Enzalutamide With or Without Abiraterone Acetate and Prednisone in Treating Patients With Castration-Resistant Metastatic Prostate Cancer

This study is currently recruiting participants. (see Contacts and Locations)
Verified May 2014 by Alliance for Clinical Trials in Oncology
Sponsor:
Collaborators:
Astellas Pharma US, Inc.
Medivation, Inc.
Biologics, Inc.
Information provided by (Responsible Party):
Alliance for Clinical Trials in Oncology
ClinicalTrials.gov Identifier:
NCT01949337
First received: September 20, 2013
Last updated: May 14, 2014
Last verified: May 2014
  Purpose

This randomized phase III trial studies enzalutamide to see how well it works compared to enzalutamide, abiraterone acetate, and prednisone in treating patients with castration-resistant metastatic prostate cancer. Androgens can cause the growth of prostate cancer cells. Drugs, such as enzalutamide, abiraterone acetate, and prednisone, may lessen the amount of androgens made by the body.


Condition Intervention Phase
Adenocarcinoma of the Prostate
Hormone-resistant Prostate Cancer
Recurrent Prostate Cancer
Stage IV Prostate Cancer
Drug: enzalutamide
Drug: abiraterone
Drug: prednisone
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase III Trial of Enzalutamide (NSC# 766085) Versus Enzalutamide, Abiraterone and Prednisone for Castration Resistant Metastatic Prostate Cancer

Resource links provided by NLM:


Further study details as provided by Alliance for Clinical Trials in Oncology:

Primary Outcome Measures:
  • Overall survival (OS) [ Time Frame: Up to 5 years post treatment ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Grade 3 or higher toxicity profile using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 [ Time Frame: Up to 5 years post treatment ] [ Designated as safety issue: Yes ]
  • Decline in Prostate Specific Antigen (PSA) [ Time Frame: Up to 5 years post treatment ] [ Designated as safety issue: Yes ]
  • Progression Free Survival (PFS) [ Time Frame: Up to 5 years post treatment ] [ Designated as safety issue: No ]
  • Objective response rate [ Time Frame: Up to 5 years post treatment ] [ Designated as safety issue: No ]
  • Radiographic Progression Free Survival (rPFS) [ Time Frame: Up to 5 years post treatment ] [ Designated as safety issue: No ]
  • Tumor burden and bone activity [ Time Frame: Up to 5 years post treatment ] [ Designated as safety issue: No ]

Estimated Enrollment: 1224
Study Start Date: January 2014
Estimated Primary Completion Date: December 2019 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm A: (enzalutamide)
Patients receive enzalutamide 160 mg PO QD. Treatment will continue until confirmed disease progression or unacceptable toxicity.
Drug: enzalutamide
Enzalutamide 160 mg daily, orally
Experimental: Arm B: (enzalutamide, abiraterone acetate, prednisone)
Patients receive enzalutamide 160 mg PO QD, abiraterone acetate 1000 mg PO QD, and prednisone 5 mg PO BID. Treatment will continue until confirmed disease progression or unacceptable toxicity.
Drug: enzalutamide
Enzalutamide 160 mg daily, orally
Drug: abiraterone
abiraterone 1000 mg daily, orally
Drug: prednisone
prednisone 5 mg twice daily, orally

Detailed Description:

Patients are randomized to one of two treatment groups: enzalutamide or enzalutamide, abiraterone and prednisone. Treatment will continue until disease progression or unacceptable toxicity. Patients are followed for clinical outcomes for a maximum of 5 years post study treatment. The primary and secondary objectives are described below.

  1. Primary Objective:

    To compare the overall survival of patients with progressive metastatic castration-resistant prostate cancer (CRPC) treated with either enzalutamide only or enzalutamide with abiraterone (abiraterone acetate) and prednisone

  2. Secondary Objectives:

    • To assess the grade 3 or higher toxicity profile and compare safety by treatment arm.
    • To assess and compare post-treatment prostate-specific antigen (PSA) declines by treatment arm.
    • To compare radiographic progression free survival defined by Prostate Cancer Working Group 2 (PCWG2), and objective response rate, by treatment arm.
    • To test for radiographic progression free survival (rPFS) treatment interaction in predicting overall survival.
    • To assess pre- and post-treatment measures of tumor burden and bone activity using sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) and technetium (Tc) methylene diphosphonate (MDP) bone scintigraphy and correlate these measures with overall survival.
    • To develop and validate prognostic and predictive models of overall survival that include baseline clinical and molecular markers.
  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Eligibility Criteria:

  1. Documentation of Disease - Progressive castration-resistant metastatic prostate cancer with histologically or cytologically confirmed adenocarcinoma of the prostate without neuroendocrine differentiation or small cell features
  2. Patients must have measurable or non-measurable disease:

    1. Measurable Disease - For visceral or extra nodal lesions to be considered measurable, they must be ≥ 10 mm in one dimension, using spiral CT. For lymph nodes to be considered measurable (ie, target or evaluable lesions), they must be ≥ 20 mm in at least one dimension, using spiral CT.
    2. Non-Measurable Disease - All other lesions, including small lesions (longest diameter < 20 mm with conventional techniques or < 10 mm with spiral CT scan) and truly non-measurable lesions. Lesions that are considered non-measurable include bone lesions (only).
  3. Progressive Disease - Patients must have progressive disease at study entry defined as one or more of the following three criteria that occurred while the patient was on androgen deprivation therapy. For patients enrolling on the basis of soft tissue or bone progression, the baseline scan must show progression relative to a comparison scan. If the comparison scan is not available, the baseline scan report must reference the previous scan to document progression.

    1. PSA progression defined by a minimum of two rising PSA levels with an interval of ≥ 1 week between each determination. Patients who received an anti-androgen must have progression documented by a minimum of two rising PSA levels with an interval of ≥ 1 week between each determination such that at least the second of these rises is ≥ 4 weeks since last flutamide or ≥ 6 weeks since last bicalutamide or nilutamide. The PSA value at the screening should be ≥ 2 µg/L (2 ng/mL)

    2. Soft tissue disease progression defined by the protocol
    3. Bone disease progression defined by the Prostate Cancer Working Group 2 (PCWG2) with two or more new lesions on bone scan
  4. Prior Treatment

    1. No treatment with prior taxane-based chemotherapy for metastatic disease


      • Patients who received prior taxane-based chemotherapy as neoadjuvant or adjuvant therapy for local disease, or who received taxane-based therapy in the PSA clinical (non-metastatic) state is allowable provided that the total duration of exposure was six cycles or less and chemotherapy was completed more than 6 months prior to registration

      • Taxane-based chemotherapy that was aborted due to allergic reactions or intolerance to chemotherapy and therefore received one cycle of prior therapy is allowable
    2. No prior enzalutamide, abiraterone or other novel antiandrogen or androgen synthesis inhibitor
    3. No treatment with any of the following for prostate cancer within 4 weeks prior to enrollment:

      • Hormonal therapy (e.g., androgen receptor [AR] antagonists, 5 alpha reductase inhibitors, estrogens) Note: Treatment with bicalutamide and nilutamide within 6 weeks prior to enrollment is not allowed. Treatment with flutamide within 4 weeks prior to enrollment is not allowed. Treatment with all other gonadotropin-releasing hormone (GnRH) analogues or antagonists is allowed.
      • Chemotherapy
      • Biologic therapy
      • Investigational therapy
      • Immunotherapy
    4. No use of herbal products that may decrease PSA levels within 4 weeks prior to enrollment
    5. No use of systemic steroids greater than the equivalent of 10 mg of prednisone/prednisolone per day within 4 weeks prior to enrollment
    6. No prior use of ketoconazole for greater than 7 days
    7. No prior radiation therapy or radionuclide therapy for the treatment of metastasis within four weeks prior to enrollment
    8. Patients receiving bisphosphonate therapy or denosumab must have been on a stable dose for at least 4 weeks prior to enrollment
    9. Patients must maintain ongoing androgen deprivation therapy with a GnRH analogue, antagonist, or bilateral orchiectomy (i.e., surgical or medical castration)
  5. Patient History

    1. No known or suspected brain metastases (NOTE: patients with treated epidural disease are allowed)
    2. No planned palliative procedures for alleviation of bone pain such as radiation therapy or surgery
    3. No structurally unstable bone lesions suggesting impending fracture
    4. No history of seizure or any condition that may increase the patient's seizure risk (e.g., prior cortical stroke, significant brain trauma). No history of transient ischemic attack (TIA) within 12 months of enrollment
    5. No clinically significant cardiovascular disease including:


      • Myocardial infarction (MI) within 6 months

      • Uncontrolled angina within 3 months

      • Congestive heart failure (CHF) with New York Heart Association (NYHA) class 3 or 4, or patients with NYHA class 3 or 4 in the past, unless a screening echocardiogram (echo) or multigated acquisition scan (MUGA) performed within three months demonstrates an ejection fraction (EF) > 45%

      • History of clinically significant ventricular arrhythmias (e.g., ventricular tachycardia, ventricular fibrillation, torsades de pointes)

      • History of Mobitz II second degree or third degree heart block without a permanent pacemaker in place

      • Hypotension (systolic blood pressure [BP] < 86 mmHg) or bradycardia (< 50 bpm) at screening 

      • Uncontrolled hypertension (systolic BP > 170 mmHg or diastolic BP > 105 mmHg at screening)
    6. No gastrointestinal (GI) disorder that negatively affects absorption
    7. No major surgery within 4 weeks prior to enrollment
  6. Age and performance status

    1. Age ≥ 18 years of age
    2. Eastern Cooperative Oncology Group (ECOG) performance status 0-1
    3. Asymptomatic or mildly symptomatic from prostate cancer
  7. Required Initial Laboratory Values

    1. Granulocytes ≥ 1,500/µL
    2. Platelet count ≥ 100,000/µL
    3. Hemoglobin ≥ 9 g/dL
    4. Creatinine ≤ 2 x upper limits of normal (ULN)
    5. Bilirubin ≥ 1.5 x ULN
    6. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≤ 2 x ULN
    7. Albumin ≥ 3 g/dl
    8. Serum testosterone ≤ 50 ng/dL (1.7 nmol/L)
  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: NCT01949337

  Show 82 Study Locations
Sponsors and Collaborators
Alliance for Clinical Trials in Oncology
Astellas Pharma US, Inc.
Medivation, Inc.
Biologics, Inc.
Investigators
Study Chair: Michael Morris, M.D. Memorial Sloan-Kettering Cancer Center
  More Information

No publications provided

Responsible Party: Alliance for Clinical Trials in Oncology
ClinicalTrials.gov Identifier: NCT01949337     History of Changes
Other Study ID Numbers: A031201, U10CA031946, NCI-2013-01737
Study First Received: September 20, 2013
Last Updated: May 14, 2014
Health Authority: United States: Food and Drug Administration
United States: NCI Central Institutional Review Board

Additional relevant MeSH terms:
Prostatic Neoplasms
Adenocarcinoma
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
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 September 16, 2014