Multicentre, 2 arm, open-label UK randomised phase II trial to determine the efficacy of niraparib versus active symptom control (ASC) in patients who have relapsed after previously receiving platinum based systemic therapy. 84 patients will be recruited from approximately 10 UK trial network sites.
Mesothelioma is a cancer that is caused by exposure to asbestos, an environmental contaminant. This cancer is incurable and lacks effective treatment, particularly after initial chemotherapy. There has not been a licenced therapy for mesothelioma since 2003, and no treatment has yet demonstrated an improvement in survival following initial chemotherapy. There is an urgent need to explore more effective approaches to therapy. Targeted treatments offer potential hope for the treatment of mesothelioma. A class of drugs called PARP (Poly Adenosine Diphosphate-ribose polymerase) inhibitors have already been proven to improve the survival of patients with breast and ovarian cancers, that carry specific mutations. Mesothelioma has been shown in a recent trial to respond to this class of agent. Further investigation is warranted to test whether PARP inhibitors could be a new treatment option for patients. As with ovarian cancer studies of the past, the NERO trial will test a PARP inhibitor (niraparib) after successful treatment with chemotherapy. Patients whose tumours shrink or stabilise following chemotherapy are expected to have a greater chance of benefit from niraparib. It's not known if niraparib will be able to improve survival of patients with mesothelioma, or indeed whether or not toxicity could occur without benefit. For that reason, patients will be randomised with a 2:1 chance of receiving the drug. Those patients who do not receive niraparib will be closely monitored for signs of early tumour growth so that they can go on to receive an alternative treatment if necessary. If the NERO trial is positive, this study will lead to the approval of a new medicine for use around the world, one that would extend the life expectancy of patients for the first time following initial chemotherapy. NERO will recruit 84 patients over 12 months. Those randomised to receive niraparib will receive a daily dose of 200 mg or 300mg for up to 24 weeks within the trial.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
88
Niraparib (\[3S\]-3-\[4-\[7-(aminocarbonyl)-2H-indazol-2-yl\] phenyl\] piperidine \[tosylate monohydrate salt\]) is an orally available, potent, and highly selective PARP1 and PARP2 inhibitor. The excipients for niraparib are lactose monohydrate and magnesium stearate. Niraparib will be supplied in bottles containing 72 capsules of 100 mg. The capsules should be swallowed whole with water. The capsules should not be chewed or crushed and can be taken without regard to meals.
ASC could involve regular specialist follow up; structured assessment of physical, psychological, and social problems; and appropriate treatment, including palliative radiotherapy and steroids.
University Hospital Southampton, Southampton General Hospital
Southampton, Hampshire, United Kingdom
Medway NHS Foundation Trust, Medway Maritime Hospital
Gillingham, Kent, United Kingdom
Somerset NHS Foundation Trust, Musgrove Park Hospital
Progression-free survival
Progression-free survival is the determined by modified RECIST (pleural disease), RECIST 1.1 (for non-pleural disease), investigator reported progression or death from any cause (whichever event comes first)
Time frame: From date of randomisation until the date of the first documented progression or date of death from any cause, whichever came first, assessed up to 18 months
Overall Survival
Time from randomisation to death from any cause
Time frame: From date of randomisation until the date of the first documented progression or date of death from any cause, whichever came first, assessed up to 18 months
Best overall response (progressive disease, stable disease, partial or complete response)
The best overall response is the best response recorded from the start of treatment until disease progression or death
Time frame: From date of randomisation until the date of the first documented progression or date of death from any cause, whichever came first, assessed up to 18 months
Disease Control
Stable disease, partial or complete response
Time frame: 12 and 24 weeks post randomisation
Duration of response
Time from complete or partial response (where this occurs) until progression or death
Time frame: From date of randomisation until the date of the first documented progression or date of death from any cause, whichever came first, assessed up to 18 months
Treatment compliance
Assessed by summarising the percentage of the received dose relative to the intended dose at each cycle
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Taunton, Somerset, United Kingdom
Belfast Health and Social Care Trust, Belfast City Hospital
Belfast, United Kingdom
Velindre University NHS Trust, Velindre Cancer Centre
Cardiff, United Kingdom
Beatson West of Scotland Cancer Centre
Glasgow, United Kingdom
The Princess Alexandra Hospital NHS Trust, The Princess Alexandra Hospital
Harlow, United Kingdom
Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital
Hull, United Kingdom
Leeds Teaching Hospitals NHS Trust, St James's Hospital
Leeds, United Kingdom
University Hospitals of Leicester NHS Trust, Royal Leicester Infirmary
Leicester, United Kingdom
...and 1 more locations
Time frame: Up to 24 weeks
Number of participants with treatment-related adverse events as assessed by CTCAE v5.0
Summary statistics and listings will be reported for patients in the safety population and will be summarised by treatment arm with classification by the latest version of MedDRA. Grade will be reported on the CTCAE toxicity scale (version 5.0). Both all cause and treatment related or emergent AEs will be included in the analysis.
Time frame: At the end of each treatment cycle (each cycle is 21 days, with a maximum of 8 cycles of treatment) for 100 days post treatment discontinuation and for ongoing drug-related AE's until resolved, return to baseline, or deemed irreversible