Lenalidomide and Cyclophosphamide in Treating Patients With Previously Treated Hormone-Refractory Prostate Cancer

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Jue Wang, MD, University of Nebraska
ClinicalTrials.gov Identifier:
NCT01093183
First received: March 24, 2010
Last updated: April 3, 2014
Last verified: April 2014
  Purpose

This phase I/II trial studies the side effects and best dose of lenalidomide when given together with cyclophosphamide and to see how well they work in treating patients with previously treated hormone-refractory prostate cancer. Lenalidomide may stop the growth of prostate cancer by blocking blood flow to the tumor. Drugs used in chemotherapy, such as cyclophosphamide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving lenalidomide together with cyclophosphamide may kill more tumor cells.


Condition Intervention Phase
Adenocarcinoma of the Prostate
Hormone-resistant Prostate Cancer
Recurrent Prostate Cancer
Drug: lenalidomide
Drug: cyclophosphamide
Other: laboratory biomarker analysis
Procedure: quality-of-life assessment
Other: questionnaire administration
Phase 1
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I/II Clinical Trial of Lenalidomide in Combination With Oral Cyclophosphamide in Patients With Previously Treated Hormone Refractory Prostate Cancer

Resource links provided by NLM:


Further study details as provided by University of Nebraska:

Primary Outcome Measures:
  • Maximum tolerated dose of lenalidomide administered in combination with oral cyclophosphamide (Phase I) [ Time Frame: 28 days ] [ Designated as safety issue: Yes ]
    Defined to be the dose cohort below which 2 of 3 or 3 of 6 patients experience dose-limiting toxicities in course 1 or the highest dose cohort of 25 mg.


Secondary Outcome Measures:
  • Proportion of patients achieving objective PSA response (50% decrease in PSA levels sustained for at least 4 weeks) as defined by PSA working group criteria [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Anti-tumor activity as assessed by the sum of complete response (CR), partial response (PR), and stable disease (SD) measured by Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 [ Time Frame: Up to 4 months ] [ Designated as safety issue: No ]
  • Proportion of patients achieving CR [ Time Frame: At 4 months ] [ Designated as safety issue: No ]
    Reported with the associated 95% confidence interval.

  • Proportion of patients achieving a CR or PR (overall response rate) [ Time Frame: At 4 months ] [ Designated as safety issue: No ]
    Reported with the associated 95% confidence interval.

  • Event-free survival [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]
    Estimated using the Kaplan-Meier method.

  • Overall survival [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]
    Estimated using the Kaplan-Meier method.

  • Change in quality of life [ Time Frame: At baseline and 8 weeks ] [ Designated as safety issue: No ]
    Assessed using the disease-specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) version 3.0 and the Prostate Cancer Module for the QLQ-C30 (PR-25) questionnaire (with 1 being not at all and 4 being very much).

  • Change in bone pain as assessed by the McGill Pain Questionnaire-Short Form (MPQ-SF) (Phase II) [ Time Frame: At baseline and every course for 4 months ] [ Designated as safety issue: No ]
    Pain intensity assessed by a 4 point pain intensity scale (with 0 being no pain and 3 being severe pain), pain degree assessed on a 0 to 10 numerical scale, and present pain intensity assessed on 0 to 5 scale (with 0 being no pain and 5 being excruciating).


Estimated Enrollment: 53
Study Start Date: March 2010
Primary Completion Date: February 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Treatment (lenalidomide and cyclophosphamide)
Patients receive lenalidomide PO QD on days 1-21 and cyclophosphamide PO QD on days 1-28. Treatment repeats every 28 days for at least 4 courses in the absence of disease progression or unacceptable toxicity. Treatment modifications may apply according to response.
Drug: lenalidomide
Given PO
Other Names:
  • CC-5013
  • IMiD-1
  • Revlimid
Drug: cyclophosphamide
Given PO
Other Names:
  • CPM
  • CTX
  • Cytoxan
  • Endoxan
  • Endoxana
Other: laboratory biomarker analysis
Correlative studies
Procedure: quality-of-life assessment
Ancillary studies
Other Name: quality of life assessment
Other: questionnaire administration
Ancillary studies

Detailed Description:

PRIMARY OBJECTIVES:

I. To determine the maximum tolerated dose (MTD) and the dose limiting toxicities (DLT) of lenalidomide administered in combination with oral cyclophosphamide.

SECONDARY OBJECTIVES:

I. To evaluate the objective prostate-specific antigen (PSA) response (50% decrease in PSA levels sustained for at least 4 weeks) as defined by PSA working group criteria; or a decrease in absolute PSA or a decrease in PSA velocity, increase in PSA doubling time, duration of any responses.

II. To explore the anti-tumor activity of the combination of lenalidomide plus oral cyclophosphamide in patients with previously treated hormone refractory prostate cancer.

III. To evaluate baseline and change of quality of life, particularly, bone pain and analgesic consumption, of the patients on this combination chemotherapy.

TERTIARY OBJECTIVES:

I. To determine whether related cytokines and biomarkers (serum levels of tumor necrosis factor-alpha, basic fibroblast growth factor, vascular endothelial growth factor [VEGF], T cell inhibitory activity, phytohemagglutinin [PHA] and interleukin [IL]-2, mononuclear cell isolation, VEGF, basic fibroblast growth factor [bFGF], IL-6) can help predict response to patients undergoing treatment with lenalidomide and cyclophosphamide.

OUTLINE: This is a phase I, dose-escalation study of lenalidomide followed by a phase II study.

Patients receive lenalidomide orally (PO) once daily (QD) on days 1-21 and cyclophosphamide PO QD on days 1-28. Treatment repeats every 28 days for at least 4 courses in the absence of disease progression or unacceptable toxicity. Treatment modifications may apply according to response.

After completion of study treatment, patients are followed up periodically.

  Eligibility

Ages Eligible for Study:   19 Years and older
Genders Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Able to provide written informed consent
  • Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less
  • Men with histologically documented previously treated hormone refractory adenocarcinoma of the prostate; mixed histology and rare subtypes histology of prostate cancer are allowed only in phase 1 portion of trial
  • Patients must be on an luteinizing-hormone-releasing hormone (LHRH) agonist or have undergone surgical castration
  • Patients must have already failed or progressed after treatment with a docetaxel-based regimen; patients who were unable to tolerate docetaxel are eligible in phase 1 portion of trial
  • Creatinine clearance >= 45 by Cockcroft-Gault formula
  • Total bilirubin =< upper limit of normal (ULN)
  • Aspartate aminotransferase (AST) < 2 x ULN
  • Alanine aminotransferase (ALT) < 2 x ULN
  • Hepatic alkaline phosphatase < 2 x ULN (< 5.0 x ULN for subjects with known bone metastases)
  • Absolute neutrophil count greater than 1,500/mm^3
  • Platelets greater than 100,000/mm^3
  • Hemoglobin >= 9.0 g/dL
  • Able to adhere to the study visit schedule and other protocol requirements
  • No serious disease or condition that, in the opinion of the investigator, would compromise the patient's ability to participate in the study
  • All study participants must be registered into the mandatory Revlimid REMS program, and be willing and able to comply with the requirements of Revlimid REMS
  • Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (patients intolerant to acetylsalicylic acid [ASA] may use warfarin or low molecular weight heparin)
  • Men must agree to use a latex condom during sexual contact with females of childbearing potential (FCBP) even if they have had a successful vasectomy
  • Male subject agrees to use an acceptable method for contraception for the duration of the study
  • Electrocardiogram (EKG) at baseline, if abnormal, not medically relevant

Exclusion Criteria:

  • Treatment with a cytotoxic chemotherapy or investigational drug within 30 days before day 1 of study treatment; palliative radiation therapy is allowed, as long as a radiated lesion is not used to assess response rate, and the radiation occurred greater than 4 weeks prior to enrollment
  • Known positive for human immunodeficiency virus (HIV) or infectious hepatitis, type A, B or C or active hepatitis
  • Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form
  • Known hypersensitivity to thalidomide, lenalidomide or cyclophosphamide
  • Active infection at the start of lenalidomide
  • Myocardial infarction within 6 months prior to enrollment or has New York Heart Association (NYHA) class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities; prior to study entry, any EKG abnormality at screening has to be documented by the investigator as not medically relevant
  • History of life threatening or recurrent thrombosis/embolism; patients may participate if they are adequately anti-coagulated during the treatment
  • Patient has > grade 2 peripheral neuropathy within 14 days before enrollment
  • Any evidence of severe or uncontrolled systemic disease (e.g., unstable or uncompensated respiratory, cardiac, hepatic, or renal disease)
  • Any unresolved chronic toxicity greater than Common Terminology Criteria (CTC) grade 2 from previous anticancer therapy (except alopecia)
  • Evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the subject to participate in the trial
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01093183

Locations
United States, Nebraska
University of Nebraska Medical Center
Omaha, Nebraska, United States, 68198
Sponsors and Collaborators
University of Nebraska
Investigators
Principal Investigator: Jue Wang University of Nebraska
  More Information

No publications provided

Responsible Party: Jue Wang, MD, Principal Investigator, University of Nebraska
ClinicalTrials.gov Identifier: NCT01093183     History of Changes
Other Study ID Numbers: 479-09, NCI-2010-00363, 479-09, P30CA036727
Study First Received: March 24, 2010
Last Updated: April 3, 2014
Health Authority: United States: Institutional Review Board

Additional relevant MeSH terms:
Adenocarcinoma
Prostatic Neoplasms
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Genital Diseases, Male
Prostatic Diseases
Cyclophosphamide
Thalidomide
Lenalidomide
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antirheumatic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors
Leprostatic Agents

ClinicalTrials.gov processed this record on July 31, 2014