Prostate Cancer Clinical Trial
Official title:
A Phase II Multicenter Study of AMG 386 and Abiraterone in Metastatic Castration Resistant Prostate Cancer
Verified date | February 2019 |
Source | National Institutes of Health Clinical Center (CC) |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Background:
- Advanced prostate cancer is treated with surgery or drugs that lower the levels of
androgens (male hormones) in the body. However, some cancers become resistant to this
treatment. These types of cancers are known as castration-resistant prostate cancers.
- Interfering with the growth of blood vessels that feed tumors can slow prostate cancer
growth. Trebananib (AMG 386), a new anticancer drug, targets the blood vessels that feed
tumors. It has been tested for different types of cancer, but not for prostate cancer.
Researchers want to see if AMG 386 can slow disease progression in men with
castration-resistant prostate cancer. AMG 386 will be given with abiraterone and
prednisone, two drugs that are also used to treat advanced prostate cancer.
Objectives:
- To test the safety and effectiveness of AMG 386 with abiraterone for castration-resistant
prostate cancer.
Eligibility:
- Men at least 18 years of age with castration-resistant prostate cancer.
Design:
- Participants will be screened with a physical exam, medical history, and imaging
studies. Blood and urine samples will also be collected.
- Participants will be separated into two groups.
- The first group will have AMG 386 once per week for a total of four doses during a
28-day cycle. They will also take abiraterone once a day and prednisone twice a day,
every day of the cycle.
- The second group will not have AMG 386. They will take abiraterone once a day and
prednisone twice a day, every day of the 28-day cycle.
- Treatment will be monitored with frequent blood tests and imaging studies.
- Participants will continue to take the study drugs as long as the disease does not
progress and there are no severe side effects.
Status | Completed |
Enrollment | 36 |
Est. completion date | July 1, 2018 |
Est. primary completion date | April 20, 2017 |
Accepts healthy volunteers | No |
Gender | Male |
Age group | 18 Years to 100 Years |
Eligibility |
- INCLUSION CRITERIA: - Must have metastatic, progressive, castrate-resistant prostate cancer (CRPC) with radiographic evidence of disease that has continued to progress radiographically or biochemically (rising prostatic specific antigen (PSA) levels on successive measurements) despite adequate androgen-deprivation therapy. If patients had been on flutamide, disease progression is documented 4 weeks or more after withdrawal. For patients on bicalutamide or nilutamide disease progression is documented 6 or more weeks after withdrawal. Flutamide, nilutamide and bicalutamide disease progression requirements only apply to patients who have been on these drugs for at least the prior 6 months. - Histopathological confirmation of prostate cancer by the Laboratory of Pathology of the National Cancer Institute (NCI) or Walter Reed National Military Medical Center prior to entering this study. Patients enrolled at participating sites may have histopathological confirmation at the enrolling center prior to entering the study. Patients whose pathology specimens are no longer available may be enrolled if the patient has a clinical course that is consistent with prostate cancer and available documentation from an outside pathology laboratory of the diagnosis. All efforts should be made to have the material forwarded to the research team for use in correlative studies in cases where original tissue blocks or archival biopsy material is available. - Patients must have metastatic disease, defined as at least one lesion on bone scan or at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as >20 mm with conventional techniques or as >10 mm with spiral computed tomography (CT) scan, magnetic resonance imaging (MRI), or calipers by clinical exam. - Patients participating in the study must have Metastatic Castration-Resistant Prostate Cancer (mCRPC). - Patients who have received docetaxel plus androgen deprivation therapy (ADT) for metastatic castrate sensitive prostate cancer are eligible for the study. (Patients may enroll as long as they did not have progressive disease while on docetaxel and are 6 months removed from treatment, with all treatment related toxicities resolving to at least grade 1.) - Patients may not have had more than 7 days of treatment with ketoconazole by mouth in the past 6 months. - Males greater than or equal to 18 years of age. Because no dosing or adverse event data are currently available on the use AMG 386 in combination with abiraterone in patients <18 years of age, children are excluded from this study, but will be eligible for future pediatric trials. - Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 2 for run-in phase; ECOG less than or equal to 1 for randomized phase. - Life expectancy of > 3 months for the run in phase and > 6 months for the randomized phase. - Adequate bone marrow, hepatic, and renal function with: - Leukocytes greater than or equal to 3000/mu L - Absolute neutrophil count (ANC) greater than or equal to 1500/mu L - Platelets greater than or equal to 100000/mu L - Total bilirubin less than or equal to 1.5 times institutional upper limits of normal - Aspartate aminotransferase (AST) serum glutamic oxaloacetic transaminase(SGOT)/alanine aminotransferase (ALT) serum glutamic pyruvic transaminase(SGPT) less than or equal to 2.5 times institutional upper limits of normal - Partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) less than or equal to 1.5 times upper limits of normal (ULN) per institutional laboratory range and international normalized ratio (INR) less than or equal to 5 - Creatinine less than or equal to 1.5 times institutional upper limits of normal OR - Creatinine clearance of >40 mL/min per 24 h urine collection or calculated according to the Cockcroft-Gault formula ---Creatinine clearance (CrCl) (mL/min) = (((140-age) times actual body weight (kg))/(72 x serum creatinine (mg/dL)))*(x 0.85 for females) - Urinary protein less than or equal to 30 mg/dL in urinalysis or less than or equal to1+ on dipstick, unless quantitative protein is <1000 mg in a 24h urine sample - Generally well-controlled blood pressure with systolic blood pressure less than or equal to 140 mmHg AND diastolic blood pressure less than or equal to 90 mmHg prior to enrollment. The use of antihypertensive medications to control hypertension is permitted. - Must have recovered from any acute toxicity related to prior therapy, including surgery. Toxicity should be less than or equal to grade 1 Common Terminology Criteria in Adverse Events (CTCAE) version 4 or has returned to baseline. Alopecia >grade 1 is permitted. - The effects of AMG 386 on the developing human fetus are unknown. For this reason and because inhibitors of angiogenesis as well as other therapeutic agents used in this trial are known to be teratogenic, men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must agree to use adequate contraception prior to the study, for the duration of study participation, and 6 months after completion of AMG 386 administration. -Must have the ability to understand and the willingness to sign a written informed consent document. EXCLUSION CRITERIA: - Patients who have had chemotherapy for metastatic castration-resistant prostate cancer. - History or presence of known central nervous system metastases. - History of venous or arterial thromboembolism within 12 months prior to enrollment/randomization. - History of clinically significant bleeding within 6 months of enrollment/randomization. - Currently or previously treated with AMG 386, or other molecules that primarily inhibit the angiopoietins or Tie2 receptor. - Clinically significant cardiovascular disease within 12 months prior to enrollment/randomization, including myocardial infarction, unstable angina, grade 2 or greater peripheral vascular disease, cerebrovascular accident, transient ischemic attack, congestive heart failure, or arrhythmias not controlled by outpatient medication or placement of percutaneous transluminal coronary angioplasty/stent. - Major surgery within 28 days prior to enrollment or still recovering from prior surgery. - Minor surgical procedures, placement of tunneled central venous access device within 3 days prior to randomization/enrollment. - Treatment within 30 days prior to enrollment with the following: cyclosporine, tacrolimus, sirolimus, mycophenolate mofetil, methotrexate, azathioprine, rapamycin, and targeted immune modulators such as abatacept (CTLA-4-Ig), adalimumab, alefacept, anakinra, belatacept (LEA29Y), efalizumab, etanercept, infliximab, or rituximab. - Patients who have had large field radiotherapy must wait 2 weeks prior to entering the study. - Non-healing wound, ulcer (including gastrointestinal), or fracture. - Contraindication to steroid use or history of allergic reactions attributable to the study compounds. - History of allergic reactions to bacterially-produced proteins. - Previously diagnosed with another malignancy, within the past two years with the exception of non-melanoma skin cancers or non-invasive bladder cancer. - Patients who have not yet completed at least 28 days (30 days for prior monoclonal antibody therapy) since receiving other investigational drugs. - Inability to absorb abiraterone after oral administration (i.e., previous major gastrointestinal surgery or gastrointestinal disease resulting in malabsorption). - Use of ketoconazole, itraconazole, ritonavir, cyclosporine, carbamazepine, phenytoin, phenobarbital within 2 weeks prior to and while on study therapy. - Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with the study agents. In addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated. - Uncontrolled intercurrent illness or infections, unstable angina pectoris, cardiac arrythmias, renal dysfunction, or psychiatric illness/social situations that would limit compliance with study requirements. - Have had treatment with docetaxel for the treatment of metastatic castrate-sensitive prostate cancer within 6 months before the first dose of study enrollment. - Have had progression of prostate cancer on prior docetaxel treatment for castrate sensitive disease. |
Country | Name | City | State |
---|---|---|---|
United States | National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda | Maryland |
United States | Fox Chase Cancer Center | Philadelphia | Pennsylvania |
Lead Sponsor | Collaborator |
---|---|
National Cancer Institute (NCI) |
United States,
Berthold DR, Sternberg CN, Tannock IF. Management of advanced prostate cancer after first-line chemotherapy. J Clin Oncol. 2005 Nov 10;23(32):8247-52. Review. — View Citation
Goktas S, Crawford ED. Optimal hormonal therapy for advanced prostatic carcinoma. Semin Oncol. 1999 Apr;26(2):162-73. Review. — View Citation
Gulley J, Dahut WL. Chemotherapy for prostate cancer: finally an advance! Am J Ther. 2004 Jul-Aug;11(4):288-94. Review. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Maximum Tolerated Dose (MTD) | The MTD is defined as the highest dose studied for which the incidence of dose limiting toxicity was less than 33%. | First 28 days of treatment | |
Other | Dose Limiting Toxicity (DLT) | DLTs are defined as any grade 3 or higher hematologic (excluding anemia) or non-hematologic toxicity considered to be possible related to AMG 386. Any treatment related adverse events that lead tor reduction of dose exposure of either agent (duration or dose) by >50% in cycle 1 will be considered a DLT. | First 28 days of treatment | |
Primary | Progression Free Survival (PFS) | PFS is defined as the duration of time from start of treatment to time of progression or death, whichever comes first. Clinical progression is assessed by the Response Criteria in Solid Tumors (RECIST) and is at least a 20% increase in the sum of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progressions). | Median potential follow-up of 50.3 months | |
Secondary | Radiographic Progression Free Survival | Radiographic progression free survival is defined as the duration of time from start of treatment to time of radiographic progression by computed tomography (CT) scan (or magnetic resonance imaging (MRI)) or bone scan. Progression is a minimum of two new lesions observed on bone scan. The minimum size for a measurable lesion on CY and MRI should be twice the slice thickness based on the assumption that CT slice thickness is 500 or less. | Median potential follow-up of 50.3 months | |
Secondary | Overall Survival | Overall Survival is the time between the first day of treatment to the day of death. | Time between the first day of treatment to the day of death, approximately 50.3 months. | |
Secondary | Count of Participants With Serious and Non-serious Adverse Events | Here is the count of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned. | Date treatment consent signed to date off study, approximately 65 months and 7 days |
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