Investigating Idetrexed and Olaparib in Patients With Ovarian Cancer

NCT06976892 | Recruiting Phase 1 DMC

• 2 other identifiers: CCR59781008393
• Study Type: interventional
• Target: 33
• Locations: 1 country
• Sites: 3

Brief Summary

Two drugs called Idetrexed and olaparib are being evaluated. Idetrexed is a type of drug called an "aFR-targeted thymidylate synthase inhibitor". Idetrexed has been designed to selectively target cancer cells that have a protein called folate receptor on the surface of cancer cells. Thymidylate synthase is key to cancer cells for creating new DNA when they multiply. Blocking the action of thymidylate synthase with a drug like Idetrexed may therefore stop cancers from growing by damaging DNA in cancer cells. Olaparib is a type of drug called a "PARP inhibitor". It prevents cells repairing DNA damage. This leads to cells dying. Combining Idetrexed and olaparib should increase the number of cancer cells dying, especially those cells that have a lot of folate receptors. Cancer cells with a high number of folate receptors should be targeted more than normal healthy cells.

Conditions

High Grade Serous Ovarian Cancer

Keywords

Ovarian Cancer; idetrexed; olaparib

Outcome Measures

Primary Outcomes (3)

• Propose a recommended dose/schedule for Phase II evaluation of the combination of Idetrexed and Olaparib

  Endpoint: Maximum tolerated dose/ schedule (MTD) of the combination of Idetrexed and Olaparib based on dose-limiting toxicities (DLT) with target acceptable DLT rate of 25%, and the Recommended Phase II dose (RP2D) and schedule (Dose Escalation only).

  End of Cycle 2 (each cycle is 28 days)

• Assess the safety and toxicity profile of Idetrexed and Olaparib

  Endpoint: determining causality of each adverse event to Idetrexed and Olaparib and grading severity according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 (Dose Escalation and Dose Expansion).

  End of Cycle 6 (each cycle is 28 days)

• Evaluate the preliminary anti-tumour activity of the combination of Idetrexed and Olaparib in alpha folate receptor overexpressing high grade serous ovarian cancer

  Endpoint: Objective response rate by the occurrence of Best Overall Response (BOR) per RECIST 1.1 criteria (Dose Expansion only).

  Until patient withdraws due to radiological progression, or begins new line of therapy.

Secondary Outcomes (3)

• Evaluate antitumour activity of the combination of Idetrexed and Olaparib

  From date of enrolment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months

• Evaluate the preliminary anti-tumour activity of the combination of Idetrexed and Olaparib in ovarian cancer irrespective of alpha folate receptor expression status

  From date of enrolment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months.

• CA125 responses

  From date of enrolment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months.

Other Outcomes (1)

• (Tertiary Objective): Retrospective evaluation of response biomarkers

  Within four weeks of patient beginning treatment.

Study Arms (2)

Dose Escalation

EXPERIMENTAL

Patients may be assigned one of four dose levels for the combination of idetrexed and Olaparib: * Dose Level 2 (starting dose): 9 mg/m2 idetrexed administered intravenously on days 1 and 15 of each cycle; 300 mg Olaparib administered orally twice per day on days 1-7 and 15-21. * Dose Level 1: 9 mg/m2 idetrexed administered intravenously on days 1 and 15 of each cycle; 200 mg Olaparib administered orally twice per day on days 1-7 and 15-21. * Dose Level -1: 9 mg/m2 idetrexed administered intravenously on days 1 and 15 of each cycle; 150 mg Olaparib administered orally twice per day on days 1-7 and 15-21. * Dose Level 3: 12 mg/m2 idetrexed administered intravenously on days 1 and 15 of each cycle; 200 mg Olaparib administered orally twice per day on days 1-7 and 15-21.

Drug: Dose Level 2 (starting dose); Drug: Dose Level 1; Drug: Dose Level -1; Drug: Dose Level 3

Dose Expansion

EXPERIMENTAL

Only patients expressing high levels of alpha-folate receptor on their tumours will be eligible. The maximum tolerated dose of Olaparib in combination with idetrexed, based on safety and efficacy data from Dose Escalation, will inform the dose carried forward to Dose Expansion.

Drug: Maximum Tolerated Dose

Interventions

Dose Level 2 (starting dose) DRUG

Idetrexed: 9 mg/m2 I.V. (days 1 \& 8) Olaparib: 300 mg P.O. (days1-7, 15-21)

Dose Escalation

Dose Level -1 DRUG

Idetrexed: 9 mg/m2 I.V. (days 1 \& 8) Olaparib: 150 mg P.O. (days1-7, 15-21)

Dose Escalation

Dose Level 3 DRUG

Idetrexed: 12 mg/m2 I.V. (days 1 \& 8) Olaparib: 200 mg P.O. (days1-7, 15-21)

Dose Escalation

Maximum Tolerated Dose DRUG

MTD of Olaparib in combination with idetrexed established from Dose Escalation

Dose Expansion

Eligibility Criteria

• Age: 18 Years+
• Gender Eligibility Details: Cisgender women
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Histologically or cytologically proven high grade serous ovarian cancer refractory to conventional treatment, or for which no conventional therapy exists or is declined by the patient.
• Measurable (as defined by RECIST v1.1) or evaluable (based on tumour markers) disease.
• Life expectancy of at least 12 weeks.
• World Health Organisation (WHO) performance status of 0-1 (Appendix 1 of Protocol).
• Haematological and biochemical indices within the ranges shown in Protocol section 4.1.1). These measurements must be performed within one week (Day -7 to Day 1) prior to the patient's first dose of IMP.
• Normal (no clinically significant abnormalities) 12-lead ECG, QTcF interval \<470 ms
• Pulmonary function test FVC of \>70%, DLCOc (DLCO corrected for Hb) of \>60%.
• years or over.
• Written (signed and dated) informed consent and be capable of co-operating with treatment and follow-up.
• For dose expansion patients only, they must have medium to high α-folate receptor expression according to the Ventana FOLR1-2.1 IHC assay.

You may not qualify if:

• Radiotherapy (except for palliative reasons), endocrine therapy, immunotherapy or chemotherapy during the previous four weeks (six weeks for nitrosoureas, Mitomycin-C) and 4 weeks for investigational medicinal products) before treatment.
• Ongoing toxic manifestations of previous treatments. Exceptions to this are alopecia or certain Grade 1 toxicities, which in the opinion of the Investigator and the DDU should not exclude the patient.
• Patients with new brain metastases. Patients with treated (surgically excised or irradiated) and stable brain metastases are eligible as long as the treatment was at least 4 weeks prior to initiation of study drug and brain MRI within 2 weeks of initiation of study drug is negative for new metastases.
• Patients with pulmonary metastases.
• History of thoracic radiation or other history likely to create pre-existing lung disease
• Presence of significant clinical ascites and/or pleural effusions.
• Female patients of child-bearing potential (or are already pregnant or lactating). However, those patients who have a negative serum or urine pregnancy test before enrolment and agree to use two forms of contraception (one effective form plus a barrier method) \[oral, injected or implanted hormonal contraception and condom; intra-uterine device and condom; diaphragm with spermicidal gel and condom\] or agree to sexual abstinence (see Protocol Section 16.5 - Appendix 5), effective from signing the consent form, throughout the trial and for six months afterwards are considered eligible.
• Major thoracic or abdominal surgery from which the patient has not yet recovered.
• Patients with sub-acute bowel obstruction.
• Organ transplant patients.
• At high medical risk because of non-malignant systemic disease including active uncontrolled infection.
• Known to be serologically positive for hepatitis B, hepatitis C or human immunodeficiency virus (HIV).
• Patients with history of QT prolongation, clinically significant VT, VF, heart block, MI within 1 year, CHF NYHA Class III or IV, unstable angina, angina within 6 months, or other evidence of clinically significant coronary artery disease/
• Is a participant or plans to participate in another interventional clinical trial, whilst taking part in this Phase I/Ib study of Idetrexed and Olaparib. Participation in an observational trial would be acceptable.
• Inability to tolerate Olaparib.

Sponsors & Collaborators

• Institute of Cancer Research, United Kingdom: lead
• Algok Bio Inc.: collaborator

Study Sites (3)

Addenbrooke's Hospital

Cambridge, Cambridgeshire, United Kingdom

NOT YET RECRUITING

Royal Marsden Hospital - Drug Development Unit

Sutton, London, SM2 5NG, United Kingdom

RECRUITING

Velindre Cancer Centre

Cardiff, Wales, United Kingdom

NOT YET RECRUITING

MeSH Terms

Conditions

Ovarian Neoplasms

Interventions

Maximum Tolerated Dose

Condition Hierarchy (Ancestors)

Endocrine Gland Neoplasms; Neoplasms by Site; Neoplasms; Ovarian Diseases; Adnexal Diseases; Genital Diseases, Female; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Neoplasms, Female; Urogenital Neoplasms; Genital Diseases; Endocrine System Diseases; Gonadal Disorders

Intervention Hierarchy (Ancestors)

Toxicity Tests; Investigative Techniques; Toxicological Phenomena; Pharmacological and Toxicological Phenomena; Physiological Phenomena

Study Officials

• Professor Udai Banerji

  Institute of Cancer Research, United Kingdom

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Alexander Cowley, Ph.D.

CONTACT

+44 20 3437 6927; idol@icr.ac.uk

Anna Zachariou, Ph.D.

CONTACT

idol@icr.ac.uk

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Up to 4 dose levels of Olaparib in combination with Idetrexed will be explored. Dose Escalation will use a flexible TIme To Event Continual Reassessment Method (TITE-CRM) including time-to-toxicity analysis to account for dose-limiting toxicities that may arise outside the initial DLT period (2 cycles). The TITE-CRM was proposed to handle the problem of long trial duration in Phase 1 trials due to late-onset toxicities. By combining a "backfilling" feature with TITE-CRM, the aim is to significantly shorten trial duration while maintaining a good assessment of the Maximum Tolerated Dose and Recommended Phase 2 Dose. The latter will consider not only the DLT outcomes, but also other parameters including activity and patient tolerability, as well as biomarker response during dose expansion. The proposed trial design ensures that the study has the advantages of both speed and efficiency. PLEASE NOTE: INTRA-PATIENT DOSE ESCALATION IS NOT PERMITTED ON THIS STUDY.

Study Record Dates

• First Submitted: April 3, 2025
• First Posted: May 16, 2025
• Study Start: August 1, 2025
• Primary Completion (Estimated): December 1, 2029
• Study Completion (Estimated): December 1, 2029
• Last Updated: August 13, 2025

Record last verified: 2025-08

Locations

GB (3)