Abstract CT125: A phase 0/2 ‘trigger’ trial of pamiparib or olaparib plus radiotherapy in patients with newly-diagnosed or recurrent glioblastoma

Abstract Background: This Phase 0/2 clinical trial evaluates the pharmacokinetic (PK), pharmacodynamic (PD), and clinical response of newly-diagnosed and recurrent glioblastoma (GBM) patients to the PARP1/2 selective inhibitors, pamiparib and olaparib, in combination with radiotherapy. Materials/Methods: In this study, newly-diagnosed (Arm A) and recurrent GBM (Arm B) patients received 4 days of pamiparib (60 mg BID) prior to planned resection at 2-4 or 8-12 hours following the final dose. Arm C included recurrent GBM patients who received 4 days of olaparib (200 mg BID) prior to resection. In the Phase 0 component of the study total and unbound drug concentrations were measured using validated LC-MS/MS methods. A PK ‘trigger’, defined as unbound drug > 5-fold biochemical IC50 in Gd-nonenhancing tumor, determined eligibility for Phase 2. PARP inhibition was assessed via ex vivo tumor tissue radiation and quantification of PAR levels compared to non-irradiated control. When demonstrating a PK response, newly-diagnosed, MGMT-unmethylated GBM or recurrent GBM patients were eligible for Phase 2 dosing of pamiparib (Arms A and B) or olaparib (Arm C) with concurrent RT followed by maintenance pamiparib or olaparib. Results: A total of 41 patients (Arm A, n=16; Arm B, n=19; Arm C, n=6) were enrolled in the Phase 0 component of the study. In Arms A and B, mean unbound concentrations of pamiparib in Gd-nonenhancing tumor were 167.3 nM and 104.3 nM respectively, and in Arm C the mean unbound concentration of olaparib was 5.2 nM. All patients in the pamiparib arms (n=35) but only 1 of 6 patients in the olaparib Arm C exceeded the PK threshold. Radiation-induced PAR expression was 2.44-fold in untreated control vs 1.16 in Arm A (p<0.05), 0.82 in Arm B (p<0.01) and 1.11 in Arm C patients. In Arm A, 7 of 11 MGMT-unmethylated GBM patients advanced to Phase 2. Two patients were ineligible due to clinical status, 1 patient was ineligible per physician decision, and 1 patient declined to participate. In Arm B, 11 of 19 patients advanced to Phase 2. Eight patients were ineligible due to clinical status. At a mean follow-up of 5.8 months, median progression-free survival (PFS) was 5.8, 6.0, and 3.8 months for Arms A (n=7), B (n=11), and C (n=1), respectively. Grade 3+ toxicities related to pamiparib occurred in 4 patients, with 2 adverse events resulted in treatment discontinuation. No grade 3+ toxicities were documented in the olaparib arm. Conclusions: Pamiparib achieved pharmacologically-relevant concentrations in Gd-nonenhancing GBM tissue and suppressed induction of PAR levels ex vivo post-radiation. The majority of newly-diagnosed patients with MGMT-unmethylated GBM and recurrent GBM patients advanced to therapeutic dosing in this trial, and pamiparib was generally well-tolerated in these patients. Citation Format: Nader Sanai, Yu-Wei Chang, Jun Jiang, Jennifer Molloy, Chelsea Pennington-Krygier, Jocelyn Harmon, Amy Hong, John Wanebo, William Kennedy, Michael Garcia, Igor Barani, Wonsuk Yoo, Artak Tovmasyan, An-Chi Tien, Jing Li, Shwetal Mehta. A phase 0/2 ‘trigger’ trial of pamiparib or olaparib plus radiotherapy in patients with newly-diagnosed or recurrent glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT125.