ClinicalTrials.gg
CompletedNCT03425201NICARAGUAUpdated Dec 31, 2024

Niraparib in Combination with Cabozantinib (XL184) in Patients with Advanced Urothelial Cancer (NICARAGUA)

A Phase 1/2 interventional study of Niraparib plus Cabozantinib in Urothelial Cancer, sponsored by Fundacion CRIS de Investigación para Vencer el Cáncer. Completed at 10 sites in Spain. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-12-31.

Sponsored by Fundacion CRIS de Investigación para Vencer el Cáncer · Phase 1/2, Interventional, and Other

Phase
Phase 1/2
Study type
Interventional
Enrollment
67
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

Cabozantinib is an oral, small-molecule tyrosine kinase inhibitor. Its primary targets are Hepatocyte growth factor receptor protein (MET), vascular endothelial growth factor receptor 1-3 (VEGFR1-3), RET, AXL, FLT3 and KIT. Cabozantinib has been approved by the FDA for clinical treatment of progressive, metastatic medullary thyroid cancer. Recently published trials have demonstrated activity for cabozantinib in patients with advanced renal cell carcinoma and metastatic castration-resistant prostate cancer (mCRPC). Furthermore, in preclinical models of urothelial carcinoma (UC) of the bladder, cabozantinib has demonstrated the ability to inhibit tumor xenograft growth. It has been suggested that levels of soluble Met ectodomain (sMet) can be measured in the urine as a useful biomarker to monitor the efficacy of c-Met therapy in bladder cancer patients. Moreover, cabozantinib has demonstrated activity in heavily pretreated, advanced bladder cancer patients, with a response rate of 19.5% and manageable toxicities.

In the phase I of this study it is proposed to evaluate DLTs of niraparib and cabozantinib combination and determine maximum tolerated dose (MTD) in patients with advanced urothelial or renal cell carcinoma. In the phase II it is proposed to make a preliminary evaluation of the efficacy of this combination in patients with urothelial cell carcinoma. Efficacy results will be correlated with genomic alterations related to c-Met and Poly [ADP-ribose] polymerase (PARP) inhibitor activity.

Read the detailed description

Bladder cancer is the 9th most common cancer worldwide, with around 429.800 new cases diagnosed in 2012 and the 5th most common cancer in Europe, with more than 151.000 new cases diagnosed in 2012. Relating mortality figures, bladder cancer is the 13th most common cause of cancer death worldwide, with around 165.100 deaths from bladder cancer in 2012 and the 9th in Europe, with around 52.400.

Cisplatin-based chemotherapy remains the standard treatment in patients with metastatic urothelial carcinoma (UC).This regimen has been associated with a median survival of 14-15 months. The prognosis of patients who progress after a platinum-based regimen is dismal. Several chemotherapy drugs tested in the second-line setting, such as taxanes, vinflunine and pemetrexed, have demonstrated limited activity, with response rates of 5-20%, median progression-free survival (PFS) of 2-4 months, and median survival of 6-8 months. Thus, there are significant unmet medical needs in the second-line setting. New therapeutic targets should be tested in urothelial carcinoma to improve these results.

Therapies targeting DNA repair pathways can exploit DNA repair defects in cancer cells to generate synthetic lethality. Alterations in DNA repair pathways have been associated with response to DNA-damaging agents. For example, defective homologous recombination (HR) plays a crucial role in tumors where platinum agents are involved in therapeutic management, as well as in those treated with PARP inhibitors, which have synthetic lethal effects when applied to cells with defective HR. Targeted mutational profiling of HR genes using next-generation sequencing has been used to identify mutations of key HR genes. Furthermore, HR-defective tumors exhibit genomic instability, including loss of heterozygosity (LOH), telomeric allelic imbalance (TAI) and large-scale state transitions (LST). A combined HR deficiency score (myChoice homologous recombination deficiency (HRD) test from Myriad Genetics) defined as the sum of LOH, TAI and LST has been developed. This score has been associated with response to platinum-based chemotherapy and in ovarian cancer with the efficacy of niraparib in patients without germline breast cancer gene (gBRCA) mutations.

In patients with muscle-invasive bladder cancer (MIBC), the Cancer Genome Atlas project found 31% of alterations in BRCA1-2 genes, mainly related to copy number and overexpression. In addition, a high percentage of tumors had alterations in other DNA repair genes. Recently, in platinum-treated UC patients, 47% of mutations in DNA repair genes have been found, including 50% of mutations in HR, Fanconi anemia, and DNA-damage-response checkpoint pathways. The presence of these mutations has been associated with survival. These results suggest a potential role for PARP inhibitors in UC. Niraparib is a highly selective inhibitor of poly (adenosine diphosphate [ADP]-ribose) polymerase (PARP)1/2 nuclear protein. PARP enzymes are involved in DNA repair through activation of the base excision repair (BER) pathway and alternative end-joining pathways and inhibition of non-homologous end-joining. PARP inhibition in cells with HR deficiency causes accumulation of unrepaired DNA double-strand breaks, leading to cell death. For these reasons, PARP inhibitors are selectively lethal in tumor cells with defective HR. Niraparib at the recommended oral dose of 300 mg daily has demonstrated efficacy in platinum- sensitive recurrent ovarian cancer with defective HR. The most significant toxicity was hematologic (thrombocytopenia, neutropenia, and anemia). Among non-hematologic toxicities, hypertension was detected in 8% of patients.

c-Met receptor tyrosine kinase (RTK) is activated by its ligand, hepatocyte growth factor (HGF), and induces increased proliferation, migration, motility, and invasion of bladder cancer cells. c-Met is overexpressed in more than 60% of metastatic bladder cancer patients and is linked to poor outcome. Furthermore, in bladder cancer, c-Met is co-expressed with other RTKs, such as AXL and PDGFR. Some evidence suggests a relationship between c-Met and AXL expression with DNA damage response and resistance to chemotherapy. For example, Balaji et al have demonstrated that AXL inhibition leads to a defect in the HR pathway, sensitizing cells to PARP inhibition. In a recently published study, a significant interaction between c-Met and Poly [ADP-ribose] polymerase 1 (PARP1) was detected in breast cancer cell lines. c-Met activity can decrease response to PARP inhibitors, whereas treatment with c-Met inhibitors renders cells more sensitive to PARP inhibition. Likewise, in in vivo models with xenograft tumors, the combination of c-Met and PARP inhibitors showed a significant reduction in tumor growth compared to either inhibitor alone. This interaction can be explained because c-Met mediates PARP1 function through phosphorylation of PARP1 at Y907. These results raise the possibility that bladder cancer patients with tumors overexpressing c-Met can benefit from the combination of c-Met inhibitors and PARP inhibitors.

Cabozantinib is an oral, small-molecule tyrosine kinase inhibitor. Its primary targets are MET, VEGFR1-3, RET, AXL, FLT3 and KIT. Cabozantinib has been approved by the FDA for clinical treatment of progressive, metastatic medullary thyroid cancer. The recommended dose of cabozantinib has been established in phase I trials at 60 mg/day in 28-day cycles. Recently published trials have demonstrated activity for cabozantinib in patients with advanced renal cell carcinoma and metastatic castration-resistant prostate cancer (mCRPC). Furthermore, in preclinical models of UC of the bladder, cabozantinib has demonstrated the ability to inhibit tumor xenograft growth. It has been suggested that levels of soluble Met ectodomain (sMet) can be measured in the urine as a useful biomarker to monitor the efficacy of c-Met therapy in bladder cancer patients. Moreover, cabozantinib has demonstrated activity in heavily pretreated, advanced bladder cancer patients, with a response rate of 19.5% and manageable toxicities.

In the phase I of this study it is proposed to evaluate DLTs of niraparib and cabozantinib combination and determine MTD in patients with advanced urothelial or renal cell carcinoma. In the phase II it is proposed to make a preliminary evaluation of the efficacy of this combination in patients with urothelial cell carcinoma. Efficacy results will be correlated with genomic alterations related to c-Met and PARP inhibitor activity.

02

Conditions studied

  • Urothelial Cancer
03

In context

Lead sponsor

Fundacion CRIS de Investigación para Vencer el Cáncer is the lead sponsor of 7 studies on the registry; none are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

Phase I study:

  1. confirmed UC of the urinary tract or renal cell carcinoma
  2. Advanced or disease that is not amenable to curative surgery or radiation
  3. Patients must be willing to provide a tumor specimen prior to enrollment
  4. Previous therapy:

    i.Renal cell carcinoma: Prior tyrosine kinase inhibitor (TKI) and mechanistic target of rapamycin (mTOR) therapies is allowed ii.UC of the urinary tract: ≤2 previous chemotherapy regimens (including a platinum-based regimen)

  5. will not be required
  6. The remaining inclusion/exclusion criteria will be identical to the phase II study
  7. Recovery to at least grade I from toxicities related to prior treatment unless non or stable on supportive therapy

Phase II study:

  1. Age ≥18 years
  2. (ECOG) Performance Status (PS) ≤1
  3. Histologically confirmed UC of the bladder, urethra, ureter or renal pelvis (patients with mixed histologies will be allowed if urothelial is the predominant component).
  4. Patients must have formalin-fixed paraffin-embedded (FFPE) tumor samples available from the primary or recurrent cancer or agree to undergo fresh prior to study treatment initiation
  5. Advanced or metastatic disease that is not amenable to curative surgery or radiation
  6. Prior treatment with one prior cytotoxic regimen of platinum-based chemotherapy. If the only prior cytotoxic therapy was administered in perioperative (ie, or adjuvant) settings, the patient will be eligible provided the interval from end of therapy to the diagnosis of metastatic disease is less than one year.
  7. Confirmed progressive disease after treatment with platinum-based chemotherapy
  8. At least one measurable disease site that has not been previously irradiated
  9. No prior therapy with Poly(ADP-ribose) polymerase (PARP) or c-Met inhibitors.
  10. Prior anti programmed cell death protein 1 (PD1) and anti programmed death-ligand 1 () therapy is permitted
  11. Adequate bone marrow, liver and renal functions as assessed by the following:

    • ≥9 g/dL; ≥1500 cells/µL; ≥100,000 g/µL;
    • Total ≤1.5 times (ULN) (≤2.0 in patients with known Gilberts syndrome); (ALT) and aspartate aminotransferase (AST) ≤2.5 times ULN unless liver metastases are present, in which case they must be ≤5x ULN.
    • Serum creatinine ≤1.5x ULN or ≥30 mL/min using Cockcroft-Gault formula
    • Urine protein/creatinine ratio (UPCR) ≤1 mg/mg (113.2 mg/mmol) creatinine or 24-hr urine protein of \<1 g
  12. greater than 3 months
  13. Patients must be able to take oral medications
  14. Participant receiving may continue as long as their dose is stable for least 4 weeks prior to initiating protocol therapy.
  15. Participant must agree to not donate blood during the study or for 90 days after the last dose of study treatment.
  16. Female participant has a negative serum pregnancy test within 7 days prior to taking study treatment if of and agrees to abstain from activities that could result in pregnancy from screening through 180 days after the last dose of study treatment, or is of non-childbearing potential. Non-childbearing potential is defined as follows (by other than medical reasons):

    • ≥45 years of age and has not had menses for >1 year
    • Patients who have been amenorrhoeic for \<2 years without history of a hysterectomy and oophorectomy must have a follicle stimulating hormone value in the range upon screening evaluation a. Post-hysterectomy, post-bilateral oophorectomy, or post-tubal ligation. Documented hysterectomy or oophorectomy must be confirmed with medical records of the actual procedure or confirmed by an ultrasound. Tubal ligation must be confirmed with medical records of the actual procedure, otherwise the patient must be willing to use 2 adequate barrier methods throughout the study, starting with the screening visit through 180 days after the last dose of study treatment. Note: Abstinence is acceptable if this is the established and preferred for the patient.
  17. Participant must agree to not breastfeed during the study or for 180 days after the last dose of study treatment.
  18. Male participant agrees to use an adequate method of contraception starting with the first dose of study treatment through 180 days after the last dose of study treatment. Note: Abstinence is acceptable if this is the established and preferred contraception for the patient.
  19. Participant must be able to understand the study procedures and agree to participate in the study by providing written

Exclusion criteria

Exclusion Criteria:

  1. Participant must not be simultaneously enrolled in any interventional clinical trial
  2. Major surgery, open or significant traumatic injury within 8 weeks prior to study entry and complete wound healing at the inclusion
  3. Participant must not have received therapy ≤ 4 weeks, or within a time interval less than at least 5 half-lives of the investigational agent, whichever is shorter, prior initiating protocol therapy.
  4. Progressed while on platinum treatment or within 2 months from completion of platinum-containing regimen. Exclusion criteria applicable only to patients included in phase II.
  5. Radiation therapy for bone or within 4 weeks before first dose of study drug. Other external radiation within 4 weeks before first dose of study drug. Subjects with ongoing complications from prior radiation therapy are not eligible
  6. Participant must not have a known to niraparib or cabozantinib components or .
  7. Participant must not have received a transfusion ( or red blood cells) ≤ 4 weeks prior to initiating protocol therapy.
  8. Participant must not have received colony stimulating factors (eg, granulocyte colony-stimulating factor, granulocyte macrophage colony stimulating factor, or recombinant erythropoietin) within 4 weeks prior initiating protocol therapy.
  9. Participant has had any known Grade 3 or 4 anemia, neutropenia or thrombocytopenia due to prior chemotherapy that persisted > 4 weeks and was related to the most recent treatment.
  10. Known history of myelodysplastic syndrome (MDS) or a pre-treatment cytogenetic testing result at risk for a diagnosis of MDS/acute myeloid leukemia (AML)
  11. Unstable systemic disease or active uncontrolled infection
  12. Any concurrent active requiring treatment (other than basal or squamous cell carcinoma of the skin, carcinoma in situ of the cervix or malignancies curatively treated > 3 years prior to study entry)
  13. Known uncontrolled symptomatic brain or or cranial epidural disease; subjects with brain metastases previously treated and on stable dose of and/or anticonvulsants for >4 weeks, or not requiring such medications, are eligible. Baseline brain scans are not required to confirm eligibility.
  14. Uncontrolled hypertension
  15. Significant cardiovascular diseases, clinically relevant cardiac arrhythmia, unstable angina or myocardial infarction within 6 months prior to randomization, congestive heart failure > (NYHA) III, severe peripheral vascular disease, >470 msec ,clinically significant pericardial effusion
  16. Receiving concomitant medications that prolong corrected QT and is unable to discontinue use
  17. Concomitant treatment, in therapeutic doses, with anticoagulants such as warfarin or warfarin-related agents, heparin, thrombin or Factor Xa inhibitors, or antiplatelet agents (eg, clopidogrel). Low dose aspirin (≤ 100 mg/day), low-dose warfarin (≤ 1 mg/day), and prophylactic low molecular weight heparin (LMWH) are permitted
  18. (PT)/international normalized ratio (INR) or partial thromboplastin time (PTT) test ≥1.3 x within 7 days before the first dose of study treatment
  19. Significant thromboembolic or vascular disorders within 6 months prior to administration of study drugs, including:

    • Symptomatic pulmonary embolism
    • Cerebrovascular accident
    • Peripheral arterial ischemia > grade 2
    • Coronary or peripheral artery bypass graft
  20. The subject has experienced any of the following within 3 months before the first dose of study treatment:

    • clinically significant hematemesis or gastrointestinal bleeding
    • clinically significant hemoptysis
  21. Any malabsorption problem that, in the investigator's opinion, would prevent adequate absorption of the study drug
  22. Patient has not recovered to baseline or ≤ Grade 1 from toxicity due to all prior therapies except alopecia and other non-clinically significant Adverse Events
  23. History of organ transplant
  24. Concurrent uncompensated hypothyroidism or thyroid dysfunction within 7 days before the first dose of study treatment
  25. Active infection requiring systemic treatment within 28 days before the first dose of study treatment
  26. Serious non-healing wound/ulcer/bone fracture within 28 days before the first dose of study treatment
  27. Gastrointestinal disorders particularly those associated with a high risk of perforation or fistula formation including:

    • Any of the following within 28 days before the first dose of study treatment: intra-abdominal tumor/ invading gastrointestinal mucosa, active peptic ulcer disease,inflammatory bowel disease (including ulcerative colitis and Crohn's disease), diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis
    • Any of the following within 6 months before the first dose of study treatment: History of abdominal fistula, gastrointestinal perforation, bowel obstruction or gastric outlet obstruction or intra-abdominal abscess
  28. Chronic concomitant treatment of strong cytochrome P450, family 3, subfamily A, polypeptide 4 () inducers (e.g., dexamethasone, phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital, and St. John's Wort)
Terms in these criteria, in plain language(32)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Histologically or cytologically confirmed

The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).

Your pathology report is the document that shows this.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Measurable disease

The amount of disease can be tracked with a defined measurement, so the study can see whether it shrinks or grows. It might be a tumour measured on a scan or, in some blood cancers such as myeloma, a marker measured in blood or urine.

The criteria or the study team say which measurement counts — having no tumour visible on a scan does not by itself rule you out.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

Adjuvant and neoadjuvant

Neoadjuvant treatment is given before the main treatment (usually surgery), often to shrink a tumour. Adjuvant treatment is given after it, to lower the chance of the cancer coming back.

PD-1, PD-L1 and checkpoint inhibitors

PD-1, PD-L1 and CTLA-4 are proteins that act as brakes on the immune system. Checkpoint inhibitors, such as pembrolizumab or nivolumab, block them so the immune system can attack a cancer.

PD-L1 can also be measured in a tumour sample. Some scores count stained tumour cells only (TPS); others also count certain immune cells (CPS). The study names the score and the minimum it uses.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

Life expectancy

The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Postmenopausal

Periods have stopped for good: usually no period for 12 months in a row without another medical reason, sometimes confirmed by a blood test (FSH).

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Brain metastases

Cancer deposits in the brain from a cancer that started elsewhere in the body (CNS metastases include the spinal cord).

Studies differ: some leave out any brain metastases, some accept ones treated and stable for some weeks. Check what this study allows.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Excipients

The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Leptomeningeal disease

Cancer that has spread to the leptomeninges, the thin layers covering the brain and spinal cord, and the fluid between them. It is not the same as brain metastases.

Criteria often treat it separately, and many studies leave it out even where treated brain metastases are allowed.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

QT and QTc

On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.

The study may name a correction formula and a limit in milliseconds, often around 450–480.

INR, PT and aPTT (clotting tests)

Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.

Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.

CTCAE grade

The US National Cancer Institute’s scale of how severe an adverse event is — any unwanted medical event during a study, such as a symptom, an illness or an abnormal test result, whether or not a treatment caused it. Whether it did is judged separately.

1
Mild.
2
Moderate.
3
Severe.
4
Life-threatening.
5
Death due to the event.

“Side effects of earlier treatment resolved to grade 1 or less” means they have settled to mild or gone.

CYP3A (CYP3A4) inhibitors and inducers

CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.

Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.

05

Study design

Phase
Phase 1 / Phase 2
Primary purpose
Other
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
67 participants (actual)

Study arms

  • Experimental
    Niraparib plus Cabozantinib

    Patients will receive niraparib and cabozantinib p.o. once daily in 28-day cycles. In phase I, patients will be accrued to each dose level in cohorts of 6 patients. Escalation will continue until a dose-limiting toxicity (DLT) is observed or the highest dose-level is reached. In phase II study patients will receive niraparib p.o. once daily and cabozantinib p.o. once daily in 28-day cycles at doses recommended in the phase I study. If niraparib or cabozantinib need to be interrupted due to toxicity, patient can continue only with the other drug.

    Drug: Niraparib plus Cabozantinib

Interventions

  • DrugNiraparib plus Cabozantinib

    Drug pages: Niraparib · Cabozantinib

    Non-randomized trial will comprise 2 stages. A dose escalation phase will characterize the safety, tolerability, DLTs and MTD, of oral niraparib plus cabozantinib in patients with urothelial or renal cell carcinoma. Subsequently, the phase II will further evaluate the safety and antitumor activity of this combination in patients with urothelial carcinoma.

06

What researchers measure

Primary outcomes

  1. Phase I: maximum tolerated dose

    Highest dose at which ≤1 out of 6 patients experience a DLT

    Time frame: up to 1 month

  2. Phase II: progression free survival

    Time from the date of first dose of study treatment to the date of progression or death (from any cause).

    Time frame: Up to 6 months

Secondary outcomes

  1. Incidence of Treatment-Emergent Adverse Events

    Number of events per patient

    Time frame: Up to 6 months

  2. Phase II: Objective Response Rate

    Response according to RECIST 1.1 criteria

    Time frame: Up to 6 months

  3. Phase II: Disease Control Rate

    Response according to RECIST 1.1 criteria

    Time frame: Up to 6 months

  4. Phase II: Duration of response

    Time from the date of response is achieved until documented tumor progression

    Time frame: Up to 6 months

  5. Phase II: Overall Survival

    Time from the date of first dose of study treatment to the date of death due to any cause

    Time frame: Up to 6 months

Other outcomes

  1. Correlation of the activity of niraparib plus cabozantinib with the molecular profile of the tumor

    Immunohistochemistry and RNA analysis of pre- and post-tumor samples

    Time frame: Up to 6 months

07

Study locations

10 sites
  • Xarxa Assistencial Universitària de Manresa
    Barcelona, Cataluña, Spain
  • ICO Badalona
    Badalona, Spain
  • Hospital Clinic
    Barcelona, Spain
  • ICO Girona
    Girona, Spain
  • ICO L'Hospitalet
    L'Hospitalet De Llobregat, Spain
  • Hospital 12 de Octubre
    Madrid, Spain
  • Hospital Madrid Norte Sanchinarro
    Madrid, Spain
  • Hospital Ramon y Cajal
    Madrid, Spain
  • Hospital Marques de Valdecilla
    Santander, Spain
  • Instituto Valenciano de Oncología
    Valencia, Spain
08

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Ran from Oct 2019 to primary completion in Jul 2024, 57 months.

How these figures are worked out, and which studies are left out of them.

Registered
Feb 1, 2018
First posted
Feb 7, 2018
StartActual
Oct 14, 2019
Primary completionActual
Jul 31, 2024
CompletionActual
Jul 31, 2024
Last update
Dec 31, 2024
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Dec 31, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03425201
Lead sponsor
Fundacion CRIS de Investigación para Vencer el Cáncer
Collaborators
Ipsen, GlaxoSmithKline, Apices Soluciones S.L.
Responsible party
Sponsor
First posted
Feb 7, 2018
Start date
Oct 14, 2019
Primary completion
Jul 31, 2024
Completion
Jul 31, 2024
Last update
Dec 31, 2024

Study contacts

Albert Font, MD
principal investigator · ICO Badalona-Hospital Germans Trias i Pujol
Daniel Castellano, MD
principal investigator · Hospital 12 de Octubre

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Dec 2024. You cannot join it, but the record below documents what was studied.

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Discussion

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Studies of the drugs tested here: Niraparib · Cabozantinib

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