Rucaparib Approved by FDA for Treatment of BRCA-Positive Ovarian Cancer
Jason M. Broderick
Published Online:11:43 AM, Mon December 19, 2016
Richard Pazdur, MD
The approval is based on data from 106 patients across 2 trials, including the ARIEL2 study. In a pooled analysis of data from the studies, the objective response rate (ORR) was 54% (95% CI, 44-64) with rucaparib.
"Today's approval is another example of the trend we are seeing in developing targeted agents to treat cancers caused by specific mutations in a patient's genes," Richard Pazdur, MD, director of the Office of Hematology and Oncology Products in the FDA's Center for Drug Evaluation and Research and acting director of the FDA's Oncology Center of Excellence. "Women with these gene abnormalities who have tried at least two chemotherapy treatments for their ovarian cancer now have an additional treatment option."
The 106 patients comprised 42 patients from a phase I/II study (NCT01482715) and 64 patients from the ARIEL2 phase II study (NCT01891344). Both trials were multicenter, single-arm, open-label studies in patients with BRCA-positive ovarian cancer who had progressed on 2 or more prior chemotherapies.
The phase I/II trial included only platinum-sensitive patients, while ARIEL2 enrolled patients who were platinum sensitive, resistant, or refractory. The group of 106 patients had a median number of prior therapies of 3 and a median age of 59 years.
The starting does of rucaparib for all patients was 600 mg twice daily. The primary outcome measures for both studies was investigator-assessed ORR and duration of response (DOR) per RECIST version 1.1.
In the pooled analysis of the 2 trials, the complete response (CR) rate was 9% and the partial response (PR) rate was 45%. The median DOR was 9.2 months (95% CI, 6.6-11.6). ORR rates were similar, regardless of whether patients had germline or somatic BRCA mutations, or mutations of the BRCA1 gene versus the BRCA2 gene. Progressive disease occurred in 9 of the 106 patients.
Among the 42 patients in the phase I/II study, the ORR was 60% (95% CI, 43-74), which included a CR rate of 10% and a PR rate of 50%. The median DOR was 7.8 months (95% CI, 5.6-10.5).
In the ARIEL2 trial, the ORR was 50% (95% CI, 37-63), comprising a CR rate of 8% and a PR rate of 42%. The median DOR was 11.6 months (95% CI, 5.5-18.2).
The safety analysis for rucaparib included 377 patients from the 2 studies who received rucaparib at 600 mg twice daily. The most common grade 3/4 adverse events (AEs) were anemia/decreased or low hemoglobin (25%), fatigue/asthenia (11%), and increased ALT/AST (11%).
Eight percent of patients discontinued treatment due to AEs associated with rucaparib. There was 1 case of myelodysplastic syndrome.
Clovis is also examining rucaparib as a maintenance therapy in patients with high-grade serous or endometrioid epithelial ovarian, primary peritoneal, or fallopian tube cancer in the phase III ARIEL3 trial (NCT01968213). The PARP inhibitor is also being explored in prostate, breast, and gastroesophageal cancers.