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Phase II study of olaparib in patients with refractory Ewing sarcoma following failure of standard chemotherapy.

Choy E, Butrynski JE, Harmon DC, Morgan JA, George S, Wagner AJ, D'Adamo D, Cote GM, Flamand Y, Benes CH, Haber DA, Baselga JM, Demetri GD - BMC Cancer (2014)

Bottom Line: There were no objective responses (PR/CR), 4 SD (duration 10.9, 11.4, 11.9, and 17.9 wks), and 8 PD as best response.No significant or unexpected toxicities were observed with olaparib, with only a single case each of grade 3 anemia and grade 3 thrombocytopenia observed.No significant responses or durable disease control was seen, and the short average interval to disease progression underscores the aggressiveness of this disease.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA, USA. echoy@mgh.harvard.edu.

ABSTRACT

Background: Preclinical studies have documented antitumor activity of PARP inhibition both in vitro and in vivo, against Ewing sarcoma cells. This study aimed to translate that observation into a clinical trial to assess the efficacy and tolerability of olaparib, a PARP inhibitor, in patients with advanced Ewing sarcoma (EWS) progressing after prior chemotherapy.

Methods: In this nonrandomized phase II trial, adult participants with radiographically measureable metastatic EWS received olaparib tablets, 400 mg orally twice daily, until disease progression or drug intolerance. Tumor measurements were determined by CT or MRI at 6 and 12 weeks after starting olaparib administration, and then every 8 weeks thereafter. Tumor response determinations were made according to RECIST 1.1, and adverse event determinations were made according to CTCAE, version 4.0. A total of 22 participants were planned to be enrolled using a conventional 2-step phase II study design. If no objective responses were observed after 12 participants had been followed for at least 3 months, further accrual would be stopped.

Results: 12 participants were enrolled, and all were evaluable. There were no objective responses (PR/CR), 4 SD (duration 10.9, 11.4, 11.9, and 17.9 wks), and 8 PD as best response. Of the SD, 2 had minor responses (-9% and -11.7% by RECIST 1.1). The median time to disease progression was 5.7 weeks. Further enrollment was therefore discontinued. No significant or unexpected toxicities were observed with olaparib, with only a single case each of grade 3 anemia and grade 3 thrombocytopenia observed.

Conclusions: This study is the first report of a prospective phase II trial to evaluate the safety and efficacy of a PARP inhibitor in patients with advanced Ewing sarcoma after failure of standard chemotherapy. Olaparib administration was safe and well tolerated when administered to this small heavily pre-treated cohort at the 400 mg BID dose, although the median duration of dosing was for only 5.7 weeks. No significant responses or durable disease control was seen, and the short average interval to disease progression underscores the aggressiveness of this disease. Other studies to combine cytotoxic chemotherapy with PARP inhibition in EWS are actively ongoing.

Trial registration: ClinicalTrials.gov Identifier: NCT01583543.

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Related in: MedlinePlus

Progression free survival.
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Fig2: Progression free survival.

Mentions: Table 3: Sixty-seven percent of the study subjects (N = 8) experienced Progressive Disease as their best response, and 33% of the study subjects (N = 4) experienced Stable Disease (Figure 1). Response was measured using RECIST criteria version 1.1. Table 3 illustrates summary data and shows that the duration of stable disease had a median value of 11.6 weeks (N = 4), with a minimum value of 10.9 weeks and a maximum value of 17.9 weeks. Progression free-survival had a median of 5.7 weeks (Figure 2). The 90% Confidence Interval for the response rate is {0 - 22%}.Table 3


Phase II study of olaparib in patients with refractory Ewing sarcoma following failure of standard chemotherapy.

Choy E, Butrynski JE, Harmon DC, Morgan JA, George S, Wagner AJ, D'Adamo D, Cote GM, Flamand Y, Benes CH, Haber DA, Baselga JM, Demetri GD - BMC Cancer (2014)

Progression free survival.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230717&req=5

Fig2: Progression free survival.
Mentions: Table 3: Sixty-seven percent of the study subjects (N = 8) experienced Progressive Disease as their best response, and 33% of the study subjects (N = 4) experienced Stable Disease (Figure 1). Response was measured using RECIST criteria version 1.1. Table 3 illustrates summary data and shows that the duration of stable disease had a median value of 11.6 weeks (N = 4), with a minimum value of 10.9 weeks and a maximum value of 17.9 weeks. Progression free-survival had a median of 5.7 weeks (Figure 2). The 90% Confidence Interval for the response rate is {0 - 22%}.Table 3

Bottom Line: There were no objective responses (PR/CR), 4 SD (duration 10.9, 11.4, 11.9, and 17.9 wks), and 8 PD as best response.No significant or unexpected toxicities were observed with olaparib, with only a single case each of grade 3 anemia and grade 3 thrombocytopenia observed.No significant responses or durable disease control was seen, and the short average interval to disease progression underscores the aggressiveness of this disease.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA, USA. echoy@mgh.harvard.edu.

ABSTRACT

Background: Preclinical studies have documented antitumor activity of PARP inhibition both in vitro and in vivo, against Ewing sarcoma cells. This study aimed to translate that observation into a clinical trial to assess the efficacy and tolerability of olaparib, a PARP inhibitor, in patients with advanced Ewing sarcoma (EWS) progressing after prior chemotherapy.

Methods: In this nonrandomized phase II trial, adult participants with radiographically measureable metastatic EWS received olaparib tablets, 400 mg orally twice daily, until disease progression or drug intolerance. Tumor measurements were determined by CT or MRI at 6 and 12 weeks after starting olaparib administration, and then every 8 weeks thereafter. Tumor response determinations were made according to RECIST 1.1, and adverse event determinations were made according to CTCAE, version 4.0. A total of 22 participants were planned to be enrolled using a conventional 2-step phase II study design. If no objective responses were observed after 12 participants had been followed for at least 3 months, further accrual would be stopped.

Results: 12 participants were enrolled, and all were evaluable. There were no objective responses (PR/CR), 4 SD (duration 10.9, 11.4, 11.9, and 17.9 wks), and 8 PD as best response. Of the SD, 2 had minor responses (-9% and -11.7% by RECIST 1.1). The median time to disease progression was 5.7 weeks. Further enrollment was therefore discontinued. No significant or unexpected toxicities were observed with olaparib, with only a single case each of grade 3 anemia and grade 3 thrombocytopenia observed.

Conclusions: This study is the first report of a prospective phase II trial to evaluate the safety and efficacy of a PARP inhibitor in patients with advanced Ewing sarcoma after failure of standard chemotherapy. Olaparib administration was safe and well tolerated when administered to this small heavily pre-treated cohort at the 400 mg BID dose, although the median duration of dosing was for only 5.7 weeks. No significant responses or durable disease control was seen, and the short average interval to disease progression underscores the aggressiveness of this disease. Other studies to combine cytotoxic chemotherapy with PARP inhibition in EWS are actively ongoing.

Trial registration: ClinicalTrials.gov Identifier: NCT01583543.

Show MeSH
Related in: MedlinePlus