This phase I trial tests the safety, side effects, and best dose of combination therapy with liposomal doxorubicin and peposertib in treating patients with sarcoma that has spread from where it first started, to other places in the body (metastatic), or cannot be removed by surgery (unresectable) and for which no known cure is available (advanced). Doxorubicin is in a class of medications called anthracyclines. Doxorubicin damages the cell's deoxyribonucleic acid (DNA) and may kill cancer cells. It also blocks a certain enzyme needed for cell division and DNA repair. Liposomal doxorubicin is a form of the anticancer drug doxorubicin that is contained inside very tiny, fat-like particles. Liposomal doxorubicin may have fewer side effects and work better than other forms of the drug. Peposertib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It may also enhance the activity of chemo- and radiotherapy. There is some pre-clinical evidence in animal models that combining peposertib with liposomal doxorubicin can shrink or stabilize certain types of cancer for longer than either drug alone, but it is not known if this will happen in people. Combination therapy with liposomal doxorubicin and peposertib may be effective in treating patients with advanced sarcoma.
PRIMARY OBJECTIVES: I. To evaluate the safety and tolerability of peposertib in combination with low-dose pegylated liposomal doxorubicin hydrochloride (liposomal doxorubicin) as evaluated by the dose-limiting toxicity (DLT) rate at each tested dose level. (Dose Escalation) II. To determine the recommended phase 2 dose (RP2D) of liposomal doxorubicin and peposertib combination and determine the maximal tolerated dose (MTD) if identified. (Dose Escalation) III. To obtain a more precise determination of adverse events (e.g. dose limiting toxicities estimate at the selected dose). (Dose Expansion) SECONDARY OBJECTIVES: I. To assess the pharmacokinetics of peposertib and liposomal doxorubicin used in combination with each other. (Dose Escalation) II. To estimate the objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 in patients with leiomyosarcoma treated with peposertib and low-dose liposomal doxorubicin. (Dose Expansion) III. To estimate the progression free survival (PFS) in patients with leiomyosarcoma treated with peposertib and low-dose liposomal doxorubicin. (Dose Expansion) IV. To assess the pharmacokinetics of peposertib and liposomal doxorubicin used in combination with each other. (Dose Expansion) V. To assess whether DNA damage is exaggerated by the low-dose liposomal doxorubicin in combination with peposertib in patients with homologous recombination (HR)-deficiency. (Dose Expansion) CORRELATIVE OBJECTIVES: I. To test the hypothesis that soft tissue sarcomas (STS) with homologous recombination deficiency (HRD) like leiomyosarcomas (LMS) will be more susceptible to DNA-protein kinase inhibitor (PKi) in combination with low-dose liposomal doxorubicin. II. To test the hypothesis that gammaH2AX and pNBS1 can be used as pharmacodynamic biomarkers of response to DNA-PKi in combination with low-dose liposomal doxorubicin. III. To test the hypothesis that disease activity correlates with circulating tumor DNA levels in the plasma. OUTLINE: This is a dose-escalation study of peposertib and liposomal doxorubicin followed by a dose-expansion study. Patients receive peposertib orally (PO) twice daily (BID) on days 1-28 of each cycle and liposomal doxorubicin intravenously (IV) on day 1 of each cycle. Cycles repeat every 28 days in the absence of disease progression, unacceptable toxicity or withdrawal of consent. Patients undergo blood sample collection and computed tomography (CT) or magnetic resonance imaging (MRI) throughout the trial. Patients also undergo tissue biopsy and echocardiography (ECHO) or multigated acquisition scan (MUGA) during screening and on the trial. Patients are followed for 30 days after removal from study or until death, whichever occurs first.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Undergo tissue biopsy
Undergo blood sample collection
Undergo CT scan
Undergo ECHO
Undergo MRI
Undergo MUGA
Given IV
Given PO
Los Angeles General Medical Center
Los Angeles, California, United States
SUSPENDEDUSC / Norris Comprehensive Cancer Center
Los Angeles, California, United States
SUSPENDEDUCHealth University of Colorado Hospital
Aurora, Colorado, United States
RECRUITINGUniversity of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, United States
RECRUITINGUniversity of Chicago Comprehensive Cancer Center
Chicago, Illinois, United States
RECRUITINGUC Comprehensive Cancer Center at Silver Cross
New Lenox, Illinois, United States
RECRUITINGUniversity of Chicago Medicine-Orland Park
Orland Park, Illinois, United States
RECRUITINGJohns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, United States
RECRUITINGNational Cancer Institute Developmental Therapeutics Clinic
Bethesda, Maryland, United States
RECRUITINGDana-Farber Cancer Institute
Boston, Massachusetts, United States
RECRUITING...and 6 more locations
Dose limiting toxicity (DLT) rate
The number and type of DLT seen at each dose level will be provided. The adverse events (AEs) will also be summarized by AE type and the maximum grade of the AE experienced by the patient for each dose level. DLT will be used to determine the recommended phase 2 dose of study drugs.
Time frame: Up to 28 days
Incidence of adverse events
AEs will be assessed using Common Terminology Criteria for Adverse Events version 5.
Time frame: Up to 30 days after the end of study treatment
Objective response rate
Assessed with Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1.
Time frame: Up to 28 days
Progression free survival
The length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse. Patients who are alive at the time of analysis without a documented disease progression will be censored at the time of their last tumor evaluation.
Time frame: From study enrollment until disease progression (determined by RECIST v1.1) or death due to any cause, whichever occurs first
Homologous recombination deficiency (HRD) status
Will be defined by HRD score and mutational signature analysis.
Time frame: Up to 1 year
Deoxyribonucleic acid damage repair activity
Will be defined by gammaH2AX and NBS1 S343 phosphorylation based on the National Clinical Laboratory Network DDR3 assay.
Time frame: Up to 1 year
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