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Rucaparib in Patients With Locally Advanced or Metastatic Urothelial Carcinoma

A Phase 2, Open-label Study of Rucaparib in Patients With Locally Advanced or Metastatic Urothelial Carcinoma

Status
Terminated
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03397394
Acronym
ATLAS
Enrollment
97
Registered
2018-01-12
Start date
2018-06-01
Completion date
2020-01-15
Last updated
2023-06-09

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Bladder Cancer, Metastatic Urothelial Carcinoma, Muscle Invasive Bladder Cancer, Renal Pelvis Carcinoma, Ureter Carcinoma, Urethra Carcinoma, Urinary Bladder Carcinoma, Urothelial Carcinoma

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

DRUGRucaparib

Rucaparib will be administered daily.

Sponsors

Foundation Medicine
CollaboratorINDUSTRY
pharmaand GmbH
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Objective Response Rate (ORR) Per RECIST Version 1.1Time from first dose to date of progression, up to approximately 19 monthsORR 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

MeasureTime frameDescription
Progression-free Survival (PFS) According to RECIST v1.1, as Assessed by the InvestigatorCycle 1 Day 1 to End of Treatment, up to approximately 10 monthsPFS 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 SurvivalThe 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 ConcentrationsFrom Cycle 2 Day 1 to Cycle 4 Day 1, or approximately 2 monthsPlasma 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

ArmCount
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
Total97

Baseline characteristics

CharacteristicHRD UnknownHRD NegativeHRD PositiveTotal
Age, Continuous66.0 years66.0 years71.0 years66.0 years
Ethnicity (NIH/OMB)
Hispanic or Latino
7 Participants4 Participants1 Participants12 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
29 Participants23 Participants17 Participants69 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
11 Participants3 Participants2 Participants16 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
2 Participants0 Participants0 Participants2 Participants
Race (NIH/OMB)
Black or African American
1 Participants2 Participants0 Participants3 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants1 Participants0 Participants1 Participants
Race (NIH/OMB)
Unknown or Not Reported
12 Participants3 Participants2 Participants17 Participants
Race (NIH/OMB)
White
32 Participants24 Participants18 Participants74 Participants
Sex: Female, Male
Female
9 Participants3 Participants9 Participants21 Participants
Sex: Female, Male
Male
38 Participants27 Participants11 Participants76 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
9 / 478 / 307 / 2024 / 97
other
Total, other adverse events
45 / 4729 / 3019 / 2093 / 97
serious
Total, serious adverse events
20 / 4714 / 3011 / 2045 / 97

Outcome results

Primary

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.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
HRD UnknownObjective Response Rate (ORR) Per RECIST Version 1.10 Participants
HRD NegativeObjective Response Rate (ORR) Per RECIST Version 1.10 Participants
HRD PositiveObjective Response Rate (ORR) Per RECIST Version 1.10 Participants
OverallObjective Response Rate (ORR) Per RECIST Version 1.10 Participants
Secondary

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

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
HRD UnknownOverall Survival15 Participants
HRD NegativeOverall Survival15 Participants
HRD PositiveOverall Survival9 Participants
OverallOverall Survival39 Participants
Secondary

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.

ArmMeasureGroupValue (MEAN)Dispersion
HRD UnknownPharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 2 Day 12354.03 ng/mLStandard Deviation 2173.055
HRD UnknownPharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 4 Day 12225.00 ng/mLStandard Deviation 763.348
HRD UnknownPharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 3 Day 12037.90 ng/mLStandard Deviation 1253.715
HRD NegativePharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 2 Day 11927.77 ng/mLStandard Deviation 1352.707
HRD NegativePharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 4 Day 12058.00 ng/mLStandard Deviation 705.28
HRD NegativePharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 3 Day 11331.17 ng/mLStandard Deviation 357.01
HRD PositivePharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 3 Day 1643.00 ng/mLStandard Deviation 688.722
HRD PositivePharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 2 Day 11853.84 ng/mLStandard Deviation 1533.622
HRD PositivePharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 4 Day 11585.00 ng/mLStandard Deviation 487.904
OverallPharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 2 Day 12129.70 ng/mLStandard Deviation 1831.099
OverallPharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 4 Day 12032.73 ng/mLStandard Deviation 672.891
OverallPharmacokinetics - Trough (Cmin) Level Rucaparib ConcentrationsCycle 3 Day 11647.33 ng/mLStandard Deviation 1068.27
Secondary

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

ArmMeasureValue (MEDIAN)
HRD UnknownProgression-free Survival (PFS) According to RECIST v1.1, as Assessed by the Investigator1.8 months
HRD NegativeProgression-free Survival (PFS) According to RECIST v1.1, as Assessed by the Investigator1.8 months
HRD PositiveProgression-free Survival (PFS) According to RECIST v1.1, as Assessed by the Investigator1.4 months
OverallProgression-free Survival (PFS) According to RECIST v1.1, as Assessed by the Investigator1.8 months

Source: ClinicalTrials.gov · Data processed: Feb 24, 2026