Inclusion Criteria:
1. Age ≥ 18 years old. 2. Participant must have brain metastasis and either. 1. Advanced BRCA1/2m cancer 2. Advanced HRR-aberrant, non-BRCA1/2m cancer 3. Advanced small
cell lung cancer 4. Advanced non-small cell lung cancer 5. Advanced Triple Negative Breast
Cancer 3. In cohorts 1 and 2, subjects will be eligible for this study based on the
presence of actionable aberrations in one or more of the following HRR genes: BRCA1/2, ATM;
BRIP1; CDK12; CHEK1; CHEK2; FANCL; PALB2; RAD51; RAD51B; RAD51C; RAD51D; RAD52; RAD54L, or
other related genes at the discretion of the principal investigator in consultation with
the MD Anderson Cancer Center Institute for Personalized Cancer Therapy Precision Oncology
Decision Support (PODS) group. Variant interpretation for actionability will be performed
by PODS.
4. Any prior SRS to brain lesions or prior excision must have occurred ≥1 week before the
start of dosing for this study. Lesions situated in a previously irradiated area are
considered measurable if progression has been demonstrated in such lesions.
5. Patients must have had at least one prior line of systemic therapy directed at their
malignancy.
6. Participant must have an Eastern Cooperative Oncology Group (ECOG) performance status of
≤ 2.
7. Adequate organ function as described below: (Note: CBC test should be obtained without
transfusion or receipt of colony-stimulating factors in the 2 weeks before obtaining).
Hematological • Absolute neutrophil count (ANC) ≥1,500 /mcL. • Platelets ≥ 100,000 / mcL. • Hemoglobin ≥ 9.0 g/dL. • Serum creatinine ≤1.5xULN OR Measured or calculated creatinine clearance ≥50 mL/min for
participants.
Hepatic.
- - Serum total bilirubin ≤1.5xULN OR Direct bilirubin ≤1 x ULN for subjects with total
bilirubin levels ≥1.5xULN ) (if associated with liver metastases or Gilbert's disease,
≤2.5 x ULN)
- Aspartate transaminase (AST) and alanine transaminase (ALT) ≤2.5 x ULN (if associated
with liver metastases, ≤5 x ULN) Coagulation.
- - International Normalized Ratio (INR) or Prothrombin Time (PT) and Activated Partial
Thromboplastin Time (aPTT) ≤1.5xULN, unless subject is receiving anticoagulant
therapy.
8. Participant must have at least one measurable brain metastasis (tumor diameter of
0.5-3 cm by mRECIST on magnetic resonance imaging [MRI]) for which all of the
following criteria have to be met: asymptomatic (no neurologic signs or symptoms),
unirradiated, not requiring immediate local intervention (surgery or radiosurgery),
and not requiring systemic glucocorticoid therapy within 10 days prior to study
treatment initiation. Patient may have other metastatic lesions which can have had
irradiation.
9. Patients must have archival systemic tumor tissue available at screening. Patients
who do not have tissue specimens available may undergo a biopsy during the screening
period. Acceptable samples include core-needle biopsies for deep systemic tumor tissue
or excisional, incisional, punch, or forceps biopsies for cutaneous, subcutaneous, or
mucosal lesions. Representative formalin-fixed paraffin-embedded (FFPE) tumor
specimens in paraffin blocks (blocks are preferred) OR at least 4 unstained slides,
with an associated pathology report, for testing of tumor PD-L1 expression. Tumor
tissue should be of good quality based on total and viable tumor content.
10. Female participant has a negative serum pregnancy test within 3 days prior to
taking study treatment if of childbearing potential and agrees use a highly effective
method of contraception (< 1% failure rate with low user dependency) from screening
through 180 days after the last dose of study treatment or is of nonchildbearing
potential. Nonchildbearing potential is defined as follows (by other than medical
reasons):
- - Patients who are ≥45 years of age and who have not had menses for >1 year or have been
amenorrhoeic for <2 years without history of a hysterectomy and oophorectomy must have
a follicle stimulating hormone value in the postmenopausal range upon screening
evaluation.
- - 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 an
adequate barrier method throughout the study, starting with the screening visit
through 180 days after the last dose of study treatment. See Section 4.4 for a list of
acceptable birth control methods. Information must be captured appropriately within
the site's source documents. Note: Abstinence is acceptable if this is the established
and preferred contraception for the patient.
- - Participant must agree to not breastfeed during the study or for 180 days after the
last dose of study treatment.
11. Male participants are eligible to participate if they agree to the following
during the treatment period and for at least 180 days after the last dose of study
treatment:
- - Refrain from donating sperm plus, either:
- Be abstinent from sexual activity as their preferred and usual lifestyle (abstinent on
a long-term and persistent basis) and agree to remain abstinent or.
- - Must agree to use a male condom (and should also be advised of the benefit for a
female partner to use a highly effective method of contraception as a condom may break
or leak) 12.
Participant must have signed and dated an IRB/IEC approved written
informed consent form in accordance with regulatory and institutional guidelines. This
must be obtained before the performance of any protocol related procedures that are
not part of normal subject care. Hence, participants must have the ability to
understand and the willingness to sign the approved written informed consent document.
13. Participant must be willing and able to comply with scheduled visits, treatment
schedule, laboratory testing, and other requirements of the study.
Exclusion Criteria:
1. Participant must not be simultaneously receiving interventional anticancer treatment.
2. Participant must not have contraindications to MRI (implanted metal device or foreign
bodies) or MRI contrast (insufficient renal function or allergy).
3. A history of / or suffers from claustrophobia or subject feels unable to lie flat and
still on their back for the required period of time in an MRI or PET/CT scanner.
4. Participant must not have symptomatic or untreated spinal cord compression.
5. Participant must not have evidence of leptomeningeal disease.
6. Participant must not have previously received a combination of PARP inhibitor and
PD-1/L1inhibitor. Participant must not have previously received equivalent of full
dose single agent PARPi. Prior therapy with PD-1/L1-inhibitor is permitted.
7. For participants choosing optional CSF collection via lumbar puncture: no medical
contraindication to lumbar puncture may be present (including severe coagulopathy,
radiographic concern for impending herniation or obstructive hydrocephalus, or soft
tissue infection at puncture site, as outlined in MD Anderson institutional policy).
LP may be deferred if at any time the treating physician determines that it would be
unsafe to perform this procedure due to the characteristics of the brain metastases
(eg. size, associated edema, etc).
8. Participant must not have had major surgery ≤ 3 weeks prior to initiating protocol
therapy and participant must have recovered from any surgical effects.
9. Participant must not have received systemic anticancer therapy ≤2 weeks prior to
initiating protocol therapy.
10. Previous systemic radiation therapy encompassing >20% of the bone marrow (but not
encompassing the CNS) within 2 weeks. 11. Previous stereotactic or highly conformal radiotherapy within 1 week before the start
of dosing for this study, whole brain radiotherapy within 2 weeks.
12. Participant must not have a known hypersensitivity to niraparib and dostarlimab
components or excipients.
13. Participants with an inactive, known or suspected autoimmune disease. Subjects with
type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin
disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment,
or conditions not expected to recur in the absence of an external trigger are
permitted to enroll.
14. Participant must not have a history of interstitial lung disease.
15. Participants with a major medical, neurologic or psychiatric condition who are judged
as unable to fully comply with study therapy or assessments should not be enrolled.
16. Participant has a history of a second malignancy, unless potentially curative
treatment has been completed with no evidence of malignancy for 2 years.
17. Patients with prostate cancer are excluded from this trial.
18. Participant has a known history of active hepatitis B or hepatitis C. Prior treated
hepatitis B or C with undetectable viral load may be enrolled.
19. Participants who have a known history of HIV positive and are on effective
anti-retroviral therapy with documented undetectable viral load and CD4 count ≥350
within 6 months of the first dose of study treatment are eligible.
20. Participants unable to undergo contrast enhanced brain MRI.
21. Participants unable to swallow pills or have significant gastrointestinal disease
which would preclude the adequate oral absorption of medications.
22. Patients who have received live vaccines within 30 days of study entrance.
23. Patients with uncontrolled high blood pressure (HTN >140/90).
24. Patients with prior diagnosis of MDS or AML.
