Abstract 1955
Background
Niraparib is a highly selective PARP-1/-2 inhibitor approved by FDA for the maintenance therapy of platinum-sensitive recurrent (PSR) ovarian cancer based on the significantly improved progression-free survival for niraparib-treated patients (pts) in the phase III NOVA study. A retrospective analysis of NOVA study suggests that pts with BW <77 kg or baseline plt count <150*109/L may have an improved safety profile from a starting dose of 200 mg once daily (QD) without compromising efficacy. A double-blinded, 2:1 randomized, placebo-controlled phase III study (NORA) is being conducted in China to investigate niraparib as maintenance therapy in Chinese pts with PSR ovarian cancer. The dosing regimen in the study was 300 mg QD but the study protocol was subsequently amended to have a starting dose of either 300 or 200 mg of niraparib/placebo QD based on baseline BW and plt counts. The trial has completed accrual and remains blinded for efficacy and safety. The current analysis was intended to evaluate niraparib tolerability for pts starting treatment with an individualized starting dose and compare with that in pts with the fixed starting dose of 300 mg QD.
Methods
The initial protocol adopted a fixed starting dose of 300 mg QD. After 16 patients were enrolled, the protocol was amended to start niraparib treatment at a dose of 200 mg QD in pts with BW <77 kg or plt count <150*109/L, and 300 mg for others. Blinded data were pooled from niraparib and placebo arms.
Results
A total of 265 pts had been enrolled, and 232 pts who have been followed up ≥ 90 days ending Mar 31, 2019 were included in this analysis. There were no major differences in key pts demographics or disease characteristics between both arms. Key safety data are presented in the table. More detailed safety data in all population will be disclosed.Table: 1004P
| Pre-Amendment, Fixed starting dose (pooled niraparib and placebo arms) | Post-Amendment, Individualized starting dose (pooled niraparib and placebo arms ) | |||
|---|---|---|---|---|
| 300 mg (N = 16) | 300 mg (N = 14) | 200 mg (N = 202) | Total (N = 216) | |
| Median BW, kg (min, max) | 62 (40,76) | 83 (78,94) | 59 (37,82) | 61 (37,94) |
| Median plt count,109/L (min, max) | 211 (124,336) | 187(153,325) | 184 (62,447) | 184 (62,447) |
| Any ≥ grade 3 TEAE, n(%) | 9 (56.3) | 4 (28.6) | 56 (27.7) | 60 (27.8) |
| ≥Grade 3 thrombocytopenia, n(%) | 3 (13.8) | 1 (7.1) | 6 (3.0) | 7 (3.2) |
| ≥Grade 3 anemia, n(%) | 4 (25.0) | 2 (14.3) | 9 (4.5) | 11 (5.1) |
| ≥Grade 3 neutropenia, n(%) | 2 (12.5) | 0 | 25 (12.4) | 25 (11.6) |
| Any serious TEAE, n(%) | 4 (25.0) | 1 (7.1) | 19 (9.4) | 20 (9.3) |
| TEAE leading to end of treatment, n (%) | 1 (6.3) | 0 | 3 (1.5) | 3 (1.4) |
Conclusions
The results indicate that niraparib tolerability will be improved with a starting dose based on body weight or platelet count.
Clinical trial identification
NCT03705156.
Editorial acknowledgement
Jun Wan and John Zhang of Zai Lab Writing and coordinated by Sean Li and Wendy Zhang of Zai Lab, Inc, funded by Zai Lab, Inc. (Shanghai,China).
Legal entity responsible for the study
Zai Lab (Shanghai) Co., Ltd.
Funding
Zai Lab (Shanghai) Co., Ltd.
Disclosure
J. Hou: Full / Part-time employment: Zai Lab (Shanghai) Co., Ltd C. Zhang: Full / Part-time employment: Zai Lab (Shanghai) Co., Ltd Y. Hei: Full / Part-time employment: Zai Lab (Shanghai) Co., Ltd. All other authors have declared no conflicts of interest.
Resources from the same session
740 - A real-world analysis of the treatment of advanced ovarian cancer with PARPIs
Presenter: Alejandra Martinez de Pinillos
Session: Poster Display session 2
Resources:
Abstract
5867 - Incidence of tumour BRCA1/2 variants in relapsed, platinum-sensitive ovarian, fallopian tube and primary peritoneal cancer
Presenter: Robert Morgan
Session: Poster Display session 2
Resources:
Abstract
2966 - Frequency of mutations in 21 hereditary breast and ovarian cancer susceptibility genes among 882 high-risk individuals
Presenter: Jihong Liu
Session: Poster Display session 2
Resources:
Abstract
1687 - BRCA testing of 1,284 Brazilian patients for hereditary breast and ovarian cancer in a routine diagnostic setting
Presenter: Fernanda Milanezi
Session: Poster Display session 2
Resources:
Abstract
3162 - A multi-center integrative study on cancer predisposition genes in Chinese patients with epithelial ovarian carcinoma
Presenter: Changbin Zhu
Session: Poster Display session 2
Resources:
Abstract
5993 - Incidental Early Occult Ovarian Cancer after Risk-Reducing Salpingo-Oophorectomy in BRCA1/2 Mutation Carriers followed in a Community Public Hospital
Presenter: Begona Grana Suarez
Session: Poster Display session 2
Resources:
Abstract
5334 - Response to chemotherapy in ovarian cancer (OC) patients with or without prior breast cancer (BC), stratified by BRCA mutation (BRCAm) status
Presenter: Angela George
Session: Poster Display session 2
Resources:
Abstract
4565 - Advanced ovarian cancer: is residual disease after debulking surgery affected by genetics factors involved in angiogenesis and immunity pathways?
Presenter: Michele Bartoletti
Session: Poster Display session 2
Resources:
Abstract
3251 - Surrogate endpoint of progression-free (PFS) and overall survival (OS) for advanced ovarian cancer (AOC) patients (pts) treated with neo-adjuvant chemotherapy (NACT): Results of the CHIVA randomized phase II GINECO study
Presenter: Fabrice Lecuru
Session: Poster Display session 2
Resources:
Abstract
3278 - Immune-Related Gene Expression Profiling after Neoadjuvant Chemotherapy (NACT) of Ovarian High-Grade Serous Carcinoma
Presenter: Luis Manso
Session: Poster Display session 2
Resources:
Abstract