Metastatic Castrate-Resistant Prostate Cancer, Prostate Cancer, PSA
Conditions
Keywords
OGX-427, Abiraterone Acetate
Brief summary
This Phase II study has been designed to evaluate the anti-tumor effects of adding OGX-427 to continuing abiraterone acetate and prednisone treatment in men with metastatic castrate-resistant prostate cancer (MCRPC) who have prostate-specific antigen (PSA) progression
Detailed description
OUTLINE: This is a multi-center study. This is an open-label, randomized, Phase II clinical trial designed to evaluate the anti-tumor effects of OGX-427 and continuing abiraterone acetate and prednisone versus continuing abiraterone acetate and prednisone alone in men with MCRPC who have evidence of PSA progression but no evidence of symptomatic or radiographic progression that would require alternative therapy (e.g., needing radiation therapy for pain or significant progression of visceral metastases). Patients on the control arm will be allowed to cross-over to receive OGX-427 following documented disease progression. Patients will be randomized with equal probability to one of the following arms: EXPERIMENTAL ARM (Arm A): OGX-427 Starting within 7 days of randomization, three loading doses of 600 mg intravenously (IV) within Week 1 if possible (up to 10 days of initiating treatment), followed by weekly doses of 800 mg IV Continuation of standard therapy with abiraterone acetate 1000 mg by mouth (PO) daily and prednisone 10-20 mg PO daily CONTROL ARM (Arm B): Continuation of standard therapy with abiraterone acetate 1000 mg PO daily and prednisone 10-20 mg PO daily After documented disease progression, patients on Arm B may opt to receive OGX-427 treatment (according to the Arm A schedule) following a screening evaluation (i.e., all inclusion and exclusion criteria have been met) Both Arms: Evaluations at 4 week-intervals. Disease assessments required at the milestone Day 60 assessment (expected to occur after 8 weeks of treatment and prior to Day 1, Week 9) and at 16, 24, 32, 40, and 48 weeks (if applicable) or until documented disease progression. Patients who are withdrawn from the study for a reason other than documented disease progression or patient withdrawal of consent will be followed every 4 weeks in the Off-Treatment Follow-up Period until documented disease progression. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 Life Expectancy: Not Specified Hematopoietic: * Absolute neutrophil count (ANC) ≥ 1.5 x 109 cells /L, platelet count ≥ 100 x 109 /L, and hemoglobin ≥ 9 g/dL without transfusion Hepatic: * Total bilirubin ≤ 1.1 x upper limit of normal (ULN) unless elevated secondary to conditions such as Gilbert's disease, in which case a direct bilirubin ≤ ULN is required * Serum glutamic pyruvic transaminase (SGPT), alanine transaminase (ALT) and alanine transaminase (SGOT) aspartate transaminase (AST) ≤ 3.0 x ULN Renal: * Creatinine ≤ 1.3 x ULN Cardiac: * Known left ventricular ejection fraction (LVEF) \<50% or New York Heart Association (NYHA) Functional Classification Class III or IV heart failure Other: * Castrate serum testosterone level (\< 50 ng/dL or \< 1.7 nmol/L) * Potassium within normal limits
Interventions
OGX-427 started within 7 days of randomization, three loading doses of 600 mg IV within Week 1 if possible (up to 10 days of initiating treatment), followed by weekly doses of 800 mg IV
Standard therapy: Abiraterone Acetate 1000 mg PO daily
Standard therapy: Prednisone 10-20 mg PO daily
Sponsors
Study design
Eligibility
Inclusion criteria
Subjects must meet ALL of the following criteria to be eligible for inclusion into the study. * Histological or cytological diagnosis of adenocarcinoma of the prostate * Metastatic disease on chest, abdominal, or pelvic computed tomography (CT) scan and/or bone scan * Currently receiving abiraterone acetate and prednisone and meeting the following criteria: * Any PSA decline within 12 weeks from initiation of abiraterone acetate * Currently tolerating abiraterone acetate (1000 mg oral daily) and prednisone (10-20 mg oral daily) * PSA progression, defined as an increase in PSA which is ≥25% above the nadir and an absolute value of ≥2 ng/mL, which is confirmed by a second value ≥2 weeks later. * No evidence of symptomatic or radiographic progression that would require alternative therapy (e.g., needing radiation therapy for pain or significant progression of visceral metastases or \>33% increase in daily opioid use within 2 weeks prior to randomization). * All patients who have not had a surgical orchiectomy must continue treatment with a luteinizing hormone-releasing hormone (LHRH) agonist or antagonist to maintain a castrate level of testosterone. * Patient must fulfill Prior Therapy criteria as follows: * Chemotherapy: no more than 1 prior chemotherapy regimen for castrate-resistant prostate cancer (CRPC) is permitted; a minimum of at least 28 days must have passed since the last dose of chemotherapy. * Hormone therapy: hormonal androgen ablation therapy prior to abiraterone is required. * Experimental therapy: prior non-cytotoxic experimental therapy is permitted provided a minimum of at least 14 days has passed since completing therapy. Prior treatment with enzalutamide (MDV3100) is allowed. * Radiation: prior external beam radiation is permitted provided a minimum of at least 14 days have passed since completing radiotherapy (exception for radiotherapy: at least 7 days since completing a single fraction of ≤800 cGy to a restricted field or limited-field radiotherapy to non-marrow bearing area such as an extremity or orbit) at the time of randomization * Must be willing to use effective contraception throughout study treatment and for 3 months after completion of study treatment if able to father a child. * Must be willing not to change (add or subtract) bone protecting therapy (bisphosphonates and/or denosumab) during the study unless changed for toxicity. * Written informed consent must be obtained prior to any protocol-specific procedures being performed.
Exclusion criteria
Subjects meeting ANY of the following
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival | 60 days | To ascertain whether Arm A has a greater proportion of patients observed to be alive without progression at Day 60 (±7 days) as compared to Arm B. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PSA Response | 60 days | Compare arms to determine the proportion of patients who have a PSA response (≥ 30% decline) and any PSA decline post-randomization. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Circulating Tumor Cell (CTC) Counts | Every 4 weeks | Compare arms to determine circulating tumor cell (CTC) counts for patients at baseline and while on study |
| Objective Response | 60 days | Compare arms to determine the objective response of study patients, per RECIST 1.1 |
| Phosphatase and Tensin Homolog (PTEN) Deletion Status | Every 4 weeks | Compare arms to determine PTEN deletion status in original pathology specimens correlated with clinical outcomes |
| Protein Levels | Every 4 weeks | Compare arms to determine levels of heat shock protein 27 (Hsp27), clusterin, and other relevant proteins of patients at baseline and during study |
| Time to Disease Progression | 60 days | Compare arms to determine the time to disease progression of study patients |
Countries
Canada, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Experimental: Arm A OGX-427 + continuation of standard therapy with abiraterone acetate and prednisone
OGX-427: OGX-427 started within 7 days of randomization, three loading doses of 600 mg IV within Week 1 if possible (up to 10 days of initiating treatment), followed by weekly doses of 800 mg IV
Abiraterone Acetate: Standard therapy: Abiraterone Acetate 1000 mg PO daily
Prednisone: Standard therapy: Prednisone 10-20 mg PO daily | 36 |
| Control Arm: Arm B Continuation of standard therapy with abiraterone acetate and prednisone
Abiraterone Acetate: Standard therapy: Abiraterone Acetate 1000 mg PO daily
Prednisone: Standard therapy: Prednisone 10-20 mg PO daily | 36 |
| Total | 72 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 2 | 4 |
| Overall Study | Lack of Efficacy | 23 | 23 |
| Overall Study | Lost to Follow-up | 0 | 1 |
| Overall Study | Protocol Violation | 2 | 0 |
| Overall Study | Withdrawal by Subject | 5 | 5 |
Baseline characteristics
| Characteristic | Total | Experimental: Arm A | Control Arm: Arm B |
|---|---|---|---|
| Age, Continuous | 72 years | 71 years | 72 years |
| ECOG Status ECOG 0 | 32 participants | 16 participants | 16 participants |
| ECOG Status ECOG 1 | 40 participants | 20 participants | 20 participants |
| Median PSA | 23 ug/L | 34.19 ug/L | 18.17 ug/L |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 8 Participants | 5 Participants | 3 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 4 Participants | 1 Participants | 3 Participants |
| Race (NIH/OMB) White | 58 Participants | 30 Participants | 28 Participants |
| Region of Enrollment Canada | 29 participants | 14 participants | 15 participants |
| Region of Enrollment United States | 43 participants | 22 participants | 21 participants |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 72 Participants | 36 Participants | 36 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 8 / 56 | 6 / 36 |
| other Total, other adverse events | 51 / 56 | 32 / 36 |
| serious Total, serious adverse events | 12 / 56 | 6 / 36 |
Outcome results
Progression-Free Survival
To ascertain whether Arm A has a greater proportion of patients observed to be alive without progression at Day 60 (±7 days) as compared to Arm B.
Time frame: 60 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental: Arm A | Progression-Free Survival | 12 participants |
| Control Arm: Arm B | Progression-Free Survival | 6 participants |
PSA Response
Compare arms to determine the proportion of patients who have a PSA response (≥ 30% decline) and any PSA decline post-randomization.
Time frame: 60 days
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Experimental: Arm A | PSA Response | PSA DECLINE >= 30% | 2 participants |
| Experimental: Arm A | PSA Response | PSA DELCINE >=50 % | 2 participants |
| Experimental: Arm A | PSA Response | ANY DECLINE | 13 participants |
| Control Arm: Arm B | PSA Response | PSA DECLINE >= 30% | 2 participants |
| Control Arm: Arm B | PSA Response | PSA DELCINE >=50 % | 1 participants |
| Control Arm: Arm B | PSA Response | ANY DECLINE | 11 participants |
Circulating Tumor Cell (CTC) Counts
Compare arms to determine circulating tumor cell (CTC) counts for patients at baseline and while on study
Time frame: Every 4 weeks
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Experimental: Arm A | Circulating Tumor Cell (CTC) Counts | Best CTC Change from Baseline >=5 to <5 | 8 participants |
| Experimental: Arm A | Circulating Tumor Cell (CTC) Counts | Best CTC Change from Baseline <5 to <5 | 16 participants |
| Experimental: Arm A | Circulating Tumor Cell (CTC) Counts | Best CTC Change from Baseline >=5 to >=5 | 7 participants |
| Experimental: Arm A | Circulating Tumor Cell (CTC) Counts | Best CTC Change from Baseline<5 to >=5 | 1 participants |
| Control Arm: Arm B | Circulating Tumor Cell (CTC) Counts | Best CTC Change from Baseline<5 to >=5 | 1 participants |
| Control Arm: Arm B | Circulating Tumor Cell (CTC) Counts | Best CTC Change from Baseline >=5 to <5 | 4 participants |
| Control Arm: Arm B | Circulating Tumor Cell (CTC) Counts | Best CTC Change from Baseline >=5 to >=5 | 10 participants |
| Control Arm: Arm B | Circulating Tumor Cell (CTC) Counts | Best CTC Change from Baseline <5 to <5 | 15 participants |
Objective Response
Compare arms to determine the objective response of study patients, per RECIST 1.1
Time frame: 60 days
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Experimental: Arm A | Objective Response | Progressive Disease | 26 participants |
| Experimental: Arm A | Objective Response | Partial Response | 1 participants |
| Experimental: Arm A | Objective Response | Stable Disease | 6 participants |
| Control Arm: Arm B | Objective Response | Progressive Disease | 25 participants |
| Control Arm: Arm B | Objective Response | Partial Response | 0 participants |
| Control Arm: Arm B | Objective Response | Stable Disease | 5 participants |
Phosphatase and Tensin Homolog (PTEN) Deletion Status
Compare arms to determine PTEN deletion status in original pathology specimens correlated with clinical outcomes
Time frame: Every 4 weeks
Population: Data for this objective was not collected or analyzed
Protein Levels
Compare arms to determine levels of heat shock protein 27 (Hsp27), clusterin, and other relevant proteins of patients at baseline and during study
Time frame: Every 4 weeks
Population: Data for this secondary objective was not collected or analyzed
Time to Disease Progression
Compare arms to determine the time to disease progression of study patients
Time frame: 60 days
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Experimental: Arm A | Time to Disease Progression | 1.9055 months |
| Control Arm: Arm B | Time to Disease Progression | 1.0842 months |