RATIONALE: AZD2281 may stop the growth of tumor cells by blocking some of the enzymes needed
for cell growth. Drugs used in chemotherapy, such as carboplatin, work in different ways to
stop the growth of tumor cells, either by killing the cells or by stopping them from
dividing. Giving AZD2281 together with carboplatin may kill more tumor cells.
PURPOSE: This phase I trial is studying the side effects and best dose of AZD2281 when given
together with carboplatin in treating patients with BRCA1/BRCA2-associated, hereditary, or
triple negative metastatic or unresectable breast cancer or ovarian epithelial cancer.
- Determine the safety and toxicity of AZD2281 and carboplatin in patients with
BRCA1/BRCA2-associated or familial breast or ovarian epithelial cancer, low genetic
risk sporadic ovarian serous epithelial cancer, or low genetic risk triple negative
- Determine the biochemical changes in poly (ADP-ribose) polymerase (PARP) activity and
γ-H2AX levels in mononuclear cells and in tumor tissue in response to treatment with
this regimen in these patients.
- Assess the clinical activity of this regimen.
- Evaluate and correlate differences in PARP and XRCC1 polymorphisms with clinical
activity and toxicity of this regimen.
- Evaluate the induction of apoptosis in tumor tissue.
- Evaluate the pharmacodynamics of this regimen.
OUTLINE: This is a dose-escalation study of AZD2281. Patients are initially enrolled in
cohort 1. Once the maximum tolerated dose (MTD) of AZD2281 is determined, additional
patients are enrolled in cohort 2 and treated at the MTD.
- Cohort 1 (dose-escalation cohort): Patients receive oral AZD2281 twice daily on days
1-7 and carboplatin* IV over 15-60 minutes on day 2. Courses repeat every 21 days in
the absence of disease progression or unacceptable toxicity.
NOTE: *Patients who experience a partial response or stable disease may receive 8-10 courses
of carboplatin (more than 10 courses will be at the investigator's discretion); patients
with complete response (CR) may receive no more than 2 courses of carboplatin past CR.
- Cohort 2 (expansion cohort): Patients receive AZD2281 (at the MTD determined in cohort
1) and carboplatin as in cohort 1.
Patients in both cohorts undergo blood sample collection periodically for analysis of PARP
inhibition by ELISA. Blood samples from patients in cohort 2 are also analyzed for
PARP/XRCC1 polymorphism, γ-H2AX determination by immunofluorescence assay, and
pharmacogenomics. Patients in cohort 2 also undergo tumor tissue sample collection at
baseline for analysis of apoptosis by TUNEL assay, PARP inhibition by ELISA, γ-H2AX
determination by immunofluorescence assay, and tissue proteomics.
After completion of study treatment, patients are followed periodically for 4 weeks.
- Histologically or cytologically confirmed breast and/or ovarian epithelial cancer,
meeting one of the following criteria:
- Documented deleterious BRCA1/BRCA2 germline mutation or BRCAPRO score ≥ 30%
- Sporadic ovarian serous epithelial cancer with negative family history, BRCAPRO
score ≤ 20%, or negative BRCA1/BRCA2 mutation
- Triple negative (estrogen receptor negative, progesterone receptor negative, and
HER2/neu negative) breast cancer with negative family history and/or BRCAPRO
score ≤ 10% or negative BRCA1/2 mutation
- Metastatic or unresectable disease for which standard curative measures do not exist
or are no longer effective
- Patients with locally advanced, unresectable breast cancer must have been
previously treated with standard therapy
- Patients with locally advanced breast cancer presenting for initial therapy
are not eligible
- No local (i.e., only in breast or chest wall) recurrence only
- Measurable and/or evaluable disease
- Disease can be safely biopsied, as determined by an interventional radiologist
- Agrees to undergo mandatory biopsy at baseline
- No diagnosis of brain metastases within the past year
- Patients with brain metastases diagnosed > 1 year ago are eligible provided the
patient has undergone resection or radiotherapy for the brain metastases and has
had no CNS recurrence for a full year
- Male or female
- Menopausal status not specified
- ECOG performance status (PS) 0-2 or Karnofsky PS 60-100%
- Life expectancy > 3 months
- Hemoglobin ≥ 10 g/dL
- Leukocytes ≥ 3,000/mcL
- Absolute neutrophil count ≥ 1,500/mcL
- Platelet count ≥ 100,000/mcL
- Total bilirubin normal (in the absence of Gilbert's syndrome)
- AST/ALT ≤ 2.5 times upper limit of normal (ULN)
- Creatinine clearance ≥ 60 mL/min OR serum creatinine ≤ 1.5 times ULN
- Corrected or ionized calcium normal
- Potassium normal
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for ≥ 3 months after
completion of study treatment
- Able to swallow pills
- No history of grade 4 allergic reaction to platinum
- Patients with ≤ grade 3 (without a reaction protocol) or ≤ grade 2 (in the face
of pretreatment, but not graduated treatment exposure) allergic reaction to
platinums are eligible
- No functional impairment due to neuropathy
- No clinically significant bleeding
- No concurrent uncontrolled illness including, but not limited to, any of the
- Ongoing or active infection
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Cardiac arrhythmia
- Psychiatric illness/social situations that would preclude study compliance
- No other invasive malignancies within the past 5 years, except non-melanomatous skin
cancer, non-invasive bladder cancer, stage I endometrial cancer, or cervical cancer
cured by surgical resection (cohort 2)
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- Recovered from prior therapy (≤ CTC grade 1)
- Chronic stable grade 2 peripheral neuropathy secondary to neurotoxicity from
prior therapy may be allowed at the discretion of the principal investigator
- At least 6 months since prior platinum drugs
- Patients with platinum-resistant disease are eligible
- More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C),
biological therapy, hormonal therapy, or radiotherapy
- More than 4 weeks since prior investigational agents
- More than 4 weeks since prior major surgery
- No prior PARP inhibitors
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No other concurrent investigational agents