Recurrent Ovarian CarcinomaPhase 3ANITANCT03598270
Platinum-based Chemotherapy With Atezolizumab and Niraparib in Patients With Recurrent Ovarian Cancer
A Phase 3 study testing Carboplatin, Paclitaxel and Niraparib in people with Recurrent Ovarian Carcinoma, run by Grupo Español de Investigación en Cáncer de Ovario at 71 sites in 5 countries.
Trial summary
Atezolizumab in this study is expected to have a positive benefit-risk profile for the treatment of patients with platinum-sensitive relapse of ovarian cancer. Of interest, atezolizumab is being investigated also in combination with platinum-based doublet chemotherapy in second line (2L)/ third line (3L)… Read more about this study
- Who is it for?
- Ages 18 years and older, women only
- Conditions the study is for
- Recurrent Ovarian Carcinoma
- What is being tested?
- Carboplatin, Paclitaxel and Niraparib
- Type of treatment
- Pill or oral medicine, Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 417 participants
- Where
- 71 sitesin 5 countries
- Study dates
- 21 Nov 2018to 5 Aug 2024
- Phase
- Phase 3
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Women only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients ≥ 18 years old
- Life expectancy ≥3 months
- Signed informed consent and ability to comply with treatment and follow-up
- Histologically confirmed diagnosis (cytology alone excluded) of high- grade serous or endometrioid ovarian, primary peritoneal or tubal carcinoma.
- Breast Cancer (BRCA) mutational status is known (germline or somatic)
- Relapsed disease more than 6 months after the last platinum dose
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- No more than 2 prior lines of chemotherapy are allowed, and the last one must contain a platinum-based regimen
- At least one measurable lesion to assess response by RECIST v1.1 criteria.
- Mandatory de novo tumor biopsy (collected within 3 months prior to randomization) sent to HistoGene X as a formalin-fixed, paraffin-embedded (FFPE) sample for PD-L1 status determination for randomization. The inclusion of patients with non informative tissue PD-L1 status will be capped to 10% of the whole study population:
- If the mandatory de novo biopsy is technically not possible or failed to produce enough representative tumor tissue, an FFPE sample from archival tissue may be acceptable after approval of the sponsor.
- Bone metastases, fine needle aspiration, brushing, cCell pellet from pleural effusion, or ascites or lavage are not acceptable.
- Two additional tumour samples are needed: Archival tumor sample must be available for exploratory PD-L1 testing in archival tissue and archival or "de novo" tissue sample for biomarkers must also be available.
- Performance status determined by Eastern Cooperative Oncology Group (ECOG) score of 0-1
- Normal organ and bone marrow function:
- Haemoglobin ≥10.0 g/dL
- Absolute neutrophil count (ANC) ≥1.5 x 109/L
- Lymphocyte count ≥0.5 × 109/L
- Platelet count ≥100 x 109/L
- Total bilirubin ≤1.5 x institutional upper limit of normal (ULN)
- Serum albumin ≥2.5 g/dL
- Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) ≤2.5 x ULN, unless liver metastases are present in which case they must be ≤5 x ULN
- Serum creatinine ≤1.5 x institutional ULN or calculated creatinine clearance ≥ 30 mL/min using the Cockcroft-Gault equation
- Patients not receiving anticoagulant medication must have an International Normalized Ratio (INR) ≤1.5 and an Activated ProThrombin Time (aPTT) ≤1.5 x ULN.
- Negative Test Results for Hepatitis.
- Toxicities related to previous treatments must be recovered to < grade 2
- Female participants must be postmenopausal or surgically sterile or otherwise have a negative serum pregnancy test within 7 days of the first study treatment and agree to abstain from heterosexual intercourse or use single or combined contraceptive methods.
- Participant must agree to not donate blood during the study or for 90 days after the last dose of study treatment.
- Participant must agree to not breastfeed during the study or for 180 days after the last dose of study treatment.
Who cannot join
- Non-epithelial tumor of the ovary, the fallopian tube or the peritoneum.
- Ovarian tumors of low malignant potential or low grade
- Other malignancy within the last 5 years except curatively treated non-melanoma skin cancer, in situ cancer of the cervix and ductal carcinoma in situ (DCIS)
- Major surgery within 4 weeks of starting study treatment or patients who have not completely recovered (Grade ≥ 2) from the effects of any major surgery at randomization
- Core biopsy or other minor surgical procedure, excluding placement of a vascular access device, within 7 days prior to Day 1, Cycle 1
- Administration of other chemotherapy drugs, anticancer therapy or anti-neoplastic hormonal therapy, or treatment with other investigational agents or devices within 28 days prior to randomization, or within a time interval less than at least 5 half-lives of the investigational agent, whichever is shorter, or anticipation to do it during the trial treatment period (non-investigational hormonal replacement therapy is permitted)
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- Palliative radiotherapy (e.g., for pain or bleeding) within 6 weeks prior to randomization or patients who have not completely recovered (Grade ≥ 2) from the effects of previous radiotherapy
- Current or recent (within 10 days prior to randomization) chronic use of aspirin (>325 mg/day) or clopidogrel (>75 mg/day)
- Clinically significant (e.g. active) cardiovascular disease
- Resting ECG with corrected QT interval (QTc) >470 msec on 2 or more time points within a 24 hour period or family history of long QT syndrome
- Left ventricular ejection fraction defined by multigated acquisition/echocardiogram (MUGA/ECHO) below the institutional lower limit of normal
- History or clinical suspicion of brain metastases or spinal cord compression. CT/MRI of the brain is mandatory (within 4 weeks prior to randomization) in case of suspected brain metastases. Spinal MRI is mandatory (within 4 weeks prior to randomization) in case of suspected spinal cord compression
- History or evidence upon neurological examination of central nervous system (CNS) disorders (e.g. uncontrolled epileptic seizures) unless adequately treated with standard medical therapy
- Current, clinically relevant bowel obstruction, including sub-occlusive disease, related to underlying disease
- Uncontrolled tumor-related pain
- Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently). Patients with indwelling catheters (e.g., PleurX) are allowed
- Uncontrolled hypercalcemia (>1.5 mmol/L ionized calcium or calcium >12 mg/dL or corrected serum calcium > ULN) or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy or denosumab
- Evidence of any other disease, metabolic dysfunction, physical examination finding or laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or puts the patient at high risk for treatment related complications
- Pregnant or lactating women
- Simultaneously receiving therapy in any interventional clinical trial
- Prior treatment with CD137 agonists or immune checkpoint stimulating or blockade therapies, such as anti-PD1, anti-PDL1 or anti-CTLA4 therapeutic antibodies
- Treatment with systemic immunostimulatory agents (including but not limited to interferon-alpha (IFN-α) and interleukin-2 (IL-2) within 4 weeks or five half-lives of the drug (whichever is shorter) prior to Cycle 1, Day 1
- Treatment with systemic corticosteroids or other systemic immunosuppressive medications (including but not limited to prednisone, dexamethasone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor (TNF) agents) within 2 weeks prior to Cycle 1, Day 1, or anticipated requirement for systemic immunosuppressive medications during the trial
- History of autoimmune disease, including but not limited to myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with anti-phospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis
- History of idiopathic pulmonary fibrosis (including pneumonitis), drug-induced pneumonitis, organizing pneumonia (i.e., bronchiolitis obliterans, cryptogenic organizing pneumonia), or evidence of active pneumonitis
- Immunocompromised patients, e.g., patients who are known to be serologically positive for human immunodeficiency virus (HIV)
- Signs or symptoms of infection within 2 weeks prior to Cycle 1, Day 1
- Active tuberculosis
- Administration of a live, attenuated vaccine (including against influenza) within 4 weeks prior to Cycle 1, Day 1 or anticipation that it will be administered at any time during the treatment period of the study or within 5 months after the final dose of atezolizumab.
- History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
- Known hypersensitivity or allergy to biopharmaceuticals produced in Chinese hamster ovary cells or to any component of the atezolizumab formulation or allergy to any of the other drugs included in the protocol or their solvents (including to Cremophor®)
- Patient has received prior treatment with a poly (adenosine diphosphate (ADP)-ribose) polymerase (PARP) inhibitor in the recurrent setting or has participated in a study where any treatment arm included administration of a PARP inhibitor in the recurrent setting, unless the patient is unblinded and there is evidence of not having received a PARP inhibitor. Patients that received PARP inhibitor as front line are eligible for the study. The duration of exposure to PARPi following front line therapy needs to be ≥18 months for BRCA mutated patients and ≥ 12 months for BRCA wild type patients.
- Patient has had any known ≥Grade 3 hematological toxicity anemia, neutropenia or thrombocytopenia due to prior cancer chemotherapy that persisted >4 weeks and was related to the most recent treatment
- Patient has any known history or current diagnosis of Myelodysplasic syndrome (MDS) or Anaplastic Myeloid Leukemia (AML)
- Previous allogeneic bone marrow transplant or previous solid organ transplantation
- Patient has a condition (such as transfusion dependent anemia or thrombocytopenia), therapy, or laboratory abnormality that might confound the study results or interfere with the patient's participation for the full duration of the study treatment
- Participant has any known hypersensitivity to niraparib components or excipients
Trial locations and contacts
71 sites in 5 countries.
71 sites in 5 countries
Spain25 sites
Complejo Hospitalario Universitario de A Coruña
A Coruña
ICO Badalona
Badalona
H. Clínic Barcelona
Barcelona
Hospital de la Santa Creu i Sant Pau
Barcelona
Hospital de la Vall d'Hebron
Barcelona
H Reina Sofía Cordoba
Córdoba
ICO Girona
Girona
ICO Hospitalet
Hospitalet Del Llobregat
Hospital de León
León
Clinica Universitaria de Navarra
Madrid
Hospital Clínico San Carlos
Madrid
Hospital Gregorio Marañon
Madrid
Hospital Universitario 12 de Octubre
Madrid
Hospital Universitario Fundación Jiménez Díaz
Madrid
Hospital Universitario La Paz
Madrid
Hospital Universitario Ramon y Cajal
Madrid
Complejo Hospitalario Regional de Málaga
Málaga
H Morales Meseguer
Murcia
Hospital Son Llatzer
Palma de Mallorca
Clinica Universidad de Navarra
Pamplona, Navarre, 31008
Hospital de Sabadell
Sabadell, Barcelona
Hospital Virgen del Rocio
Seville
H La Fe de Valencia
Valencia
Hospital Clínico Universitario de Valencia
Valencia
Hospital Universitario Miguel Servet
Zaragoza
France20 sites
ICO - Paul Paupin - ANGERS
Angers, 49055
CHU Besançon
Besançon, 25000
Institut Bergonié
Bordeaux, 33000
Centre François Baclesse
Caen, 14000
Centre Jean Perrin
Clermont-Ferrand, 63011
Centre Léon Bérard
Lyon, 69008
Institut Paoli Calmettes
Marseille, 13009
ICM Val d'Aurelle
Montpellier, 34298
Centre Antoine Lacassagne
Nice, 06100
ONCOGARD - Institut de Cancérologie du Gard
Nîmes, 30900
Hôpital Cochin
Paris, 75014
Hôpital Européen Georges Pompidou
Paris, 75015
Groupe Hospitalier Diaconesses-Croix Saint Simon
Paris, 75020
Hôpital Tenon
Paris, 75020
HPCA Cario
Plérin, 22198
Institut Curie - Hopital Claudius Régaud
Saint-Cloud, 92210
Institut Curie - Hôpital René Huguenin- SAINT CLOUD
Saint-Cloud, 92210
ICO Centre René Gauducheau
Saint-Herblain, 44800
Institut de Cancérologie de Lorraine
Vandœuvre-lès-Nancy, 54519
Gustave Roussy
Villejuif, 94800
Germany14 sites
Hochtaunus-Kliniken
Bad Homburg
Universitätsklinikum Carl Gustav Carus Dresden
Dresden
Kliniken Essen-Mitte
Essen
Mammazentrum Hamburg am Krankenhaus Jerusalem
Hamburg
Diakovere Krankenhaus
Hanover
Klinikum Kulmbach
Kulmbach
Universitätsklinikum Mannheim
Mannheim, 68167
Universitätsklinikum Münster
Münster
MVZ Nordhausen
Nordhausen
Klinikum Oldenburg AöR
Oldenburg
ROMed Klinikum Rosenheim
Rosenheim
Universitätsklinikum Tübingen
Tübingen
Universitätsfrauenklinik Ulm
Ulm
HELIOS Dr. Horst Schmidt Kliniken Wiesbaden
Wiesbaden
Italy7 sites
Spedali Civili
Brescia
Asst Lecco
Lecco
Istituto Europeo di Oncologia
Milan
I.R.C.C.S. Istituto Oncologico Veneto
Padova
Arcispedale Santa Maria Nuova
Reggio Emilia
AO Città della Salute e della Scienza- Ospedale Sant'Anna
Torino
Ospedale Mauriziano Umberto I
Torino
Belgium5 sites
Grand Hôpital de Charleroi
Charleroi
UZ Leuven
Leuven
CHU de Liège, site Sart Tilman
Liège
CHU Ambroise Paré
Mons
CHU UCL Namur site St. Elisabeth
Namur
About this study
Official title: A Phase III Randomized, Double-blinded Trial of Platinum-based Chemotherapy With or Without Atezolizumab Followed by Niraparib Maintenance With or Without Atezolizumab in Patients With Recurrent Ovarian, Tubal or Peritoneal Cancer and Platinum Treatment-free Interval (TFIp) >6 Months
Atezolizumab in this study is expected to have a positive benefit-risk profile for the treatment of patients with platinum-sensitive relapse of ovarian cancer. Of interest, atezolizumab is being investigated also in combination with platinum-based doublet chemotherapy in second line (2L)/ third line (3L) platinum-sensitive recurrent ovarian cancer patients in ATALANTE (NCT02891824), which also includes bevacizumab in the combination. The study is proceeding as expected after >100 patients enrolled and under independent Data Monitoring Committee (IDMC) supervision.
Platinum-containing therapy is considered the treatment of choice for patients with platinum-sensitive relapse. However the duration of response and the prolongation of the progression free interval with chemotherapy are usually brief, among other because these chemotherapy regimens cannot be continued until progression as they are associated with neurological, renal and hematological toxicity and cannot generally be tolerated for more than about 6 to 9 cycles.
Read more
Niraparib received FDA approval in March 2017 as maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer who are in complete or partial response to platinum-based chemotherapy. Recently, the European Medicines Agency (EMA) has also approved niraparib as maintenance monotherapy. Despite the progress brought about by niraparib, there is a need for a more effective treatment to extend the progression free interval in this patient population. The combination with immune checkpoint inhibitors such as anti-death protein 1 (anti-PD1) or anti-death protein ligand 1 (anti-PD-L1) has a compelling rationale to this aim, especially under the light of the emerging clinical data of this combination.
The use of atezolizumab concurrent to platinum-containing chemotherapy followed by niraparib as maintenance therapy after completion of chemotherapy, as per normal clinical practice, may provide further benefit to patients in terms of prolonging the progression free interval and increasing the interval between lines of chemotherapy, hence delaying further hospitalization and the cumulative toxicities associated with chemotherapy. Additionally, preliminary studies with atezolizumab suggest an acceptable tolerability profile for long term clinical use in recurrent ovarian cancer patients and other indications.
- Conditions
- Recurrent Ovarian Carcinoma
- Being tested
- Placebo, Carboplatin, Paclitaxel, Niraparib, Gemcitabine
- Keywords
- Ovarian, Atezolizumab, Niraparib
- Medical subject headings
- Ovarian Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
PlaceboDrug
Also called Placebo of Atezolizumab
Volume equivalent to 1200 mg of atezolizumab drug product. Intravenous Day 1
CarboplatinDrug
Intravenous. Day 1
PaclitaxelDrug
175 mg/m². Intravenous. Day 1
NiraparibDrug
200 mg or 300 mg. Oral. From day 1 to 21
GemcitabineDrug
1000 mg/m². Intravenous. Day 1 and day 8.
Pegylated liposomal doxorubicin (PLD)Drug
30 mg/m². Intravenous. Day 1
AtezolizumabDrug
Also called Tecentriq
1200 mg. Intravenous. Day 1
| Study group | Role | What they receive |
|---|---|---|
| Arm A (Control Arm) | Placebo comparator | Placebo of atezolizumab in combination with one of the platinum based regimens below (investigator's choice) followed by maintenance niraparib with placebo:
* Carboplatin (AUC = 5, d1) plus paclitaxel and placebo every 3 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with placebo every 3 weeks
* Carboplatin (AUC = 4, d1) plus gemcitabine and placebo every 3 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with placebo every 3 weeks.
* Carboplatin (AUC = 5, d1) plus pegylated liposomal doxorubicin (PLD) and placebo every 4 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with placebo every 3 weeks. Receives: Drug: Placebo; Drug: Carboplatin; Drug: Paclitaxel; Drug: Niraparib; Drug: Gemcitabine; Drug: Pegylated liposomal doxorubicin (PLD) |
| Arm B (experimental arm) | Experimental | Atezolizumab in combination with one of the platinum based regimens below (investigator's choice) followed by maintenance niraparib with atezolizumab:
* Carboplatin (AUC = 5, d1) plus paclitaxel and atezolizumab every 3 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with atezolizumab every 3 weeks.
* Carboplatin (AUC = 4, d1) plus gemcitabine and atezolizumab every 3 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with atezolizumab every 3 weeks.
* Carboplatin (AUC = 5, d1) plus pegylated liposomal doxorubicin (PLD) and atezolizumab every 4 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with atezolizumab every 3 weeks. Receives: Drug: Carboplatin; Drug: Paclitaxel; Drug: Niraparib; Drug: Gemcitabine; Drug: Pegylated liposomal doxorubicin (PLD); Drug: Atezolizumab |
What is being measured
The primary outcome is the main question the study is designed to answer.
Progression-free survival (PFS)
Period from study entry (day of randomization) until disease progression, death or date of last contact. Progression will be based on tumor assessment made by the investigators according to the RECIST v1.1 criteria.
Measured: 30 months
Secondary outcomes (21)
Overall survival (OS)
The observed length of life from entry into the study (day of randomization) to death due to any cause, or the date of last contact if patient alive.
Measured: 60 months
Time to first subsequent therapy or death (TFST)
Time from the date of randomization in the current study to the start date of the first subsequent anticancer therapy.
Measured: 60 months
Time to second subsequent therapy or death (TSST)
Time from the date of randomization in the current study to the start date of the second subsequent anticancer therapy
Measured: 60 months
Time to second progression or death (PFS2)
Time from treatment randomization to the earliest date of assessment of progression on the next anticancer therapy following study treatment or death by any cause.
Measured: 60 months
Incidence of Treatment Adverse Events
Frequency and severity of adverse events as assessed by CTCAE version 5.0 for the regimens administered on this study
Measured: 60 months
Patient-reported abdominal symptoms
Clinically-meaningful improvement in patient-reported abdominal pain or bloating, defined as a 10-point decrease from the baseline score on either of the two items of the EORTC quality of life questionnaire-ovarian cancer module (QLQ-OV28) abdominal/GI symptom scale (items 31 and 32)
Measured: 60 months
Patient-reported outcomes (PROs) of function and health related quality of life (HRQoL)
Clinical improvement, remaining stable, or deterioration in patient-reported function and HRQoL, defined as a 10-point increase, changes within 10 points, and a 10-point decrease, respectively, from the baseline score on each of the functional (physical, role, emotional, and social) and global health status/HRQoL scales of EORTC QLQ-C30
Measured: 60 months
Objective Response Rate (ORR)
Based on investigator assessment by RECIST v1.1 during the chemotherapy phase and during the maintenance phase
Measured: 60 months
Duration of response (DOR)
Based on investigator assessment by RECIST v1.1 during the chemotherapy phase and during the maintenance phase
Measured: 60 months
Progression-free survival (PFS) from the beginning of the maintenance phase in all patients, in patients in complete or partial response after completing chemotherapy and in patients with stable disease after completing chemotherapy
Period from start of maintenance treatment until disease progression, death or date of last contact assessed by the investigator according to RECIST v1.1 criteria, in all patients receiving maintenance treatment as well as in the subgroup of patients with complete response/partial response (CR/PR) of stable disease (SD) after completing chemotherapy
Measured: 60 months
Progression Free Survival (PFS) and BRCA status.
Relationship of PFS with BRCA mutational status
Measured: 60 months
Overall Survival (OS) and BRCA status.
Relationship of OS with BRCA mutational status
Measured: 60 months
Time to first subsequent therapy or death (TFST) and BRCA status.
Relationship of TFST with BRCA mutational status
Measured: 60 months
Objective Response Rate (ORR) and BRCA status.
Relationship of ORR with BRCA mutational status
Measured: 60 months
Duration of Response (DOR) and BRCA status.
Relationship of DOR with BRCA mutational status
Measured: 60 months
Progression Free Survival (PFS) and PD-L1 status
Relationship of PFS with PD-L1 expression status
Measured: 60 months
Overall Survival (OS) and PD-L1 status
Relationship of OS with PD-L1 expression status
Measured: 60 months
Time to first subsequent therapy or death (TFST) and PD-L1 status
Relationship of TFST with PD-L1 expression status
Measured: 60 months
Objective Response Rate (ORR) and PD-L1 status
Relationship of ORR with PD-L1 expression status
Measured: 60 months
Duration of Response (DOR) and PD-L1 status
Relationship of DOR with PD-L1 expression status
Measured: 60 months
Efficacy of atezolizumab compared to placebo in the PD-L1 negative and PD-L1 positive subgroups
To evaluate the immune response to atezolizumab
Measured: 60 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted26 Jul 2018
- Study start21 Nov 2018
- Primary completion5 Aug 2024
- Study completion5 Aug 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Recurrent Ovarian CarcinomaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Randomized, double-blinded, multi-center study
- Masking
- Triple blind
- Who is masked
- Participant, Care provider, Investigator
- Enrolment
- 417 participants (actual)
Sponsor and investigators
- Lead sponsor
- Grupo Español de Investigación en Cáncer de Ovario
- Sponsor type
- University, hospital or other
- Collaborators
- Hoffmann-La Roche, GlaxoSmithKline, AGO Study Group, Belgian Gynaecological Oncology Group, ARCAGY/ GINECO GROUP, Israeli Society of Gynecologic Oncology, MaNGO, Apices Soluciones S.L.
- Responsible party
- Sponsor
- Investigators
- Antonio González Martín, MD PhD, Principal investigator, Clinica Universitaria de Navarra
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03598270
- Sponsor's protocol ID
- ENGOT-Ov41/GEICO 69-O/ANITA
- Other IDs
- 2018-000366-11, ENGOT-Ov41, GEICO 69-O, 2018
- Acronym
- ANITA
- Status last verified
- Aug 2024
- First submitted
- 2 Jun 2018
- Last updated
- 30 Aug 2024
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Gonzalez-Martin A, Rubio MJ, Heitz F, Depont Christensen R, Colombo N, Van Gorp T, Romeo M, Ray-Coquard I, Gaba L, Leary A, De Sande LM, Lebreton C, Redondo A, Fabbro M, Barretina Ginesta MP, Follana P, Perez-Fidalgo JA, Rodrigues M, Santaballa A, Sabatier R, Bermejo-Perez MJ, Lotz JP, Pardo B, Marquina G, Sanchez-Lorenzo L, Quindos M, Estevez-Garcia P, Guerra Alia E, Manso L, Casado V, Kommoss S, Tognon G, Henry S, Bruchim I, Oaknin A, Selle F. Atezolizumab Combined With Platinum and Maintenance Niraparib for Recurrent Ovarian Cancer With a Platinum-Free Interval >6 Months: ENGOT-OV41/GEICO 69-O/ANITA Phase III Trial. J Clin Oncol. 2024 Dec 20;42(36):4294-4304. doi: 10.1200/JCO.24.00668. Epub 2024 Sep 18.
PubMed 39292975Gonzalez Martin A, Sanchez Lorenzo L, Colombo N, dePont Christensen R, Heitz F, Meirovitz M, Selle F, van Gorp T, Alvarez N, Sanchez J, Marques C. A phase III, randomized, double blinded trial of platinum based chemotherapy with or without atezolizumab followed by niraparib maintenance with or without atezolizumab in patients with recurrent ovarian, tubal, or peritoneal cancer and platinum treatment free interval of more than 6 months: ENGOT-Ov41/GEICO 69-O/ANITA Trial. Int J Gynecol Cancer. 2021 Apr;31(4):617-622. doi: 10.1136/ijgc-2020-001633. Epub 2020 Dec 14.
PubMed 33318079
Study at a glance
From the registry record, last updated by the sponsor on 30 Aug 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Phase III Randomized, Double-blinded Trial of Platinum-based Chemotherapy With or Without Atezolizumab Followed by Niraparib Maintenance With or Without Atezolizumab in Patients With Recurrent Ovarian, Tubal or Peritoneal Cancer and Platinum Treatment-free Interval (TFIp) >6 Months
- ClinicalTrials.gov ID
- NCT03598270
- Acronym / sponsor ID
- ANITA / ENGOT-Ov41/GEICO 69-O/ANITA
- Conditions
- Recurrent Ovarian Carcinoma
- Keywords
- Ovarian, Atezolizumab, Niraparib
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 417 participants (actual)
- Lead sponsor
- Grupo Español de Investigación en Cáncer de OvarioUniversity, hospital or other
- Collaborators
- Hoffmann-La Roche, GlaxoSmithKline, AGO Study Group, Belgian Gynaecological Oncology Group, ARCAGY/ GINECO GROUP, Israeli Society of Gynecologic Oncology, MaNGO, Apices Soluciones S.L.
- Study start
- 21 Nov 2018 (actual)
- Primary completion
- 5 Aug 2024 (actual)
- Study completion
- 5 Aug 2024 (actual)
- First posted
- 26 Jul 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Atezolizumab in this study is expected to have a positive benefit-risk profile for the treatment of patients with platinum-sensitive relapse of ovarian cancer. Of interest, atezolizumab is being investigated also in combination with platinum-based doublet chemotherapy in second line (2L)/ third line (3L) platinum-sensitive recurrent ovarian cancer patients in ATALANTE (NCT02891824), which also includes bevacizumab in the combination. The study is proceeding as expected after >100 patients enrolled and under independent Data Monitoring Committee (IDMC) supervision.
Platinum-containing therapy is considered the treatment of choice for patients with platinum-sensitive relapse. However the duration of response and the prolongation of the progression free interval with chemotherapy are usually brief, among other because these chemotherapy regimens cannot be continued until progression as they are associated with neurological, renal and hematological toxicity and cannot generally be tolerated for more than about 6 to 9 cycles.
Niraparib received FDA approval in March 2017 as maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer who are in complete or partial response to platinum-based chemotherapy. Recently, the European Medicines Agency (EMA) has also approved niraparib as maintenance monotherapy. Despite the progress brought about by niraparib, there is a need for a more effective treatment to extend the progression free interval in this patient population. The combination with immune checkpoint inhibitors such as anti-death protein 1 (anti-PD1) or anti-death protein ligand 1 (anti-PD-L1) has a compelling rationale to this aim, especially under the light of the emerging clinical data of this combination.
The use of atezolizumab concurrent to platinum-containing chemotherapy followed by niraparib as maintenance therapy after completion of chemotherapy, as per normal clinical practice, may provide further benefit to patients in terms of prolonging the progression free interval and increasing the interval between lines of chemotherapy, hence delaying further hospitalization and the cumulative toxicities associated with chemotherapy. Additionally, preliminary studies with atezolizumab suggest an acceptable tolerability profile for long term clinical use in recurrent ovarian cancer patients and other indications.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, care provider, investigator)
- Number of arms
- 2
- Model description
- Randomized, double-blinded, multi-center study
| Arm | Type | Receives |
|---|---|---|
| Arm A (Control Arm) | Placebo comparator | Drug: Placebo, Drug: Carboplatin, Drug: Paclitaxel, Drug: Niraparib, Drug: Gemcitabine, Drug: Pegylated liposomal doxorubicin (PLD)Placebo of atezolizumab in combination with one of the platinum based regimens below (investigator's choice) followed by maintenance niraparib with placebo: * Carboplatin (AUC = 5, d1) plus paclitaxel and placebo every 3 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with placebo every 3 weeks * Carboplatin (AUC = 4, d1) plus gemcitabine and placebo every 3 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with placebo every 3 weeks. * Carboplatin (AUC = 5, d1) plus pegylated liposomal doxorubicin (PLD) and placebo every 4 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with placebo every 3 weeks. |
| Arm B (experimental arm) | Experimental | Drug: Carboplatin, Drug: Paclitaxel, Drug: Niraparib, Drug: Gemcitabine, Drug: Pegylated liposomal doxorubicin (PLD), Drug: AtezolizumabAtezolizumab in combination with one of the platinum based regimens below (investigator's choice) followed by maintenance niraparib with atezolizumab: * Carboplatin (AUC = 5, d1) plus paclitaxel and atezolizumab every 3 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with atezolizumab every 3 weeks. * Carboplatin (AUC = 4, d1) plus gemcitabine and atezolizumab every 3 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with atezolizumab every 3 weeks. * Carboplatin (AUC = 5, d1) plus pegylated liposomal doxorubicin (PLD) and atezolizumab every 4 weeks. Non-progressing patients will be switched to maintenance niraparib in combination with atezolizumab every 3 weeks. |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (28 listed)
- Patients ≥ 18 years old
- Life expectancy ≥3 months
- Signed informed consent and ability to comply with treatment and follow-up
- Histologically confirmed diagnosis (cytology alone excluded) of high- grade serous or endometrioid ovarian, primary peritoneal or tubal carcinoma.
- Breast Cancer (BRCA) mutational status is known (germline or somatic)
Key exclusion criteria (37 listed)
- Non-epithelial tumor of the ovary, the fallopian tube or the peritoneum.
- Ovarian tumors of low malignant potential or low grade
- Other malignancy within the last 5 years except curatively treated non-melanoma skin cancer, in situ cancer of the cervix and ductal carcinoma in situ (DCIS)
- Major surgery within 4 weeks of starting study treatment or patients who have not completely recovered (Grade ≥ 2) from the effects of any major surgery at randomization
- Core biopsy or other minor surgical procedure, excluding placement of a vascular access device, within 7 days prior to Day 1, Cycle 1
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| PlaceboAlso: Placebo of AtezolizumabVolume equivalent to 1200 mg of atezolizumab drug product. Intravenous Day 1 | Drug | Arm A (Control Arm) |
| CarboplatinIntravenous. Day 1 | Drug | Arm A (Control Arm), Arm B (experimental arm) |
| Paclitaxel175 mg/m². Intravenous. Day 1 | Drug | Arm A (Control Arm), Arm B (experimental arm) |
| Niraparib200 mg or 300 mg. Oral. From day 1 to 21 | Drug | Arm A (Control Arm), Arm B (experimental arm) |
| Gemcitabine1000 mg/m². Intravenous. Day 1 and day 8. | Drug | Arm A (Control Arm), Arm B (experimental arm) |
| Pegylated liposomal doxorubicin (PLD)30 mg/m². Intravenous. Day 1 | Drug | Arm A (Control Arm), Arm B (experimental arm) |
| AtezolizumabAlso: Tecentriq1200 mg. Intravenous. Day 1 | Drug | Arm B (experimental arm) |
Primary outcome
Progression-free survival (PFS)
Time frame: 30 months
Period from study entry (day of randomization) until disease progression, death or date of last contact. Progression will be based on tumor assessment made by the investigators according to the RECIST v1.1 criteria.
21 secondary outcomes
Overall survival (OS)
Time frame: 60 months
Time to first subsequent therapy or death (TFST)
Time frame: 60 months
Time to second subsequent therapy or death (TSST)
Time frame: 60 months
Time to second progression or death (PFS2)
Time frame: 60 months
Incidence of Treatment Adverse Events
Time frame: 60 months
Patient-reported abdominal symptoms
Time frame: 60 months
Patient-reported outcomes (PROs) of function and health related quality of life (HRQoL)
Time frame: 60 months
Objective Response Rate (ORR)
Time frame: 60 months
Duration of response (DOR)
Time frame: 60 months
Progression-free survival (PFS) from the beginning of the maintenance phase in all patients, in patients in complete or partial response after completing chemotherapy and in patients with stable disease after completing chemotherapy
Time frame: 60 months
Progression Free Survival (PFS) and BRCA status.
Time frame: 60 months
Overall Survival (OS) and BRCA status.
Time frame: 60 months
Time to first subsequent therapy or death (TFST) and BRCA status.
Time frame: 60 months
Objective Response Rate (ORR) and BRCA status.
Time frame: 60 months
Duration of Response (DOR) and BRCA status.
Time frame: 60 months
Progression Free Survival (PFS) and PD-L1 status
Time frame: 60 months
Overall Survival (OS) and PD-L1 status
Time frame: 60 months
Time to first subsequent therapy or death (TFST) and PD-L1 status
Time frame: 60 months
Objective Response Rate (ORR) and PD-L1 status
Time frame: 60 months
Duration of Response (DOR) and PD-L1 status
Time frame: 60 months
Efficacy of atezolizumab compared to placebo in the PD-L1 negative and PD-L1 positive subgroups
Time frame: 60 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 30 Aug 2024.
- Derived from this study: PubMed 39292975Gonzalez-Martin A, Rubio MJ, Heitz F, Depont Christensen R, Colombo N, Van Gorp T, Romeo M, Ray-Coquard I, Gaba L, Leary A, De Sande LM, Lebreton C, Redondo A, Fabbro M, Barretina Ginesta MP, Follana P, Perez-Fidalgo JA, Rodrigues M, Santaballa A, Sabatier R, Bermejo-Perez MJ, Lotz JP, Pardo B, Marquina G, Sanchez-Lorenzo L, Quindos M, Estevez-Garcia P, Guerra Alia E, Manso L, Casado V, Kommoss S, Tognon G, Henry S, Bruchim I, Oaknin A, Selle F. Atezolizumab Combined With Platinum and Maintenance Niraparib for Recurrent Ovarian Cancer With a Platinum-Free Interval >6 Months: ENGOT-OV41/GEICO 69-O/ANITA Phase III Trial. J Clin Oncol. 2024 Dec 20;42(36):4294-4304. doi: 10.1200/JCO.24.00668. Epub 2024 Sep 18.
- Derived from this study: PubMed 33318079Gonzalez Martin A, Sanchez Lorenzo L, Colombo N, dePont Christensen R, Heitz F, Meirovitz M, Selle F, van Gorp T, Alvarez N, Sanchez J, Marques C. A phase III, randomized, double blinded trial of platinum based chemotherapy with or without atezolizumab followed by niraparib maintenance with or without atezolizumab in patients with recurrent ovarian, tubal, or peritoneal cancer and platinum treatment free interval of more than 6 months: ENGOT-Ov41/GEICO 69-O/ANITA Trial. Int J Gynecol Cancer. 2021 Apr;31(4):617-622. doi: 10.1136/ijgc-2020-001633. Epub 2020 Dec 14.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Antonio González Martín, MD PhD principal investigator
Clinica Universitaria de Navarra
71 sites in 5 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Carboplatin, Paclitaxel and Niraparib in people with Recurrent Ovarian Carcinoma, run by Grupo Español de Investigación en Cáncer de Ovario at 71 sites in 5 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 28 inclusion and 37 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 30 Aug 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 71 sites in Spain, France, Germany, Italy, Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Progression-free survival (PFS) (time frame: 30 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03598270, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Aug 2024.