Hormone Refractory Prostate Cancer
Conditions
Brief summary
The purpose of this study is to determine the biochemical response rate (PSA) to single agent RAD001 in patients with metastatic hormone-refractory prostate cancer (HRPC).
Detailed description
This is a single center, Phase II study of RAD001 in men with HRPC. The study design is a straight forward, two-stage design with tumor biopsies scheduled at screening and again at 4 weeks. FLT-PET scans are performed at screening and again at day 28, following initiation of treatment in the first 10 patients. Patients are assessed for adverse events every two weeks for the first month and monthly thereafter. Patients are assessed for response by PSA every 4 weeks and when applicable, for objective response every 2 months. If 4 or more responses are seen in the first 39 patients then the study will expand to 60 patients.
Interventions
DRUGRAD001
RAD001 at a dose of 10 mg PO daily
Sponsors
Novartis Pharmaceuticals
Daniel George, MD
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically confirmed diagnosis of adenocarcinoma of the prostate * Clinical or radiographic evidence of metastatic disease * ADT using LHRH agonist (eg leuprolide, goserelin) must continue on therapy. However, ketoconazole, estrogens, and all other forms of hormonal manipulation are not permitted on study. * Evidence of disease progression on ADT as evidenced by: * 2 consecutive PSA levels 50% or greater above the PSA nadir achieved on ADT and separated at least 1 week apart, or * Radiographic evidence of disease progression defined by RECIST criteria and compared to prior studies on ADT. * A minimum of 6 weeks has elapsed off of anti-androgen therapy without withdrawal response. * A minimum of 4 weeks from any prior radiation therapy, surgery, chemotherapy or other investigational agent * Biopsies will not be performed if platelet counts \< 75,000/ ul, PTT, PT or INR \> 1.4 times control * Patients must have normal organ and marrow function as defined below: * hemoglobin \> 9.0g/dL * absolute neutrophil count \> 1,500/μl * platelets \> 100,000/μl * total bilirubin \< 1.5 X upper limit of normal (ULN) * AST(SGOT)/ALT(SGPT) \< 2.5 X ULN * creatinine \< 1.5 X ULN * total fasting cholesterol \< 350 * total triglycerides \< 300 * Patients on antilipid therapy may participate in this study. * Age \> 18 years * ECOG performance status 0 or 1 * Ability to swallow and retain oral medication * Ability to understand and the willingness to sign a written informed consent document.
Exclusion criteria
* History of solid organ or stem cell transplantation * Also, no current use of chronic immunosuppressive therapy is allowed * Patients with known brain metastases (or history of brain metastases) * History of HIV, hepatitis B, or hepatitis C infection * Patients who have received investigational, biologic, hormonal (other than ADT), immunotherapy, or chemotherapy less than 4 weeks prior to entry on this study or have not recovered from the toxic effects of such therapy * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection (requiring antifungal, antibiotic or antiviral therapy), symptomatic congestive heart failure (NYHC III or greater), unstable angina pectoris, cardiac arrhythmia (uncontrolled SVT or any VT), or psychiatric illness/social situations that would limit compliance with study requirements * History of malabsorption syndrome, disease significantly affecting gastrointestinal function or major resection of the stomach or small bowel that could affect absorption, distribution, metabolism or excretion of study drugs. * Any unresolved bowel obstruction or diarrhea
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Biochemical Response Rate | Patients were followed for a median of 315 days | Number of participants with 50% decline in serum PSA from baseline was pre-set as the primary measure of disease response. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pathologic Response | Patients were followed for a median of 315 days | Number of participants with either a 50% or greater decrease in proliferation index or a 50% or greater increase in apoptotic index |
| Progression Free Survival | Patients were followed for a median of 315 days, with the last patient censored at 1309 days. | Time in months from the start of study treatment to the date of first progression according to RECIST 1.0, or to death due to any cause. Patients alive who had not progressed as of the last follow-up had PFS censored at the last follow-up date. Median PFS was estimated using a Kaplan-Meier curve. |
| Molecular Response | Patients were followed for a median of 315 days | Functional extent of mTOR inhibition by changes in the phosphorylation status of pS6 in prostate tumors. |
| Clinical Response | Patients were followed for a median of 315 days | The percentage of participants with a complete or partial response as defined by RECIST 1.0. Response Criteria are defined below: Complete Response: Disappearance of all target lesions Partial Response: At least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD Progressive Disease: At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions Stable Disease: Neither sufficient shrinkage to qualify for partial response nor sufficient increase to qualify for progressive disease, taking as reference the smallest sum LD |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| RAD001 RAD001 at a dose of 10 mg PO daily | 35 |
| Total | 35 |
Baseline characteristics
| Characteristic | RAD001 |
|---|---|
| Age, Continuous | 71 years |
| Sex: Female, Male Female | 0 Participants |
| Sex: Female, Male Male | 35 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 35 / 35 |
| serious Total, serious adverse events | 8 / 35 |
Outcome results
Primary
Biochemical Response Rate
Number of participants with 50% decline in serum PSA from baseline was pre-set as the primary measure of disease response.
Time frame: Patients were followed for a median of 315 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RAD001 | Biochemical Response Rate | 0 participants |
Secondary
Clinical Response
The percentage of participants with a complete or partial response as defined by RECIST 1.0. Response Criteria are defined below: Complete Response: Disappearance of all target lesions Partial Response: At least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD Progressive Disease: At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions Stable Disease: Neither sufficient shrinkage to qualify for partial response nor sufficient increase to qualify for progressive disease, taking as reference the smallest sum LD
Time frame: Patients were followed for a median of 315 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RAD001 | Clinical Response | 0 participants |
Secondary
Molecular Response
Functional extent of mTOR inhibition by changes in the phosphorylation status of pS6 in prostate tumors.
Time frame: Patients were followed for a median of 315 days
Population: Immunohistochemistry (IHC) for pS6 was compared for 9 pairs of samples for which paraffin embedded tissue was available.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| RAD001 | Molecular Response | 60.11 percentage of decrease |
Secondary
Pathologic Response
Number of participants with either a 50% or greater decrease in proliferation index or a 50% or greater increase in apoptotic index
Time frame: Patients were followed for a median of 315 days
Population: Only subjects with paired samples were included in this analysis
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RAD001 | Pathologic Response | 0 participants |
Secondary
Progression Free Survival
Time in months from the start of study treatment to the date of first progression according to RECIST 1.0, or to death due to any cause. Patients alive who had not progressed as of the last follow-up had PFS censored at the last follow-up date. Median PFS was estimated using a Kaplan-Meier curve.
Time frame: Patients were followed for a median of 315 days, with the last patient censored at 1309 days.
Population: Intent to treat
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| RAD001 | Progression Free Survival | 3.58 months |