Safety and Efficacy Studies of Panobinostat and Bicalutamide in Patients With Recurrent Prostate Cancer After Castration

This study is currently recruiting participants. (see Contacts and Locations)
Verified February 2014 by New York University School of Medicine
Sponsor:
Collaborator:
Novartis
Information provided by (Responsible Party):
New York University School of Medicine
ClinicalTrials.gov Identifier:
NCT00878436
First received: April 8, 2009
Last updated: February 10, 2014
Last verified: February 2014
  Purpose

This trial is designed to investigate the safety, dosing schedule, and efficacy of the combination treatment of Panobinostat (a histone deacetylase inhibitor) and hormone therapy for recurrent prostate cancer. This trial is at its Phase II stage. As of July 23, 2013 Arm B was closed to accrual, all the remaining slots in accrual will be allocated to Arm A.


Condition Intervention Phase
Prostate Cancer
Prostatic Neoplasms
Drug: Panobinostat
Drug: Bicalutamide
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase I/II Randomized Trial of LBH589 (Panobinostat) at Two Dose Levels Combined With Bicalutamide (Casodex) in Men With Castration-resistant Prostate Cancer

Resource links provided by NLM:


Further study details as provided by New York University School of Medicine:

Primary Outcome Measures:
  • the proportion of patients free of progression and without symptomatic deterioration [ Time Frame: 9 months ] [ Designated as safety issue: No ]
    measured by PSA and /or metastases progression criteria by body CT following RECIST criteria 1.1 and/or bones scan following the appearance of at least 2 new bone metastases and confirmation of 2 additional bone metastasis on a subsequent bone scan 6-8 weeks later and/or clinical progression.


Secondary Outcome Measures:
  • Time to PSA progression [ Time Frame: up to 2 years ] [ Designated as safety issue: No ]
    PSA progression is defined as a 25% or greater increase in PSA and an absolute increase value of 2 ng/ml or more over a nadir or baseline documented and confirmed by a second value three weeks later

  • proportion of patients that achieve a 50% or greater PSA decline by 9 months of therapy [ Time Frame: 9 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 78
Study Start Date: June 2009
Estimated Study Completion Date: May 2015
Estimated Primary Completion Date: December 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm A (120 mg/week)

Each treatment cycle has 21 days:

Bicalutamide (Casodex®) 50mg P.O. daily, continuously, with the addition of:

40 mg Panobinostat 3 times per week (120 mg per week) for 2 consecutive weeks with one week rest

Drug: Panobinostat
Other Name: LBH589
Drug: Bicalutamide
Other Name: Casodex
Experimental: Arm B (60 mg/week)-Closed to accrual

Each treatment cycle has 21 days:

Bicalutamide (Casodex®) 50mg P.O. daily, continuously, with the addition of:

20 mg Panobinostat 3 times per week (60 mg per week) for 2 consecutive weeks with one week rest

Drug: Panobinostat
Other Name: LBH589
Drug: Bicalutamide
Other Name: Casodex

Detailed Description:

The preclinical data indicate that Panobinostat restores the sensitivity of androgen-independent cells to bicalutamide (Casodex®) and the combination has synergistic inhibitory activity. Here, we hypothesize that treatment of castration-resistant patients with Panobinostat will enhance the response to the second line hormone therapy with bicalutamide (Casodex®). In the proposed phase I study, the maximum tolerated dose of tri-weekly, intermittent oral Panobinostat at three different dose levels (60, 90, 120 mg/week) in combination with Casodex (50mg PO) will be determined; The following phase II study will evaluated the efficacies of 9-month treatments of the selected Panobinostat-Casodex combination and also a lower dose of Panobinostat. We expect that Casodex-Panobinostat combination treatment of castration-resistant patients will prevent biochemical and/or metastatic disease progression of these patients compared to historical controls in the same time period.

  Eligibility

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

Inclusion Criteria:

  • Male patients aged ≥ 18 years old
  • Ability to provide written informed consent obtained prior to participation in the study and any related procedures being performed
  • Patients must meet laboratory criteria
  • Baseline MUGA or ECHO must demonstrate LVEF ≥ the lower limit of the institutional normal.
  • ECOG Performance Status of ≤ 2
  • Documented history of adenocarcinoma of the prostate.
  • Patients must have evidence of disease progression while receiving androgen suppression therapy by orchiectomy or other primary hormonal therapy including, but not limited to (LHRH agonist therapy (e.g., leuprolide or goserelin) or LHRH antagonist (e.g. aberelix). Note: patients who have not undergone bilateral orchiectomy must continue LHRH therapy while on protocol
  • Testosterone must be < 50 ng/dl confirmed within 4 weeks prior to registration for patients on LHRH therapy
  • Patients must have evidence of disease progression with either one or both of the conditions listed:

    • Biochemical progression only
    • Metastases on bone scan
  • Patients may have received one chemotherapy, investigational agent or immunotherapy in the neoadjuvant, adjuvant setting or during initial LHRH therapy with new evidence of disease progression after discontinuation of therapy for ≥ 2 weeks.
  • Patients must have received one or more prior second line hormone therapy for progression while on LHRH treatment or orchiectomy.
  • Patients treated with one first line chemotherapy combination for hormone refractory progression ≥ 4 weeks prior to registration who have evidence of disease progression and had only one second line hormone therapy and did not experience PSA response to bicalutamide (Casodex®) withdrawal.

Exclusion Criteria:

  • Prior treatment with an HDAC inhibitor
  • Impaired cardiac function including any one of the following:

    • Screening ECG with a QTc > 450 msec confirmed by central laboratory prior to enrollment to the study
    • Patients with congenital long QT syndrome
    • History of sustained ventricular tachycardia
    • Any history of ventricular fibrillation or torsades de pointes
    • Bradycardia defined as heart rate < 50 beats per minute. Patients with a pacemaker and heart rate ≥ 50 beats per minute are eligible.
    • Patients with a myocardial infarction or unstable angina within 6 months of study entry
    • Congestive heart failure (NY Heart Association class III or IV)
    • Right bundle branch block in conjunction with left anterior hemi-block (bifasicular block)
  • Uncontrolled hypertension
  • Concomitant use of drugs with a risk of causing torsades de pointes
  • Concomitant use of CYP3A4 inhibitors
  • Patients with unresolved diarrhea greater than CTCAE grade 1
  • Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of oral LBH589
  • Other concurrent severe and/or uncontrolled medical conditions
  • Patients who have received chemotherapy, any investigational drug or undergone major surgery < 4 weeks prior to starting study drug or who have not recovered from side effects of such therapy.
  • Concomitant use of any anti-cancer therapy or radiation therapy.
  • Male patients whose sexual partners are WOCBP not using effective birth control
  • Patients with a history of another primary malignancy within the last 2 years that was not curatively treated, excluding basal or squamous cell carcinoma of the skin
  • Patients with known positivity for human immunodeficiency virus (HIV) or hepatitis C; baseline testing for HIV and hepatitis C is not required
  • Patients with any significant history of non-compliance to medical regimens or with inability to grant a reliable informed consent
  • Patients previously treated with bicalutamide (Casodex®) who experienced a PSA withdrawal response in the washout period as described in Inclusion #11 will not be eligible
  • Concurrent use of estrogens or estrogen like substances (i.e. PC-SPES, Saw Palmetto, or other herbal product which may contain phytoestrogens) is not allowed. Prior use of these agents will need to be discontinued at least 4 weeks prior to enrollment, for the above.
  • Radiotherapy within the 4 weeks prior to registration
  • Inadequate bone marrow function measured 28 days prior to registration
  • No serious concurrent medical illness or active infection that would jeopardize the ability of the patient to receive therapy as outlined in the protocol with reasonable safety.
  • Liver metastasis.
  • The use of bisphosphonates in the absence of metastasis will not be allowed. Patients on bisphosphonates for more than 4 weeks for asymptomatic bone metastasis and with continued evidence of PSA progression may continue on bisphosphonates every 4 weeks.
  • Hydronephrosis with impaired renal function.
  • Active spinal cord compression.
  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: NCT00878436

Contacts
Contact: Anna Ferrari, MD 212-731-5389 anna.ferrari@nyumc.org

Locations
United States, Illinois
Northwestern University (Chicago Cancer Prostate Assoc.) Withdrawn
Chicago, Illinois, United States, 60611
United States, Michigan
Wayne State (Karmanos Cancer Institute) Withdrawn
Detroit, Michigan, United States, 48201
United States, New Jersey
The Cancer Institute of New Jersey Recruiting
New Brunswick, New Jersey, United States, 08903
Contact: Robert DiPaola, MD         
Principal Investigator: Mark Stein, MD         
United States, New York
North Shore University Hospital-Monter Cancer Center Active, not recruiting
Lake Success, New York, United States, 11042
NYU Cancer Center Recruiting
New York, New York, United States, 10016
Principal Investigator: Anna Ferrari, MD         
United States, Oregon
Oregon Health & Science University Active, not recruiting
Portland, Oregon, United States, 97239
Sponsors and Collaborators
New York University School of Medicine
Novartis
Investigators
Principal Investigator: Anna Ferrari, MD New York University School of Medicine
  More Information

No publications provided

Responsible Party: New York University School of Medicine
ClinicalTrials.gov Identifier: NCT00878436     History of Changes
Other Study ID Numbers: NYU 08-479
Study First Received: April 8, 2009
Last Updated: February 10, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by New York University School of Medicine:
histone deacetylase inhibitor
hormone therapy
androgen-independent
PSA
androgen receptor

Additional relevant MeSH terms:
Neoplasms
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Genital Diseases, Male
Prostatic Diseases
Bicalutamide
Histone Deacetylase Inhibitors
Androgen Antagonists
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on July 22, 2014