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Carboplatin, Everolimus, and Prednisone in Treating Patients With Metastatic Prostate Cancer That Progressed After Docetaxel

Phase II Trial of Carboplatin and Everolimus (RAD001) in Metastatic Castrate Resistant Prostate Cancer (CRPC) Pretreated With Docetaxel Chemotherapy.

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01051570
Enrollment
26
Registered
2010-01-18
Start date
2010-02-28
Completion date
2013-09-30
Last updated
2020-12-01

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, recurrent prostate cancer, stage IV prostate cancer, adenocarcinoma of the prostate

Brief summary

RATIONALE: Drugs used in chemotherapy, such as carboplatin and prednisone, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Everolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Giving carboplatin together with everolimus and prednisone may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving carboplatin together with everolimus and prednisone works in treating patients with metastatic prostate cancer that progressed after docetaxel.

Detailed description

OBJECTIVES: Primary * To evaluate the time to progression (TTP) achieved with carboplatin and everolimus in patients with castrate resistant metastatic prostate cancer that progressed after docetaxel-based chemotherapy. Secondary * To evaluate the safety of this regimen. * To assess the PSA response rate in patients treated with this regimen. * To evaluate the overall survival (OS) outcome in these patients. * To investigate the association of TTP and PSA response rate with correlative markers, such as phospho mTOR, pAKT, and p70S6. * To evaluate the pharmacokinetics of this regimen. * To explore the association of TTP, OS, and circulating tumor tumor cell count. OUTLINE: Patients receive carboplatin IV over 30-60 minutes on day 1, oral prednisone twice daily on days on days 1-21, and oral everolimus once daily on days 2-21 of course 1 and on days 1-21 of subsequent courses. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Blood and tumor tissue samples are collected periodically for pharmacodynamic, pharmacokinetic, and biomarker analysis. After completion of study treatment, patients are followed up every 3 months.

Interventions

DRUGcarboplatin

AUC = 5 by Calvert's formula, day 1 of each 21 day cycle

5 mg orally starting on Day 2 then continuous

DRUGprednisone

5 mg orally twice a day starting on Day 1 then continuous

OTHERlaboratory biomarker analysis

Samples will be collected from archival tissue.

OTHERpharmacological study

Samples will be collected Cycle 1, day 1, 2 & 8 and Cycle 2, Day 1 & 2

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Barbara Ann Karmanos Cancer Institute
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
MALE
Age
18 Years to 120 Years
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically confirmed metastatic adenocarcinoma of the prostate * Objective disease progression or rising PSA despite androgen deprivation therapy and antiandrogen withdrawal (when applicable) * Progressed after ≥ 1 prior docetaxel-based chemotherapy regimen for metastatic disease * Patients with measurable disease\* must have either rising PSA, increase in size of the lesion(s), or both * Patients with rising PSA as the only evidence of disease progression must demonstrate a rising trend with 2 successive elevations ≥ 1 week apart * Patients with no measurable disease must have a PSA ≥ 5 ng/mL or new areas of bony metastases on bone scan NOTE: \*There is no minimum PSA requirement for patients with measurable disease * Documented to be castrate with a testosterone level of ≤ 0.5 ng/mL * Leuteinizing hormone-releasing hormone agonist therapy must be continued, if required to maintain castrate levels of testosterone * No uncontrolled brain or leptomeningeal metastases, including patients who continue to require glucocorticoids for brain or leptomeningeal metastases PATIENT CHARACTERISTICS: * Zubrod performance status 0-1 * ANC ≥ 1,500/mm\^3 * Hemoglobin ≥ 9.0 g/dL * Platelet count ≥ 100,000/mm\^3 * Total bilirubin ≤ 1.5 times upper limit of normal (ULN) * Calculated creatinine clearance ≥ 50 mL/min OR serum creatinine ≤ 2 mg/dL * AST and/or ALT ≤ 2.5 times ULN if alkaline phosphatase normal OR alkaline phosphatase ≤ 4 times ULN if AST and/or ALT normal (for patients without documented bone metastases or for patients with liver metastases) * AST and/or ALT \< 2.5 times ULN, without regard to alkaline phosphatase levels (for patients with documented bone metastases) * Fasting serum cholesterol ≤ 300 mg/dL OR ≤ 7.75 mmol/L AND fasting triglycerides ≤ 2.5 times ULN (in the case that one or both of these thresholds are exceeded, the patient is eligible only after initiation of appropriate lipid-lowering medication) * Fertile patients must use effective contraception during and for ≥ 6 months after completion of study treatment * Willing and able to comply with this study * Able to ingest oral medication * No other malignancies except non-melanoma skin cancer or any other adequately treated cancer in complete remission for ≥ 2 years * No significant traumatic injury within the past 4 weeks * No active (acute or chronic) or uncontrolled severe infections * No severe and/or uncontrolled medical conditions or other conditions that could affect study participation, including the following: * NYHA class III-IV symptomatic congestive heart failure * Unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction within the past 6 months, serious uncontrolled cardiac arrhythmia, or any other clinically significant cardiac disease * Severely impaired lung function as defined by spirometry and DLCO that is 50% of the normal predicted value and/or oxygen saturation that is ≤ 88% at rest on room air * Uncontrolled diabetes as defined by fasting serum glucose \> 1.5 times ULN * Liver disease such as cirrhosis, chronic active hepatitis, or chronic persistent hepatitis * Known history of HIV seropositivity, hepatitis B or C * Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of everolimus (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection) * Active, bleeding diathesis * No known hypersensitivity to everolimus or other rapamycins (sirolimus, temsirolimus) or to their excipients * No history of noncompliance to medical regimens * No uncontrolled diabetes mellitus PRIOR CONCURRENT THERAPY: * See Disease Characteristics * At least 1 prior docetaxel based regimen for metastatic disease * Docetaxel based combination therapy or docetaxel alone considered as 1 regimen * No more than 2 prior chemotherapy regimens for metastatic disease * No prior treatment with an mTOR inhibitor (sirolimus, temsirolimus, everolimus) * At least 6 weeks since prior bicalutamide or nilutamide * At least 4 weeks since prior flutamide * More than 4 weeks since prior and no other concurrent investigational drugs * More than 4 weeks since prior and no other concurrent anticancer therapies (including chemotherapy, radiotherapy, or antibody-based therapy) * More than 4 weeks since prior and no concurrent major surgery (defined as requiring general anesthesia) and recovered * More than 1 week since prior and no concurrent immunization with attenuated live vaccines * No concurrent chronic, systemic treatment with corticosteroids or other immunosuppressive agents * Topical or inhaled corticosteroids are allowed * No concurrent prophylactic growth factors * Concurrent bisphosphonate therapy allowed

Design outcomes

Primary

MeasureTime frameDescription
Time to Progression (TTP)Up to 63 days while on treatment, then up 90 days thereafter. From date of registration to date of progressive disease.Progression defined as at least a 20% increase in the sum of the longest diameter (LD) of target lesions taking as references the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.

Secondary

MeasureTime frameDescription
Number of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaDay 1 of each cycle (every 21 days), through study completion, an average of 6 monthsNumber of Participants with Grade 3/4 Toxicity as measured by NCI CTCAE v3.0 criteria
PSA Response RateDay 1 of each cycle (every 21 days), through study completion, an average of 6 monthsPSA response rate with response defined as =\> a 30% reduction in PSA
Association of PSA Response Rate With Correlative Markers (Phospho mTOR, pAKT, and p70S6)Archival tissue will be collected if available. Optional biopsies pre-treatment and 24 hours after first everolimus and carboplatin dosePSA response defined as a decrease of 30% or more will be tabled against mTOR, pAKT, and p70S6 (1+, 2+, 3+ vs ND)
Pharmacokinetics: Observed Carboplatin AUC Was Estimated Based on the Concentration in the 2.75-h Sample.Samples were collected Cycle 2, Day 1Using a limited sampling model (i.e., AUC = 0.52 × C2.75h + 0.92) (Sorensen et al., 1993), observed carboplatin AUC was estimated based on the concentration in the 2.75-h sample.
Overall SurvivalAfter treatment, participants will be contacted every 3 months up to 4 yearsOverall Survival as measured by the Kaplan-Meier method

Countries

United States

Participant flow

Participants by arm

ArmCount
Carboplatin, RAD 001 & Prednisone
Carboplatin: AUC=4 by Calvert's formula (max dose 600 mg)\*IV over 30-60 min, Day 1 of a 21 day cycle RAD 001: 5 mg Orally daily, starting from Day 2 continuously Prednisone 5 mg Orally twice daily, continuously carboplatin: AUC = 5 by Calvert's formula, day 1 of each 21 day cycle RAD 001: 5 mg orally starting on Day 2 then continuous prednisone: 5 mg orally twice a day starting on Day 1 then continuous laboratory biomarker analysis: Samples will be collected from archival tissue. pharmacological study: Samples will be collected Cycle 1, day 1, 2 & 8 and Cycle 2, Day 1 & 2
26
Total26

Baseline characteristics

CharacteristicCarboplatin, RAD 001 & Prednisone
Age, Continuous69 years
Region of Enrollment
United States
26 participants
Sex: Female, Male
Female
0 Participants
Sex: Female, Male
Male
26 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
17 / 26
serious
Total, serious adverse events
10 / 26

Outcome results

Primary

Time to Progression (TTP)

Progression defined as at least a 20% increase in the sum of the longest diameter (LD) of target lesions taking as references the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.

Time frame: Up to 63 days while on treatment, then up 90 days thereafter. From date of registration to date of progressive disease.

ArmMeasureValue (MEDIAN)
Carboplatin, RAD 001 & PrednisoneTime to Progression (TTP)2.5 months
Secondary

Association of PSA Response Rate With Correlative Markers (Phospho mTOR, pAKT, and p70S6)

PSA response defined as a decrease of 30% or more will be tabled against mTOR, pAKT, and p70S6 (1+, 2+, 3+ vs ND)

Time frame: Archival tissue will be collected if available. Optional biopsies pre-treatment and 24 hours after first everolimus and carboplatin dose

Population: There were only 2 responders of the 10 participants who were measured for mTOR, pAKT, and p70S6.

ArmMeasureGroupValue (NUMBER)
Carboplatin, RAD 001 & PrednisoneAssociation of PSA Response Rate With Correlative Markers (Phospho mTOR, pAKT, and p70S6)pAKT(ND) vs Responder1 participants
Carboplatin, RAD 001 & PrednisoneAssociation of PSA Response Rate With Correlative Markers (Phospho mTOR, pAKT, and p70S6)mTOR(ND) vs Responder0 participants
Carboplatin, RAD 001 & PrednisoneAssociation of PSA Response Rate With Correlative Markers (Phospho mTOR, pAKT, and p70S6)p70S6(ND) vs Responder1 participants
Secondary

Number of Participants With Toxicity as Measured by NCI CTCAE v3.0 Criteria

Number of Participants with Grade 3/4 Toxicity as measured by NCI CTCAE v3.0 criteria

Time frame: Day 1 of each cycle (every 21 days), through study completion, an average of 6 months

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaAnemia10 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaThrombocytopenia9 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaLymphopenia6 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaLeukopenia4 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaInfection without neutropenia4 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaHypophosphatemia4 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaNeutropenia3 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaDehydration3 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaHyperglycemia3 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaHyponatremia3 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaPulmonary embolism2 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaFatigue2 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaHypercholesterolemia1 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaRash1 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaAST1 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaHypomagnesemia1 Participants
Carboplatin, RAD 001 & PrednisoneNumber of Participants With Toxicity as Measured by NCI CTCAE v3.0 CriteriaHypokalemia1 Participants
Secondary

Overall Survival

Overall Survival as measured by the Kaplan-Meier method

Time frame: After treatment, participants will be contacted every 3 months up to 4 years

ArmMeasureValue (MEDIAN)
Carboplatin, RAD 001 & PrednisoneOverall Survival12.5 months
Secondary

Pharmacokinetics: Observed Carboplatin AUC Was Estimated Based on the Concentration in the 2.75-h Sample.

Using a limited sampling model (i.e., AUC = 0.52 × C2.75h + 0.92) (Sorensen et al., 1993), observed carboplatin AUC was estimated based on the concentration in the 2.75-h sample.

Time frame: Samples were collected Cycle 2, Day 1

Population: Limited PK sampling for carboplatin were obtained at 2.75 and 24 h after the end of infusion from 8 patients.

ArmMeasureValue (MEAN)
Carboplatin, RAD 001 & PrednisonePharmacokinetics: Observed Carboplatin AUC Was Estimated Based on the Concentration in the 2.75-h Sample.5.8 mg/ml*min
Secondary

PSA Response Rate

PSA response rate with response defined as =\> a 30% reduction in PSA

Time frame: Day 1 of each cycle (every 21 days), through study completion, an average of 6 months

ArmMeasureValue (NUMBER)
Carboplatin, RAD 001 & PrednisonePSA Response Rate15 percentage of participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026