A Study to Evaluate the Safety, Tolerability and Efficacy of a Liproca® Depot Injection in Patients With Prostate Cancer

Prostate Cancer Clinical Trial

Official title:

A Single Blind, Two-Stage Dose Finding Study to Evaluate the Safety, Tolerability and Efficacy of a Single Liproca® Depot Injection Into the Prostate in Patients With Localized Prostate Cancer, Assigned to Active Surveillance Who Are at High Risk for Disease Progression (Followed by an Open Label Extension With a Repeat Injection (Optional)).

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03348527
• Other study ID #: LPC-004
• Status: Completed
• Phase: Phase 2
• Start date: May 12, 2017
• Est. completion date: November 30, 2020

Study information

• Verified date: December 2020
• Source: Lidds AB
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A Single Blind, Two-Stage Dose Finding Study to Evaluate the Safety, Tolerability and Efficacy of a Single Liproca® Depot Injection into the Prostate in Patients with Localized Prostate Cancer,Assigned to Active Surveillance who are at High Risk for Disease Progression (followed by an Open Label Extension with a Repeat Injection (Optional))

Description:

Patients assigned to Active Surveillance and who have fulfilled all inclusion criteria will receive a prophylactic antibiotic and a local anaesthetic (according to the Investigator's Standard of Care) prior to administration of Liproca® Depot. 60 subjects will be enrolled. The Single Dose Study will be conducted in two stages: In Stage I, 20 subjects will be randomized into two groups to receive one dose of Liproca® Depot equal to 35% (Cohort 1) or 45 % (Cohort 2) of their prostate volume (mL) (N=10:10). Two weeks after all subjects have received their initial dose, the Data Safety Monitoring Board (DSMB) will review the subjects' safety and tolerability data over the first 14 days after receiving treatment. In Stage II, 40 subjects will be randomized to receive either 16mL (Cohort 3) or 20mL (Cohort 4) of Liproca® Depot. All subjects in Stage I and Stage II will be followed for 24 weeks. Subjects who complete the Single Dose Study and who experience no safety or tolerability issues, as determined by the Investigator, may be offered an option to participate in the Open Label Extension Study (OLE). Subjects enrolled in the OLE will be observed for PSA recurrence every 8 weeks. If PSA recurrence is confirmed (defined as a PSA level exceeding at least 100 % of Baseline value) subjects will receive a second treatment of Liproca® Depot. The dose will be injected into the tumour focus/foci and in close proximity to the tumour, based on a prostate biopsy (and MRI, if applicable), using a TRUS for guidance. Stage I subjects who received 35% volume of Liproca® Depot will receive 16 mL and subjects who received 45% volume of Liproca® Depot will receive 20 mL. Stage II subjects will receive the same dose of Liproca® Depot that was administered in the first treatment. Subjects in the OLE receiving a second injection will be followed up for an additional 24 weeks for safety, tolerability and efficacy. After this period, subjects may undergo MRI imaging and a prostate biopsy.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 61
• Est. completion date: November 30, 2020
• Est. primary completion date: October 30, 2020
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Signed informed consent prior to any study specific procedures being performed
• 18 - 80 years of age, inclusive
• Assigned to Active Surveillance
• Histologically confirmed, localized prostate cancer within 24 months of Screening
• Gleason score 3+3 or 3+4 with one or more of the following characteristics:

PSA > 6.0 µg/L (ng/mL) and PSA density > 0.15; PSA > 10.0 µg/L and < 20 µg/L (ng/mL); Any systematic core > 50% involvement; Any PI-RADS score 4 or 5 on MRI; Any Gleason grade 4, Men of African descent

• Patient has a negative bone scan within the last 12 months
• Patient is able to have an MRI
• Prostate volume = 80 mL (measured by MRI within 12 months of Screening or has been scheduled for an MRI prior to Screening)
• eGFR = 30 mL/min, using the Cockcroft - Gault Equation: = [{(140 - age in years) x (weight in kg)} x 1.23] / serum Creatinine in micromol/l
• AST, ALT and ALP = 1.5 times upper limit of normal
• Patient must be willing to comply with all study procedures
• Patients must agree to the use of medically acceptable methods of contraception, including non-hormonal intrauterine device (IUD) or double barrier method (condom with foam or vaginal spermicidal suppository, diaphragm with spermicide) for the duration of the study (24 weeks), unless the patient and/or their partner has been surgically sterilized

Exclusion Criteria:

• PSA > 20 µg/L (ng/mL)
• Previous or ongoing hormonal therapy for prostate cancer
• Positive urine culture before treatment with prophylactic antibiotics
• Ongoing or previous therapy with finasteride or dutasteride in the last 3 months
• Ongoing or previous invasive therapy for benign prostate hyperplasia (BPH) (e.g. TURP,TUMT, HIFU, etc.)
• Use of pacemaker or other implanted electronic devices
• Metal implant in the pelvis (e.g. hip replacement) that may affect the MRI of the prostate
• Allergy to Liproca® Depot and its ingredients
• Severe micturition symptoms (I-PSS >15 or residual urine volume > 150 mL) confirmed by repeat measurement or Qmax< 12 mL/s
• Ongoing therapy with the anticoagulant Acetyl Salicylic Acid (ASA) (more than 100mg/day) as preventive anti-thrombotic therapy should be withdrawn temporarily before treatment with Liproca® Depot, as determined by the Investigator. Other anticoagulants should be withdrawn in cooperation with the treating physician
• Use of any previous focal prostate cancer treatment, such as transurethral resection, cryotherapy, high intensity frequency ultrasound (HIFU) and/or photodynamic therapy
• Concomitant systemic treatment with corticosteroids or immune modulating agents
• Known immunosuppressive disease (e.g. HIV, Type II Diabetes). Patients with well controlled Type II Diabetes may be included, as determined by Investigator
• Simultaneous participation in any other study involving an investigational product or device,or having participated in a prostate cancer study within the last 12 months prior to starting treatment with Liproca® Depot
• Infection in WHO Risk Group 2, 3 or 4

Related Conditions & MeSH terms

• Prostate Cancer
• Prostatic Neoplasms

Intervention

Drug:
• 2-Hydroxyflutamide Depot
Liproca® Depot is a depot formulation containing a bioresorbable, controlled-release,formulation of the nonsteroidal antiandrogen 2-hydroxyflutamide

Locations

Country	Name	City	State
Canada	Jonathan Giddens Medicine Professional Corporation	Brampton	Ontario
Canada	G. Kenneth Jansz Medicine Professional Corporation	Burlington	Ontario
Canada	Nova Scotia Health Authority	Halifax	Nova Scotia
Canada	The Fe/Male Health Centres	Oakville	Ontario
Canada	CIUSSS de l'Estrie - CHUS	Sherbrooke	Quebec
Canada	Sunnybrook Health Sciences Centre	Toronto	Ontario
Finland	Helsinki University Hospital	Helsinki
Finland	Tampere University Hospital	Tampere
Lithuania	Hospital of Lithuanian University of Health Sciences	Kaunas
Lithuania	National Cancer Institute - Oncourology Department	Vilnius

Sponsors (2)

Lead Sponsor	Collaborator
Lidds AB	CMX Research

Countries where clinical trial is conducted

Canada,  Finland,  Lithuania, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Highest Tolerable Dose of Liproca Depot	To define the highest tolerable dose of Liproca Depot for transrectal injection into the prostate.	24 weeks
Secondary	Liproca Depot Effect on Prostate Specific Antigen Levels	To determine the absolute level and % decrease of PSA level at Week 8, 16, 20 and 24, and PSA nadir.	24 weeks
Secondary	Liproca Depot Effect on Prostate Volume	To determine the effect on prostate volume at Week 20 after treatment with one of four doses of Liproca Depot based on an MRI evaluation. Measured by %decrease versus Baseline and as absolute values.	20 weeks
Secondary	Evaluation of Lesions	MRI evaluation of Lesions based on PI-RADS (Prostate Imaging Reporting and Data System) score 20 weeks after treatment with one of four doses of Liproca Depot.	20 weeks
Secondary	Quality of Life (QoL) Questionnaire Score	Assessment of QoL Questionnaire scores at Baseline, Week 8,16,20 and 24 after treatment with one of four doses of Liproca Depot.	24 weeks
Secondary	Micturition Status using the International Prostate Symptom Score (I-PSS)	Micturition status will be assessed using the I-PSS Questionnaire at Week 8, 20 and 24 after treatment with one of four doses of Liproca Depot.	24 weeks
Secondary	Frequency of Adverse Events	All adverse events related to Liproca Depot or its administration, incidence of AEs, withdrawals due to AEs and all Serious Adverse Events (SAEs) will be assessed. All adverse events will be reported and followed until resolved or until, in the Investigator's opinion, the condition has become stable and is unlikely to change further.	24 weeks
Secondary	Change in Testosterone Levels	Testosterone levels (nmol/L) will be assessed at Baseline, Week 8 and 24 after treatment with one of four doses of Liproca Depot.	24 weeks
Secondary	Systematic Exposure of 2-hydroxyflutamide	To examine the systematic exposure of 2-hydroxyflutamide at Baseline, Hour 2, Day 2,4,7 and 14, week 8 and end of study for all subjects in Phase I and a subset of 12 subjects in Stage II.	24 weeks
Secondary	Pharmacokinetics of 2-hydroxyflutamide	To examine the pharmacokinetics of 2-hydroxyflutamide at Baseline, Hour 2, Day 2,4,7 and 14, week 8 and end of study for all subjects in Phase I and a subset of 12 subjects in Stage II.	24 weeks