Neoplasms, Prostatic Neoplasms
Conditions
Keywords
Cancer, Prostate
Brief summary
This is a randomized, open-label, multi-center study comparing the safety and efficacy of XRP6258 plus prednisone to mitoxantrone plus prednisone in the treatment of hormone refractory metastatic prostate cancer previously treated with a Taxotere®-containing regimen. The primary objective is overall survival. Secondary objectives include progression free survival, overall response rate, prostate-specific antigen (PSA) response/progression, pain response/progression, overall safety, and pharmacokinetics. Patients will be treated until disease progression, death, unacceptable toxicity, or for a maximum of 10 cycles. Patients will have long-term follow-up for a maximum of up to 2 years.
Interventions
25 mg/m\^2 administered by intravenous (IV) route over 1 hour on day 1 of each 21-day cycle
12 mg/m\^2 administered by intravenous (IV) route over 15-30 minutes on day 1 of each 21-day cycle
10 mg daily administered by oral route
Sponsors
Study design
Eligibility
Inclusion criteria
1. Histologically or cytologically confirmed adenocarcinoma of the prostate that is refractory to hormone therapy and previously treated with a Taxotere®-containing regimen. 2. Documented progression of disease (demonstrating at least one visceral or soft tissue metastatic lesion, including a new lesion). Patients with non-measurable disease must have documented rising prostate-specific antigen (PSA) levels or appearance of new lesion. 3. Surgical or hormone-induced castration 4. Life expectancy \> 2 months 5. Eastern Cooperative Oncology Group (ECOG) performance status 0 - 2
Exclusion criteria
1. Previous treatment with mitoxantrone 2. Previous treatment with \<225 mg/m\^2 cumulative dose of Taxotere (or docetaxel) 3. Prior radiotherapy to ≥ 40% of bone marrow 4. Surgery, radiation, chemotherapy, or other anti-cancer therapy within 4 weeks prior to enrollment in the study 5. Other prior malignancy, except for adequately treated superficial basal cell skin cancer, or any other cancer from which the patient has been disease-free for less than 5 years 6. Known brain or leptomeningeal involvement 7. Other concurrent serious illness or medical conditions 8. Inadequate organ function evidenced by unacceptable laboratory results The investigator will evaluate whether there are other reasons why a patient may not participate.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | From the date of randomization up to 104 weeks (study cut-off) | Overall survival was defined as the time interval from the date of randomization to the date of death due to any cause. In the absence of confirmation of death, the survival time was censored at the last date patient was known to be alive or at the cut-off date, whichever had come first. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Tumor Response | From the date of randomization up to 104 weeks (study cut-off) | Tumor Overall Response Rate (ORR) (only in patients with measurable disease): Objective responses (Complete Response and Partial Response) for measurable disease as assessed by investigators according to RECIST criteria. Complete Response (CR) is defined as: Disappearance of all target lesions. Partial Response (PR) is defined as: At least a 30% decrease in the sum of longest diameter (LD) of target lesions taking as reference baseline sum LD. Confirmation of objective responses will be performed by repeat tumor imaging (CT scans, MRI, bone scans) after the first documentation of response. |
| Time to Tumor Progression | From the date of randomization up to 104 weeks (study cut-off) | Time to tumor progression is defined as the number of months from randomization until evidence of progressive disease (RECIST) |
| Time to Prostatic Specific Antigen (PSA) Progression | at screening, day 1 of every treatment cycle, up to 104 weeks (study cut-off) | In PSA non-responders, progression will be defined as a 25% increase over nadir and increase in the absolute value PSA level by at least 5 ng/ml and confirmed by a second value at least 4 weeks later. In PSA responders and in patients not evaluable for PSA response at baseline, progression will be defined as a ≥50% increase over nadir, provided that the increase is a minimum of 5 ng/ml and confirmed by a second value at least 1 week later. |
| Time to Progression Free Survival (PFS) | From the date of randomization up to 104 weeks (study cut-off) | Progression free survival was defined as a composite endpoint evaluated from the date of randomization to the date of tumor progression, PSA progression, pain progression, or death due to any cause, whichever occurred first |
| Time to Pain Progression | from baseline up to 104 weeks (study cut-off) | Pain Progression is defined as an increase of ≥1 point in the median Personal Pain Intensity (PPI) from its nadir noted on 2 consecutive 3-week-apart visits or ≥25 % increase in the mean analgesic score compared with the baseline score & noted on 2 consecutive 3-week-apart visits or requirement for local palliative radiotherapy. Evaluation of the PPI & analgesic scores are based on the short-form McGill Pain Questionnaire which consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0=none (best) 1=mild 2=moderate 3=severe (worst) (TOTAL: 0=best 45=worst) |
| Pain Response | from baseline up to 104 weeks (study cut-off) | Pain Response was defined as a two-point or greater reduction from baseline median Present Pain Intensity (PPI) score without an increased Analgesic Score (AS) or a decrease of ≥50% in the AS without an increase in the PPI score, maintained for at least 3 weeks. |
| PSA (Prostate-Specific Antigen) Response | from baseline up to 104 weeks (study cut-off) | PSA response was defined as a ≥ 50% reduction in serum PSA, determined only for patients with a serum PSA ≥ 20ng/mL at baseline, confirmed by a repeat PSA ≥ 3 weeks later. |
Countries
Argentina, Belgium, Brazil, Canada, Chile, Czechia, Denmark, Finland, France, Germany, Hungary, India, Italy, Mexico, Netherlands, Russia, Singapore, Slovakia, South Africa, South Korea, Spain, Sweden, Taiwan, Turkey (Türkiye), United Kingdom, United States
Participant flow
Recruitment details
Multicenter study: 146 actives sites from 26 countries in Europe, USA, South America and Asia Pacific region. Study initiation date: January 2nd, 2007; study completion date/study cut off date: September 25th, 2009.
Pre-assignment details
165 patients signed informed consent but were not randomized and considered as screen failure. Intention to Treat Population (ITT or randomized patients): 755 patients (377 mitoxantrone, 378 cabazitaxel). Safety population (treated patients): 742 patients (371 mitoxantrone, 371 cabazitaxel) (Patients not treated: 6 mitoxantrone, 7 cabazitaxel).
Participants by arm
| Arm | Count |
|---|---|
| Mitoxantrone + Prednisone mitoxantrone 12 mg/m\^2 (Day 1) by intravenous (IV) every 3 weeks, and prednisone 10 mg orally given daily | 377 |
| Cabazitaxel + Prednisone cabazitaxel 25 mg/m\^2 (Day 1) by intravenous (IV) every 3 weeks, and prednisone 10 mg orally given daily | 378 |
| Total | 755 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | abnormal liver function tests | 0 | 1 |
| Overall Study | Adverse Event | 32 | 67 |
| Overall Study | Clinical deterioration | 1 | 0 |
| Overall Study | Disease progression | 267 | 180 |
| Overall Study | Investigator's decision | 1 | 4 |
| Overall Study | Lost to Follow-up | 2 | 0 |
| Overall Study | Non-compliance to protocol | 0 | 1 |
| Overall Study | Non-confirmed Disease progression | 1 | 1 |
| Overall Study | Not treated | 6 | 7 |
| Overall Study | Patient unable to come to the clinic | 0 | 1 |
| Overall Study | Screened failure | 2 | 1 |
| Overall Study | Screening error | 2 | 1 |
| Overall Study | Withdrawal by Subject | 17 | 8 |
| Overall Study | Withdrawal by subject's family | 0 | 1 |
Baseline characteristics
| Characteristic | Mitoxantrone + Prednisone | Cabazitaxel + Prednisone | Total |
|---|---|---|---|
| Age Continuous | 67.0 years | 68.0 years | 67 years |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 0 - Fully Active | 120 Participants | 141 Participants | 261 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 1 - Ambulatory, Restricted Activity | 224 Participants | 209 Participants | 433 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 2 - Ambulatory, No Work Activities | 33 Participants | 28 Participants | 61 Participants |
| Extent of disease Locoregional Recurrence | 20 Participants | 14 Participants | 34 Participants |
| Extent of disease Metastatic | 356 Participants | 364 Participants | 720 Participants |
| Extent of disease Missing | 1 Participants | 0 Participants | 1 Participants |
| Measurable disease Measurable disease | 204 Participants | 201 Participants | 405 Participants |
| Measurable disease Not Measurable disease | 173 Participants | 177 Participants | 350 Participants |
| Prostatic Specific Antigen PSA | 127.5 ng/mL | 143.9 ng/mL | 135.00 ng/mL |
| Region of Enrollment Argentina | 7 participants | 3 participants | 10 participants |
| Region of Enrollment Belgium | 16 participants | 15 participants | 31 participants |
| Region of Enrollment Brazil | 7 participants | 4 participants | 11 participants |
| Region of Enrollment Canada | 16 participants | 16 participants | 32 participants |
| Region of Enrollment Chile | 9 participants | 12 participants | 21 participants |
| Region of Enrollment Czech Republic | 10 participants | 12 participants | 22 participants |
| Region of Enrollment Denmark | 19 participants | 26 participants | 45 participants |
| Region of Enrollment Finland | 4 participants | 1 participants | 5 participants |
| Region of Enrollment France | 44 participants | 46 participants | 90 participants |
| Region of Enrollment Germany | 6 participants | 11 participants | 17 participants |
| Region of Enrollment Hungary | 8 participants | 7 participants | 15 participants |
| Region of Enrollment India | 11 participants | 9 participants | 20 participants |
| Region of Enrollment Italy | 17 participants | 18 participants | 35 participants |
| Region of Enrollment Korea, Republic of | 8 participants | 7 participants | 15 participants |
| Region of Enrollment Mexico | 2 participants | 3 participants | 5 participants |
| Region of Enrollment Netherlands | 8 participants | 9 participants | 17 participants |
| Region of Enrollment Russian Federation | 6 participants | 4 participants | 10 participants |
| Region of Enrollment Singapore | 6 participants | 3 participants | 9 participants |
| Region of Enrollment Slovakia | 1 participants | 1 participants | 2 participants |
| Region of Enrollment South Africa | 7 participants | 9 participants | 16 participants |
| Region of Enrollment Spain | 10 participants | 9 participants | 19 participants |
| Region of Enrollment Sweden | 11 participants | 10 participants | 21 participants |
| Region of Enrollment Taiwan | 4 participants | 7 participants | 11 participants |
| Region of Enrollment Turkey | 17 participants | 19 participants | 36 participants |
| Region of Enrollment United Kingdom | 17 participants | 20 participants | 37 participants |
| Region of Enrollment United States | 106 participants | 97 participants | 203 participants |
| Sex/Gender, Customized Male | 377 participants | 378 participants | 755 participants |
| Tumor Location: number of sites involved 1 | 134 Participants | 146 Participants | 280 Participants |
| Tumor Location: number of sites involved 2 | 117 Participants | 112 Participants | 229 Participants |
| Tumor Location: number of sites involved 3 | 78 Participants | 73 Participants | 151 Participants |
| Tumor Location: number of sites involved 4 or more | 43 Participants | 44 Participants | 87 Participants |
| Tumor Location: number of sites involved Missing | 5 Participants | 3 Participants | 8 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 323 / 371 | 350 / 371 |
| serious Total, serious adverse events | 77 / 371 | 145 / 371 |
Outcome results
Overall Survival
Overall survival was defined as the time interval from the date of randomization to the date of death due to any cause. In the absence of confirmation of death, the survival time was censored at the last date patient was known to be alive or at the cut-off date, whichever had come first.
Time frame: From the date of randomization up to 104 weeks (study cut-off)
Population: Analysis was performed on the intention To Treat (ITT) population. The ITT population is composed of all randomized patients (i.e. patients assigned to a treatment group by the randomization, regardless of whether patients received any study drug or received a different study drug from which they were randomized).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Mitoxantrone + Prednisone | Overall Survival | 12.7 Months |
| Cabazitaxel + Prednisone | Overall Survival | 15.1 Months |
Overall Tumor Response
Tumor Overall Response Rate (ORR) (only in patients with measurable disease): Objective responses (Complete Response and Partial Response) for measurable disease as assessed by investigators according to RECIST criteria. Complete Response (CR) is defined as: Disappearance of all target lesions. Partial Response (PR) is defined as: At least a 30% decrease in the sum of longest diameter (LD) of target lesions taking as reference baseline sum LD. Confirmation of objective responses will be performed by repeat tumor imaging (CT scans, MRI, bone scans) after the first documentation of response.
Time frame: From the date of randomization up to 104 weeks (study cut-off)
Population: Tumor response rate was evaluated only for patients, in the Intention-To-Treat (ITT) population, with measurable disease by Response Evaluation Criteria in Solid Tumor (RECIST).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mitoxantrone + Prednisone | Overall Tumor Response | 4.4 percentage of participants |
| Cabazitaxel + Prednisone | Overall Tumor Response | 14.4 percentage of participants |
Pain Response
Pain Response was defined as a two-point or greater reduction from baseline median Present Pain Intensity (PPI) score without an increased Analgesic Score (AS) or a decrease of ≥50% in the AS without an increase in the PPI score, maintained for at least 3 weeks.
Time frame: from baseline up to 104 weeks (study cut-off)
Population: Pain Response (applies only to patients, in the Intention-To-Treat (ITT) population, with median PPI ≥2 on McGill-Melzack scale and/or mean Analgesic Score ≥10 points at baseline)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mitoxantrone + Prednisone | Pain Response | 7.7 Percentage of participants |
| Cabazitaxel + Prednisone | Pain Response | 9.2 Percentage of participants |
PSA (Prostate-Specific Antigen) Response
PSA response was defined as a ≥ 50% reduction in serum PSA, determined only for patients with a serum PSA ≥ 20ng/mL at baseline, confirmed by a repeat PSA ≥ 3 weeks later.
Time frame: from baseline up to 104 weeks (study cut-off)
Population: Prostate Specific Antigen (PSA) response was evaluated only in patients, in the Intention-To-Treat population, with a baseline PSA \>20ng/mL.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mitoxantrone + Prednisone | PSA (Prostate-Specific Antigen) Response | 17.8 Percentage of participants |
| Cabazitaxel + Prednisone | PSA (Prostate-Specific Antigen) Response | 39.2 Percentage of participants |
Time to Pain Progression
Pain Progression is defined as an increase of ≥1 point in the median Personal Pain Intensity (PPI) from its nadir noted on 2 consecutive 3-week-apart visits or ≥25 % increase in the mean analgesic score compared with the baseline score & noted on 2 consecutive 3-week-apart visits or requirement for local palliative radiotherapy. Evaluation of the PPI & analgesic scores are based on the short-form McGill Pain Questionnaire which consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0=none (best) 1=mild 2=moderate 3=severe (worst) (TOTAL: 0=best 45=worst)
Time frame: from baseline up to 104 weeks (study cut-off)
Population: Analysis was performed on the intention To Treat (ITT) population. Data from 265 and 279 patients in the cabazitaxel and mitoxantrone groups, respectively, were censored as a results of \> 2 PPI and/or AS assessments being missed during the same week (unless a complete evaluation of ≥5 values showed pain progression).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Mitoxantrone + Prednisone | Time to Pain Progression | NA Months |
| Cabazitaxel + Prednisone | Time to Pain Progression | 11.1 Months |
Time to Progression Free Survival (PFS)
Progression free survival was defined as a composite endpoint evaluated from the date of randomization to the date of tumor progression, PSA progression, pain progression, or death due to any cause, whichever occurred first
Time frame: From the date of randomization up to 104 weeks (study cut-off)
Population: Analysis was performed on the intention To Treat (ITT) population. The ITT population is composed of all randomized patients (i.e. patients assigned to a treatment group by the randomization, regardless of whether patients received any study drug or received a different study drug from which they were randomized).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Mitoxantrone + Prednisone | Time to Progression Free Survival (PFS) | 1.4 Months |
| Cabazitaxel + Prednisone | Time to Progression Free Survival (PFS) | 2.8 Months |
Time to Prostatic Specific Antigen (PSA) Progression
In PSA non-responders, progression will be defined as a 25% increase over nadir and increase in the absolute value PSA level by at least 5 ng/ml and confirmed by a second value at least 4 weeks later. In PSA responders and in patients not evaluable for PSA response at baseline, progression will be defined as a ≥50% increase over nadir, provided that the increase is a minimum of 5 ng/ml and confirmed by a second value at least 1 week later.
Time frame: at screening, day 1 of every treatment cycle, up to 104 weeks (study cut-off)
Population: Analysis was performed on the intention To Treat (ITT) population. The ITT population is composed of all randomized patients (i.e. patients assigned to a treatment group by the randomization, regardless of whether patients received any study drug or received a different study drug from which they were randomized).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Mitoxantrone + Prednisone | Time to Prostatic Specific Antigen (PSA) Progression | 3.1 Months |
| Cabazitaxel + Prednisone | Time to Prostatic Specific Antigen (PSA) Progression | 6.4 Months |
Time to Tumor Progression
Time to tumor progression is defined as the number of months from randomization until evidence of progressive disease (RECIST)
Time frame: From the date of randomization up to 104 weeks (study cut-off)
Population: Analysis was performed on the intention To Treat (ITT) population. The ITT population is composed of all randomized patients (i.e. patients assigned to a treatment group by the randomization, regardless of whether patients received any study drug or received a different study drug from which they were randomized).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Mitoxantrone + Prednisone | Time to Tumor Progression | 5.4 Months |
| Cabazitaxel + Prednisone | Time to Tumor Progression | 8.8 Months |