Ovarian Cancer

The main purposes of this study are: •To see how your cancer responds to the study treatment of rucaparib and/or nivolumab; •To look at the good and/or bad effects that the study treatment of rucaparib and/or nivolumab has on you and on your disease; •To look for biomarkers in your tumor tissue and blood samples to find out why patients with your type of cancer respond or do not respond to a combination of rucaparib and nivolumab; •To learn about how you feel while you are taking the study drug

Rucaparib ; Nivolumab

Nivolumab
Rucaparib

vial
Tablet

10
300;250;200

Primary Objective:
• To evaluate PFS by Response Evaluation Criteria in Solid Tumors (RECIST), as assessed by the investigator, in molecularly-defined HRD subgroups, using the following parallel comparisons:
- Arm A (oral rucaparib+ intravenous [IV] nivolumab) versus Arm B (oral rucaparib+IV placebo)
- Arm A (oral rucaparib+IV nivolumab) versus Arm D (placebo [oral and IV])
- Arm B (oral rucaparib+IV placebo) versus Arm D (placebo [oral and IV])
Secondary Objectives:
• To evaluate PFS by RECIST, as assessed by the blinded independent central review (BICR), in molecularly-defined HRD subgroups
• To evaluate survival benefit
• To evaluate the objective response rate (ORR) and duration of response (DOR), as assessed by the investigator, in patients with measurable disease at baseline
• To evaluate safety

Inclusion Criteria
Eligible patients must meet the following inclusion criteria:
1. Have signed an Institutional Review Board (IRB)/ Independent Ethics Committee (IEC)-approved informed consent form prior to any study-specific evaluation.
2. Be ≥ 20years of age at the time the informed consent form is signed
3. Have newly diagnosed, histologically confirmed, advanced (International Federation of Gynecology and Obstetrics [FIGO] stage III-IV), high grade epithelial ovarian, fallopian tube, or primary peritoneal cancer.
4. Completed cytoreductive surgery, including at least a bilateral salpingo-oophorectomy and partial omentectomy, either prior to chemotherapy (primary surgery) or following neoadjuvant chemotherapy (interval debulking).
5. Have received 4 to 8 cycles of first line platinum-doublet treatment per standard clinical practice, including a minimum of 4 cycles of a platinum/ taxane combination.
a. A patient with best response of partial response (PR) must have received at least 6 cycles.
b. Bevacizumab is allowed during the chemotherapy phase, but not during maintenance ie, during therapy directed by this protocol.
6. Have completed first-line platinum-based chemotherapy and surgery with a response, in the opinion of the investigator, defined as no evidence of disease progression or rising CA-125 at any time during front-line treatment; and:
a. No evidence of measurable disease by RECIST 1.1 (if complete resection/R0 at primary or interval cytoreductive surgery); or
b. A partial or complete response per RECIST 1.1 (if measurable disease was present after surgery and prior to chemotherapy); or
c. A GCIG CA-125 response (if only non-measurable disease was present after surgery and prior to chemotherapy).
7. Pre-treatment CA-125 measurements must meet criterion specified below:
a. If the first value is within upper limit of normal (ULN), the patient is eligible to be randomized and a second sample is not required;
b. If the first value is greater than ULN, a second assessment must be performed at least 7 days after the first. If the second assessment is ≥ 15% than the first value, the patient is not eligible.
8. Patient must be randomized within 8 weeks of the first day of the last cycle of chemotherapy.
9. Have sufficient formalin-fixed paraffin-embedded (FFPE) tumor tissue (1 × 4 µm section for hematoxylin and eosin [H&E] stain and approximately 8 to 12 × 10 µm sections, or equivalent) available for planned analyses.
a. Submission of a tumor block is preferred; if sections are provided, these must all be from the same tumor sample.
b. Tumor tissue from the cytoreductive surgery is required.
c. Sample must be received at the central laboratory at least 3 weeks prior to planned start of treatment to enable stratification for randomization.
10. Have adequate organ function confirmed by the following laboratory values obtained within 14 days prior to the first dose of study drug:
a. Bone Marrow Function
i. Absolute neutrophil count (ANC) ≥ 1.5 × 109/L
ii. Platelets ≥ 100 × 109/L
iii. Hemoglobin ≥ 9 g/dL
b. Hepatic Function
i. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 1.5 × ULN
ii. Bilirubin ≤ 1.5 × ULN; < 2 × ULN if hyperbilirubinemia is due to Gilbert′s syndrome
iii. Serum albumin ≥ 30 g/L (3.0 g/dL)
c. Renal Function
i. Serum creatinine ≤ 1.5 × ULN unless estimated glomerular filtration rate (GFR) ≥ 30 mL/min using the Cockcroft Gault formula
11. Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
Exclusion Criteria
Patients will be excluded from participation if any of the following criteria apply:
1. Non epithelial tumors (pure sarcomas) or ovarian tumors with low malignant potential (ie, borderline tumors) or mucinous tumors. Mixed mullerian tumors/carcinosarcomas are allowed.
2. Active second malignancy, ie, patient known to have potentially fatal cancer present for which she may be (but not necessarily) currently receiving treatment.
a. Patients with a history of malignancy that has been completely treated, with no evidence of active cancer for 3 years prior to enrollment, or patients with surgically-cured low-risk tumors, such as early-stage cervical or endometrial cancer are allowed to enroll.
3. Known central nervous system brain metastases.
4. Any prior treatment for ovarian cancer, other than the first-line platinum regimen, including any maintenance treatment between completion of the platinum regimen and initiation of study drug in this study.
a. Ongoing hormonal treatment for previously treated breast cancer is permitted. Hormonal maintenance treatment for ovarian cancer is not allowed.
5. Has evidence of interstitial lung disease, active pneumonitis, myocarditis or a history of myocarditis.
6. Patients with an active, known or suspected autoimmune disease (eg, autoimmune hepatitis). Patients with type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.
7. Patients with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of randomization. Inhaled or topical steroids, and adrenal replacement steroid doses > 10 mg daily prednisone equivalent, are permitted in the absence of active autoimmune disease.
8. Drainage of ascites during the final 2 cycles of treatment with the platinum regimen.
9. Pre-existing duodenal stent and/or any gastrointestinal disorder or defect that would, in the opinion of the investigator, interfere with absorption of study treatment.
10. Known history of positive test for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS). NOTE: Testing for HIV must be performed at all sites where mandated locally.
11. Any positive test result for hepatitis B virus or hepatitis C virus indicating presence of virus, eg, hepatitis B surface antigen (HBsAg, Australia antigen) positive, or hepatitis C antibody (anti-HCV) positive (except if HCV-RNA negative).
12. Pregnant, or breast feeding. All study participants must agree to avoid pregnancy achieved through assisted reproductive technology for the duration of study treatment and for a minimum of 6 months following the last dose of study drug (oral or IV, whichever is later).
13. Received chemotherapy within 14 days prior to first dose of study drug and/or ongoing adverse effects from such treatment > National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03 Grade 1, with the exception of Grade 2 non-hematologic toxicity such as alopecia, peripheral neuropathy, Grade 2 anemia with hemoglobin ≥ 9 g/dL, and related effects of prior chemotherapy that are unlikely to be exacerbated by treatment with study drug.
14. Non-study related minor surgical procedure (eg, placement of a central venous access port) ≤ 5 days, or major surgical procedure ≤ 21 days, prior to first dose of study drug; in all cases, the patient must be sufficiently recovered and stable before treatment administration.
15. Presence of any other condition that may increase the risk associated with study participation or may interfere with the interpretation of study results, and, in the opinion of the investigator, would make the patient inappropriate for entry into the study.
16. Hospitalization for bowel obstruction within 12 weeks prior to enrollment.