Prostate Cancer
Conditions
Brief summary
This is a non-randomized multi-center Phase 1b/2a dose escalation and dose expansion study testing DKN-01 as monotherapy or in combination with docetaxel in metastatic castration-resistant prostate cancer. Patients need to be biomarker positive (Dickkopf-1 \[DKK1\]) either in plasma or biopsy. Other biopsies for correlative studies are encouraged but not mandatory. Pharmacokinetic (PK) testing of one pre-treatment blood sample and one post-treatment blood sample will be mandatory on Day 1 of every cycle.
Interventions
DRUGDKN-01
DKN-01 is a large molecular weight protein that will be given as a flat dose on a Days 1 and 15 of a 21-day cycle in Dose-Escalation Cohort 1A and Dose-Expansion Cohort 1B. DKN-01 will be given on Days 1 and 15 on a 28-day cycle in Dose-Escalation Cohort 2A and Dose-Expansion Cohort 2B. The dose of DKN-01 will be administered as an intravenous (IV) infusion over 60 (±) 15 minutes.
DRUGDocetaxel
Docetaxel will be administered as an IV infusion over approximately 60 (±15) minutes on day 1 of a 21-day cycle in Cohorts 1A and 1B. In Cohort 1A, docetaxel must be dosed at 75 mg/m2 on cycle 1 day 1. Docetaxel can be dosed at 75 mg/m2 or 60 mg/m2 in subsequent cycles depending on clinical discretion and dose modification guidelines. Regardless of dose, docetaxel must be dosed in 21-day cycles. In Cohort 1B, cycle 1 day 1 dosing of docetaxel will either be 75 mg/m2 or 60 mg/m2 depending on clinical discretion.
Sponsors
Leap Therapeutics, Inc.
NYU Langone Health
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Age \>18 years. * Have a histologically or cytologically confirmed cancer of prostate origin (adenocarcinoma, poorly differentiated carcinoma, or neuroendocrine carcinoma are all allowed). * Patients with pure neuroendocrine carcinoma must have had at least one line of platinum-based chemotherapy unless the patient is intolerant of or is refusing chemotherapy. * Patients with pure neuroendocrine carcinoma do not need to have been previously treated with androgen receptor (AR) signaling inhibitors (abiraterone or enzalutamide or apalutamide or darolutamide) but must have castrate testosterone and have castration-resistant disease. * Surgically or medically castrated, with testosterone levels of \< 50 ng/dL (\< 2.0 nM). If the patient is being treated with luteinizing hormone-releasing hormone (LHRH) agonists (patient who have not undergone orchiectomy), this therapy must have been initiated at least 4 weeks prior to C1D1 and must be continued throughout the study. * Cohorts 1A, 1B: Patients must have progressed despite 1 or more androgen receptor (AR) signaling inhibitors (abiraterone or enzalutamide or apalutamide or darolutamide) and have not received prior taxane-based chemotherapy for prostate cancer. Prior treatment with an AR signaling inhibitor for castration-sensitive disease will be allowed if the time to progression was within 1 year after starting drug. Prior treatment with a taxane-based chemotherapy for castration-sensitive disease will be exclusionary. (Prior treatment with an AR signaling inhibitor is not required for pure prostate neuroendocrine carcinoma as in inclusion 2.) * Cohorts 2A and 2B: Patients must have progressed despite 1 or more AR signaling inhibitor (abiraterone or enzalutamide or apalutamide or darolutamide) and either had disease progression, were intolerant of, or refused 1 or more taxane-based chemotherapies for mCRPC. (Prior treatment with an AR signaling inhibitor is not required for pure prostate neuroendocrine carcinoma as in inclusion 2.) * Cohort 1B. Patients must have measurable disease per RECIST v1.1 guidelines AND must have either: * PSA progression is defined by Prostate Cancer Working Group 3 (PCWG3) criteria as a minimum of two consecutive rising levels, with an interval of ≥1 week between each determination with a minimum PSA of 1 ng/mL, if PSA is the sole evidence of progression, OR * Radionuclide bone progression as defined by at least two new metastatic lesions (per PCWG3), OR * Soft tissue progression on transaxial imaging: new or progressive soft tissue masses on computed tomography (CT) or magnetic resonance imaging (MRI) scans as defined by RECIST v1.1. * Cohorts 1A, 2A, 2B. Patients must have baseline progression defined as one of the following: * PSA progression is defined by PCWG3 criteria as a minimum of two consecutive rising levels, with an interval of ≥1 week between each determination with a minimum PSA of 2 ng/mL. * Radionuclide bone progression as defined by at least two new metastatic lesions (per PCWG3). * Soft tissue progression on transaxial imaging: new or progressive soft tissue masses on computed tomography (CT) or magnetic resonance imaging (MRI) scans as defined by RECIST v1.1. * Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1. * Estimated life expectancy of at least 3 months, in the judgment of the Investigator. * Required initial laboratory values within 14 days of C1D1: * Total bilirubin within normal limits for the institution. (For Cohorts 2A and 2B, total bilirubin \< 3 × ULN is acceptable with known liver metastases). * For Cohorts 1A, 1B transaminases \[aspartate aminotransferase (AST) and alanine aminotransferase (ALT)\] ≤1.5 × the upper limit of normal (ULN). For Cohorts 2A and 2B, AST and ALT ≤ 5.0 × ULN is acceptable with known liver metastases. * Creatinine ≤2.0 or calculated creatinine clearance ≥50 mL/min using the Cockcroft and Gault Method (Cockroft and Gault 1976). * Absolute neutrophil count ≥1000 cells/µl. * Absolute lymphocyte count ≥500/µl. * Hemoglobin ≥8.5 g/dL. * Platelet count ≥100,000 cells/µl. (For Cohorts 2A and 2B, Platelet count ≥75,000 cells/µl). * International normalized ratio (INR) (prothrombin time \[PT\])/partial thromboplastin time (PTT) ≤1.5 × ULN unless receiving anticoagulant, in which case INR ≤3.0 and no active bleeding, (ie, no clinically significant bleeding within 14 days prior to first dose of study therapy. * Sexually active male patients must agree to use adequate contraception (hormonal or barrier method of birth control) during the study and for 6 months after their last dose of study drug. Should a patient's partner become pregnant or suspect she is pregnant while participating in the study, the Investigator should be immediately informed. * Reliable and willing to make themselves available for the duration of the study and are willing to follow study-specific procedures. * Provided written informed consent prior to any study-specific procedures. * Submission of a next-generation sequencing report from prostate cancer tissue or ctDNA from a CLIA certified lab if available. If no such report is available, a statement attesting to the lack of such a report is sufficient for eligibility.
Exclusion criteria
* Any anti-cancer therapy (with the exception of luteinizing hormone-releasing hormone \[LHRH\] analog or antagonist) within 2 weeks prior to initiation of study treatment. * Any investigational anti-cancer therapy within 4 weeks of initiation of study treatment. * New York Heart Association Class III or IV heart failure, or myocardial infarction within the past 6 months, or unstable arrhythmia within 3 months. * Uncontrolled bacterial, viral, or fungal infections, within 7 days of study entry. * History of malignancy other than prostate cancer within 2 years prior to screening, except for malignancies with a negligible risk of metastasis or death (e.g., 5-year OS rate \> 90%), such as non-melanoma skin carcinoma or ductal carcinoma in situ. * Known to be human immunodeficiency virus (HIV) positive, have positive hepatitis B surface antigen (HBSAg), or positive hepatitis C antibody (HCAb) test. (Hepatitis C antibody-positive patients with an undetectable hepatitis C virus (HCV) RNA will be eligible.) * History of solid organ transplant (ie, heart, lungs, liver, or kidney). * History of autologous/allogenic bone marrow transplant. * Serious nonmalignant disease that could compromise protocol objectives in the opinion of the Investigator and/or Sponsor. * Major surgical procedures or significant traumatic injury within 4 weeks prior to study entry (minor surgical procedures within 1 week of study entry). Note: Diagnostic cystoscopy is not exclusionary at any time during screening. History of osteonecrosis of the hip. Other hip pathology such as degenerative disease or malignant involvement are not exclusionary. Screening of asymptomatic patients is not required. * Active or untreated central nervous system (CNS) malignancy or metastasis. Screening for CNS metastases of asymptomatic patients without a history of CNS metastases is not required. Patients with treated CNS metastases are eligible provided they meet all of the following criteria: * Evaluable disease outside the CNS. * No history of intracranial or intraspinal hemorrhage. * No evidence of significant vasogenic edema. * No ongoing requirement for corticosteroids as therapy for CNS disease. (Anti-convulsants at a stable dose for \> one month is allowed.) * No stereotactic radiation, whole brain radiation within 4 weeks of C1D1. * Patients with CNS metastases treated by neurosurgical resection or brain biopsy within 3 month prior to C1D1 will not be allowed. * Radiographic demonstration of interim stability (ie, no progression) between completion of CNS-directed therapy and the screening radiographic study. * Screening CNS radiographic study ≥4 weeks since completion of radiotherapy or surgical resection and ≥2 weeks since discontinuation of corticosteroids. * Any other condition, disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complications. * Active substance abuse. * Receipt of any live vaccine within 30 days before the first dose of study treatment or anticipation that such a live vaccine will be required during study participation. * Previously treated with an anti-DKK1 therapy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Dose Limiting Toxicities Observed by End of Treatment Cycle 1 | Up to End of Cycle 1 (Up to Day 21 for Cohort 1A, Up to Day 28 for Cohort 2A) | Measured among Phase I dose-escalation cohorts (arms 1A.1, 1A.2, 2A.1, and 2A.2) only. |
| Number of Participants With a Best Overall Response of Complete Response (iCR) or Partial Response (iPR) Per iRECIST by End of Long-Term Follow-Up Period | Up to Year 2 Post-Baseline | iRECIST will be used by the Investigator to assess tumor response and progression. An iCR is defined as the disappearance of all target lesions as assessed by iRECIST; an iPR is defined as at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters, as assessed by iRECIST. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) | Up to Year 2 Post-Baseline | Defined as the time from the first dose of study treatment to documentation of radiographic progression in soft tissue as assessed by Investigator using iRECIST, in bone as assessed by Investigator using Prostate Cancer Working Group 3 (PCWG3), or death, whichever occurs first. |
| Number of Participants With a Decline in Prostate-Specific Antigen (PSA) of at Least 50% Relative to Baseline | Up to Year 2 Post-Baseline | — |
| Maximal Percent Change in PSA Measured After Treatment Initiation | Up to Year 2 Post-Baseline | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Cohort 1A.1 (DKN-01 300mg, Docetaxel 75 mg/m2) Participants in the dose-escalation Cohort 1A.1 who received DKN-01 300mg and Docetaxel 75 mg/m2. | 3 |
| Cohort 1A.2 (DKN-01 600mg, Docetaxel 75 mg/m2) Participants in the dose-escalation Cohort 1A.2 who received DKN-01 600mg and Docetaxel 75 mg/m2. | 3 |
| Cohort 1B (DKN-01 600mg [Phase II Dose], Docetaxel 75 mg/m2) Participants in the Phase II dose-expansion Cohort 1B who received DKN-01 600mg \[Phase II Dose\] and Docetaxel 75 mg/m2. | 2 |
| Cohort 2A.1 (DKN-01 300mg) Participants in dose-escalation Cohort 2A.1 who received DKN-01 300mg monotherapy. | 4 |
| Cohort 2A.2 (DKN-01 600mg) Participants in dose-escalation Cohort 2A.1 who received DKN-01 600mg monotherapy. | 3 |
| Cohort 2B (DKN-01 600mg [Phase 2 Dose]) Participants in the Phase II dose-expansion Cohort 2B who received DKN-01 600mg \[Phase II Dose\] monotherapy. | 3 |
| Total | 18 |
Baseline characteristics
| Characteristic | Cohort 1A.1 (DKN-01 300mg, Docetaxel 75 mg/m2) | Total | Cohort 2B (DKN-01 600mg [Phase 2 Dose]) | Cohort 2A.2 (DKN-01 600mg) | Cohort 2A.1 (DKN-01 300mg) | Cohort 1B (DKN-01 600mg [Phase II Dose], Docetaxel 75 mg/m2) | Cohort 1A.2 (DKN-01 600mg, Docetaxel 75 mg/m2) |
|---|---|---|---|---|---|---|---|
| Age, Continuous | 66 years | 70 years | 64 years | 74 years | 65 years | 76 years | 68 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 3 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 2 Participants | 14 Participants | 2 Participants | 3 Participants | 4 Participants | 0 Participants | 3 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 3 Participants | 0 Participants | 1 Participants | 2 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 2 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 2 Participants | 13 Participants | 2 Participants | 2 Participants | 2 Participants | 2 Participants | 3 Participants |
| Region of Enrollment United States | 3 participants | 18 participants | 3 participants | 3 participants | 4 participants | 2 participants | 3 participants |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 3 Participants | 18 Participants | 3 Participants | 3 Participants | 4 Participants | 2 Participants | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 3 | 0 / 5 | 0 / 4 | 0 / 6 |
| other Total, other adverse events | 3 / 3 | 5 / 5 | 4 / 4 | 6 / 6 |
| serious Total, serious adverse events | 1 / 3 | 1 / 5 | 0 / 4 | 2 / 6 |
Outcome results
Primary
Number of Dose Limiting Toxicities Observed by End of Treatment Cycle 1
Measured among Phase I dose-escalation cohorts (arms 1A.1, 1A.2, 2A.1, and 2A.2) only.
Time frame: Up to End of Cycle 1 (Up to Day 21 for Cohort 1A, Up to Day 28 for Cohort 2A)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cohort 1A.1 (DKN-01 300mg, Docetaxel 75 mg/m2) | Number of Dose Limiting Toxicities Observed by End of Treatment Cycle 1 | 0 Number of events | Standard Deviation 0 |
| Cohort 1A.2 (DKN-01 600mg, Docetaxel 75 mg/m2) | Number of Dose Limiting Toxicities Observed by End of Treatment Cycle 1 | 0 Number of events | Standard Deviation 0 |
| Cohort 2A.1 (DKN-01 300mg) | Number of Dose Limiting Toxicities Observed by End of Treatment Cycle 1 | 0 Number of events | Standard Deviation 0 |
| Cohort 2A.2 (DKN-01 600mg) | Number of Dose Limiting Toxicities Observed by End of Treatment Cycle 1 | 0 Number of events | Standard Deviation 0 |
Primary
Number of Participants With a Best Overall Response of Complete Response (iCR) or Partial Response (iPR) Per iRECIST by End of Long-Term Follow-Up Period
iRECIST will be used by the Investigator to assess tumor response and progression. An iCR is defined as the disappearance of all target lesions as assessed by iRECIST; an iPR is defined as at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters, as assessed by iRECIST.
Time frame: Up to Year 2 Post-Baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Cohort 1A.1 (DKN-01 300mg, Docetaxel 75 mg/m2) | Number of Participants With a Best Overall Response of Complete Response (iCR) or Partial Response (iPR) Per iRECIST by End of Long-Term Follow-Up Period | 3 Participants |
| Cohort 1A.2 (DKN-01 600mg, Docetaxel 75 mg/m2) | Number of Participants With a Best Overall Response of Complete Response (iCR) or Partial Response (iPR) Per iRECIST by End of Long-Term Follow-Up Period | 2 Participants |
| Cohort 2A.1 (DKN-01 300mg) | Number of Participants With a Best Overall Response of Complete Response (iCR) or Partial Response (iPR) Per iRECIST by End of Long-Term Follow-Up Period | 0 Participants |
| Cohort 2A.2 (DKN-01 600mg) | Number of Participants With a Best Overall Response of Complete Response (iCR) or Partial Response (iPR) Per iRECIST by End of Long-Term Follow-Up Period | 0 Participants |
| Cohort 2A.2 (DKN-01 600mg) | Number of Participants With a Best Overall Response of Complete Response (iCR) or Partial Response (iPR) Per iRECIST by End of Long-Term Follow-Up Period | 0 Participants |
| Cohort 2B (DKN-01 600mg [Phase 2 Dose]) | Number of Participants With a Best Overall Response of Complete Response (iCR) or Partial Response (iPR) Per iRECIST by End of Long-Term Follow-Up Period | 0 Participants |
Secondary
Maximal Percent Change in PSA Measured After Treatment Initiation
Time frame: Up to Year 2 Post-Baseline
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1A.1 (DKN-01 300mg, Docetaxel 75 mg/m2) | Maximal Percent Change in PSA Measured After Treatment Initiation | -74 Percentage |
| Cohort 1A.2 (DKN-01 600mg, Docetaxel 75 mg/m2) | Maximal Percent Change in PSA Measured After Treatment Initiation | -87 Percentage |
| Cohort 2A.1 (DKN-01 300mg) | Maximal Percent Change in PSA Measured After Treatment Initiation | 0 Percentage |
| Cohort 2A.2 (DKN-01 600mg) | Maximal Percent Change in PSA Measured After Treatment Initiation | 93 Percentage |
| Cohort 2A.2 (DKN-01 600mg) | Maximal Percent Change in PSA Measured After Treatment Initiation | 57 Percentage |
| Cohort 2B (DKN-01 600mg [Phase 2 Dose]) | Maximal Percent Change in PSA Measured After Treatment Initiation | 28 Percentage |
Secondary
Number of Participants With a Decline in Prostate-Specific Antigen (PSA) of at Least 50% Relative to Baseline
Time frame: Up to Year 2 Post-Baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Cohort 1A.1 (DKN-01 300mg, Docetaxel 75 mg/m2) | Number of Participants With a Decline in Prostate-Specific Antigen (PSA) of at Least 50% Relative to Baseline | 3 Participants |
| Cohort 1A.2 (DKN-01 600mg, Docetaxel 75 mg/m2) | Number of Participants With a Decline in Prostate-Specific Antigen (PSA) of at Least 50% Relative to Baseline | 2 Participants |
| Cohort 2A.1 (DKN-01 300mg) | Number of Participants With a Decline in Prostate-Specific Antigen (PSA) of at Least 50% Relative to Baseline | 0 Participants |
| Cohort 2A.2 (DKN-01 600mg) | Number of Participants With a Decline in Prostate-Specific Antigen (PSA) of at Least 50% Relative to Baseline | 0 Participants |
| Cohort 2A.2 (DKN-01 600mg) | Number of Participants With a Decline in Prostate-Specific Antigen (PSA) of at Least 50% Relative to Baseline | 0 Participants |
| Cohort 2B (DKN-01 600mg [Phase 2 Dose]) | Number of Participants With a Decline in Prostate-Specific Antigen (PSA) of at Least 50% Relative to Baseline | 0 Participants |
Secondary
Progression-Free Survival (PFS)
Defined as the time from the first dose of study treatment to documentation of radiographic progression in soft tissue as assessed by Investigator using iRECIST, in bone as assessed by Investigator using Prostate Cancer Working Group 3 (PCWG3), or death, whichever occurs first.
Time frame: Up to Year 2 Post-Baseline
Population: Data for this outcome measure was not collected among participants in the Monotherapy arms (2A.1, 2A.2, and 2B).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1A.1 (DKN-01 300mg, Docetaxel 75 mg/m2) | Progression-Free Survival (PFS) | 6.3 Months |
| Cohort 1A.2 (DKN-01 600mg, Docetaxel 75 mg/m2) | Progression-Free Survival (PFS) | 8.1 Months |
| Cohort 2A.1 (DKN-01 300mg) | Progression-Free Survival (PFS) | 2 Months |