Phase II trial of the PARP inhibitor, niraparib, in BAP1 and other DNA damage response (DDR) pathway deficient neoplasms including cholangiocarcinoma.

Authors

Thomas George

Thomas J. George

University of Florida Health Cancer Center, Gainesville, FL

Thomas J. George , David L. DeRemer , Hiral D. Parekh , Ji-Hyun Lee , Merry Jennifer Markham , Karen Colleen Daily , Frederic J. Kaye , Stephen Staal , Dennie V. Jones , Bruce K. Stechmiller , Carmen Joseph Allegra , Robert A. Hromas

Organizations

University of Florida Health Cancer Center, Gainesville, FL, University of Florida/UF Health Cancer Center, Gainesville, FL, UF Health Cancer Center, Gainesville, FL, Univ of Florida, Gainesville, FL, University of Texas Health Science Center at San Antonio, San Antonio, TX

Research Funding

Pharmaceutical/Biotech Company
Tesaro University of Florida Health Cancer Center

Background: BRCA1-Associated Protein 1 (BAP1) is a critical regulator of the cell cycle, cellular differentiation, cell death, and DNA damage response. It also acts as a tumor suppressor. Preclinical models demonstrate significant synthetic lethality in BAP1 mutant cell lines and patient xenografts when treated with PARP inhibitors, independent of underlying BRCA status, suggesting this mutation confers a BRCA-like phenotype. BAP1 is mutated, leading to a loss of functional protein, in up to 30% of cholangiocarcinomas as well as several other solid tumors. Methods: This phase 2, open-label, single arm study aims to exploit the concept of synthetic lethality with the use of the PARP inhibitor niraparib in pts with metastatic relapsed or refractory solid tumors. Eligible pts with measurable metastatic and incurable solid tumors are assigned to one of two cohorts: Cohort A (histology-specific): tumors harboring suspected BAP1 mutations including cholangiocarcinoma, uveal melanoma, mesothelioma or clear cell renal cell carcinoma with tissue available for BAP1 mutational assessment via NGS or Cohort B (histology-agnostic): tumors with known DNA damage response (DDR) mutations (Table) confirmed by CLIA-approved NGS. Other key eligibility criteria include age ≥18 years, adequate cardiac, renal, hepatic function and ECOG performance status of 0 to 1. Pts with known BRCA1 or BRCA2 mutations or prior PARPi exposure are excluded. Pts receive niraparib 200-300mg daily (depending on weight and/or platelet count) continuously. Primary endpoint is objective response rate with secondary endpoints of PFS, OS, toxicity and exploratory biomarker determinations. Radiographic response by RECIST criteria is measured every 8 weeks on treatment. Enrollment continues to a maximum of 47 evaluable subjects with expansion cohorts allowable for histologic or molecular subtypes meeting pre-specified responses. Clinical trial information: NCT03207347

DNA damage response genes with mutations eligible for Cohort B.

ARID1A ATM ATR BACH1 (BRIP1) BAP1 BARD1
BLM CHEK1 CHEK2 CDK2 CDK4 ERCC
FAM175A FEN1 IDH1 IDH2 MRE11A NBN (NBS1)
PALB2 POLD1 PRKDC (DNA-PK) PTEN RAD50 RAD51
RAD52 RAD54 RPA1 SLX4 WRN XRCC

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Abstract Details

Meeting

2020 Gastrointestinal Cancers Symposium

Session Type

Trials in Progress Poster Session

Session Title

Trials in Progress Poster Session B: Hepatobiliary Cancer, Neuroendocrine/Carcinoid, Pancreatic Cancer, and Small Bowel Cancer

Track

Hepatobiliary Cancer,Neuroendocrine/Carcinoid,Pancreatic Cancer,Small Bowel Cancer

Sub Track

Therapeutics

Clinical Trial Registration Number

NCT03207347

Citation

J Clin Oncol 38, 2020 (suppl 4; abstr TPS591)

Abstract #

TPS591

Poster Bd #

P4

Abstract Disclosures