Prostate Cancer
Conditions
Keywords
adenocarcinoma of the prostate, recurrent prostate cancer, stage IV prostate cancer
Brief summary
RATIONALE: Giving low doses of chemotherapy, such as fludarabine, and radiation therapy before a donor stem cell transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune system and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil after transplant may stop this from happening. PURPOSE: This phase II trial is studying how well giving fludarabine together with total-body irradiation works in treating patients who are undergoing a donor stem cell transplant for progressive metastatic prostate cancer that has not responded to previous hormone therapy.
Detailed description
OBJECTIVES: * Determine the treatment-related mortality in patients with hormone-refractory, progressive metastatic prostate cancer treated with nonmyeloablative conditioning comprising fludarabine and total-body irradiation followed by allogeneic hematopoietic stem cell transplantation. OUTLINE: * Nonmyeloablative conditioning regimen: Patients receive fludarabine IV on days -4 to -2 and total-body irradiation (TBI) on day 0. * Allogeneic hematopoietic stem cell transplantation (AHSCT): After TBI, patients undergo AHSCT on day 0. * Immunosuppression: Patients receive oral cyclosporine twice daily on days -3 to 56 followed by a taper until day 81. Patients also receive oral mycophenolate mofetil twice daily on days 0-27 (if patient has a related donor) OR three times daily on days 0-29 and then twice daily on days 30-149 followed by additional tapering until day 180 (if patient has an unrelated donor). PROJECTED ACCRUAL: A total of 10 patients will be accrued for this study.
Interventions
OTHERNonmyeloablative stem cell conditioning regimen
Conditioning: Fludarabine 30 mg/m2/day x 3, day -4 to day -2 TBI 200 cGy x 1, day 0 Hematopoeitic Stem Cell Transplantation: Infusion of peripheral blood stem cells, day 0 Immunosuppression: For related donors: cyclosporine (CSP) 5 mg/kg p.o. bid, day -3 to day +56, then taper by 20% every 5 days to be completed by day +81 For related donors: mycophenolate mofetil (MMF) 15 mg/kg p.o. q 12 hours, day 0 to day +27, then stop For unrelated donors: cyclosporine (CSP) 5 mg/kg p.o. bid, day -3 to day +56, then taper by 20% every 5 days to be completed by day +81 For unrelated donors: mycophenolate mofetil (MMF) 15 mg/kg tid day +0 to day +29, 15 mg/kg bid day +30 to day +149, and then taper by 25% per week from day +150 to day +180. Discontinue by day +181.
Sponsors
National Cancer Institute (NCI)
OHSU Knight Cancer Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Diagnosis of adenocarcinoma of the prostate * Metastatic and progressive disease * Refractory to hormonal therapy * Prostate-specific antigen (PSA) \> 5 ng/mL * Previously treated with a docetaxel-based regimen * No CNS metastases PATIENT CHARACTERISTICS: Performance status * Karnofsky 70-100% Life expectancy * More than 6 months Hematopoietic * Not specified Hepatic * Bilirubin \< 2 times upper limit of normal (ULN) * AST and ALT \< 4 times ULN Renal * Creatinine clearance \> 50 mL/min Cardiovascular * LVEF \> 35% * No symptomatic congestive heart failure Pulmonary * DLCO \> 40% of predicted OR * Total lung capacity or FEV\_1 \> 30% of predicted Other * HIV negative PRIOR CONCURRENT THERAPY: Chemotherapy * See Disease Characteristics Endocrine therapy * See Disease Characteristics PATIENT AND DONOR SELECTION CRITERIA 4.1 Patient Inclusion Criteria: 4.1.1 Males aged 18-75. 4.1.2 Pathologically proven adenocarcinoma of the prostate with metastases and progressive disease (new metastatic lesions or increase in cancer-related pain or a rising PSA defined by consensus criteria. (A rising PSA will be defined as 2 measurements higher than an initial value. The second of the 3 measurements must be at least 7 days after the first). 4.1.3 Progressive disease despite hormonal management (including antiandrogen withdrawal, 6 weeks for bicalutamide, 4 weeks for flutamide or nilutamide) 4.1.4 PSA \> 5 ng/mL 4.1.5 Serum testosterone level \< 50 ng/mL 4.1.6 Prior treatment with a docetaxel-based regimen. 4.1.7 Performance status: Karnofsky Performance Scale (KPS) 70-100%. (Appendix III). 4.1.8 Signed informed patient consent. 4.2 Patient
Exclusion criteria
4.2.1 Expected survival less than 6 months 4.2.2 Active central nervous system involvement or spinal instability 4.2.3 Organ dysfunction: 4.2.3.1 Cardiac: Ejection fraction \<35% or symptomatic congestive heart failure. 4.2.3.2 Pulmonary: DLCO \<40% of predicted or either TLC or FEV1 \< 30% predicted. 4.2.3.3 Liver dysfunction: serum total bilirubin \>2x upper limit of normal (ULN) or either ALT or AST \>4x ULN 4.2.3.4 Renal dysfunction: creatinine clearance \< 50 ml/min 4.2.4 HIV seropositivity 4.2 Related Donor Inclusion criteria: 4.3.1 Age 18-75 4.3.2 Related to the patient and genotypically or phenotypically HLA-identical. (Appendix IV) 4.3.3 Able to give consent to peripheral blood stem cell mobilization with G-CSF and apheresis collection. Bone marrow donors are not eligible. 4.3 Unrelated Donor Inclusion criteria: 4.4.1 Age 18-75. 4.4.2 Unrelated donors who are prospectively: 4.4.2.1 Matched for HLA-DRB1 and -DQB1 alleles by high resolution typing AND 4.4.2.2 Matched for all serologically recognized HLA-A or -B or -C antigens and at least five of six HLA-A or -B or -C alleles as defined by Appendix IV. 4.4.3 Able to give consent to peripheral blood stem cell mobilization with G-CSF and apheresis collection. Bone marrow unrelated donors are not eligible. 4.4 Related and Unrelated Donor
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Treatment-related mortality as measured by Kaplan-Meier at 5 years following transplant | — |
Secondary
| Measure | Time frame |
|---|---|
| Safety by CTCAE v 3.0 at 100 days following transplant | — |
| Response rate by RECIST criteria at 5 years following transplant | — |
| Time to progression by Kaplan-Meier at 5 years following transplant | — |
| Overall survival by Kaplan-Meier at 5 years following transplant | — |
| Response as measured by a 50% reduction in the prostate-specific antigen at 5 years following transplant | — |
Outcome results
None listed