Ovarian Neoplasm, Fallopian Tube Neoplasms, Peritoneal Neoplasms
Conditions
Brief summary
The primary objectives of this study are to evaluate progression-free survival (PFS) by blinded independent central review (BICR) and overall survival (OS) (evaluated independently, as dual primary endpoints) in patients treated with intermittent regimen of relacorilant in combination with nab-paclitaxel compared with patients treated with nab-paclitaxel monotherapy.
Detailed description
As there are no currently approved therapies or effective standard of care for heavily pretreated patients with ovarian cancer who have exhausted single-agent chemotherapy and/or bevacizumab, the combination of intermittently administered relacorilant and nab-paclitaxel may demonstrate a substantial improvement without increased toxicity compared with nab-paclitaxel. Patients will receive study treatment until confirmed progressive disease (PD) or unacceptable toxicity. All patients will be followed for the collection of study endpoints, inclusive of disease progression and survival.
Interventions
DRUGRelacorilant 150 mg
Relacorilant is administered as capsules for oral dosing once daily on the day before, the day of, and the day after nab-paclitaxel administration.
Nab-paclitaxel is administered as intravenous (IV) infusion over 30-40 minutes on Days 1, 8, and 15 of each 28-day cycle.
Nab-paclitaxel is administered as IV infusion over 30-40 minutes on Days 1, 8, and 15 of each 28-day cycle.
Sponsors
Corcept Therapeutics
Gynecologic Oncology Group
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Signed and dated Institutional Review Board/Independent Ethics Committee-approved informed consent form prior to study-specific screening procedures. * Confirmed histologic diagnosis of high-grade (Grade 3) serous, epithelial ovarian, primary peritoneal, or fallopian tube carcinoma. * Patients must have platinum-resistant disease (defined as RECIST v1.1 defined progression \<6 months from completion of a platinum-containing therapy). * Must consent to provide archival tumor-tissue block or slides. Patients may consent to an optional tumor biopsy if archival tumor is unavailable. * Has a life expectancy of ≥3 months. * At least one lesion that meets the definition of measurable disease by RECIST v1.1 * Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1. * Able to comply with protocol requirements. * Able to swallow and retain oral medication and does not have uncontrolled emesis. * Received at least 1 but ≤3 lines of prior systemic anticancer therapy and at least 1 prior line of platinum therapy and prior treatment with bevacizumab is required. * Has adequate organ function meeting the following laboratory-test criteria: Absolute neutrophil count (ANC) ≥1500 cells/mm\^3, Platelet count ≥100,000/mm\^3, Hemoglobin ≥9 g/dL, Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≤2.5 × upper limit of normal (ULN), or ≤5 × ULN in context of liver metastases, Total bilirubin ≤1.5 × ULN, and Albumin ≥3 g/dL, and creatinine clearance \>40 mL/min/1.73 m\^2 (measured or estimated). * Negative pregnancy test for patients of childbearing potential; patients of childbearing potential must agree to use highly effective contraceptive method(s); hormonal contraceptives are not allowed. * Coronavirus disease (COVID-19) approved vaccines are accepted concomitant medications when recommended by the Investigator.
Exclusion criteria
* Has clinically relevant toxicity from prior systemic anticancer therapies or radiotherapy that has not resolved to ≤Grade 1 prior to randomization. * Has had any major surgery within 4 weeks prior to randomization. * Has low-grade endometrioid, clear cell, mucinous, or sarcomatous histology, or mixed tumors containing any of these histologies, or low-grade or borderline ovarian tumor. * Has primary platinum-refractory disease, defined as disease that did not respond to or has progressed ≤1 month of the last dose of first-line platinum-containing chemotherapy. * Has not received prior bevacizumab treatment. * Has been treated with the following prior to randomization: chemotherapy, immunotherapy, investigational agent treatments for disease under study within 28 days before first dose of study drug, radiotherapy not completed at least 2 weeks prior to first dose of study drug, hormonal anticancer therapies within 7 days of first dose of study drug, and systemic, inhaled, or prescription strength topical corticosteroids within 21 days of first dose of study drug. * Has received wide-field radiation to more than 25% of marrow-bearing areas. * Has toxicities of prior therapies that have not resolved by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0, ≤Grade 1. * Requires treatment with chronic or frequently used oral corticosteroids for medical conditions or illnesses. * Has a history of severe hypersensitivity or severe reaction to any of the study drugs. * Is receiving concurrent treatment with mifepristone or other glucocorticoid receptor (GR) modulators. * Has peripheral neuropathy from any cause \>Grade 1. * Pregnant or lactating patients or patients expecting to conceive children within the projected duration of the trial, starting with the screening visit through at least 1 month after the last dose of relacorilant, or 6 months after the last dose of nab-paclitaxel whichever is the longest. * Has clinically significant uncontrolled condition(s) or condition which, in the opinion of the Investigator, may confound the results of the trial or interfere with the patient's safety or participation. * Has current chronic/active infection with human immunodeficiency virus or current chronic/active infection with hepatitis C virus or hepatitis B virus. * Has any untreated or symptomatic central nervous system (CNS) metastases. * Patients with a history of other malignancy within 3 years prior to randomization. * Is taking a concomitant medication that is a strong cytochrome P450 (CYP)3A inhibitor or strong CYP3A inducer, or that is a substrate of CYP3A with a narrow therapeutic window. * Concurrent treatment on other investigational treatment studies for the treatment of ovarian, fallopian tube, or primary peritoneal cancer. * Has received a live vaccine within 30 days prior to the study start date.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival (PFS) as Assessed by Blinded Independent Central Review (BICR) | Up to 20 months | PFS was assessed as the time from randomization until the time of first documented progressive disease (PD) or death due to any cause, whichever occurs first. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions, or an unequivocal progression in a non-target lesion, or the appearance of new lesions. |
| Overall Survival | Up to 32 months | Overall survival (OS) was assessed as the time from randomization to death by any cause. The data values are Kaplan-Meier estimates. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PFS as Assessed by the Investigator | Up to 20 months | PFS was assessed as the time from randomization until the time of first documented progressive disease (PD) by RECIST v1.1, or death due to any cause, whichever occurs first. |
| Objective Response as Assessed by the Investigator | Up to 20 months | Objective response was assessed as the proportion of patients with measurable disease at baseline who attained complete response (CR) or partial response (PR). Confirmation of the response was not required for this outcome measure per RECIST v1.1 criteria for randomized controlled clinical trials. Responses were assessed by imaging, using RECIST v1.1 criteria for target lesions: CR, Disappearance of all target lesions; PR, ≥30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR. |
| Best Overall Response as Assessed by the Investigator | Up to 20 months | Best overall response was assessed as the proportion of patients with at least 1 post Baseline scan who attained CR, PR, stable disease (SD), or PD as best response by RECIST v1.1. |
| Duration of Confirmed Responses as Assessed by the Investigator | From the time of confirmed CR or PR to the time of the first PD or death (Up to 18 months) | The median duration of response is presented for confirmed responses (CR or PR) per RECIST v1.1. Duration of response was from the first documented and confirmed response to the first objectively documented PD as assessed by the Investigator, or death due to any cause, whichever occurs first. |
| Clinical Benefit Rate at 24 Weeks as Assessed by BICR and the Investigator | 24 weeks | Clinical benefit rate was assessed as the proportion of patients who attained CR, PR, or stable disease (SD) for 24 weeks per RECIST v1.1 as assessed by BICR and as assessed by the Investigator. |
| Cancer Antigen (CA)-125 Response | Up to 24 months | CA-125 response was assessed per Gynecologic Cancer Intergroup (GCIG) criteria defined as ≥50% reduction in CA-125 from a pretreatment sample and maintained for ≥28 days in patients with a pretreatment sample that is at least twice the upper limit of the reference range within 2 weeks before starting the treatment. In addition, patients who have a CA-125 response and whose CA-125 level fell to within the reference range were classified as CA-125 complete responders. |
| Combined Overall Response Rate by RECIST v1.1 and CA-125 Defined by GCIG Criteria | Up to 15 months | Combined response was assessed as the proportion of patients with tumor response per RECIST v1.1 assessed by the investigator and for CA-125 response per GCIG criteria. |
| Number of Patients With One or More Adverse Events | Up to 22 months | — |
| Number of Patients Who Discontinued the Study Treatment Due to an Adverse Event | Up to 25 months | — |
Countries
Argentina, Australia, Belgium, Brazil, Canada, France, Hungary, Israel, Italy, Poland, South Korea, Spain, United Kingdom, United States
Contacts
STUDY_DIRECTORAdrian Jubb, MBChB, PhD, FRCPath
Corcept Therapeutics
Participant flow
Recruitment details
A total of 498 patients were screened and 381 were enrolled into the study.
Pre-assignment details
One patient in the relacorilant 150 mg with nab-paclitaxel 80 mg/m\^2 arm discontinued the study with Withdrawal by Subject as the reason but died 6 days later. This patient death is recorded in the All-cause Mortality table in the Adverse Event Module.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 61.8 years STANDARD_DEVIATION 9.65 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 17 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 146 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 30 Participants |
| Primary Diagnosis Fallopian cancer | 35 Participants |
| Primary Diagnosis Ovarian cancer | 331 Participants |
| Primary Diagnosis Primary peritoneal cancer | 11 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 48 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants |
| Race (NIH/OMB) More than one race | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 49 Participants |
| Race (NIH/OMB) White | 271 Participants |
| Sex: Female, Male Female | 188 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 129 / 188 | 157 / 193 |
| other Total, other adverse events | 183 / 188 | 185 / 190 |
| serious Total, serious adverse events | 66 / 188 | 45 / 190 |
Outcome results
None listed