A Study to Determine Safety and Tolerability of Enzalutamide (MDV3100) in Combination With Abiraterone Acetate in Bone Metastatic Castration-Resistant Prostate Cancer Patients

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Medivation, Inc.
Information provided by (Responsible Party):
Astellas Pharma Inc ( Astellas Pharma Global Development, Inc. )
ClinicalTrials.gov Identifier:
NCT01650194
First received: July 24, 2012
Last updated: April 11, 2014
Last verified: April 2014
  Purpose

The purpose of this study is to explore the safety and tolerability of enzalutamide in combination with abiraterone acetate plus prednisone. Subjects diagnosed with cancer of the prostate that is getting worse and spread to the bone despite receiving hormone treatment will be enrolled and receive study treatment until disease progression.


Condition Intervention Phase
Metastatic Castration-Resistant Prostate Cancer
Drug: enzalutamide
Drug: abiraterone acetate
Drug: prednisone
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase 2 Study Determining Safety and Tolerability of Enzalutamide (Formerly MDV3100) in Combination With Abiraterone Acetate in Bone Metastatic Castration-Resistant Prostate Cancer Patients

Resource links provided by NLM:


Further study details as provided by Astellas Pharma Inc:

Primary Outcome Measures:
  • Nature, frequency and severity of adverse events [ Time Frame: Until documented disease progression (up to 24 months) ] [ Designated as safety issue: No ]
  • Safety assessed by laboratory tests, vital signs, 12 lead electrocardiograms (ECGs) and physical examinations [ Time Frame: Until documented disease progression (up to 24 months) ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Testosterone concentration in bone marrow aspirate and blood [ Time Frame: Baseline and Week 9 ] [ Designated as safety issue: No ]
  • Dihydrotestosterone (DHT) concentration in bone marrow aspirate and blood [ Time Frame: Baseline and Week 9 ] [ Designated as safety issue: No ]
  • Expression and localization of androgen receptor [ Time Frame: Baseline and Week 9 ] [ Designated as safety issue: No ]
  • Splice variants [ Time Frame: Baseline and Week 9 ] [ Designated as safety issue: No ]
  • CYP17 expression [ Time Frame: Baseline and Week 9 ] [ Designated as safety issue: No ]
  • Prostate-specific antigen (PSA) levels) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  • Progression free survival (PFS) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
    Defined as the time interval from the date of starting treatment until the date of documented progression or death in absence of progression.

  • Objective response according to Response Evaluation Criteria in Solid Tumors 1.1 (RECIST) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
    Partial or complete response

  • Bone scan results [ Time Frame: Week 13, Week 25 and every subsequent 12 weeks (up to 24 months) ] [ Designated as safety issue: No ]
  • Bone specific alkaline phosphatase [ Time Frame: 24 months ] [ Designated as safety issue: No ]
    Marker of bone metabolism

  • Urine N-telopeptides [ Time Frame: Baseline and Week 9 ] [ Designated as safety issue: No ]
    Marker of bone metabolism


Enrollment: 60
Study Start Date: June 2012
Estimated Study Completion Date: June 2014
Estimated Primary Completion Date: June 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Enzalutamide combined with abiraterone acetate plus prednisone
Enzalutamide daily, abiraterone acetate daily, prednisone twice daily
Drug: enzalutamide
oral
Other Name: MDV3100
Drug: abiraterone acetate
oral
Drug: prednisone
oral

Detailed Description:

For the study duration, all subjects will maintain androgen deprivation with a gonadotropin releasing hormone (GnRH) agonist or antagonist or orchiectomy. Study drug will be administered until disease progression. Disease progression is defined as a composite endpoint consisting of either clinical deterioration, radiographic progression or prostate-specific antigen (PSA) progression according to the Prostate Cancer Clinical Trials Working Group 2 (PCWG2) criteria.

  Eligibility

Genders Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Histologically or cytologically confirmed adenocarcinoma of the prostate without neuroendocrine differentiation or small cell features
  • Presence of metastatic disease to the bone
  • Ongoing androgen deprivation therapy with a gonadotropin releasing hormone (GnRH) analogue or orchiectomy (i.e., surgical or medical castration)
  • Subject receiving bisphosphonate or denosumab therapy must have been on stable doses for at least 4 weeks prior to Day 1
  • Progressive disease defined as one or more of the following three criteria (Note: subjects who received an antiandrogen must demonstrate disease progression following discontinuation of antiandrogren):

    • PSA progression defined by a minimum of two rising PSA levels with an interval of ≥ 1 week between each determination. The PSA value at the Screening visit should be ≥ 2 ng/mL
    • Soft tissue disease progression as defined by the Response Evaluation Criteria in Solid Tumors (RECIST 1.1)
    • Bone disease progression defined by PCWG2 criteria (two or more new lesions on bone scan compared with prior scan)
  • Subject previously treated with chemotherapy must have no more than two prior chemotherapy regimens for the treatment of metastatic prostate cancer
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
  • Agree to use a double-barrier method of contraception which involves the use of a condom in combination with one of the following: contraceptive sponge, diaphragm, or cervical ring with spermicidal gel or foam, if having sex with a woman of child-bearing potential during the length of the study and for one week after abiraterone is discontinued and for at least three months after enzalutamide is discontinued
  • Subject agrees not to participate in another interventional study while on treatment

Exclusion Criteria:

  • Known or suspected metastases in the brain
  • Absolute neutrophil count < 1,000/μL, platelet count < 75,000/μL, and hemoglobin < 9 g/dL (NOTE: subject may not have received any growth factors or blood transfusions within seven days of the hematologic laboratory values obtained at the Screening visit)
  • Total bilirubin (TBL), alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 2.5 times the upper limit of normal
  • Creatinine (Cr) > 2 mg/dL
  • Treatment with androgen receptor antagonists (bicalutamide, flutamide, nilutamide), 5-α reductase inhibitors (finasteride, dutasteride), estrogens, chemotherapy, or biologic therapy within 4 weeks of Day 1 visit
  • Radiation therapy within 3 weeks (if single fraction of radiotherapy within 2 weeks) of Day 1 visit, or radionuclide therapy within 8 weeks of Day 1
  • Planned palliative procedures for alleviation of bone pain such as radiation therapy or surgery
  • Structurally unstable bone lesions suggesting impending fracture
  • History of seizure or any condition that may predispose to seizure including, but not limited to underlying brain injury, stroke, primary brain tumors, brain metastases, or alcoholism. Also, history of loss of consciousness or transient ischemic attack within 12 months of enrollment (Day 1 visit)
  • Clinically significant cardiovascular disease including:

    • Myocardial infarction within 6 months of Screening visit;
    • Uncontrolled angina within 3 months of Screening visit;
    • Congestive heart failure New York Heart Association (NYHA) class 3 or 4, or subjects with history of congestive heart failure NYHA class 3 or 4 in the past, or history of anthracycline or anthracenedione (mitoxantrone) treatment, unless a screening echocardiogram or multi-gated acquisition scan (MUGA) performed within three months of the Screening visit results in a left ventricular ejection fraction that is ≥ 45%
    • History of clinically significant ventricular arrhythmias (e.g., ventricular tachycardia, ventricular fibrillation, torsade de pointes)
    • Prolonged corrected QT interval by the Fridericia correction formula (QTcF) on the Electrocardiogram (ECG) > 470 msec.
    • History of Mobitz II second degree or third degree heart block without a permanent pacemaker in place
    • Hypotension (systolic blood pressure < 86 mmHg or bradycardia with a heart rate of <50 beats per minute on the ECG., unless pharmaceutically induced and thus reversible (i.e. beta blockers).
    • Uncontrolled hypertension as indicated by a resting systolic blood pressure >170 mmHg or diastolic blood pressure >105 mmHg
  • Prior use of ketoconazole, abiraterone acetate or enzalutamide, or participation in a previous clinical trial of ketoconazole, abiraterone acetate or enzalutamide
  • History of significant bleeding disorder unrelated to cancer, including:

    • Diagnosed congenital bleeding disorders (e.g., von Willebrand's disease)
    • Diagnosed acquired bleeding disorder within one year (e.g., acquired anti-factor VIII antibodies) of Screening visit
    • History of GI bleeding within 6 months of Screening visit
  • Active or symptomatic viral hepatitis or chronic liver disease
  • Known history of pituitary or adrenal dysfunction
  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: NCT01650194

Locations
United States, Texas
MD Anderson Cancer Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
Astellas Pharma Global Development, Inc.
Medivation, Inc.
Investigators
Study Director: Associate Medical Director Astellas Pharma Global Development
  More Information

No publications provided

Responsible Party: Astellas Pharma Inc ( Astellas Pharma Global Development, Inc. )
ClinicalTrials.gov Identifier: NCT01650194     History of Changes
Other Study ID Numbers: 9785-CL-0011
Study First Received: July 24, 2012
Last Updated: April 11, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by Astellas Pharma Inc:
MDV3100
prostate
cancer
enzalutamide
abiraterone acetate
prednisone

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Prednisone
Anti-Inflammatory Agents
Therapeutic Uses
Pharmacologic Actions
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal
Antineoplastic Agents

ClinicalTrials.gov processed this record on August 21, 2014