Phase II Study of Olaparib and Temozolomide for Advanced Uterine Leiomyosarcoma (NCI Protocol 10250)

Matthew Ingham, Jacob B. Allred, Li Chen, Biswasjit Das, Bose Kochupurakkal, Katherine Gano, Suzanne George, Steven Attia, Melissa A. Burgess, Mahesh Seetharam, Sosipatros A. Boikos, Nam Bui, James L. Chen, Julia L. Close, Gregory M. Cote, Premal H. Thaker, S. Percy Ivy, Sminu Bose, Alan D'Andrea, Adrian Marino-EnriquezGeoffrey I. Shapiro, Gary K. Schwartz

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

PURPOSEUterine leiomyosarcoma (uLMS) is an aggressive subtype of soft-tissue sarcoma with frequent metastatic relapse after curative surgery. Chemotherapy provides limited benefit for advanced disease. Multiomics profiling studies have identified homologous recombination deficiency in uLMS. In preclinical studies where olaparib and temozolomide provided modest activity, the combination was highly effective for inhibiting uLMS tumor growth.PATIENTS AND METHODSNCI Protocol 10250 is a single-arm, open-label, multicenter, phase II study evaluating olaparib and temozolomide in advanced uLMS. Patients with progression on ≥1 prior line received temozolomide 75 mg/m2 orally once daily with olaparib 200 mg orally twice a day both on days 1-7 in 21-day cycles. The primary end point was the best objective response rate (ORR) within 6 months. A one-stage binomial design was used. If ≥5 of 22 responded, the treatment would be considered promising (93% power; α =.06). All patients underwent paired biopsies that were evaluated with whole-exome sequencing (WES)/RNAseq and a RAD51 foci formation assay.RESULTSTwenty-two patients were evaluable. The median age was 55 years, and 59% had received three or more prior lines. Best ORR within 6 months was 23% (5 of 22). The overall ORR was 27% (6 of 22). The median progression-free survival (mPFS) was 6.9 months (95% CI, 5.4 months to not estimable). Hematologic toxicity was common (grade 3/4 neutropenia: 75%; thrombocytopenia: 32%) but manageable with dose modification. Five of 16 (31%) of tumors contained a deleterious homologous recombination gene alteration by WES, and 9 of 18 (50%) were homologous recombination-deficient by the RAD51 assay. In an exploratory analysis, mPFS was prolonged for patients with homologous recombination-deficient versus homologous recombination-proficient tumors (11.2 v 5.4 months, P =.05) by RAD51.CONCLUSIONOlaparib and temozolomide met the prespecified primary end point and provided meaningful clinical benefit in patients with advanced, pretreated uLMS.

Original languageEnglish
Pages (from-to)4154-4163
Number of pages10
JournalJournal of Clinical Oncology
Volume41
Issue number25
DOIs
StatePublished - Sep 1 2023

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