Kim A Reiss1, Joseph M Herman2, Deborah Armstrong1, Marianna Zahurak3, Anthony Fyles4, Anthony Brade4, Michael Milosevic4, Laura A Dawson4, Angela Scardina1, Patricia Fischer1, Amy Hacker-Prietz2, Robert J Kinders5, Lihua Wang5, Alice Chen6, Sarah Temkin7, Naomi Horiba7, Lee-Anne Stayner8, Lillian L Siu8, Nilofer S Azad9. 1. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Department of Medical Oncology, United States. 2. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Department of Radiation Oncology, United States. 3. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Department of Statistics, United States. 4. Princess Margaret Cancer Centre/University Health Network, Department of Radiation Oncology, University of Toronto, Canada. 5. National Cancer Institute, Office of the Director, United States. 6. National Cancer Institute, Cancer Therapy Evaluation Program, United States. 7. The University of Maryland School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, United States. 8. Princess Margaret Cancer Centre/University Health Network, Department of Medical Oncology and Hematology, University of Toronto, Canada. 9. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Department of Medical Oncology, United States. Electronic address: nazad2@jhmi.edu.
Abstract
BACKGROUND: The combination of low-dose radiation therapy with PARP inhibition enhances anti-tumor efficacy through potentiating DNA damage. We combined low-dose fractionated whole abdominal radiation (LDFWAR) with ABT-888 in patients with peritoneal carcinomatosis with a dose escalation in ovarian and fallopian cancer patients (OV). METHODS: Patients were treated with veliparib, 40-400mg orally BID on days 1-21 of 3 28-day cycles on 6 dose levels. Dose levels 5 and 6 included only OV patients. LDFWAR consisted of 21.6Gy in 36 fractions, 0.6Gy twice daily on days 1 and 5 for weeks 1-3 of each cycle. Circulating tumor material and quality of life were serially assessed. RESULTS: 32pts were treated. Median follow-up was 45months (10-50). The most common treatment-related grade 3 and 4 toxicities were lymphopenia (59%), anemia (9%), thrombocytopenia (12%), neutropenia (6%), leukopenia (6%), nausea (6%), diarrhea (6%), anorexia (6%), vomiting (6%) and fatigue (6%). The maximum tolerated dose was determined to be 250mg PO BID. Median PFS was 3.6months and median OS was 9.1months. In OV patients, OS was longer for platinum-sensitive patients (10.9mo) compared to platinum-resistant patients (5.8mo). QoL decreased for all groups during treatment. Germline BRCA status was known for 14/18 patients with OV cancers, 5 of whom were BRCA mutation carriers. One objective response (3%) was observed. CONCLUSION: ABT-888 plus LDFWAR is tolerable with gastrointestinal symptoms, fatigue and myelosuppression as the most common toxicities. The single observed objective response was in a germline BRCA mutated, platinum-sensitive patient. Copyright Â
BACKGROUND: The combination of low-dose radiation therapy with PARP inhibition enhances anti-tumor efficacy through potentiating DNA damage. We combined low-dose fractionated whole abdominal radiation (LDFWAR) with ABT-888 in patients with peritoneal carcinomatosis with a dose escalation in ovarian and fallopian cancerpatients (OV). METHODS:Patients were treated with veliparib, 40-400mg orally BID on days 1-21 of 3 28-day cycles on 6 dose levels. Dose levels 5 and 6 included only OV patients. LDFWAR consisted of 21.6Gy in 36 fractions, 0.6Gy twice daily on days 1 and 5 for weeks 1-3 of each cycle. Circulating tumor material and quality of life were serially assessed. RESULTS: 32pts were treated. Median follow-up was 45months (10-50). The most common treatment-related grade 3 and 4 toxicities were lymphopenia (59%), anemia (9%), thrombocytopenia (12%), neutropenia (6%), leukopenia (6%), nausea (6%), diarrhea (6%), anorexia (6%), vomiting (6%) and fatigue (6%). The maximum tolerated dose was determined to be 250mg PO BID. Median PFS was 3.6months and median OS was 9.1months. In OV patients, OS was longer for platinum-sensitive patients (10.9mo) compared to platinum-resistant patients (5.8mo). QoL decreased for all groups during treatment. Germline BRCA status was known for 14/18 patients with OV cancers, 5 of whom were BRCA mutation carriers. One objective response (3%) was observed. CONCLUSION:ABT-888 plus LDFWAR is tolerable with gastrointestinal symptoms, fatigue and myelosuppression as the most common toxicities. The single observed objective response was in a germline BRCA mutated, platinum-sensitive patient. Copyright Â
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