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| Name | Class |
|---|---|
| Bristol-Myers Squibb | INDUSTRY |
| Clovis Oncology, Inc. | INDUSTRY |
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The study population is advanced gastric, gastroesophageal, and esophageal adenocarcinoma participants who have failed upfront standard of care chemotherapy. The goal is to demonstrate that Rucaparib plus Ramucirumab with or without Nivolumab has a higher response rate than what has been reported for Ramucirumab in previously treated patients. Trial will be a phase 1/2 trial. The Phase 1 portion will determine the recommended Phase 2 treatment dose for the combination of Rucaparib plus Ramucirumab and Nivolumab and enroll approximately 6-9 participants. The Phase 2 portion of the study will involve 52 participants allocated between two treatment groups comparing Rucaparib plus Ramucirumab with or without Nivolumab. The participants will be selected based on the results of a screening HRD gene panel.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Safety Lead In | Experimental |
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| Cohort A | Experimental |
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| Cohort B | Active Comparator |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rucaparib | Drug | Rucaparib tablet |
|
| Measure | Description | Time Frame |
|---|---|---|
| Recommended Phase 2 Dose (RP2D) | Defined as the highest dose studied for which the observed incidence of dose limiting toxicities (DLT) is less than 33%. DLTs will be measured per the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. | Up to 28 days |
| Overall Response Rate (ORR) | Defined as the proportion of participants with overall response to therapy. Overall response is defined as the best response recorded, (including Complete Response (CR) and Partial Response (PR)), from the start of the treatment until the end of treatment. ORR will be measured per the Modified Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria | up to 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Number of participants with treatment related adverse events (TRAEs) | Determining per CTCAE 5.0 | Up to 12 months |
| Overall Benefit Rate (OBR) | Defined as the proportion of participants with overall benefit to therapy. Overall benefit is defined as the best response recorded, (including complete Response (CR), Partial Response (PR), and Stable Disease (SD)), from the start of the treatment until the end of treatment. Determine overall benefit of therapy using modified RECIST version 1.1 |
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Inclusion Criteria:
Exclusion Criteria:
Prior treatment with a programmed cell death protein 1 (PD1) or programmed death- ligand 1 (PD-L1) inhibitors
Prior treatment with poly-(ADP-Ribose)polymerase (PARP)
Patients with microsatellite instability (MSI) high or mismatch repair (MMR) deficient tumors
Abdominal fistula, GI perforation, bowel obstruction, or intra-abdominal abscess within 6 months before first dose
Evidence of active peptic ulcer disease, inflammatory bowel disease, diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis, acute pancreatitis, acute obstruction of the pancreatic duct or common bile duct, or gastric outlet obstruction
Inability to swallow tablets
Uncontrollable ascites or pleural effusion
Cavitating pulmonary lesion(s) or known endotracheal or endobronchial disease manifestation
Clinically significant hematuria, hematemesis, or hemoptysis, or other history of significant bleeding within 12 weeks
Lesions invading any major blood vessels
Receipt of the last dose of anticancer therapy less than 28 days prior to the first dose of study drug
Major surgery within 8 weeks before first dose of study treatment
History of allogenic organ transplantation
Active infection including tuberculosis, hepatitis B, hepatitis C, or human immunodeficiency virus. Patients with a past or resolved hepatitis B virus (HBV) infection are eligible. Patients positive for hepatitis C antibody are eligible only if polymerase chain reaction is negative for hepatitis C virus (HCV) RNA
Receipt of live attenuated vaccine within 30 days prior to the first dose of study drug
Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, or serious chronic gastrointestinal conditions
Uncontrolled hypertension defined as sustained blood pressure (BP) > 150 mm Hg systolic or > 100 mm Hg diastolic despite optimal antihypertensive treatment
Prolonged baseline QT interval corrected for heart rate greater than 470 ms
Brain metastases or spinal cord compression. Patients whose brain metastases have been treated may participate provided they show radiographic stability
Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients
Current or anticipated use of other investigational agents while participating in this study
History of another primary malignancy except for:
Psychiatric illness/social situations that would limit compliance with study requirements
Pregnant or breast feeding
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| Name | Affiliation | Role |
|---|---|---|
| Anwaar Saeed, MD | Kansas University Cancer Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Chicago Medical Center | Chicago | Illinois | 60637 | United States | ||
| KU Cancer Center |
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Phase 1 - Safety Lead In - Enroll 6-9 molecularly unselected participants to determine the safety of the triplet combination of Rucaparib plus Ramucirumab and Nivolumab. One level dose de-escalation of Rucaparib will be planned based on dose limiting toxicity (DLT) signal of the first 6 participants run in phase.
Phase 2 - Parallel - Enroll 52 participants (26 in each cohort), open label, two treatment cohorts design evaluating Rucaparib plus Ramucirumab with or without Nivolumab. 50 percent (%) of participants enrollment to each treatment cohort will represent molecularly unselected population and the remaining 50% will be selected based on integrated screening tumor Homologous Recombination Deficiency (HRD) gene panel. The primary objective is efficacy by measuring the Overall Response Rate (ORR).
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| Ramucirumab | Drug | Ramucirumab intravenous solution |
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| Nivolumab | Drug | Nivolumab intravenous solution |
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| Up to 12 months |
| Progression free survival (PFS) | Reported as the proportion of participants that achieve PFS. PFS is defined as the time from the start of treatment until the first documentation of disease progression or death due to any cause, whichever occurs first. Measured per modified RECIST version 1.1 | Up to 12 months |
| Overall survival (OS) | Defined as the time from the start of treatment until death due to any cause, reported as the mean of all participants' OS. Measured per the medical record. | Up to 12 months |
| Fairway |
| Kansas |
| 66205 |
| United States |
| University of Kansas Cancer Center - CRC | Fairway | Kansas | 66205 | United States |
| University of Kansas Cancer Center - West | Kansas City | Kansas | 66112 | United States |
| The University of Kansas Cancer Center, Westwood Campus | Kansas City | Kansas | 66205 | United States |
| University of Kansas Cancer Center - Overland Park | Overland Park | Kansas | 66210 | United States |
| University of Kansas Cancer Center - North | Kansas City | Missouri | 64154 | United States |
| University of Kansas Cancer Center - Lee's Summit | Lee's Summit | Missouri | 64064 | United States |
| ID | Term |
|---|---|
| C562730 | Adenocarcinoma Of Esophagus |
| D013274 | Stomach Neoplasms |
| D000230 | Adenocarcinoma |
| ID | Term |
|---|---|
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D013272 | Stomach Diseases |
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
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| ID | Term |
|---|---|
| C531549 | rucaparib |
| D000096662 | Ramucirumab |
| D000077594 | Nivolumab |
| ID | Term |
|---|---|
| D061067 | Antibodies, Monoclonal, Humanized |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
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