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S1014 Abiraterone Acetate in Treating Patients With Prostate Cancer Who Have Undergone Initial Hormone Therapy

Abiraterone Acetate Treatment for Prostate Cancer Patients With a PSA of More Than Four Following Initial Androgen Deprivation Therapy Phase II

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01309672
Enrollment
41
Registered
2011-03-07
Start date
2011-08-09
Completion date
2024-04-11
Last updated
2025-02-26

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

Conditions

Prostate Cancer

Keywords

adenocarcinoma of the prostate, hormone-resistant prostate cancer, stage IV prostate cancer, recurrent prostate cancer

Brief summary

RATIONALE: Androgens can cause the growth of prostate cancer cells. Antiandrogen drugs, such as abiraterone acetate, may lessen the amount of androgens made by the body. It may also stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. PURPOSE: This phase II trial is studying the side effects and how well abiraterone acetate works in treating patients with prostate cancer who have undergone initial hormone therapy.

Detailed description

OBJECTIVES: Primary * To assess the rate of achieving a prostate-specific antigen (PSA) of ≤ 0.2 ng/mL with abiraterone acetate therapy in men with metastatic prostate cancer with a sub-optimal response to androgen-deprivation therapy (ADT). Secondary * To assess the overall survival and objective progression-free survival of this group of patients. * To assess PSA partial response. * To evaluate the qualitative and quantitative toxicity of abiraterone acetate. OUTLINE: This is a multicenter study. Patients receive abiraterone acetate orally daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients receive androgen blockade with GNRH agonist (goserelin acetate or leuprolide acetate) or a GNRH antagonist (degarelix) per the treating physician and this will be given continuously until evidence of disease progression. Bilateral surgical orchiectomy is also acceptable. After completion of study therapy, patients are followed up every 3 months for 1 year and then every 6 months for up to 3 years.

Interventions

DRUGabiraterone acetate

1,000 mg, oral (on an empty stomach at least 2 hours after or 1 hour before eating); taken daily

DRUGPrednisone

5 mg, oral, 5 mg twice daily

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
SWOG Cancer Research Network
Lead SponsorNETWORK

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 or cytologically proven diagnosis of adenocarcinoma of the prostate * Metastatic (M1) disease as evidenced by soft tissue and/or bony metastases at the time of initiation of androgen-deprivation therapy (ADT) * Must have at least one of the following: * Visceral disease (liver, lung, other viscera) * Bone metastases to sites in either the axial (spine, pelvis, ribs, or skull) and/or the appendicular (clavicle, humerus, or femur) skeleton * Distant lymph node disease (e.g., above the aortic bifurcation, etc.) * No small cell or neuroendocrine prostate cancer * Patients must be receiving ADT (e.g., gonadotropin-releasing hormone \[GNRH\] antagonist, with or without antiandrogen) prior to entering this study * Degarelix, a FDA-approved GNRH antagonist, is an acceptable form of ADT * Bilateral surgical orchiectomy is also acceptable * Suboptimal response to ADT induction as defined by the following criteria: * Declining PSA (current PSA is less than the PSA prior to starting ADT) that fails to reach 4 ng/mL or below despite continuous ADT * PSA of \> 4 ng/mL must be observed between 6-12 months after the initiation of ADT * Documentation of failure to achieve this PSA of ≤ 4 ng/mL must be within 28 days of registration * The PSA must be obtained after any applicable antiandrogen washout period * If the PSA is declining or stable (defined as a PSA rise ≤ 0.1 ng/mL from nadir) and the patient is on an antiandrogen, they must remain on the antiandrogen * Patients with stable or declining PSA who have had previous antiandrogen exposure, but are not taking an antiandrogen at the time of registration, must wait at least 6 weeks from the last antiandrogen dose before registration and still demonstrate a stable or falling PSA which is \> 4 ng/mL by month 12, in order to be eligible * If the PSA is rising and they are on an antiandrogen, formal antiandrogen washout must be performed (4 weeks for flutamide and 6 weeks for bicalutamide and nilutamide with no evidence of a falling PSA after washout) * No patients with radiographic progression when compared to available imaging studies performed prior to starting the GNRH agonist/antagonist therapy * Patients who have measurable disease must have radiographic assessment (at least an abdominal/pelvic CT scan) within 28 days prior to registration * Non-measurable disease must be assessed (i.e., bone scan) within 42 days prior to registration * No patients with a history of brain metastases or who currently have treated or untreated brain metastases * Patients with clinical evidence of brain metastases must have a brain CT scan or MRI negative for metastatic disease within 56 days prior to registration PATIENT CHARACTERISTICS: * Zubrod performance status 0-2 * ANC ≥ 1,500/μL * Platelet count ≥ 100,000/μL * Hemoglobin ≥ 10 g/dL * Serum creatinine ≤ 1.5 times the upper limit of normal (ULN) OR creatinine clearance ≥ 60 mL/min * Bilirubin ≤ 1.5 times ULN (unless documented Gilbert disease) * AST and ALT \< 1.5 times ULN * Potassium ≥ 3.5 mmol/L * Patient must have a testosterone value of \< 50 ng/dL obtained within 28 days prior to registration * Patients must have controlled blood pressure defined as systolic blood pressure \< 160 mm Hg and diastolic blood pressure \< 95 mm Hg * Patients with a history of hypertension are eligible provided blood pressure is controlled by anti-hypertensive treatment * Patients who have partners of child-bearing potential must be willing to use a method of birth control with adequate barrier protection during the study and for 1 week after the last study drug administration * Must be able to take oral medication without crushing, dissolving, or chewing tablets * Patients must not have a history of gastrointestinal disorders (medical disorders or extensive surgery) that may interfere with the absorption of abiraterone acetate * No other prior malignancy is allowed except for any of the following: * Adequately treated basal cell or squamous cell skin cancer * Adequately treated stage I or II cancer from which the patient is currently in complete remission * Any other cancer from which the patient has been disease-free for 5 years * No patients with active or symptomatic viral hepatitis or chronic liver disease * No moderate (Child-Pugh B) or severe (Child-Pugh C) hepatic impairment * No history of NYHA class III or IV heart failure * Patients must have LVEF ≥ 50% * No known allergies, hypersensitivity, or intolerance to abiraterone acetate, prednisone, or their excipients PRIOR CONCURRENT THERAPY: * See Disease Characteristics * Patients with a history of prior neoadjuvant or adjuvant GNRH agonist/antagonist therapy (related to previous surgery or radiation) are eligible provided they finished this therapy at least two years prior to registration * Prior enrollment to SWOG-S0925 (either arm) is not exclusionary * At least 6 weeks since prior and no concurrent finasteride or dutasteride * At least 28 days since prior radiotherapy or surgery and recovered * At least 4 weeks since prior investigational products * At least 4 weeks since prior flutamide (6 weeks for bicalutamide and nilutamide) with no evidence of a falling PSA * No other concurrent oral antiandrogen * No prior or concurrent cytotoxic chemotherapy or radiopharmaceuticals for prostate cancer * No prior or concurrent ketoconazole for the treatment of prostate cancer * Not requiring more than 10 mg a day of prednisone for another medical indication * Not planning to receive any concurrent cytotoxic chemotherapy, immunotherapy, surgery, or radiotherapy during protocol treatment * No concurrent hormonal-acting agents, including diethylstilbestrol/DES, aldosterone, PC-SPES, or spironolactone * No concurrent antifungal medication (e.g., fluconazole or itraconazole) * No medications that alter cardiac conduction * No prior Provenge (sipuleucel-T)

Design outcomes

Primary

MeasureTime frameDescription
Number of Patients With Undetectable PSA12 monthsundetectable PSA defined as \<= 0.2 ng/mL. Patients not responding in the first year were deemed non-responders.

Secondary

MeasureTime frameDescription
Number of Patients With PSA Partial Response12 monthsPSA reduction to \< 4 ng/ml, but \>0.2 ng/ml
Objective Progression-free Survival3 yearsProgression defined as unequivocal progression of disease, progressive disease as defined by Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), progressive disease as defined by the Prostate Cancer Clinical Trials Working Group bone scan progression criteria, or death due to disease.
Overall Survival3 years
Number of Patients With Toxicity of Abiraterone AcetateUp to 3 yearsOnly adverse events that are possibly, probably or definitely related to study drug are reported.

Countries

United States

Participant flow

Participants by arm

ArmCount
Abiraterone Acetate + Prednisone
Abiraterone, 1,000 mg, oral (on an empty stomach at least 2 hours after or 1 hour before eating); to be taken daily Prednisone, 5 mg, oral, 5 mg twice daily abiraterone acetate: 1,000 mg, oral (on an empty stomach at least 2 hours after or 1 hour before eating); taken daily Prednisone: 5 mg, oral, 5 mg twice daily
40
Total40

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyAdverse Event5
Overall StudyLack of Efficacy20
Overall StudyOther9
Overall StudyWithdrawal by Subject3

Baseline characteristics

CharacteristicAbiraterone Acetate + Prednisone
Age, Continuous66 years
Antiandrogen use
No
5 Participants
Antiandrogen use
Yes
35 Participants
Gleason Score
2-6
3 Participants
Gleason Score
7
7 Participants
Gleason Score
8-10
30 Participants
Metastasis
Bone
37 Participants
Metastasis
Lymph node
8 Participants
Metastasis
Visceral
6 Participants
Performance Status
0-1
39 Participants
Performance Status
2
1 Participants
Prostatectomy
No
35 Participants
Prostatectomy
Yes
5 Participants
Prostate RT
No
35 Participants
Prostate RT
Yes
5 Participants
PSA at entry23.6 ng/mL
PSA status at registration
Rising level
34 Participants
PSA status at registration
Stable/falling level
6 Participants
Race/Ethnicity, Customized
Ethnicity
Hispanic
4 Participants
Race/Ethnicity, Customized
Ethnicity
Not Hispanic/unknown
36 Participants
Race (NIH/OMB)
American Indian or Alaska Native
1 Participants
Race (NIH/OMB)
Asian
2 Participants
Race (NIH/OMB)
Black or African American
10 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
White
27 Participants
Sex: Female, Male
Female
0 Participants
Sex: Female, Male
Male
40 Participants
Testosterone12.8 ng/dL

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
39 / 40
serious
Total, serious adverse events
16 / 40

Outcome results

Primary

Number of Patients With Undetectable PSA

undetectable PSA defined as \<= 0.2 ng/mL. Patients not responding in the first year were deemed non-responders.

Time frame: 12 months

Population: All patients who received at least 1 dose of protocol treatment

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Abiraterone Acetate + PrednisoneNumber of Patients With Undetectable PSA5 Participants
Secondary

Number of Patients With PSA Partial Response

PSA reduction to \< 4 ng/ml, but \>0.2 ng/ml

Time frame: 12 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Abiraterone Acetate + PrednisoneNumber of Patients With PSA Partial Response13 Participants
Secondary

Number of Patients With Toxicity of Abiraterone Acetate

Only adverse events that are possibly, probably or definitely related to study drug are reported.

Time frame: Up to 3 years

Population: All participants receiving at least some protocol treatment

ArmMeasureGroupValue (NUMBER)
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateAlanine aminotransferase increased2 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateAnorexia1 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateAspartate aminotransferase increased2 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateHyperglycemia2 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateHypertension2 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateHypokalemia2 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateINR increased1 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateLeukocytosis1 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateLung infection1 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateNausea2 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateRectal hemorrhage1 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateThromboembolic event1 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateVomiting2 Participants
Abiraterone Acetate + PrednisoneNumber of Patients With Toxicity of Abiraterone AcetateWeight gain1 Participants
Secondary

Objective Progression-free Survival

Progression defined as unequivocal progression of disease, progressive disease as defined by Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), progressive disease as defined by the Prostate Cancer Clinical Trials Working Group bone scan progression criteria, or death due to disease.

Time frame: 3 years

ArmMeasureValue (MEDIAN)
Abiraterone Acetate + PrednisoneObjective Progression-free Survival17.5 months
Secondary

Overall Survival

Time frame: 3 years

ArmMeasureValue (MEDIAN)
Abiraterone Acetate + PrednisoneOverall Survival25.8 months

Source: ClinicalTrials.gov · Data processed: Mar 5, 2026