Bladder Cancer, Metastatic Urothelial Carcinoma, Muscle Invasive Bladder Cancer, Renal Pelvis Carcinoma, Ureter Carcinoma, Urethra Carcinoma, Urinary Bladder Carcinoma, Urothelial Carcinoma
Conditions
Keywords
PARP inhibitor, PARPi, HRD, ATLAS, homologous recombination, DNA repair, LOH, DNA defect, DNA anomaly, Rucaparib, MIBC
Brief summary
The purpose of the ATLAS study is to determine how patients with locally advanced unresectable or metastatic urothelial carcinoma respond to treatment with rucaparib.
Interventions
Rucaparib will be administered daily.
Sponsors
Study design
Eligibility
Inclusion criteria
* Have histologically or cytologically confirmed locally advanced unresectable or metastatic transitional cell carcinoma of the urothelium (renal pelvis, ureter, urinary bladder or urethra) * Received 1 or 2 prior treatment regimens for advanced or metastatic disease * Confirmed radiologic disease progression during or following recent treatment * Mandatory biopsy is required during screening * Measurable disease per RECIST v1.1 * Adequate organ function * ECOG 0 or 1
Exclusion criteria
* Prior treatment with a PARP inhibitor * Symptomatic and/or untreated CNS metastases * Duodenal stent and/or any gastrointestinal disorder that may interfere with absorption of rucaparib
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR) Per RECIST Version 1.1 | Time from first dose to date of progression, up to approximately 19 months | ORR is defined as the proportion of patients with a confirmed response of complete response (CR) or partial response (PR) by RECIST v1.1 as assessed by the investigator. Complete Response (CR) is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm. Partial Response (PR), is at least a 30% decrease in the sum of the longest diameter of target lesions, taking as reference the baseline sum of longest diameter. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival (PFS) According to RECIST v1.1, as Assessed by the Investigator | Cycle 1 Day 1 to End of Treatment, up to approximately 10 months | PFS is calculated as 1+ the number of days from the first dose of study drug to disease progression by RECIST, as determined by the investigator or death due to any cause, whichever occurs first. |
| Overall Survival | The total study time for reporting of deaths was approximately 19 months. | Overall survival (OS) was defined as time from the date of first dose of rucaparib to the date of death due to any cause. Patients without a known date of death were to be censored on the date the patient was last known to be alive. A Kaplan-Meier analysis of OS was planned, however, due to early study termination and limited duration of OS follow-up, a descriptive summary of total deaths are presented. This includes deaths recorded on study (from first dose of study drug until 28 days after last dose of study drug), and deaths recorded in long-term follow-up (from last dose +28 days until death, loss to follow-up, withdrawal of consent, or study closure). |
| Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | From Cycle 2 Day 1 to Cycle 4 Day 1, or approximately 2 months | Plasma were collected for trough level PK analysis of rucaparib 1 hour before the morning dose on Cycle 2 Day 1, Cycle 3 Day 1, and Cycle 4 Day 1. |
Countries
France, Germany, Italy, Spain, United Kingdom, United States
Participant flow
Recruitment details
97 subjects were recruited from 40 sites across 6 countries.
Participants by arm
| Arm | Count |
|---|---|
| HRD Unknown Patients with HRD status unknown who received continuous dosing with rucaparib 600 mg twice a day (BID) in 28-day cycles. Patients whose tumor genome-wide LOH was not tested or not determined were considered HRD unknown. | 47 |
| HRD Negative Patients with HRD status negative who received continuous dosing with rucaparib 600 mg twice a day (BID) in 28-day cycles. Patients whose tumor had genome-wide LOH \< 10% were considered HRD-negative. | 30 |
| HRD Positive Patients with HRD status positive who received continuous dosing with rucaparib 600 mg twice a day (BID) in 28-day cycles. Patients whose tumor had genome-wide LOH ≥ 10% were considered HRD-positive. | 20 |
| Total | 97 |
Baseline characteristics
| Characteristic | HRD Unknown | HRD Negative | HRD Positive | Total |
|---|---|---|---|---|
| Age, Continuous | 66.0 years | 66.0 years | 71.0 years | 66.0 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 7 Participants | 4 Participants | 1 Participants | 12 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 29 Participants | 23 Participants | 17 Participants | 69 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 11 Participants | 3 Participants | 2 Participants | 16 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 0 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 2 Participants | 0 Participants | 3 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 12 Participants | 3 Participants | 2 Participants | 17 Participants |
| Race (NIH/OMB) White | 32 Participants | 24 Participants | 18 Participants | 74 Participants |
| Sex: Female, Male Female | 9 Participants | 3 Participants | 9 Participants | 21 Participants |
| Sex: Female, Male Male | 38 Participants | 27 Participants | 11 Participants | 76 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 9 / 47 | 8 / 30 | 7 / 20 | 24 / 97 |
| other Total, other adverse events | 45 / 47 | 29 / 30 | 19 / 20 | 93 / 97 |
| serious Total, serious adverse events | 20 / 47 | 14 / 30 | 11 / 20 | 45 / 97 |
Outcome results
Objective Response Rate (ORR) Per RECIST Version 1.1
ORR is defined as the proportion of patients with a confirmed response of complete response (CR) or partial response (PR) by RECIST v1.1 as assessed by the investigator. Complete Response (CR) is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm. Partial Response (PR), is at least a 30% decrease in the sum of the longest diameter of target lesions, taking as reference the baseline sum of longest diameter.
Time frame: Time from first dose to date of progression, up to approximately 19 months
Population: Intent-to-treat Population (ITT) with measurable disease at Baseline - The ITT population includes all patients who received at least 1 dose of rucaparib. One patient each in the HRD negative and HRD positive groups did not have measurable disease at Baseline.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| HRD Unknown | Objective Response Rate (ORR) Per RECIST Version 1.1 | 0 Participants |
| HRD Negative | Objective Response Rate (ORR) Per RECIST Version 1.1 | 0 Participants |
| HRD Positive | Objective Response Rate (ORR) Per RECIST Version 1.1 | 0 Participants |
| Overall | Objective Response Rate (ORR) Per RECIST Version 1.1 | 0 Participants |
Overall Survival
Overall survival (OS) was defined as time from the date of first dose of rucaparib to the date of death due to any cause. Patients without a known date of death were to be censored on the date the patient was last known to be alive. A Kaplan-Meier analysis of OS was planned, however, due to early study termination and limited duration of OS follow-up, a descriptive summary of total deaths are presented. This includes deaths recorded on study (from first dose of study drug until 28 days after last dose of study drug), and deaths recorded in long-term follow-up (from last dose +28 days until death, loss to follow-up, withdrawal of consent, or study closure).
Time frame: The total study time for reporting of deaths was approximately 19 months.
Population: Intent-to-Treat population - all patients who received at least 1 dose of rucaparib
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| HRD Unknown | Overall Survival | 15 Participants |
| HRD Negative | Overall Survival | 15 Participants |
| HRD Positive | Overall Survival | 9 Participants |
| Overall | Overall Survival | 39 Participants |
Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations
Plasma were collected for trough level PK analysis of rucaparib 1 hour before the morning dose on Cycle 2 Day 1, Cycle 3 Day 1, and Cycle 4 Day 1.
Time frame: From Cycle 2 Day 1 to Cycle 4 Day 1, or approximately 2 months
Population: Safety population - all patients who received at least 1 dose of rucaparib and who had at least 1 PK sample collected. The number analyzed at each timepoint includes only those participants who remained on study and with viable samples collected at that timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| HRD Unknown | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 2 Day 1 | 2354.03 ng/mL | Standard Deviation 2173.055 |
| HRD Unknown | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 4 Day 1 | 2225.00 ng/mL | Standard Deviation 763.348 |
| HRD Unknown | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 3 Day 1 | 2037.90 ng/mL | Standard Deviation 1253.715 |
| HRD Negative | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 2 Day 1 | 1927.77 ng/mL | Standard Deviation 1352.707 |
| HRD Negative | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 4 Day 1 | 2058.00 ng/mL | Standard Deviation 705.28 |
| HRD Negative | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 3 Day 1 | 1331.17 ng/mL | Standard Deviation 357.01 |
| HRD Positive | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 3 Day 1 | 643.00 ng/mL | Standard Deviation 688.722 |
| HRD Positive | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 2 Day 1 | 1853.84 ng/mL | Standard Deviation 1533.622 |
| HRD Positive | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 4 Day 1 | 1585.00 ng/mL | Standard Deviation 487.904 |
| Overall | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 2 Day 1 | 2129.70 ng/mL | Standard Deviation 1831.099 |
| Overall | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 4 Day 1 | 2032.73 ng/mL | Standard Deviation 672.891 |
| Overall | Pharmacokinetics - Trough (Cmin) Level Rucaparib Concentrations | Cycle 3 Day 1 | 1647.33 ng/mL | Standard Deviation 1068.27 |
Progression-free Survival (PFS) According to RECIST v1.1, as Assessed by the Investigator
PFS is calculated as 1+ the number of days from the first dose of study drug to disease progression by RECIST, as determined by the investigator or death due to any cause, whichever occurs first.
Time frame: Cycle 1 Day 1 to End of Treatment, up to approximately 10 months
Population: Intent-to-Treat population - all patients who received at least 1 dose of rucaparib
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| HRD Unknown | Progression-free Survival (PFS) According to RECIST v1.1, as Assessed by the Investigator | 1.8 months |
| HRD Negative | Progression-free Survival (PFS) According to RECIST v1.1, as Assessed by the Investigator | 1.8 months |
| HRD Positive | Progression-free Survival (PFS) According to RECIST v1.1, as Assessed by the Investigator | 1.4 months |
| Overall | Progression-free Survival (PFS) According to RECIST v1.1, as Assessed by the Investigator | 1.8 months |