Metastatic Castrate Resistant Prostate Cancer
Conditions
Brief summary
The purpose of this study is to confirm that tasquinimod used as maintenance therapy is active and tolerable in patients with metastatic castrate-resistant prostate cancer not progressing after a first chemotherapy with docetaxel.
Interventions
A patient's dose will escalate from one level to the next, once tolerability of the current dose is established. If tolerability issues arise at 0.5 or 1 mg/day, patients will have their dose reduced to 0.25 or 0.5 mg/day, respectively.
Placebo capsules are identical to tasquinimod capsules in appearance and excipients but exclude the active compound (tasquinimod), to be taken orally once a day with water and food
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically documented prostate cancer with evidence of metastatic disease on radiological evaluation, with or without symptoms (defined according to the BPI scale, with use of analgesics or narcotics) * Has received a first line docetaxel based chemotherapy (as a monotherapy) every 3 weeks schedule of administration with corticosteroids for a minimum of 6 cycles with a cumulative dose ≥360 mg/m2. Any combination with investigational or non investigational agent is prohibited * Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 * Docetaxel-related adverse effects must have been resolved to NCI-CTCAE v4.03 (Common Toxicity Criteria for Adverse Effects) Grade ≤1. Chemotherapy-induced alopecia and Grade 2 peripheral neuropathy are allowed * No progressive disease at the end of docetaxel treatment defined according to RECIST criteria, no new lesion(s) assessed by bone scan and no elevated prostate specific antigen (PSA) for the three last tests with PSA3≤PSA2≤PSA1. The time between each PSA test should be preferably at least 14 days, however, a minimum of 7 days is acceptable. Note: PSA value can be rounded to the nearest whole number if PSA\>10 ng/mL. If the PSA3 value is above the PSA2, a fourth PSA test will be performed. The PSA4 value should be below or equal to PSA2 * Last dose of docetaxel administered between 21 and 42 days before randomisation * Chemical or surgical castration verified by levels of serum testosterone ≤50 ng/dL (1.75 nmol/L)
Exclusion criteria
* Has concurrent use of other anticancer agents or treatments, with the following exceptions: ongoing treatment with luteinising hormone-releasing hormone agonists or antagonists, denosumab or bisphosphonate (e.g., zoledronic acid) is permitted if started ≥4 weeks prior to Screening. Ongoing treatment should be kept at a stable dose regimen * Has ongoing treatment with warfarin * Had prior radiation therapy since starting docetaxel. Exceptions may be made for palliative non-myelosuppressive radiation therapy administered more than 2 weeks prior to randomisation * Had prior strontium, samarium or radium therapy or prior treatment with tasquinimod, or any agents with antiangiogenic properties * Has ongoing treatment with corticosteroids at \>10 mg/day prednisolone equivalent * Has prostate cancer pain that warrants the initiation of radiotherapy or chemotherapy * Has known brain or epidural metastases. Patients with previous medullary cord compression without any neurological deficit could be included * Has a history of other malignancies, except adequately treated non-melanoma skin cancer or other solid tumours curatively treated, without evidence of disease for \>5 years
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Radiological Progression Free Survival [PFS] | Every 8 weeks until disease progression documentation (approximately up to 2.5 years) | The time from the date of randomisation to the date of radiological progression or death due to any cause. Radiological progression was defined \- Using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for soft tissue lesions (Eisenhauer, EJC 2009), as at least a 20% relative and a 5 mm absolute increase in the sum of diameters of target lesions, taking as reference the smallest sum of diameters recorded on study (including Screening or the appearance of one or more new lesions) for target Lesions. Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions \- Using Prostate Cancer Clinical Working Group in March 2008 (PCWG2) criteria for bone lesions (Scher, JCO 2008). Progression was defined as appearance of 2 or more bone lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Progression Free Survival [PFS] on Next-line Therapy (PFS 2) | Every 3 months after study treatment stop (follow-up) until progression under the next line therapy (approximately up to 2.5 years) | The time from the date of randomisation to the date of radiological progression free survival \[PFS\] on next-line therapy (PFS 2) or death due to any cause. Radiological progression was defined \- Using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for soft tissue lesions (Eisenhauer, EJC 2009), as at least a 20% relative and a 5 mm absolute increase in the sum of diameters of target lesions, taking as reference the smallest sum of diameters recorded on study (including Screening or the appearance of one or more new lesions) for target Lesions. Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions \- Using Prostate Cancer Clinical Working Group in March 2008 (PCWG2) criteria for bone lesions (Scher, JCO 2008). Progression was defined as appearance of 2 or more bone lesions. |
| Symptomatic PFS Based on Number of Subjects Who Had Symptomatic Progression or Death | Every 8 weeks until symptomatic or radiological progression documentation (approximately up to 2.5 years) | Symptomatic PFS is defined as the time from the date of randomisation to the date of symptomatic progression or death due to prostate cancer, whichever occurs first \[symptomatic progression as assessed by Brief Pain Inventory (BPI) and analgesic use\]. Symptomatic progression was defined by the occurrence of pain with documented disease, skeleton related adverse events. The median symptomatic PFS for placebo and tasquinimod groups was not reached. Tasquinimod: Patients censored = 48, Patients at risk (t=0) = 71 Placebo: Patients censored = 54, Patients at risk (t=0) = 73 |
| Time to Further Anticancer Treatment for Prostate Cancer | Every 3 months after study treatment stop until further anticancer therapy for prostate cancer (approximately up to 2.5 years) | Time from randomisation to further treatment for prostate cancer |
| Overall Survival Based on Number of Subjects Who Died | Every 3 months after study treatment stop until death (approximately up to 2.5 years) | Overall survival is defined as the time from randomisation to death due to any cause. The number of participants who died is presented since the Median was not reached for this assessment. Tasquinimod: Patients censored = 63, Patients at risk (t=0) = 71 Placebo: Patients censored = 67, Patients at risk (t=0) = 73 |
| Change From Baseline of EuroQol-5 Dimension QoL Instrument (EQ-5D) VAS Score | Baseline and End-of-study Visit (approximately up to 2.5 years) | Baseline is defined as last measurement collected prior to the first dose of study drug. End of Study visit (within 14 days of last dose of study treatment) The EQ-5D, a 5-item scale useful in health resource utilisation and cost comparisons between treatment groups designed for self-completion by patients consists of two pages \[EQ-5 descriptive system and EQ Visual Analogue Scale(VAS)\]. The EQ-5 descriptive system comprises five dimensions: mobility, self care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, severe problems. The EQ-VAS records the respondent's self-rated health on a vertical VAS. The respondents are asked to mark health status on the day of the interview on a 10cm vertical scale with end points of 0 to100. There are notes at the both ends of the scale that the bottom rate(0) corresponds to the worst health you can imagine, and the highest rate(100) corresponds to the best health you can imagine |
| Safety Profile of Tasquinimod | At regular intervals during the study treatment period and every 3 months during the follow-up until death (approximately up to 2.5 years) | Number of subjects reporting adverse events |
| Time to Deterioration in Functional Assessment of Cancer Therapy - Prostate (FACT-P) | Up to End of Study visit (approximately up to 2.5 years) | End of Study visit (within 14 days of last dose of study treatment) Impact of tasquinimod on health related quality of life (QoL) - Analysis of time to deterioration in FACT-P The FACT-P measurement system is a validated collection of health related quality of life (HRQOL) questionnaires used to assess HRQOL in men with prostate cancer. It is appropriate for use with patients with any form of cancer and extensions of it have been used and validated in other chronic illness condition. The FACT-P is a self-administered 39-item scale comprising five domains: physical well-being, social/family well-being, functional well-being, emotional well-being and additional concerns. The individual subscale scores range from 0 to a high between 24 and 48 and the total score ranges between 0 and 156, with higher scores representing better Quality of Life (QoL) |
Countries
Belgium, Czechia, Denmark, France, Germany, Hungary, Italy, Lithuania, Poland, Spain, United Kingdom
Participant flow
Recruitment details
The study was performed as a multicentre study at 51 investigational sites (of which 44 randomised patients) in Belgium, Czech Republic, Denmark, France, Germany, Hungary, Italy, Lithuania, Poland, Spain and United Kingdom (UK)
Pre-assignment details
A total of 219 patients were screened and 144 patients were randomised.
Participants by arm
| Arm | Count |
|---|---|
| Tasquinimod 1 capsule daily, taken orally with water and food (0.25 mg initially then dose escalated to 0.5 mg and then to 1 mg per day) until disease progression.
Tasquinimod: Patients received initially an oral dose of 0.25 mg/day of tasquinimod, starting on Day 1, for at least 2 weeks. Once tolerability of the 0.25 mg/day dose was established, patients received a dose increase to 0.5 mg/day for at least 2 weeks, and then increased to 1 mg/day of study treatment. Patients showing poor tolerability for the escalated doses of tasquinimod were allowed to continue study treatment at the highest individually tolerated dose | 71 |
| Placebo 1 capsule daily, taken orally with water and food until disease progression
Placebo: Patients received Placebo capsules (identical to tasquinimod capsules) to be taken orally once a day with water and food | 73 |
| Total | 144 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 13 | 3 |
| Overall Study | Consent withdrawn | 13 | 6 |
| Overall Study | Disease progression | 37 | 50 |
| Overall Study | Other | 8 | 14 |
Baseline characteristics
| Characteristic | Tasquinimod | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 69.6 years STANDARD_DEVIATION 7.18 | 69.6 years STANDARD_DEVIATION 5.57 | 69.6 years STANDARD_DEVIATION 6.39 |
| Age, Customized 18 to ≤ 65 years | 18 participants | 17 participants | 35 participants |
| Age, Customized 66 to ≤ 75 years | 40 participants | 45 participants | 85 participants |
| Age, Customized > 75 years | 13 participants | 11 participants | 24 participants |
| BMI | 27.67 kg/m^2 STANDARD_DEVIATION 3.543 | 28.01 kg/m^2 STANDARD_DEVIATION 4.399 | 27.84 kg/m^2 STANDARD_DEVIATION 3.987 |
| ECOG Performance Status Score 0 (Normal Activity) | 39 participants | 31 participants | 70 participants |
| ECOG Performance Status Score 1 (Restricted Activity) | 32 participants | 38 participants | 70 participants |
| ECOG Performance Status Score Missing | 0 participants | 4 participants | 4 participants |
| Ethnicity Hispanic or Latino | 2 participants | 4 participants | 6 participants |
| Ethnicity Missing | 17 participants | 14 participants | 31 participants |
| Ethnicity Not Hispanic or Latino | 52 participants | 55 participants | 107 participants |
| Race/Ethnicity, Customized Black/African American | 0 participants | 1 participants | 1 participants |
| Race/Ethnicity, Customized Caucasian/White | 52 participants | 58 participants | 110 participants |
| Race/Ethnicity, Customized Missing | 18 participants | 14 participants | 32 participants |
| Race/Ethnicity, Customized Multiple Race | 1 participants | 0 participants | 1 participants |
| Region Eastern Europe | 18 participants | 16 participants | 34 participants |
| Region Western Europe | 53 participants | 57 participants | 110 participants |
| Region of Enrollment Belgium | 5 participants | 6 participants | 11 participants |
| Region of Enrollment Czech Republic | 5 participants | 1 participants | 6 participants |
| Region of Enrollment Denmark | 6 participants | 13 participants | 19 participants |
| Region of Enrollment France | 17 participants | 14 participants | 31 participants |
| Region of Enrollment Germany | 3 participants | 3 participants | 6 participants |
| Region of Enrollment Hungary | 2 participants | 2 participants | 4 participants |
| Region of Enrollment Italy | 9 participants | 5 participants | 14 participants |
| Region of Enrollment Lithuania | 7 participants | 10 participants | 17 participants |
| Region of Enrollment Poland | 4 participants | 3 participants | 7 participants |
| Region of Enrollment Spain | 5 participants | 10 participants | 15 participants |
| Region of Enrollment United Kingdom | 8 participants | 6 participants | 14 participants |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 71 Participants | 73 Participants | 144 Participants |
| Weight | 83.7 kg STANDARD_DEVIATION 12.57 | 83.4 kg STANDARD_DEVIATION 15.09 | 83.6 kg STANDARD_DEVIATION 13.86 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 69 / 71 | 66 / 70 |
| serious Total, serious adverse events | 24 / 71 | 16 / 70 |
Outcome results
Time to Radiological Progression Free Survival [PFS]
The time from the date of randomisation to the date of radiological progression or death due to any cause. Radiological progression was defined \- Using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for soft tissue lesions (Eisenhauer, EJC 2009), as at least a 20% relative and a 5 mm absolute increase in the sum of diameters of target lesions, taking as reference the smallest sum of diameters recorded on study (including Screening or the appearance of one or more new lesions) for target Lesions. Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions \- Using Prostate Cancer Clinical Working Group in March 2008 (PCWG2) criteria for bone lesions (Scher, JCO 2008). Progression was defined as appearance of 2 or more bone lesions.
Time frame: Every 8 weeks until disease progression documentation (approximately up to 2.5 years)
Population: Intention to treat (ITT) Population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tasquinimod | Time to Radiological Progression Free Survival [PFS] | 31.7 weeks |
| Placebo | Time to Radiological Progression Free Survival [PFS] | 22.7 weeks |
Change From Baseline of EuroQol-5 Dimension QoL Instrument (EQ-5D) VAS Score
Baseline is defined as last measurement collected prior to the first dose of study drug. End of Study visit (within 14 days of last dose of study treatment) The EQ-5D, a 5-item scale useful in health resource utilisation and cost comparisons between treatment groups designed for self-completion by patients consists of two pages \[EQ-5 descriptive system and EQ Visual Analogue Scale(VAS)\]. The EQ-5 descriptive system comprises five dimensions: mobility, self care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, severe problems. The EQ-VAS records the respondent's self-rated health on a vertical VAS. The respondents are asked to mark health status on the day of the interview on a 10cm vertical scale with end points of 0 to100. There are notes at the both ends of the scale that the bottom rate(0) corresponds to the worst health you can imagine, and the highest rate(100) corresponds to the best health you can imagine
Time frame: Baseline and End-of-study Visit (approximately up to 2.5 years)
Population: ITT population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tasquinimod | Change From Baseline of EuroQol-5 Dimension QoL Instrument (EQ-5D) VAS Score | -9.0 Score on scale |
| Placebo | Change From Baseline of EuroQol-5 Dimension QoL Instrument (EQ-5D) VAS Score | -3.5 Score on scale |
Overall Survival Based on Number of Subjects Who Died
Overall survival is defined as the time from randomisation to death due to any cause. The number of participants who died is presented since the Median was not reached for this assessment. Tasquinimod: Patients censored = 63, Patients at risk (t=0) = 71 Placebo: Patients censored = 67, Patients at risk (t=0) = 73
Time frame: Every 3 months after study treatment stop until death (approximately up to 2.5 years)
Population: ITT Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Tasquinimod | Overall Survival Based on Number of Subjects Who Died | 8 participants |
| Placebo | Overall Survival Based on Number of Subjects Who Died | 6 participants |
Safety Profile of Tasquinimod
Number of subjects reporting adverse events
Time frame: At regular intervals during the study treatment period and every 3 months during the follow-up until death (approximately up to 2.5 years)
Population: Safety Population: All patients who received at least one dose of study treatment. Patients were allocated to the treatment they actually received
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tasquinimod | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 3] | 32 participants |
| Tasquinimod | Safety Profile of Tasquinimod | Causality of TEAEs [Not Drug Related] | 15 participants |
| Tasquinimod | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 3-5 (severe)] | 36 participants |
| Tasquinimod | Safety Profile of Tasquinimod | TEAEs Leading to Drug Withdrawal | 12 participants |
| Tasquinimod | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 2 (moderate)] | 28 participants |
| Tasquinimod | Safety Profile of Tasquinimod | TEAEs leading to Dose Reduction | 16 participants |
| Tasquinimod | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 4] | 3 participants |
| Tasquinimod | Safety Profile of Tasquinimod | TEAEs leading to Drug Interruption | 33 participants |
| Tasquinimod | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 1 (mild)] | 5 participants |
| Tasquinimod | Safety Profile of Tasquinimod | TEAEs Leading to Death | 1 participants |
| Tasquinimod | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 5] | 1 participants |
| Tasquinimod | Safety Profile of Tasquinimod | Serious Adverse Event (SAEs) | 24 participants |
| Tasquinimod | Safety Profile of Tasquinimod | Causality of TEAEs [Drug Related] | 54 participants |
| Tasquinimod | Safety Profile of Tasquinimod | Drug Related SAEs | 6 participants |
| Tasquinimod | Safety Profile of Tasquinimod | Any Treatment Emergent Adverse Event (TEAEs) | 69 participants |
| Placebo | Safety Profile of Tasquinimod | Drug Related SAEs | 2 participants |
| Placebo | Safety Profile of Tasquinimod | Any Treatment Emergent Adverse Event (TEAEs) | 66 participants |
| Placebo | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 3-5 (severe)] | 19 participants |
| Placebo | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 5] | 3 participants |
| Placebo | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 4] | 2 participants |
| Placebo | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 3] | 14 participants |
| Placebo | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 2 (moderate)] | 28 participants |
| Placebo | Safety Profile of Tasquinimod | Intensity of TEAEs [Grade 1 (mild)] | 19 participants |
| Placebo | Safety Profile of Tasquinimod | Causality of TEAEs [Drug Related] | 38 participants |
| Placebo | Safety Profile of Tasquinimod | Causality of TEAEs [Not Drug Related] | 28 participants |
| Placebo | Safety Profile of Tasquinimod | TEAEs Leading to Drug Withdrawal | 3 participants |
| Placebo | Safety Profile of Tasquinimod | TEAEs leading to Dose Reduction | 2 participants |
| Placebo | Safety Profile of Tasquinimod | TEAEs leading to Drug Interruption | 12 participants |
| Placebo | Safety Profile of Tasquinimod | TEAEs Leading to Death | 0 participants |
| Placebo | Safety Profile of Tasquinimod | Serious Adverse Event (SAEs) | 16 participants |
Symptomatic PFS Based on Number of Subjects Who Had Symptomatic Progression or Death
Symptomatic PFS is defined as the time from the date of randomisation to the date of symptomatic progression or death due to prostate cancer, whichever occurs first \[symptomatic progression as assessed by Brief Pain Inventory (BPI) and analgesic use\]. Symptomatic progression was defined by the occurrence of pain with documented disease, skeleton related adverse events. The median symptomatic PFS for placebo and tasquinimod groups was not reached. Tasquinimod: Patients censored = 48, Patients at risk (t=0) = 71 Placebo: Patients censored = 54, Patients at risk (t=0) = 73
Time frame: Every 8 weeks until symptomatic or radiological progression documentation (approximately up to 2.5 years)
Population: ITT Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Tasquinimod | Symptomatic PFS Based on Number of Subjects Who Had Symptomatic Progression or Death | 23 participants |
| Placebo | Symptomatic PFS Based on Number of Subjects Who Had Symptomatic Progression or Death | 19 participants |
Time to Deterioration in Functional Assessment of Cancer Therapy - Prostate (FACT-P)
End of Study visit (within 14 days of last dose of study treatment) Impact of tasquinimod on health related quality of life (QoL) - Analysis of time to deterioration in FACT-P The FACT-P measurement system is a validated collection of health related quality of life (HRQOL) questionnaires used to assess HRQOL in men with prostate cancer. It is appropriate for use with patients with any form of cancer and extensions of it have been used and validated in other chronic illness condition. The FACT-P is a self-administered 39-item scale comprising five domains: physical well-being, social/family well-being, functional well-being, emotional well-being and additional concerns. The individual subscale scores range from 0 to a high between 24 and 48 and the total score ranges between 0 and 156, with higher scores representing better Quality of Life (QoL)
Time frame: Up to End of Study visit (approximately up to 2.5 years)
Population: ITT population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tasquinimod | Time to Deterioration in Functional Assessment of Cancer Therapy - Prostate (FACT-P) | 8.1 weeks |
| Placebo | Time to Deterioration in Functional Assessment of Cancer Therapy - Prostate (FACT-P) | 15.7 weeks |
Time to Further Anticancer Treatment for Prostate Cancer
Time from randomisation to further treatment for prostate cancer
Time frame: Every 3 months after study treatment stop until further anticancer therapy for prostate cancer (approximately up to 2.5 years)
Population: ITT population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tasquinimod | Time to Further Anticancer Treatment for Prostate Cancer | 42.3 weeks |
| Placebo | Time to Further Anticancer Treatment for Prostate Cancer | 29.0 weeks |
Time to Progression Free Survival [PFS] on Next-line Therapy (PFS 2)
The time from the date of randomisation to the date of radiological progression free survival \[PFS\] on next-line therapy (PFS 2) or death due to any cause. Radiological progression was defined \- Using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for soft tissue lesions (Eisenhauer, EJC 2009), as at least a 20% relative and a 5 mm absolute increase in the sum of diameters of target lesions, taking as reference the smallest sum of diameters recorded on study (including Screening or the appearance of one or more new lesions) for target Lesions. Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions \- Using Prostate Cancer Clinical Working Group in March 2008 (PCWG2) criteria for bone lesions (Scher, JCO 2008). Progression was defined as appearance of 2 or more bone lesions.
Time frame: Every 3 months after study treatment stop (follow-up) until progression under the next line therapy (approximately up to 2.5 years)
Population: ITT Population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Tasquinimod | Time to Progression Free Survival [PFS] on Next-line Therapy (PFS 2) | 19.3 weeks |
| Placebo | Time to Progression Free Survival [PFS] on Next-line Therapy (PFS 2) | 24.1 weeks |