1. Study protocols of three parallel phase 1 trials combining radical radiotherapy with the PARP inhibitor olaparib
- Author
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de Haan, R, van Werkhoven, E, van den Heuvel, M M, Peulen, H M U, Sonke, G S, Elkhuizen, P, van den Brekel, M W M, Tesselaar, M E T, Vens, C, Schellens, J H M, van Triest, B, Verheij, M, Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, Arbeids- en Organisatie Psychologie (Psychologie, FMG), FMG, MKA AMC (OII, ACTA), Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, CCA - Cancer Treatment and quality of life, Academic Medical Center, and Maxillofacial Surgery (AMC)
- Subjects
0301 basic medicine ,Oncology ,Cancer Research ,Lung Neoplasms ,medicine.medical_treatment ,Piperazines ,Study Protocol ,chemistry.chemical_compound ,Olaparib ,0302 clinical medicine ,TITE-CRM ,Surgical oncology ,Carcinoma, Non-Small-Cell Lung ,Neoplasms ,Doselimiting toxicity ,Dose limiting toxicity ,Common Terminology Criteria for Adverse Events ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Tolerability ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,PARP inhibitor ,Carcinoma, Squamous Cell ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] ,medicine.medical_specialty ,Maximum Tolerated Dose ,Antineoplastic Agents ,Breast Neoplasms ,Phase 1 ,Poly(ADP-ribose) Polymerase Inhibitors ,Rare cancers Radboud Institute for Molecular Life Sciences [Radboudumc 9] ,lcsh:RC254-282 ,03 medical and health sciences ,Breast cancer ,SDG 3 - Good Health and Well-being ,Internal medicine ,Genetics ,medicine ,Humans ,Radiotherapy ,Dose escalation ,business.industry ,Radiosensitisation ,medicine.disease ,Head and neck squamous-cell carcinoma ,Radiation therapy ,030104 developmental biology ,chemistry ,Phthalazines ,Radiotherapy, Adjuvant ,business - Abstract
BackgroundPoly (ADP-ribose) Polymerase (PARP) inhibitors are promising novel radiosensitisers. Pre-clinical models have demonstrated potent and tumour-specific radiosensitisation by PARP inhibitors. Olaparib is a PARP inhibitor with a favourable safety profile in comparison to clinically used radiosensitisers including cisplatin when used as single agent. However, data on safety, tolerability and efficacy of olaparib in combination with radiotherapy are limited.MethodsOlaparib is dose escalated in combination with radical (chemo-)radiotherapy regimens for non-small cell lung cancer (NSCLC), breast cancer and head and neck squamous cell carcinoma (HNSCC) in three parallel single institution phase 1 trials. All trials investigate a combination treatment of olaparib and radiotherapy, the NSCLC trial also investigates a triple combination of olaparib, radiotherapy and concurrent low dose cisplatin. The primary objective is to identify the maximum tolerated dose of olaparib in these combination treatments, defined as the dose closest to but not exceeding a 15% probability of dose limiting toxicity. Each trial has a separate dose limiting toxicity definition, taking into account incidence, duration and severity of expected toxicities without olaparib. Dose escalation is performed using a time-to-event continual reassessment method (TITE-CRM). TITE-CRM enables the incorporation of late onset toxicity until one year after treatment in the dose limiting toxicity definition while maintaining an acceptable trial duration. Olaparib treatment starts two days before radiotherapy and continues during weekends until two days after radiotherapy. Olaparib will also be given two weeks and one week before radiotherapy in the breast cancer trial and HNSCC trial respectively to allow for translational research. Toxicity is scored using common terminology criteria for adverse events (CTCAE) version 4.03. Blood samples, and tumour biopsies in the breast cancer trial, are collected for pharmacokinetic and pharmacodynamic analyses.DiscussionWe designed three parallel phase 1 trials to assess the safety and tolerability of the PARP inhibitor olaparib in combination with radical (chemo-)radiotherapy treatment regimens. PARP inhibitors have the potential to improve outcomes in patients treated with radical (chemo-)radiotherapy, by achieving higher locoregional control rates and/or less treatment associated toxicity.Trial registrationClinicalTrials.govIdentifiers: NCT01562210 (registered March 23, 2012), NCT02227082 (retrospectively registered August 27, 2014), NCT02229656 (registered September 1, 2014).
- Published
- 2019
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