Testing the Use of A Single Drug (Olaparib) or the Combination of Two Drugs (Cediranib and Olaparib) Compared to the Usual Chemotherapy for Women With Platinum Sensitive Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

NCT02446600 — Phase 3, Active not recruiting, 579 participants, National Cancer Institute (NCI)

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A Phase III Study Comparing Single-Agent Olaparib or the Combination of Cediranib and Olaparib to Standard Platinum-Based Chemotherapy in Women With Recurrent Platinum-Sensitive Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

RegistryNCT02446600
StatusActive not recruiting
PhasePhase 3
Study typeInterventional; randomized, parallel, masking: none, treatment
Enrollment579 (Actual)
SponsorNational Cancer Institute (NCI) (Nih); collaborators: AstraZeneca, NRG Oncology
ConditionsFallopian Tube Clear Cell Adenocarcinoma, Fallopian Tube Transitional Cell Carcinoma, Fallopian Tube Undifferentiated Carcinoma, Ovarian Clear Cell Adenocarcinoma, Ovarian Endometrioid Tumor, Ovarian Seromucinous Carcinoma, Ovarian Serous Tumor, Ovarian Transitional Cell Carcinoma, Ovarian Undifferentiated Carcinoma, Recurrent Fallopian Tube Carcinoma, Recurrent Ovarian Carcinoma, Recurrent Ovarian Endometrioid Adenocarcinoma, Recurrent Primary Peritoneal Carcinoma
InterventionsBiospecimen Collection, Carboplatin, Cediranib Maleate, Computed Tomography, Echocardiography Test, Gemcitabine, Gemcitabine Hydrochloride, Laboratory Biomarker Analysis, Magnetic Resonance Imaging, Multigated Acquisition Scan, Olaparib, Paclitaxel, Pegylated Liposomal Doxorubicin Hydrochloride, Pharmacological Study, Quality-of-Life Assessment (Procedure, drug, other)
Datesstart 2016-03-28, primary completion 2020-02-23, completion 2027-03-04 (estimated), first posted 2015-05-18, last updated 2026-10-01
Locations356 sites in United States, Canada, Japan, South Korea

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-Summary

This phase III trial studies olaparib or cediranib maleate and olaparib to see how well they work compared with standard platinum-based chemotherapy in treating patients with platinum-sensitive ovarian, fallopian tube, or primary peritoneal cancer that has come back. Olaparib and cediranib maleate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Cediranib maleate may stop the growth of ovarian, fallopian tube, or primary peritoneal cancer by blocking the growth of new blood vessels necessary for tumor growth. Drugs used in chemotherapy, such as carboplatin, paclitaxel, gemcitabine hydrochloride, and pegylated liposomal doxorubicin hydrochloride work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether olaparib or cediranib maleate and olaparib is more effective than standard platinum-based chemotherapy in treating patients with platinum-sensitive ovarian, fallopian tube, or primary peritoneal cancer.

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+Detailed description

PRIMARY OBJECTIVE:

I. Assess the efficacy of either single agent olaparib or the combination of cediranib (cediranib maleate) and olaparib, as measured by progression free survival (PFS), as compared to standard platinum-based chemotherapy in the setting of recurrent platinum-sensitive ovarian, primary peritoneal or fallopian tube cancer.

SECONDARY OBJECTIVES:

I. Assess the efficacy of single agent olaparib or the combination of cediranib and olaparib, as measured by response rate and overall survival as compared to standard platinum-based chemotherapy in the setting of recurrent platinum-sensitive ovarian, primary peritoneal or fallopian tube cancer.

II. Assess the efficacy of single agent olaparib or the combination of cediranib and olaparib, as measured by PFS, in women with or without deleterious germline breast cancer (BRCA) mutations (gBRCAmt) in the setting of recurrent platinum-sensitive ovarian, primary peritoneal, or fallopian tube cancer.

III. Assess the effect on disease-related symptoms (DRS) as measured by the 9-item DRS-P subscale of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy (NCCN-FACT) Ovarian Symptom Index-18 (NFOSI-18), of single agent olaparib or cediranib and olaparib, compared to standard platinum-based chemotherapy, in the setting of recurrent platinum sensitive ovarian, primary peritoneal or fallopian tube cancer.

IV. Assess the efficacy of single agent olaparib or the combination of cediranib and olaparib, as measured by PFS, in women with or without homologous repair deficiencies as measured by BROCA in the setting of recurrent platinum-sensitive ovarian, primary peritoneal, or fallopian tube cancer.

V. To assess changes in the number of circulating endothelial cells (CECs) following three days of treatment with olaparib, combination olaparib/cediranib, or standard platinum-based chemotherapy in women with recurrent platinum-sensitive ovarian, primary peritoneal, or fallopian tube cancer.

VI. To assess whether change in the number of circulating endothelial cells (CECs) following three days of treatment with olaparib, combination olaparib/cediranib, or standard platinum-based chemotherapy in women with recurrent platinum-sensitive ovarian, primary peritoneal, or fallopian tube cancer is prognostic for PFS.

VII. To develop a profile from a panel of angiogenic biomarkers in women with recurrent platinum-sensitive ovarian, primary peritoneal, or fallopian tube cancer which is associated with PFS, and then validate the predictive value of this biomarker profile.

EXPLORATORY OBJECTIVES:

I. To assess the time from randomization to the first non-study, anti-cancer therapy, surgery or death (TFST) for single-agent olaparib or combination cediranib and olaparib relative to standard platinum-based chemotherapy in the setting of recurrent platinum-sensitive ovarian, primary peritoneal or fallopian tube cancer.

II. To assess the time from randomization to the second non-study, anti-cancer therapy, surgery or death (TSST) for single-agent olaparib or combination cediranib and olaparib relative to standard platinum-based chemotherapy in the setting of recurrent platinum-sensitive ovarian, primary peritoneal or fallopian tube cancer.

III. Assess the effect on secondary measures of quality of life, as assessed by the treatment side effects (TSE) and function/well-being (F/WB) subscales of the NFOSI-18, sensory neuropathy as measured by the FACT/Gynecologic Oncology Group-Neurotoxicity version 4 (GOG-Ntx-4), and health utility as measured by the Euro Quality of Life-5 Dimension (EQ-5D), of single agent olaparib or cediranib and olaparib, compared to standard platinum-based chemotherapy, in the setting of recurrent platinum sensitive ovarian, primary peritoneal or fallopian tube cancer.

OUTLINE: Patients are randomized to 1 of 3 treatment arms.

ARM I: Patients may be treated with one of the three regimens per investigator discretion.

REGIMEN I: Patients receive paclitaxel intravenously (IV) over 3 hours and carboplatin IV over 30-60 minutes and on day 1. Treatment repeats every 21 days for at least 4 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography (ECHO) or multigated acquisition scan (MUGA) during screening. Patients also undergo computed tomography (CT) or magnetic resonance imaging (MRI) as well as blood sample collection throughout the trial.

REGIMEN II: Patients receive gemcitabine hydrochloride IV over 30 minutes on days 1 and 8 and carboplatin IV over 30-60 minutes on day 1. Treatment repeats every 21 for at least 4 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO or MUGA during screening. Patients also undergo CT or MRI as well as blood sample collection throughout the trial.

REGIMEN III: Patients receive pegylated liposomal doxorubicin hydrochloride IV and carboplatin IV over 30-60 minutes and on day 1. Treatment repeats every 28 days for at least 4 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO or MUGA during screening and as clinically indicated on study. Patients also undergo CT or MRI as well as blood sample collection throughout the trial.

ARM II: Patients receive olaparib orally (PO) twice daily (BID). Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO or MUGA during screening. Patients also undergo CT or MRI as well as blood sample collection throughout the trial.

ARM III: Patients receive olaparib PO BID and cediranib maleate PO once daily (QD). Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO or MUGA during screening and as clinically indicated on study. Patients also undergo CT or MRI as well as blood sample collection throughout the trial.

After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

+Arms and interventions

ArmTypeInterventionsDescription
Arm I (platinum-based chemotherapy)Active comparatorDrug: Carboplatin; Procedure: Computed Tomography; Procedure: Echocardiography Test; Drug: Gemcitabine; Drug: Gemcitabine Hydrochloride; Other: Laboratory Biomarker Analysis; Procedure: Magnetic Resonance Imaging; Procedure: Multigated Acquisition Scan; Drug: Paclitaxel; Drug: Pegylated Liposomal Doxorubicin Hydrochloride; Other: Quality-of-Life AssessmentSee detailed description.
Arm II (olaparib)ExperimentalProcedure: Biospecimen Collection; Procedure: Computed Tomography; Procedure: Echocardiography Test; Other: Laboratory Biomarker Analysis; Procedure: Magnetic Resonance Imaging; Procedure: Multigated Acquisition Scan; Drug: Olaparib; Other: Pharmacological Study; Other: Quality-of-Life AssessmentPatients receive olaparib PO BID. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO or MUGA during screening. Patients also undergo CT or MRI as well as blood sample collection throughout the trial.
Arm III (olaparib, cediranib maleate)ExperimentalProcedure: Biospecimen Collection; Drug: Cediranib Maleate; Procedure: Computed Tomography; Procedure: Echocardiography Test; Other: Laboratory Biomarker Analysis; Procedure: Magnetic Resonance Imaging; Procedure: Multigated Acquisition Scan; Drug: Olaparib; Other: Pharmacological Study; Other: Quality-of-Life AssessmentPatients receive olaparib PO BID and cediranib maleate PO QD. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO or MUGA during screening and as clinically indicated on study. Patients also undergo CT or MRI as well as blood sample collection throughout the trial.
  • Biospecimen Collection (Procedure), also known as Biological Sample Collection, Biospecimen Collected, Sample Collection, Specimen Collection: Undergo blood sample collection
  • Carboplatin (Drug), also known as Blastocarb, Carboplat, Carboplatin Hexal, Carboplatino, Carboplatinum, Carbosin, Carbosol, Carbotec, CBDCA, Displata, Ercar, JM-8, JM8, Nealorin, Novoplatinum, Paraplatin, Paraplatin AQ, Paraplatine, Platinwas, Ribocarbo: Given IV
  • Cediranib Maleate (Drug), also known as AZD2171, AZD2171 Maleate, Recentin: Given PO
  • Computed Tomography (Procedure), also known as CAT, CAT Scan, Computed Axial Tomography, Computerized Axial Tomography, Computerized axial tomography (procedure), Computerized Tomography, Computerized Tomography (CT) scan, CT, CT Scan, Diagnostic CAT Scan, Diagnostic CAT Scan Service Type, tomography: Undergo CT
  • Echocardiography Test (Procedure), also known as EC, Echocardiography: Undergo ECHO
  • Gemcitabine (Drug), also known as dFdC, dFdCyd, Difluorodeoxycytidine: Given IV
  • Gemcitabine Hydrochloride (Drug), also known as dFdCyd, Difluorodeoxycytidine Hydrochloride, Gemcitabine HCI, Gemzar, LY 188011, LY-188011, LY188011: Given IV
  • Laboratory Biomarker Analysis (Other): Correlative studies
  • Magnetic Resonance Imaging (Procedure), also known as Magnetic Resonance, Magnetic Resonance Imaging (MRI), Magnetic resonance imaging (procedure), Magnetic Resonance Imaging Scan, Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance, MR, MR Imaging, MRI, MRI Scan, MRIs, NMR Imaging, NMRI, Nuclear Magnetic Resonance Imaging, sMRI, Structural MRI: Undergo MRI
  • Multigated Acquisition Scan (Procedure), also known as Blood Pool Scan, Equilibrium Radionuclide Angiography, Gated Blood Pool Imaging, Gated Heart Pool Scan, MUGA, MUGA Scan, Multi-Gated Acquisition Scan, Radionuclide Ventriculogram Scan, Radionuclide Ventriculography, RNV Scan, RNVG, SYMA Scanning, Synchronized Multigated Acquisition Scanning: Undergo MUGA
  • Olaparib (Drug), also known as AZD 2281, AZD-2281, AZD2281, KU 0059436, KU-0059436, KU0059436, Lynparza, Olanib, Olaparix, PARP Inhibitor AZD2281: Given PO
  • Paclitaxel (Drug), also known as Anzatax, Asotax, Bristaxol, Praxel, Taxol, Taxol Konzentrat: Given IV
  • Pegylated Liposomal Doxorubicin Hydrochloride (Drug), also known as ATI-0918, Caelyx, Dox-SL, Doxil, Doxilen, Doxorubicin HCl Liposomal, Doxorubicin HCl Liposome, Doxorubicin Hydrochloride Liposome, Doxorubicin Liposomal, Duomeisu, Evacet, LipoDox, Lipodox 50, Liposomal Adriamycin, Liposomal Doxorubicin Hydrochloride, Liposomal-Encapsulated Doxorubicin, Pegylated Doxorubicin HCl Liposome, Pegylated Liposomal Doxorubicin, S-Liposomal Doxorubicin, Stealth Liposomal Doxorubicin, TLC D-99: Given IV
  • Pharmacological Study (Other): Correlative studies
  • Quality-of-Life Assessment (Other), also known as Quality of Life Assessment: Ancillary studies

+Outcome measures

Primary outcomes

  • Progression Free Survival Determined Using Response Evaluation Criteria in Solid Tumors Version 1.1 Criteria [The protocol required lesion assessments every 9 weeks from cycle 1, day 1 for the first year, then every 12 weeks thereafter until disease progression. An average of approximately 10 months.]: Progression free survival (PFS) was defined as the number of months between study enrollment and documentation of disease progression (RECIST 1.1) or death from any cause. Patients still alive and disease free at the last follow-up were censored on the date of last CT Scan, or the CT Scan date prior to two missed assessments. Japanese cohort not included in progression free survival analysis, only included in toxicity assessments.

Secondary outcomes

  • Overall Survival [Approximately 30 months]: Overall survival (OS) was defined as the number of months between study enrollment and death from any cause. Patients still alive at the last follow-up were censored on the date of last contact. Japanese cohort not included in overall survival analysis, the cohort was only included in toxicity assessments.
  • Frequency and Severity of Adverse Effects [During treatment period and up to 100 days after stopping the study treatment, up to 39 months.]: Number of treated patients with Adverse Events (grade 3 or higher) observed while receiving randomized therapy, by Preferred term with incidence rate greater than 5%.
  • Patient Reported Scores of Disease-related Symptoms as Measured by the National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Ovarian Symptom Index-18 Disease-Related Symptom-Physical [Prior to cycle 1, week 12, week 24, week 36, week 48, week 60, week 72, week 84, week 96 and 108 weeks after starting treatment]: Disease-related physical symptoms were measured by the Disease-Related Symptom-Physical (DRS-P) subscale of the National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Ovarian Symptom Index-18 (NCCN/FOSI-18). The DRS-P subscale is composed of 9 items. For the negative statements (or questions), reversal was performed prior to score calculation. According to the FACIT measurement system, a subscale score was the summation of the individual item scores if more than 50% of subscale items were answered. When unanswered items existed, a subscale score was prorated by multiplying the mean of the answered item scores by the number of items in the subscale. The DRS-P score ranges 0-36 with a larger score suggesting better QOL (Quality of Life) or less symptoms. This analysis did not include the Japanese cohort.

Other outcomes

  • Time From Randomization to the First Non-study, Anti-cancer Treatment or Death [Up to 5 years]
  • Time From Randomization to the Second Non-study, Anti-cancer Treatment or Death [Up to 5 years]

+Eligibility

Sex: Female, ages: 18 Years to any

Inclusion Criteria:

* Patients must have platinum-sensitive recurrent high-grade serous or high-grade endometrioid ovarian, primary peritoneal, or fallopian tube cancers; patients with other (clear cell, mixed epithelial, undifferentiated carcinoma, or transitional cell carcinoma) high-risk histologies are also eligible, provided that the patient has a known deleterious germline BRCA1 or BRCA2 mutation identified through testing at a clinical laboratory; Note: Due to the long acceptance of germline BRCA testing through Myriad, Myriad testing will be accepted; if testing for germline BRCA is done by other organizations, documentation from a qualified medical professional (e.g., ovarian cancer specialty physician involved in the field, high risk genetics physician, genetics counselor) listing the mutation and confirming that the laboratory results showed a recognized germline deleterious BRCA1 or BRCA2 mutation or BRCA rearrangement is required; please collect a copy of Myriad or other BRCA mutational analysis (positive or VUS or negative) reports

  * Platinum-sensitive disease defined as no clinical or radiographic evidence of disease recurrence for > 6 months (or 182 days) after last receipt of platinum-based therapy
  * Patients must have had a complete clinical response to their prior line of platinum therapy and cannot have had progression through prior platinum-based therapy
* Patients must have signed an approved informed consent and authorization permitting release of personal health information
* Patients must have evaluable disease - defined as one of the following:

  * Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 measurable disease OR
  * Evaluable disease (defined as solid and/or cystic abnormalities on radiographic imaging that do not meet RECIST 1.1 definitions for target lesions OR ascites and/or pleural effusion that has been pathologically demonstrated to be disease-related) AND a cancer antigen 125 (CA125) that has doubled from the post-treatment nadir and is also greater than 2 times upper limit of normal (ULN)
* Prior therapy:

  * Prior chemotherapy must have included a first-line platinum-based regimen with or without intravenous consolidation chemotherapy
  * Patients may have received an unlimited number of platinum-based therapies in the recurrent setting
  * Patients may have received up to 1 non-platinum-based line of therapy in the recurrent setting; prior hormonal therapy will not be considered to count as this non-platinum-based line
  * Patients may not have had a prior anti-angiogenic agent in the recurrent setting; prior use of bevacizumab in the upfront or upfront maintenance setting is allowed
  * Patients may not have previously received a poly adenosine diphosphate (ADP) ribose polymerase (PARP)-inhibitor
  * Prior hormonal-based therapy for ovarian, primary peritoneal, or fallopian tube cancer is acceptable
* Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2 (Karnofsky >= 60%)
* Absolute neutrophil count >= 1,500/mcL
* Platelets >= 100,000/mcL
* Hemoglobin >= 10 g/dL
* Creatinine =< the institutional upper limit of normal (ULN) OR creatinine clearance >= 60 mL/min/1.73 m\^2 for patients with creatinine levels above institutional normal
* Urine protein: creatinine ratio (UPC) of =< 1 or less than or equal to 2+ proteinuria on two consecutive dipsticks taken no less than 1 week apart; UPC is the preferred test; patients with >= 2+ proteinuria on dipstick must also have a 24 hour urine collection demonstrating =< 500 mg over 24 hours
* Total bilirubin =< 1.5 x the institutional ULN
* Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) =< 3 times institutional ULN
* Toxicities of prior therapy (excepting alopecia) should be resolved to less than or equal to grade 1 as per National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE); patients with long-standing stable grade 2 neuropathy may be considered after discussion with the overall principal investigator (PI), but may not receive carboplatin and paclitaxel as the reference regimen, if randomized to that arm
* Patients must be able to swallow and retain oral medications and without gastrointestinal illnesses that would preclude absorption of cediranib or olaparib
* Patients must have adequately controlled blood pressure (BP), with a BP no greater than 140 mmHg (systolic) and 90 mmHg (diastolic) for eligibility; patients must have a BP of =< 140/90 mmHg taken in the clinic setting by a medical professional within 2 weeks prior to starting study; patients with hypertension may be managed with up to a maximum of three antihypertensive medications; it is strongly recommended that patients who are on three antihypertensive medications be followed by a cardiologist or blood pressure specialist for management of blood pressure while on protocol
* Patients must be willing and able to check and record daily blood pressure readings; blood pressure cuffs will be provided to patients randomized to Arm III
* Cediranib has been shown to terminate fetal development in the rat, as expected for a process dependent on VEGF signaling; for this reason, women of child-bearing potential must have a negative pregnancy test prior to study entry; women of child-bearing potential must agree to use two reliable forms of contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 6 weeks after cediranib discontinuation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
* Adequately controlled thyroid function, with no symptoms of thyroid dysfunction and thyroid stimulating hormone (TSH) within normal limits
* Age >= 18

Exclusion Criteria:

* Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) of starting treatment or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier; patients may not have had hormonal therapy within 2 weeks prior to entering the study; patients receiving raloxifene for bone health as per Food and Drug Administration (FDA) indication may remain on raloxifene absent other drug interactions
* Patients may not be receiving any other investigational agents nor have participated in an investigational trial within the past 4 weeks
* Patients may not be receiving any medication that may markedly affect renal function (e.g., vancomycin, amphotericin, pentamidine)
* Patients may not have received prior treatment affecting the vascular endothelial growth factor (VEGF) pathway (including, but not limited to thalidomide, sunitinib, pazopanib, sorafenib, and nintedanib); bevacizumab used in the upfront setting in conjunction with chemotherapy and/or as maintenance to treat newly diagnosed disease will be allowed
* Patients may not have previously received a PARP inhibitor
* CA-125 only disease without RECIST 1.1 measurable or otherwise evaluable disease
* Patients with untreated brain metastases, spinal cord compression, or evidence of symptomatic brain metastases or leptomeningeal disease as noted on CT or MRI scans should not be included on this study, since neurologic dysfunction may confound the evaluation of neurologic and other adverse events; screening imaging to rule out brain metastases is not required for screening, but should be performed prior to study enrollment if clinically indicated; patients with treated brain metastases and resolution of any associated symptoms must demonstrate stable post-therapeutic imaging for at least 6 months following therapy prior to starting study drug
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to cediranib or olaparib
* Participants receiving any medications or substances that are strong inhibitors or inducers of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) are ineligible; strong inhibitors and inducers of UGT/PgP should be used with caution
* History of gastrointestinal perforation; patients with a history of abdominal fistula will be considered eligible if the fistula was surgically repaired or has healed, there has been no evidence of fistula for at least 6 months, and patient is deemed to be at low risk of recurrent fistula
* History of intra-abdominal abscess within the past 3 months
* Current signs and/or symptoms of bowel obstruction or signs and/or symptoms of bowel obstruction within 3 months prior to starting study drugs
* Dependency on intravenous (IV) hydration or total parenteral nutrition (TPN)
* Any concomitant or prior invasive malignancies with the following curatively treated exceptions:

  * Treated limited stage basal cell or squamous cell carcinoma of the skin
  * Carcinoma in situ of the breast or cervix
  * Primary endometrial cancer meeting the following conditions: stage not greater than IA, grade 1 or 2, no more than superficial myometrial invasion, without vascular or lymphatic invasion; no poorly differentiated subtypes, including papillary serous/serous, clear cell, or other International Federation of Gynecology and Obstetrics (FIGO) grade 3 lesions
  * Prior cancer treated with a curative intent with no evidence of recurrent disease 3 years following diagnosis and judged by the investigator to be at low risk of recurrence
* Patients with any of the following:

  * History of myocardial infarction within six months
  * Unstable angina
  * Resting electrocardiogram (ECG) with clinically significant abnormal findings
  * New York Heart Association (NYHA) classification of III or IV
* If cardiac function assessment is clinically indicated or performed: left ventricular ejection fraction (LVEF) less than normal per institutional guidelines, or < 55%, if threshold for normal not otherwise specified by institutional guidelines

  * Patients with the following risk factors should have a baseline cardiac function assessment:

    * Prior treatment with anthracyclines
    * Prior treatment with trastuzumab
    * Prior central thoracic radiation therapy (RT), including RT to the heart
    * History of myocardial infarction within 6 to 12 months (patients with history of myocardial infarction within 6 months are excluded from the study)
    * Prior history of impaired cardiac function
* History of stroke or transient ischemic attack within six months
* Any prior history of hypertensive crisis or hypertensive encephalopathy
* Clinically significant peripheral vascular disease or vascular disease (including aortic aneurysm or aortic dissection)
* Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to starting cediranib
* Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia (other than atrial fibrillation with controlled ventricular rate), or psychiatric illness/social situations that would limit compliance with study requirements
* Pregnant women are excluded from this study because cediranib and olaparib are agents with the potential for teratogenic or abortifacient effects; because there is an unknown but potential risk of adverse events in nursing infants secondary to treatment of the mother with cediranib and olaparib, breastfeeding should be discontinued if the mother is treated with cediranib or olaparib; these potential risks may also apply to other agents used in this study
* Known HIV-positive individuals are ineligible because of the potential for pharmacokinetic interactions with cediranib or olaparib; in addition, these individuals are at increased risk of lethal infections when treated with marrow-suppressive therapy
* Patients may not use any complementary or alternative medicines including natural herbal products or folk remedies as they may interfere with the effectiveness of the study treatments
* No features suggestive of myelodysplastic syndrome (MDS) or acute myelogenous leukemia (AML) on peripheral blood smear or bone marrow biopsy, if clinically indicated
* No prior allogeneic bone marrow transplant or double umbilical cord blood transplantation (dUBCT)

+Posted results

Participant flow

MilestoneArm I (Platinum-based Chemotherapy)Arm II (Olaparib)Arm III (Olaparib, Cediranib Maleate)Japanese Cohort
Started18719018913
Completed14717816212
Not completed4012271

Outcome results

  • Progression Free Survival Determined Using Response Evaluation Criteria in Solid Tumors Version 1.1 Criteria (Primary), Median, months: Arm I (Platinum-based Chemotherapy) 10.3 (8.7 to 11.2); Arm II (Olaparib) 8.2 (6.6 to 8.7); Arm III (Olaparib, Cediranib Maleate) 10.4 (8.5 to 12.5) (p 0.077)
  • Overall Survival (Secondary), Median, months: Arm I (Platinum-based Chemotherapy) 31.3 (26.4 to 34.4); Arm II (Olaparib) 29.2 (23.9 to 32.7); Arm III (Olaparib, Cediranib Maleate) 30.5 (27.0 to 36.5)
  • Frequency and Severity of Adverse Effects (Secondary), Count of participants, Participants: Arm I (Platinum-based Chemotherapy) 23; Arm II (Olaparib) 28; Arm III (Olaparib, Cediranib Maleate) 11; Japanese Cohort 1
  • Patient Reported Scores of Disease-related Symptoms as Measured by the National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Ovarian Symptom Index-18 Disease-Related Symptom-Physical (Secondary), Mean, score on a scale: Arm I (Platinum-based Chemotherapy) 17.1 +/- 3.0; Arm II (Olaparib) 17.8 +/- 2.7; Arm III (Olaparib, Cediranib Maleate) 17.9 +/- 2.5
  • Time From Randomization to the First Non-study, Anti-cancer Treatment or Death (Other pre specified)
  • Time From Randomization to the Second Non-study, Anti-cancer Treatment or Death (Other pre specified)

Adverse events

Time frame: Starting with the first treatment received, and ending 100 days after the last treatment, or at the last following, whichever is sooner, up to 39 months.

ArmDeathsSerious adverse eventsOther adverse events
Arm I (Platinum-based Chemotherapy)72/187 (38.5%)18/187 (9.6%)169/187 (90.4%)
Arm II (Olaparib)95/189 (50.3%)22/189 (11.6%)184/189 (97.4%)
Arm III (Olaparib, Cediranib Maleate)84/189 (44.4%)29/189 (15.3%)184/189 (97.4%)
Japanese Cohort4/13 (30.8%)1/13 (7.7%)13/13 (100.0%)

Serious adverse events by term

TermOrgan systemArm I (Platinum-based Chemotherapy)Arm II (Olaparib)Arm III (Olaparib, Cediranib Maleate)Japanese Cohort
AnemiaBlood and lymphatic system disorders2/1879/1894/1890/13
Febrile NeutropeniaBlood and lymphatic system disorders1/1870/1890/1890/13
Atrial FibrillationCardiac disorders0/1871/1891/1890/13
AsystoleCardiac disorders0/1871/1890/1890/13
Cardiac ArrestCardiac disorders0/1871/1890/1890/13
Pericardial EffusionCardiac disorders0/1870/1890/1891/13
Chest Pain - CardiacCardiac disorders0/1871/1890/1890/13
Eye Disorders - OtherEye disorders1/1870/1890/1890/13
Duodenal ObstructionGastrointestinal disorders1/1870/1890/1890/13
Colonic ObstructionGastrointestinal disorders1/1872/1890/1890/13
Colonic PerforationGastrointestinal disorders0/1871/1890/1890/13
ColitisGastrointestinal disorders0/1870/1892/1890/13
ConstipationGastrointestinal disorders2/1870/1890/1890/13
DiarrheaGastrointestinal disorders0/1871/1890/1890/13
VomitingGastrointestinal disorders0/1872/1893/1890/13
Small Intestinal PerforationGastrointestinal disorders1/1870/1890/1890/13
Small Intestinal ObstructionGastrointestinal disorders2/1873/1896/1891/13
Abdominal PainGastrointestinal disorders0/1873/1891/1890/13
Mucositis OralGastrointestinal disorders0/1870/1891/1890/13
Lower Gastrointestinal HemorrhageGastrointestinal disorders0/1870/1891/1890/13
IleusGastrointestinal disorders0/1870/1891/1890/13
Abdominal DistensionGastrointestinal disorders0/1871/1890/1890/13
NauseaGastrointestinal disorders1/1874/1891/1890/13
PancreatitisGastrointestinal disorders0/1870/1891/1890/13
AscitesGastrointestinal disorders0/1871/1890/1890/13
Edema LimbsGeneral disorders0/1870/1891/1890/13
FatigueGeneral disorders0/1872/1892/1890/13
Death NosGeneral disorders1/1871/1890/1890/13
FeverGeneral disorders0/1870/1892/1890/13
Infusion Related ReactionGeneral disorders1/1870/1890/1890/13
Bile Duct StenosisHepatobiliary disorders0/1870/1891/1890/13
Infections And Infestations - OtherInfections and infestations0/1870/1891/1890/13
Skin InfectionInfections and infestations0/1871/1891/1890/13
SepsisInfections and infestations1/1871/1892/1890/13
Pelvic InfectionInfections and infestations0/1871/1890/1890/13
Lung InfectionInfections and infestations0/1871/1891/1890/13
Urinary Tract InfectionInfections and infestations0/1870/1893/1890/13
Enterocolitis InfectiousInfections and infestations2/1870/1890/1890/13
AppendicitisInfections and infestations0/1870/1891/1890/13
FallInjury, poisoning and procedural complications0/1871/1890/1890/13
Platelet Count DecreasedInvestigations3/1870/1890/1890/13
Electrocardiogram Qt Corrected Interval ProlongedInvestigations0/1871/1890/1890/13
Creatinine IncreasedInvestigations0/1871/1890/1890/13
Neutrophil Count DecreasedInvestigations2/1871/1891/1890/13
HyponatremiaMetabolism and nutrition disorders0/1871/1891/1890/13
HypokalemiaMetabolism and nutrition disorders1/1870/1890/1890/13
DehydrationMetabolism and nutrition disorders0/1871/1890/1890/13
AnorexiaMetabolism and nutrition disorders0/1870/1891/1891/13
Musculoskeletal And Connective Tissue Disorder - OMusculoskeletal and connective tissue disorders1/1871/1890/1890/13
Neoplasms Benign, Malignant And Unspecified (InclNeoplasms benign, malignant and unspecified (incl cysts and polyps)0/1870/1891/1890/13
Treatment Related Secondary MalignancyNeoplasms benign, malignant and unspecified (incl cysts and polyps)0/1871/1890/1890/13
Myelodysplastic SyndromeNeoplasms benign, malignant and unspecified (incl cysts and polyps)1/1870/1891/1890/13
StrokeNervous system disorders1/1870/1891/1890/13
Peripheral Motor NeuropathyNervous system disorders1/1870/1890/1890/13
LethargyNervous system disorders1/1870/1890/1890/13
Intracranial HemorrhageNervous system disorders0/1870/1892/1890/13
HeadacheNervous system disorders0/1870/1891/1890/13
SyncopeNervous system disorders0/1871/1890/1890/13
DizzinessNervous system disorders0/1870/1891/1890/13
DepressionPsychiatric disorders1/1870/1890/1890/13

11 more terms not shown.

Other adverse events by term

TermOrgan systemArm I (Platinum-based Chemotherapy)Arm II (Olaparib)Arm III (Olaparib, Cediranib Maleate)Japanese Cohort
Thrombotic Thrombocytopenic PurpuraBlood and lymphatic system disorders1/1870/1890/1890/13
Lymph Node PainBlood and lymphatic system disorders0/1871/1890/1890/13
LeukocytosisBlood and lymphatic system disorders0/1871/1890/1890/13
Hemolytic Uremic SyndromeBlood and lymphatic system disorders0/1871/1890/1890/13
Blood And Lymphatic System Disorders - OtherBlood and lymphatic system disorders1/1876/1899/1890/13
AnemiaBlood and lymphatic system disorders96/18794/18937/1893/13
Febrile NeutropeniaBlood and lymphatic system disorders3/1870/1892/1890/13
Atrial FibrillationCardiac disorders2/1872/1892/1890/13
AsystoleCardiac disorders0/1871/1890/1890/13
Cardiac ArrestCardiac disorders0/1871/1890/1890/13
Supraventricular TachycardiaCardiac disorders0/1871/1890/1890/13
Sinus BradycardiaCardiac disorders0/1870/1894/1890/13
PalpitationsCardiac disorders7/1872/1891/1890/13
Myocardial InfarctionCardiac disorders0/1871/1890/1890/13
Heart FailureCardiac disorders1/1870/1890/1890/13
Left Ventricular Systolic DysfunctionCardiac disorders1/1870/1890/1890/13
Atrial FlutterCardiac disorders1/1871/1891/1890/13
Cardiac Disorders - OtherCardiac disorders0/1870/1893/1890/13
Pericardial EffusionCardiac disorders1/1870/1890/1891/13
Sinus TachycardiaCardiac disorders6/1871/1895/1890/13
Chest Pain - CardiacCardiac disorders0/1872/1894/1890/13
Middle Ear InflammationEar and labyrinth disorders0/1870/1891/1890/13
Ear And Labyrinth Disorders - OtherEar and labyrinth disorders1/1871/1892/1890/13
VertigoEar and labyrinth disorders1/1874/1890/1890/13
TinnitusEar and labyrinth disorders8/1878/1898/1890/13
Hearing ImpairedEar and labyrinth disorders3/1872/1891/1890/13
Ear PainEar and labyrinth disorders3/1872/1898/1890/13
HypothyroidismEndocrine disorders3/1874/18960/1897/13
HyperthyroidismEndocrine disorders3/1872/18914/1890/13
Endocrine Disorders - OtherEndocrine disorders0/1870/1896/1890/13
HypoparathyroidismEndocrine disorders0/1870/1891/1891/13
Eye Disorders - OtherEye disorders4/1871/1896/1890/13
Watering EyesEye disorders0/1873/1892/1890/13
Eye PainEye disorders2/1871/1892/1890/13
GlaucomaEye disorders1/1870/1890/1890/13
CataractEye disorders2/1871/1893/1890/13
PhotophobiaEye disorders1/1870/1891/1890/13
ConjunctivitisEye disorders1/1870/1890/1890/13
Blurred VisionEye disorders16/1876/18915/1890/13
Dry EyeEye disorders1/1870/1893/1890/13
Retinal DetachmentEye disorders0/1871/1890/1890/13
FloatersEye disorders0/1872/1891/1890/13
EnterocolitisGastrointestinal disorders0/1870/1892/1890/13
DysphagiaGastrointestinal disorders4/1873/1897/1890/13
DyspepsiaGastrointestinal disorders14/18726/18918/1890/13
Duodenal ObstructionGastrointestinal disorders1/1870/1891/1890/13
Duodenal FistulaGastrointestinal disorders1/1870/1890/1890/13
Dry MouthGastrointestinal disorders4/1876/18925/1890/13
Colonic UlcerGastrointestinal disorders0/1870/1891/1890/13
Colonic ObstructionGastrointestinal disorders1/1871/1891/1890/13
Colonic PerforationGastrointestinal disorders0/1871/1890/1890/13
Colonic FistulaGastrointestinal disorders0/1871/1890/1890/13
ColitisGastrointestinal disorders0/1870/1896/1890/13
ConstipationGastrointestinal disorders71/18770/18961/1891/13
DiarrheaGastrointestinal disorders40/18751/189151/18911/13
VomitingGastrointestinal disorders39/18765/18984/1896/13
BloatingGastrointestinal disorders7/18723/18917/1890/13
Small Intestinal PerforationGastrointestinal disorders1/1870/1890/1890/13
Stomach PainGastrointestinal disorders3/1872/1896/1891/13
Salivary Duct InflammationGastrointestinal disorders0/1871/1890/1890/13

285 more terms not shown.

+Locations (356)

FacilityCityCountryStatus
University of Alabama at Birmingham Cancer CenterBirmingham, AlabamaUnited States
University of South Alabama Mitchell Cancer InstituteMobile, AlabamaUnited States
Alaska Women's Cancer CareAnchorage, AlaskaUnited States
Providence Alaska Medical CenterAnchorage, AlaskaUnited States
Arizona Oncology Associates-West Orange GroveTucson, ArizonaUnited States
Arizona Oncology Associates-WilmotTucson, ArizonaUnited States
University of Arkansas for Medical SciencesLittle Rock, ArkansasUnited States
PCR OncologyArroyo Grande, CaliforniaUnited States
Mercy San Juan Medical CenterCarmichael, CaliforniaUnited States
Marin Cancer Care IncGreenbrae, CaliforniaUnited States
UC San Diego Moores Cancer CenterLa Jolla, CaliforniaUnited States
Cedars-Sinai Medical CenterLos Angeles, CaliforniaUnited States
Palo Alto Medical Foundation-Camino DivisionMountain View, CaliforniaUnited States
Palo Alto Medical Foundation-Gynecologic OncologyMountain View, CaliforniaUnited States
Kaiser Permanente-OaklandOakland, CaliforniaUnited States
Palo Alto Medical Foundation Health CarePalo Alto, CaliforniaUnited States
Sutter Roseville Medical CenterRoseville, CaliforniaUnited States
Mercy Cancer Center - SacramentoSacramento, CaliforniaUnited States
Sutter Medical Center SacramentoSacramento, CaliforniaUnited States
University of California Davis Comprehensive Cancer CenterSacramento, CaliforniaUnited States
Kaiser Permanente Sacramento Medical CenterSacramento, CaliforniaUnited States
California Pacific Medical Center-Pacific CampusSan Francisco, CaliforniaUnited States
Kaiser Permanente-San FranciscoSan Francisco, CaliforniaUnited States
UCSF Medical Center-Mission BaySan Francisco, CaliforniaUnited States
Pacific Central Coast Health Center-San Luis ObispoSan Luis Obispo, CaliforniaUnited States
Kaiser Permanente Medical Center - Santa ClaraSanta Clara, CaliforniaUnited States
Palo Alto Medical Foundation-Santa CruzSanta Cruz, CaliforniaUnited States
Sutter Pacific Medical FoundationSanta Rosa, CaliforniaUnited States
Palo Alto Medical Foundation-SunnyvaleSunnyvale, CaliforniaUnited States
Kaiser Permanente-VallejoVallejo, CaliforniaUnited States
Kaiser Permanente-Walnut CreekWalnut Creek, CaliforniaUnited States
Woodland Memorial HospitalWoodland, CaliforniaUnited States
Rocky Mountain Cancer Centers-AuroraAurora, ColoradoUnited States
UCHealth University of Colorado HospitalAurora, ColoradoUnited States
Penrose-Saint Francis HealthcareColorado Springs, ColoradoUnited States
UCHealth Memorial Hospital CentralColorado Springs, ColoradoUnited States
Kaiser Permanente-FranklinDenver, ColoradoUnited States
Rocky Mountain Cancer Centers-RoseDenver, ColoradoUnited States
Poudre Valley HospitalFort Collins, ColoradoUnited States
Kaiser Permanente-Rock CreekLafayette, ColoradoUnited States
Rocky Mountain Cancer Centers-LittletonLittleton, ColoradoUnited States
Kaiser Permanente-Lone TreeLone Tree, ColoradoUnited States
Rocky Mountain Cancer Centers-Sky RidgeLone Tree, ColoradoUnited States
Intermountain Health Lutheran HospitalWheat Ridge, ColoradoUnited States
Smilow Cancer Hospital Care Center-FairfieldFairfield, ConnecticutUnited States
Hartford HospitalHartford, ConnecticutUnited States
Smilow Cancer Hospital Care Center at Saint FrancisHartford, ConnecticutUnited States
Middlesex HospitalMiddletown, ConnecticutUnited States
The Hospital of Central ConnecticutNew Britain, ConnecticutUnited States
Yale UniversityNew Haven, ConnecticutUnited States
Smilow Cancer Hospital-Torrington Care CenterTorrington, ConnecticutUnited States
Smilow Cancer Hospital Care Center-TrumbullTrumbull, ConnecticutUnited States
Helen F Graham Cancer CenterNewark, DelawareUnited States
Christiana Care Health System-Christiana HospitalNewark, DelawareUnited States
Beebe Health CampusRehoboth Beach, DelawareUnited States
TidalHealth Nanticoke / Allen Cancer CenterSeaford, DelawareUnited States
Sibley Memorial HospitalWashington D.C., District of ColumbiaUnited States
UF Health Cancer Institute - GainesvilleGainesville, FloridaUnited States
University Cancer and Blood Center LLCAthens, GeorgiaUnited States
Piedmont HospitalAtlanta, GeorgiaUnited States
Northside HospitalAtlanta, GeorgiaUnited States
Emory Decatur HospitalDecatur, GeorgiaUnited States
Atrium Health NavicentMacon, GeorgiaUnited States
Memorial Health University Medical CenterSavannah, GeorgiaUnited States
Lewis Cancer and Research Pavilion at Saint Joseph's/CandlerSavannah, GeorgiaUnited States
Queen's Medical CenterHonolulu, HawaiiUnited States
Kapiolani Medical Center for Women and ChildrenHonolulu, HawaiiUnited States
Saint Alphonsus Cancer Care Center-BoiseBoise, IdahoUnited States
Saint Luke's Cancer Institute - BoiseBoise, IdahoUnited States
Saint Luke's Cancer Institute - FruitlandFruitland, IdahoUnited States
Saint Luke's Cancer Institute - MeridianMeridian, IdahoUnited States
Saint Luke's Cancer Institute - NampaNampa, IdahoUnited States
Rush-Copley Medical CenterAurora, IllinoisUnited States
Illinois CancerCare-BloomingtonBloomington, IllinoisUnited States
Illinois CancerCare-CantonCanton, IllinoisUnited States
Illinois CancerCare-CarthageCarthage, IllinoisUnited States
Centralia Oncology ClinicCentralia, IllinoisUnited States
Northwestern UniversityChicago, IllinoisUnited States
John H Stroger Jr Hospital of Cook CountyChicago, IllinoisUnited States
Rush MD Anderson Cancer CenterChicago, IllinoisUnited States
UChicago Medicine Comprehensive Cancer Center - Saint Joseph HospitalChicago, IllinoisUnited States
Cancer Care Specialists of Illinois - DecaturDecatur, IllinoisUnited States
Decatur Memorial HospitalDecatur, IllinoisUnited States
Crossroads Cancer CenterEffingham, IllinoisUnited States
Illinois CancerCare-EurekaEureka, IllinoisUnited States
NorthShore University HealthSystem-Evanston HospitalEvanston, IllinoisUnited States
Illinois CancerCare-GalesburgGalesburg, IllinoisUnited States
Northwestern Medicine Cancer Center DelnorGeneva, IllinoisUnited States
NorthShore University HealthSystem-Glenbrook HospitalGlenview, IllinoisUnited States
NorthShore University HealthSystem-Highland Park HospitalHighland Park, IllinoisUnited States
Sudarshan K Sharma MD Limited-Gynecologic OncologyHinsdale, IllinoisUnited States
Illinois CancerCare-Kewanee ClinicKewanee, IllinoisUnited States
Illinois CancerCare-MacombMacomb, IllinoisUnited States
Cancer Care Center of O'FallonO'Fallon, IllinoisUnited States
Illinois CancerCare-Ottawa ClinicOttawa, IllinoisUnited States
Advocate Lutheran General HospitalPark Ridge, IllinoisUnited States
Illinois CancerCare-PekinPekin, IllinoisUnited States
Illinois CancerCare-PeoriaPeoria, IllinoisUnited States
Illinois CancerCare-PeruPeru, IllinoisUnited States
Illinois CancerCare-PrincetonPrinceton, IllinoisUnited States

256 more sites not listed.

+Publications

  • Results publication: Gaitskell K, Rogozinska E, Platt S, Chen Y, Abd El Aziz M, Tattersall A, Morrison J. Angiogenesis inhibitors for the treatment of epithelial ovarian cancer. Cochrane Database Syst Rev. 2023 Apr 18;4(4):CD007930. doi: 10.1002/14651858.CD007930.pub3. PMID 37185961
  • Results publication: Liu JF, Brady MF, Matulonis UA, Miller A, Kohn EC, Swisher EM, Cella D, Tew WP, Cloven NG, Muller CY, Bender DP, Moore RG, Michelin DP, Waggoner SE, Geller MA, Fujiwara K, D'Andre SD, Carney M, Alvarez Secord A, Moxley KM, Bookman MA. Olaparib With or Without Cediranib Versus Platinum-Based Chemotherapy in Recurrent Platinum-Sensitive Ovarian Cancer (NRG-GY004): A Randomized, Open-Label, Phase III Trial. J Clin Oncol. 2022 Jul 1;40(19):2138-2147. doi: 10.1200/JCO.21.02011. Epub 2022 Mar 15. PMID 35290101
  • Results publication: Tattersall A, Ryan N, Wiggans AJ, Rogozinska E, Morrison J. Poly(ADP-ribose) polymerase (PARP) inhibitors for the treatment of ovarian cancer. Cochrane Database Syst Rev. 2022 Feb 16;2(2):CD007929. doi: 10.1002/14651858.CD007929.pub4. PMID 35170751

+Study documents

+Investigators

+Funding

NIH grants: U10CA180868