DOLAF: An international multicenter phase II trial of durvalumab (MEDI4736) plus olaparib plus fulvestrant in patients with metastatic or locally advanced ER-positive, HER2-negative breast cancer selected using criteria that predict sensitivity to olaparib.

Authors

null

Severine Guiu Lahaye

Institut de Cancerologie de Montpellier, Montpellier, France

Severine Guiu Lahaye , Judith Balmana Gelpi , Ludovic Gauthier , Frédéric Bigot , Anthony Goncalves , Jean-Sebastien Frenel , Thomas Bachelot , Florence Dalenc , Audrey Mailliez , Camille Chakiba , Dominique Genet , Nathalie Dohollou , Isabelle Desmoulins , Jean-Luc Re Canon , Clara Guyonneau , Adrien Buisson , Louise-Marie Chevalier , Suzette Delaloge , Philippe Follana

Organizations

Institut de Cancerologie de Montpellier, Montpellier, France, Clinical Cancer Genetics and Breast Cancer Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain, Institut régional du Cancer de Montpellier, Montpellier, France, Institut de Cancerologie de l'Ouest, Angers, France, Institut Paoli-Calmettes, Marseille, France, Institut de Cancerologie de l'Ouest, Saint-Herblain, France, Centre Léon Bérard, Lyon, France, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France, Centre Oscar Lambret, Lille, France, Institut Bergonié, Bordeaux, France, ARCH/Polyclinique de Limoges, Limoges, France, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France, Centre Georges-François Leclerc, Dijon, France, Grand Hôpital de Charleroi, Charleroi, Belgium, Unicancer, Paris, France, Department of Biopathology, Centre Léon BERARD, Lyon, France, Department of Biopathology, ICO-Centre Paul Papin, Angers, France, Gustave Roussy, Paris, France, GINECO and Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France

Research Funding

Pharmaceutical/Biotech Company

Background: PARP inhibitors have documented clinical activity in patients with HER2 negative breast cancer (BC) and a germline pathogenic variant (PV) in BRCA1 or BRCA2. Defects in other genes involved in homologous recombination DNA repair (HRR) or mismatch repair pathway (microsatellite instability MSI) have been associated with preclinical cellular sensitivity to PARP inhibitors. Several preclinical and clinical studies have suggested synergy between immune checkpoint blockade and PARP inhibitors. Indeed, tumors with deficiency in HRR have higher mutagenic potential and produce a larger number of neoantigens. Around 60% of BC with a germline PV in BRCA1/2 are ER+/HER2- tumors, and the ER-pathway remains a key target of their therapy. The combination of PARP inhibitors with endocrine therapy has shown to be superior to monotherapy. Methods: DOLAF is an open-label, international, multicentric, phase II trial assessing the combination of olaparib, fulvestrant, and durvalumab in ER+/HER2- metastatic or locally advanced BC with somatic or germline PV in BRCA1,BRCA2 or other genes implicated in the HRR pathway (ATM, BARD1, BRIP1, CDK12, CHEK1, CHEK2, FANCA, FAND2, FANCL, MRE11A, NBN, PALB2, PPP2R2A, RAD51B, RAD51C, RAD51D and RAD54L) or in MSI status or other actionable genes (AKT1, ESR1, FGFR1, FGFR2, FGFR3, and PIK3CA) all based on central tumor NGS. Further an amendment in May 2021, patients with only alterations in these other actionable genes can no longer be included. Patients must have received 1 prior line of endocrine therapy for their metastatic BC, including CDK4/6 inhibitor and maximum of 1 line of chemotherapy in the metastatic setting. Patients receive olaparib (twice daily at 300 mg), fulvestrant (2 intramuscular injections of 250 mg every 28 days) and durvalumab (1500 mg intravenous every 4 weeks). The primary objective is to evaluate the progression-free survival rate at 24 weeks. Secondary endpoints include safety, overall survival, objective response rate, in the overall population and in the germline BRCA mutated population. With an optimum two-stage Simon design, α = 2.5%, β = 5%, p0 (probability of inefficiency maximum) = 50%, p1 (probability of minimum efficiency) = 65%, it is necessary to include 158 patients. The strategy could be considered sufficiently effective if there are at least 87 patients without progression at 24 weeks. Given the lack of safety data from this association, a safety run-in phase including 6 patients has been completed without DLT. As of December 31, 2021, 266 patients have been screened of whom 102 have been treated. The first interim analysis occured in November 2021 after the inclusion of 64 evaluable patients. IDMC suggested that the trial continue as planned. Clinical trial information: NCT04053322.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Breast Cancer—Metastatic

Track

Breast Cancer

Sub Track

Hormone Receptor-Positive

Clinical Trial Registration Number

NCT04053322

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr TPS1116)

DOI

10.1200/JCO.2022.40.16_suppl.TPS1116

Abstract #

TPS1116

Poster Bd #

488b

Abstract Disclosures