Prostate Cancer
Conditions
Keywords
Hormone Resistant Prostate Cancer, Endothelin A Receptor Antagonist, Endothelin A, Endothelin A antagonist
Brief summary
Enthuse M1C is a large phase III clinical trial studying the safety and efficacy of ZD4054 (Zibotentan) in combination with docetaxel (Taxotere) in patients with metastatic hormone resistant prostate cancer (HRPC). This clinical trial will test if the Endothelin A Receptor Antagonist ZD4054 (Zibotentan) can further improve survival compared with docetaxel alone. ZD4054 (Zibotentan) is a new type of agent, which is thought to slow tumour growth and spread by blocking Endothelin A receptor activity. This trial will look at the effects of ZD4054 (Zibotentan) in hormone resistant prostate cancer patients with bone metastases compared with docetaxel. All patients participating in this clinical trial will receive docetaxel chemotherapy, which is a commonly used chemotherapy to treat prostate cancer in addition to other existing prostate cancer therapies. Half the patients will receive ZD4054 (Zibotentan), and half the patients will receive placebo in addition to docetaxel and other prostate cancer therapy. By participating in this trial there is a 50% chance that patients will receive an agent that may further slow the progression of the tumour. No patients will be deprived of standard prostate cancer therapy.
Interventions
intravenous infusion given every three weeks
10 mg oral once daily dose
placebo oral tablet once daily
Sponsors
Study design
Eligibility
Inclusion criteria
Patients who answer TRUE to the following criteria may be eligible to participate in this trial. * Confirmed diagnosis of prostate cancer (adenocarcinoma of the prostate) that has spread to the bone (bone metastasis) * Increasing Prostate Specific Antigen (PSA), collected within one year of enrollment * Currently receiving treatment with surgical or medical castration
Exclusion criteria
Patients who answer TRUE to the following ARE NOT eligible to participate in this trial. * Previous treatment with chemotherapy (paclitaxel, docetaxel, and mitoxantrone). Prior targeted cancer therapies are permitted if received during a previous clinical trial. * Suffering from heart failure or had a myocardial infarction within last 6 months * A history of epilepsy or seizures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | Patients were followed for survival up to 40 months | Median time (in months) from randomisation until death using the Kaplan-Meier method. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Skeletal Related Events | While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months) | Median time (in months) from randomisation until occurrence of a skeletal related event using the Kaplan-Meier method, where skeletal related event is defined as the first occurrence of a pathological fracture, a vertebral compression fracture not related to trauma, prophylactic surgery or radiation for impending fracture or spinal cord compression, or a spinal cord compression. |
| Time to Prostate-specific Antigen (PSA) Progression | While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months) | Median time (in months) from randomisation until first PSA value \>50% higher than baseline of at least 5ng/ml seen in at least 2 consecutive PSA values at least 2 weeks apart using the Kaplan-Meier method. |
| Time to Pain Progression | While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months) | Median time (in months) from randomisation until date of first assessment of increased pain using the Kaplan-Meier method, where increased pain event is defined as the first of a patient requiring opiate medication for duration of ≥1 week for pain due to prostate cancer metastasis, pain due to metastasis that has an increase in the worst pain item of the Brief Pain Inventory (BPI) from baseline to a minimum score of 5 with no decrease in analgesic use, or pain due to metastasis requiring radionuclide therapy, radiation therapy or surgery. |
| Progression Free Survival | Patients were followed for progression up to 40 months | Median time (in months) from randomisation until clinical progression of disease using the Kaplan-Meier method. Progression is defined, using RECIST, as a measurable increase in the smallest dimension of any target or non-target lesion, or the appearance of new lesions, since baseline |
| Health Related Quality of Life | While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months) | Median time (in months) from randomisation until deterioration of Health Related Quality of Life using the Kaplan-Meier method, where deterioration is defined as a change from baseline of less than or equal to -6 points in Total FACT-P score maintained for 2 consecutive visits. |
| PSA Response | While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months) | PSA response defined as \>50% decrease in serum PSA values from baseline seen in at least 2 consecutive PSA values at least 2 weeks apart. |
| Pain Response | While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months) | Number of patients with a pain response, defined as a decrease in brief pain inventory questionnaire (BPI) of at least 2 points from baseline or a decrease in opiate use of 25% from baseline. |
Countries
Argentina, Australia, Brazil, Canada, Czechia, Finland, France, Germany, Hungary, India, Italy, Netherlands, Peru, Poland, Portugal, Romania, Russia, Serbia, South Africa, South Korea, Spain, Sweden, Switzerland, Taiwan, United Kingdom, United States
Participant flow
Recruitment details
1494 patients with hormone resistant prostate cancer patients and bone metastasis were recruited between 24th January 2008 and 10th May 2011
Pre-assignment details
442 of the 1494 enrolled patients were not randomised to treatment groups as they failed screening.
Participants by arm
| Arm | Count |
|---|---|
| ZD4054 + Docetaxel XD4054 10 mg oral tablet once daily + docetaxel intravenous infusion every 3 weeks | 524 |
| Placebo + Docetaxel placebo oral tablet once daily + docetaxel intravenous infusion every 3 weeks | 528 |
| Total | 1,052 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 87 | 76 |
| Overall Study | Lost to Follow-up | 3 | 2 |
| Overall Study | Patients randomized but not treated | 2 | 3 |
| Overall Study | Protocol Violation | 2 | 3 |
| Overall Study | Reason not otherwise captured, eg; death | 265 | 290 |
| Overall Study | Withdrawal by Subject | 71 | 77 |
Baseline characteristics
| Characteristic | ZD4054 + Docetaxel | Placebo + Docetaxel | Total |
|---|---|---|---|
| Age Continuous overall | 8.1 years STANDARD_DEVIATION 67.7 | 7.8 years STANDARD_DEVIATION 67.6 | 7.9 years STANDARD_DEVIATION 67.6 |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 524 Participants | 528 Participants | 1052 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 490 / 522 | 483 / 525 |
| serious Total, serious adverse events | 214 / 522 | 203 / 525 |
Outcome results
Overall Survival
Median time (in months) from randomisation until death using the Kaplan-Meier method.
Time frame: Patients were followed for survival up to 40 months
Population: Full Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| ZD4054 + Docetaxel | Overall Survival | 20.0 Months |
| Placebo + Docetaxel | Overall Survival | 19.2 Months |
Health Related Quality of Life
Median time (in months) from randomisation until deterioration of Health Related Quality of Life using the Kaplan-Meier method, where deterioration is defined as a change from baseline of less than or equal to -6 points in Total FACT-P score maintained for 2 consecutive visits.
Time frame: While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months)
Population: Full Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| ZD4054 + Docetaxel | Health Related Quality of Life | 4.4 Months |
| Placebo + Docetaxel | Health Related Quality of Life | 5.1 Months |
Incidence of Skeletal Related Events
Median time (in months) from randomisation until occurrence of a skeletal related event using the Kaplan-Meier method, where skeletal related event is defined as the first occurrence of a pathological fracture, a vertebral compression fracture not related to trauma, prophylactic surgery or radiation for impending fracture or spinal cord compression, or a spinal cord compression.
Time frame: While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months)
Population: Full Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| ZD4054 + Docetaxel | Incidence of Skeletal Related Events | 17.4 Months |
| Placebo + Docetaxel | Incidence of Skeletal Related Events | 17.3 Months |
Pain Response
Number of patients with a pain response, defined as a decrease in brief pain inventory questionnaire (BPI) of at least 2 points from baseline or a decrease in opiate use of 25% from baseline.
Time frame: While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months)
Population: The Pain Response Analysis Set includes patients who were either receiving opiates at baseline (randomisation) or with a baseline BPI score ≥2.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| ZD4054 + Docetaxel | Pain Response | 255 Participants |
| Placebo + Docetaxel | Pain Response | 276 Participants |
Progression Free Survival
Median time (in months) from randomisation until clinical progression of disease using the Kaplan-Meier method. Progression is defined, using RECIST, as a measurable increase in the smallest dimension of any target or non-target lesion, or the appearance of new lesions, since baseline
Time frame: Patients were followed for progression up to 40 months
Population: Full Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| ZD4054 + Docetaxel | Progression Free Survival | 7.0 Months |
| Placebo + Docetaxel | Progression Free Survival | 7.9 Months |
PSA Response
PSA response defined as \>50% decrease in serum PSA values from baseline seen in at least 2 consecutive PSA values at least 2 weeks apart.
Time frame: While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months)
Population: Full Analysis Set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| ZD4054 + Docetaxel | PSA Response | 279 Participants |
| Placebo + Docetaxel | PSA Response | 298 Participants |
Time to Pain Progression
Median time (in months) from randomisation until date of first assessment of increased pain using the Kaplan-Meier method, where increased pain event is defined as the first of a patient requiring opiate medication for duration of ≥1 week for pain due to prostate cancer metastasis, pain due to metastasis that has an increase in the worst pain item of the Brief Pain Inventory (BPI) from baseline to a minimum score of 5 with no decrease in analgesic use, or pain due to metastasis requiring radionuclide therapy, radiation therapy or surgery.
Time frame: While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months)
Population: Full Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| ZD4054 + Docetaxel | Time to Pain Progression | 9.3 Months |
| Placebo + Docetaxel | Time to Pain Progression | 10.0 Months |
Time to Prostate-specific Antigen (PSA) Progression
Median time (in months) from randomisation until first PSA value \>50% higher than baseline of at least 5ng/ml seen in at least 2 consecutive PSA values at least 2 weeks apart using the Kaplan-Meier method.
Time frame: While receiving docetaxel study visits were aligned with its administration ie every 3weeks, after 12 weeks and completion of docetaxel therapy every 12 weeks (up to 40 months)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| ZD4054 + Docetaxel | Time to Prostate-specific Antigen (PSA) Progression | 11.9 Months |
| Placebo + Docetaxel | Time to Prostate-specific Antigen (PSA) Progression | 12.1 Months |