicating whether the subject experiences a pCR to neoadjuvant therapy.
Time frame: up to 4 weeks post-surgery
Stage 2 - Clinical complete response (cCR)
Clinical complete response (cCR) will be determined for each subject in Stage 2 as a binary variable indicating whether the subject experiences a cCR to neoadjuvant therapy.
Time frame: up to 4 weeks post-surgery
Stage 2 - Relapse-free survival
RFS will be determined for all subjects in Stage 2 and is defined as the duration of time from enrollment to the first occurrence of either disease progression prior to surgery, disease relapse after surgery, or death.
Time frame: up to 5 years post-treatment discontinuation
Stage 2 - Overall survival
Overall survival is defined as the duration of time from enrollment to the date of death from any cause.
Time frame: up to 5 years post-treatment discontinuation
Stage 2 - Cumulative incidence of secondary malignancies including MDS
Secondary malignancies (including MDS) will be defined as a time to event endpoint and will be calculated from the date of enrollment.
Time frame: up to 5 years post-treatment discontinuation
Stage 2 - Overall safety profile - Adverse Events of Special Interest (AESIs)
The AESI variable will be determined for each subject as a binary variability indicating whether or not subject experienced a protocol-defined AESI.
Time frame: up to 4 weeks post-surgery
Stage 2 - Overall safety profile - Adverse Events (AEs)
The AE variable will be determined for each subject as a binary variability indicating whether or not subject experienced an AE per CTCAE V5.0.
Time frame: up to 4 weeks post-surgery
Stage 2 - Overall safety profile - Serious Adverse Events (SAEs)
The SAE variable will be determined for each subject as a binary variability indicating whether or not subject experienced a protocol-defined SAE.
Time frame: up to 4 weeks post-surgery
Stage 2 - Overall safety profile - Death on Study Therapy
The death of study therapy variable will be determined for each subject as a binary variability indicating whether or not subject experienced a Grade 5 event.
Time frame: up to 4 weeks post-surgery
Stage 2 - Overall safety profile - Complete Blood Count with Differential (CBCD)
The CBCD variable will be collected quantitatively for each subject.
Time frame: up to 4 weeks post-surgery
Stage 2 - Overall safety profile - Comprehensive Metabolic Profile (CMP)
The CMP variable will be collected quantitatively for each subject.
Time frame: up to 4 weeks post-surgery