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A Phase III Trial of ZD4054 (Zibotentan) (Endothelin A Antagonist) and Docetaxel in Metastatic Hormone Resistant Prostate Cancer

A Phase III, Randomised, Double-blind, Placebo-controlled Study to Assess the Efficacy and Safety of 10 mg ZD4054 (Zibotentan) in Combination With Docetaxel in Comparison With Docetaxel in Patients With Metastatic Hormone-resistant Prostate Cancer

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00617669
Acronym
ENTHUSE M1C
Enrollment
1494
Registered
2008-02-18
Start date
2008-01-31
Completion date
2011-07-31
Last updated
2012-09-10

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Prostate Cancer

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

DRUGDocetaxel

intravenous infusion given every three weeks

DRUGZD4054

10 mg oral once daily dose

DRUGPlacebo

placebo oral tablet once daily

Sponsors

AstraZeneca
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)

Eligibility

Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Overall SurvivalPatients were followed for survival up to 40 monthsMedian time (in months) from randomisation until death using the Kaplan-Meier method.

Secondary

MeasureTime frameDescription
Incidence of Skeletal Related EventsWhile 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) ProgressionWhile 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 ProgressionWhile 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 SurvivalPatients were followed for progression up to 40 monthsMedian 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 LifeWhile 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 ResponseWhile 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 ResponseWhile 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

ArmCount
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
Total1,052

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event8776
Overall StudyLost to Follow-up32
Overall StudyPatients randomized but not treated23
Overall StudyProtocol Violation23
Overall StudyReason not otherwise captured, eg; death265290
Overall StudyWithdrawal by Subject7177

Baseline characteristics

CharacteristicZD4054 + DocetaxelPlacebo + DocetaxelTotal
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 Participants0 Participants0 Participants
Sex: Female, Male
Male
524 Participants528 Participants1052 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
490 / 522483 / 525
serious
Total, serious adverse events
214 / 522203 / 525

Outcome results

Primary

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

ArmMeasureValue (MEDIAN)
ZD4054 + DocetaxelOverall Survival20.0 Months
Placebo + DocetaxelOverall Survival19.2 Months
Secondary

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

ArmMeasureValue (MEDIAN)
ZD4054 + DocetaxelHealth Related Quality of Life4.4 Months
Placebo + DocetaxelHealth Related Quality of Life5.1 Months
Secondary

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

ArmMeasureValue (MEDIAN)
ZD4054 + DocetaxelIncidence of Skeletal Related Events17.4 Months
Placebo + DocetaxelIncidence of Skeletal Related Events17.3 Months
Secondary

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.

ArmMeasureValue (NUMBER)
ZD4054 + DocetaxelPain Response255 Participants
Placebo + DocetaxelPain Response276 Participants
Secondary

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

ArmMeasureValue (MEDIAN)
ZD4054 + DocetaxelProgression Free Survival7.0 Months
Placebo + DocetaxelProgression Free Survival7.9 Months
Secondary

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

ArmMeasureValue (NUMBER)
ZD4054 + DocetaxelPSA Response279 Participants
Placebo + DocetaxelPSA Response298 Participants
Secondary

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

ArmMeasureValue (MEDIAN)
ZD4054 + DocetaxelTime to Pain Progression9.3 Months
Placebo + DocetaxelTime to Pain Progression10.0 Months
Secondary

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)

ArmMeasureValue (MEDIAN)
ZD4054 + DocetaxelTime to Prostate-specific Antigen (PSA) Progression11.9 Months
Placebo + DocetaxelTime to Prostate-specific Antigen (PSA) Progression12.1 Months

Source: ClinicalTrials.gov · Data processed: Feb 21, 2026