Prostate Cancer, Recurrent Prostate Cancer
Conditions
Keywords
Prostate cancer, MMR-deficient prostate cancer, Biochemically recurrent prostate cancer, non-castrating therapy, Nivolumab
Brief summary
MMR-deficient cancers of any histologic type appear to be very sensitive to PD-1 blockade with pembrolizumab, and similar data are also beginning to emerge for nivolumab and other immune checkpoint inhibitors. Among the MMR-deficient cancers, the best antitumor responses are often associated with high microsatellite instability (MSI-H status), higher tumor mutational burden (TMB), and higher predicted neoantigen load. Prevalence estimates of MMR deficiency across solid tumor types range from 1% to 20% depending on the type of malignancy. In prostate cancer, 1-3% of unselected cases harbor MMR deficiency and/or microsatellite instability. For men who previously received definitive treatment for prostate cancer and subsequently develop detectable prostate specific antigen (PSA) levels, the clinical state is known as biochemically recurrent prostate cancer. The current standard of care treatment for patients with biochemically recurrent prostate cancer is either surveillance or androgen deprivation therapy (ADT). ADT has not been shown to provide a survival benefit in this setting, and the decision to initiate ADT will depend on patient preference and perceived risks of the disease. A non-hormonal therapy such as nivolumab would provide an alternative to ADT in patients with biomarker selected (i.e. dMMR, MSI-H, high TMB, or CDK12-altered) biochemically recurrent prostate cancer.
Interventions
DRUGNivolumab
Nivolumab 480mg intravenously every 4 weeks
Sponsors
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Bristol-Myers Squibb
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Willing and able to provide signed informed consent and HIPAA authorization for the release of personal health information * Males aged 18 years and above * Prior local therapy with prostatectomy or EBRT/brachytherapy is required * Prior salvage or adjuvant radiation therapy is allowed but not mandated. Radiation therapy must have been completed for at least 6 months. * Absolute PSA \>=1.0 ng/mL at screening * Must have at least one of the following genetic alterations identified using archival tissue (i.e. prostate needle biopsy prior to radiation therapy or prostatectomy specimen): * Microsatellite instability (MSI-high) status by clinical grade testing * MMR protein loss (MSH2, MSH6, MLH1, PMS2) by immunohistochemistry * Inactivating mutation of MSH2, MSH6, MLH1 or PSM2 by clinical grade genomic testing * Tumor mutational burden \>= 20 mutations/megabase (TMB \>=20 muts/Mb) by clinical grade testing * Inactivating mutation (at least monoallelic of CDK12 by clinical grade testing * Serum testosterone \>= 150 ng/dL * No radiographic evidence of metastatic disease by CT scan and bone scan, performed within the prior 4 weeks. * Karnofsky Performance Status (KPS) \>= 70% within 14 days before start of study treatment (ECOG \<=1) * Participants must have normal organ and bone marrow function measured within 28 days prior to administration of study treatment as defined below: * Hemoglobin \>= 9.0 g/dL with no blood transfusion in the past 28 days * Absolute neutrophil count (ANC) \>= 1.0x10\^9 / L * Platelet count \>= 100 x 10\^9 /L * Total bilirubin within institutional upper limit of normal (ULN) (in patients with Gilbert's syndrome, total bilirubin \<1.5x institutional ULN will be acceptable) * Aspartate aminotransferase (AST), Serum Glutamic Oxaloacetic Transaminase (SGOT) / Alanine aminotransferase (ALT), Serum Glutamic Pyruvate Transaminase (SGPT) within institutional ULN * Participants must have creatinine clearance estimated using the Cockcroft-Gault equation of \>=40 mL/min: Estimated creatinine clearance = \[(140 - age (years)) x weight (kg)\] / \[serum creatinine (mg/dL) x 72\] * Participants must have a life expectancy of \>= 6 months * Male participants and their partners who are sexually active and of childbearing potential must agree to the use of two highly effective forms of contraception in combination, throughout the period of taking study treatment and for 7 months after the last dose of nivolumab to prevent pregnancy in a partner. * No evidence (within 5 years) of prior malignancies (except successfully treated basal cell or squamous cell carcinoma of the skin)
Exclusion criteria
* Metastatic disease or currently active second malignancy * Prior androgen deprivation therapy (ADT) in the past 6 months. Prior ADT in context of neoadjuvant/adjuvant primary; prior ADT for biochemical recurrence is allowed, as long as no ADT has been administered in past 6 months and testosterone has recovered (\>150 ng/dL) * Prior oral anti-androgen (e.g. bicalutamide, nilutamide, enzalutamide, apalutamide), or androgen synthesis inhibitor (e.g. abiraterone, orteronel) within the past 2 weeks is not permitted. 5-alpha reductase inhibitor therapy (e.g. finasteride, dutasteride) is allowed, as long as subject has been stable on medication for past 6 months. * Involvement in the planning and/or conduct of the study (applies to both BMS staff and/or staff at the study site) * Participation in another clinical study with an investigational product during the last 4 weeks/28 days * Patients should be excluded if they have had prior systemic treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell costimulation or immune checkpoint pathways * Patients should be excluded if they have an active, known or suspected autoimmune disease (e.g. inflammatory bowel disease, rheumatoid arthritis, autoimmune hepatitis, lupus, celiac disease). Subjects are permitted to enroll if they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recure in the absence of an external trigger. * Patients should be excluded if they have a condition requiring systemic treatment with either corticosteroids (\>10 mg daily prednisone daily equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses \>10mg daily prednisone equivalents are permitted in the absence of active autoimmune disease * Permitted therapies include topical, ocular, intra-articular, intranasal, and inhalational corticosteroids (with minimal systemic absorption). Physiologic replacement doses of systemic corticosteroids are permitted, even if \> 10 mg/day prednisone equivalents. A brief course of corticosteroids for prophylaxis (e.g. contrast dye allergy) or for treatment of nonautoimmune conditions (e.g. delayed-type hypersensitivity reaction caused by contact allergen) is permitted. * As there is potential for hepatic toxicity with nivolumab, drugs with a predisposition to hepatotoxicity should be used with caution in patients treated with nivolumab-containing regimen. * Patients should be excluded if they have a positive test for hepatitis B virus surface antigen (HBVsAg) or hepatitis C virus ribonucleic acid (HCV antibody) indicating acute or chronic infection * Patients should be excluded if they have known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS). * History of allergy to study drug components * History of severe hypersensitivity reaction to any monoclonal antibody * Any other serious illness or medical condition that would, in the opinion of the investigator, make this protocol unreasonably hazardous, including but not limited to: * Any uncontrolled major infection * Cardiac failure NYHA (New York Heart Association) III or IV * Crohn's disease or ulcerative colitis * Bone marrow dysplasia * Known allergy to any of the compounds under investigation * Unmanageable fecal incontinence * Poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease or active, uncontrolled infection. Examples include, but are not limited to, uncontrolled ventricular arrhythmia, recent (within 6 months) myocardial infarction, uncontrolled major seizure disorder, extensive interstitial bilateral lung disease, or any psychiatric disorder that prohibits obtaining informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With PSA50 Response | up to 6 months post-intervention, up to 2 years of treatment | Percentage of participants who have received at least 1 dose of Nivolumab who experience a confirmed \>=50% decline in prostate specific antigen (PSA) from baseline, as defined by Prostate Cancer Working Group 3 (PCWG3) criteria. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Achieve Undetectable PSA | up to 6 months post-intervention, up to 2 years of treatment | Number of participants who achieve PSA \< 0.1 ng/mL lasting at least 12 weeks. |
| Safety and Tolerability of Nivolumab in Biochemically Recurrent Prostate Cancer as Assessed by Number of Participants Experiencing Treatment-Emergent Adverse Events | up to 100 days post-intervention, up to 2 years of treatment | Number of participants experiencing adverse events Grade 3 or higher as defined by CTCAE v5.0 |
| Metastasis-free Survival | up to 6 months post-intervention, up to 2 years of treatment | Median time from first dose of nivolumab until the development of radiographic metastatic disease on CT imaging and/or bone scan, as defined by PCWG3 |
| Time to Initiation of Next Systemic Therapy | up to 6 months post-intervention, up to 2 years of treatment | Median time from first dose of nivolumab until next systemic therapy |
| PSA Progression-free Survival (PSA-PFS) | From start of treatment until the date of first documented PSA increase of 25%, assessed up to 28 days after last treatment dose. | Median time from initiation of therapy until confirmed PSA increase of 25% (PCWG3). Estimated using Kaplan-Meier method. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORMark Markowski, MD/PhD
Johns Hopkins University
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 70 years |
| Genomic Abnormality CDK12 mutation | 1 Participants |
| Genomic Abnormality MLH1 mutation | 1 Participants |
| Genomic Abnormality MSH2 mutation | 3 Participants |
| Genomic Abnormality MSH6 mutation | 1 Participants |
| Genomic Abnormality PMS2 mutation | 2 Participants |
| Gleason score Gleason score 10 | 0 Participants |
| Gleason score Gleason score 7 | 4 Participants |
| Gleason score Gleason score 8 | 1 Participants |
| Gleason score Gleason score 9 | 3 Participants |
| Prostate Directed Therapy Radiation | 1 Participants |
| Prostate Directed Therapy Surgery | 7 Participants |
| Prostate-Specific Antigen Doubling Time (PSADT) | 5.9 months |
| Prostate-Specific Antigen (PSA) | 3.2 ng/ml |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 0 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 | 7 Participants |
| Sex: Female, Male Female | 0 Participants |
| Sex: Female, Male Male | 8 Participants |
| Testosterone | 505 ng/dl |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 8 |
| other Total, other adverse events | 8 / 8 |
| serious Total, serious adverse events | 1 / 8 |
Outcome results
None listed