A Randomized Clinical Trial Investigating Olaparib, Durvalumab (MEDI4736) and UV1 as Maintenance Therapy in BRCAwt Patients with Recurrent Ovarian Cancer

1. Capable of giving signed informed consent which includes compliance with the
requirements and restrictions listed in the informed consent form (ICF) and in
this protocol. The consent must be signed before the time of inclusion.
2. Histologically diagnosed with epithelial ovarian, fallopian tube or primary
peritoneal cancer, excluding mucinous or low-grade serous histology.
3. Radiological or histological confirmation of relapse disease >= 6 months
after penultimate chemotherapy.
4. Patients who are non-gBRCAmut or tBRCAwt.
5. Have completed at least two lines, but no more than 3 lines, of
chemotherapy, which means that patients at first or second relapse with
treatment free interval of more than 6 months on penultimate chemotherapy are
eligible. See Figure 3, section 5.
- a. Patients must have completed at least 4 cycles of the latest
platinum-containing chemotherapy.
6. Be either:
- a. PARPi naive.
- b. Earlier treated with PARPi and not progressed during 6 months of PARPi
therapy.
7. Must not, in the opinion of the investigator, have progressed on, or after,
latest platinumcontaining chemotherapy. This means that patients with CR, PR,
or SD or no evidence of disease are eligible. It should be documented CR or PR
on the post-treatment scan following completion of the last chemotherapy course.
8. Patient consents to HRD test (Acceptable HRD tests: Myriad myChoice® CDx,
Leuven HRD test, NOGGO GISv1, and TSO 500 HRD).
9. Must be randomized in the study within 10 weeks of completion of the final
dose of platinum-containing chemotherapy.
10. Age >=18 years.
11. Body weight > 30 kg.
12. Eastern Cooperative Oncology Group (ECOG) performance status 0-1 (Appendix
3)
13. Must have a life expectancy >= 16 weeks.
14. Must have normal organ and bone marrow function measured within 28 days
prior to
administration of study treatment as defined below:
- Haemoglobin >= 10.0 g/dL (6,2 mmol/L) with no blood transfusion in the past 28
days.
- Absolute neutrophil count (ANC) >= 1.5 x 109/L.
- Platelet count >= 100 x 109/L.
- Total bilirubin <= 1.5 x institutional upper limit of normal (ULN).
- Aspartate aminotransferase (AST) (Serum Glutamic Oxaloacetic Transaminase
(SGOT)) / Alanine aminotransferase (ALT) (Serum Glutamic Pyruvate Transaminase
(SGPT)) <= 2.5 x institutional upper limit of normal unless liver metastases are
present in which case, they must be <= 5x ULN.
- Must have creatinine clearance estimated of >= 51 mL/min using the
Cockcroft-Gault equation or based on a urine test:
- Estimated creatinine clearance = [[140 - age(yr)] x weight(kg)] / [72 x serum
Cr (mg/dL)] (multiply by 0.85 for women).
15. Ability to swallow oral medications (tablets) without chewing, breaking,
crushing, opening, or otherwise altering the product formulation.
16. Post-menopausal or evidence of non-childbearing status for women of
childbearing potential: negative urine or serum pregnancy test within 28 days
of study treatment and confirmed prior to treatment on day 1.
Post-menopausal is defined as:
- Amenorrhoeic for 1 year or more following cessation of exogenous hormonal
treatments.
- Luteinizing hormone (LH) and Follicle stimulating hormone (FSH) levels in the
postmenopausal
range for women under 50.
- radiation-induced oophorectomy with last menses > 1 year ago.
- chemotherapy-induced menopause with > 1 year interval since last menses.
- surgical sterilisation (bilateral oophorectomy or hysterectomy).

1. Previous use of immune checkpoint inhibitors.
- a. In case the patient has participated in an immune checkpoint inhibitor
blinded study, the patient may be enrolled without unblinding.
2. Other malignancy unless curatively treated with no evidence of disease for >=
5 years except adequately treated non-melanoma skin cancer, curatively treated
in situ cancer of the cervix, ductal carcinoma in situ (DCIS), Stage 1, grade 1
endometrial carcinoma.
3. Resting ECG indicating uncontrolled, potentially reversible cardiac
conditions, as judged by the investigator (e.g., unstable ischemia,
uncontrolled symptomatic arrhythmia, congestive heart failure, QTcF
prolongation >= 470 ms, electrolyte disturbances, etc.), or patients with
congenital long QT syndrome.
4. Patients with myelodysplastic syndrome/acute myeloid leukemia or with
features suggestive of MDS/AML.
5. Patients with symptomatic uncontrolled brain metastases. A scan to confirm
the absence of brain metastases is not required. The patient can receive a
stable dose of corticosteroids before and during the study if these were
started at least 4 weeks prior to treatment. Patients with spinal cord
compression unless considered to have received definitive treatment for this
and evidence of clinically stable disease for 28 days.
6. Patients considered a poor medical risk due to a serious, uncontrolled
medical disorder, non-malignant systemic disease, or active, uncontrolled
infection. Examples include but are not limited to, uncontrolled ventricular
arrhythmia, recent (within 3 months) myocardial infarction, uncontrolled major
seizure disorder, unstable spinal cord compression, superior vena cava
syndrome, extensive interstitial bilateral lung disease on High Resolution
Computed Tomography (HRCT) scan.
7. Concomitant treatment with bevacizumab within the last 3 weeks.
8. Concomitant therapy with any other anticancer therapy or chronic use of
systemic corticosteroids of more than 10mg prednisolone daily.
9. Concomitant use of known strong CYP3A inhibitors (e.g., itraconazole,
telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or
cobicistat, indinavir,
saquinavir, nelfinavir, boceprevir, telaprevir) or moderate CYP3A inhibitors
(e.g., ciprofloxacin, erythromycin, diltiazem, fluconazole, verapamil). The
required washout period prior to starting study treatment is 2 weeks.
10. Concomitant use of known strong CYP3A inducers (e.g., phenobarbital,
enzalutamide, phenytoin, rifampicin, rifabutin, rifapentine, carbamazepine,
nevirapine and St John*s
Wort) or moderate CYP3A inducers (e.g., bosentan, efavirenz, modafinil). The
required washout period prior to starting study treatment is 5 weeks for
enzalutamide or
phenobarbital and 3 weeks for other agents.
11. Previous allogeneic bone marrow transplant or double umbilical cord blood
transplantation.
12. Major surgery or significant traumatic injury within 28 days of
randomization.
13. Immunocompromised patients, e.g., patients who are known to be
serologically positive for human immunodeficiency virus (HIV), patients with
active hepatitis B (defined as
having a positive hepatitis B surface antigen [HBsAg] test at screening) or
hepatitis C. Patients with past hepatitis B virus (HBV) infection or resolved
HBV infection (defined
as having a negative HBsAg test and a positive antibody to hepatitis B core
antigen [anti- HBc] antibody test) are eligible. Patients positive for
hepatitis C virus (HCV) antibody are
eligible only if polymerase chain reaction (PCR) is negative for HCV RNA.
14. Pregnancy, lactation, or intention to become pregnant during the study
or/and within 1 month after the last dose of olaparib. If the patient can
become pregnant, the patient must
be on acceptable birth control listed in Appendix 5.
15. Participation in a clinical study within 28 days or 5 half-lives of the
drug, whichever is longest.
16. Patients unable to swallow orally administered medication and patients with
gastrointestinal disorders likely to interfere with absorption of the study
medication.
17. Patients with a history of allergy or hypersensitivity to any of the study
drugs (including human granulocyte-macrophage colony stimulating factor),
yeast-derived products or any
constituent of the products.
18. Any unresolved toxicity NCI CTCAE Grade >= 2 from previous anticancer
therapy except for alopecia, vitiligo, and the laboratory values defined in the
inclusion criteria.
- a. Patients with Grade >= 2 neuropathy will be evaluated on a case-by-case
basis after consultation with the Sponsor.
- b. Patients with irreversible toxicity not reasonably expected to be
exacerbated by treatment with durvalumab may be included only after
consultation with the Lead Clinician.
19. Active or prior documented autoimmune or inflammatory disorders (including
inflammatory bowel disease [e.g., colitis or Crohn*s disease], diverticulitis
[with the exception of diverticulosis], systemic lupus erythematosus,
Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis,
Graves* disease, rheumatoid arthritis, hypophysitis, uveitis, etc]). The
following are exceptions to this criterion:
- a. Patients with vitiligo or alopecia.
- b. Patients with hypothyroidism (e.g., following Hashimoto syndrome) stable
on hormone replacement.
- c. Any chronic skin condition that does not require systemic therapy.
- d. Patients without active disease in the last 5 years may be included but
only after consultation with the Sponsor.
- e. Patients with celiac disease controlled by diet alone.
20. Uncontrolled intercurrent illness, including but not limited to, ongoing or
active infection, symptomatic congestive heart failure, uncontrolled
hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung
disease, serious chronic gastrointestinal conditions associated with diarrhoea,
or psychiatric illness/social situations that would
limit compliance with study requirement, substantially increase risk of
incurring AEs or compromise the ability of the patient to give written informed
consent.
21. Mean QT interval corrected for heart rate using Fridericia*s formula (QTcF)
>= 470 ms calculated from 3 ECGs (within 15 minutes at 5 minutes apart). A
single ECG >= 470 ms
- a. is sufficient.
22. History of active primary immunodeficiency.
23. Active infection including tuberculosis (TB) (clinical evaluation that
includes clinical history, physical examination and radiographic findings, and
TB testing in line with local practice).
24. Receipt of live attenuated vaccine within 30 days prior to the first dose
of IMP. Note:
Patients, if enrolled, should not receive live vaccine whilst receiving IMP and
up to 30 days after the last dose of IMP.
25. Has active infection with SARS-CoV-2 (antigen test).
26. Patients unable to be regularly followed for any reason (geographic,
familiar, social, psychologic, housed in an institution e.g., prison because of
a court agreement or administrative order according § 40 Abs. 1 S. 3 Nr. 4
AMG.).
27. Patients that are depending on the sponsor/CRO or investigational site as
well as on the investigator.