A Phase I/II Study of Azacitidine, Docetaxel, and Prednisone for Metastatic Prostate Cancer Patients

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Rakesh Singal, University of Miami
ClinicalTrials.gov Identifier:
NCT00503984
First received: July 17, 2007
Last updated: December 9, 2015
Last verified: December 2015
  Purpose
Azacitidine can reverse clinical resistance to docetaxel through upregulation of Growth Arrest and DNA Damage inducible alpha (GADD45α) and other epigenetically regulated genes.

Condition Intervention Phase
Prostate Cancer
Pain
Drug: Azacitidine
Drug: Docetaxel
Drug: Prednisone
Genetic: GADD45α methylation and expression analysis
Drug: Pegfilgrastim
Drug: Filgrastim
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Crossover Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I/II Study of Azacitidine (Vidaza), Docetaxel and Prednisone for Patients With Hormone Refractory Metastatic Prostate Cancer Previously Treated With a Taxotere Containing Regimen.

Resource links provided by NLM:


Further study details as provided by University of Miami:

Primary Outcome Measures:
  • Phase I - Recommended Phase Two Dose (RPTD) of Azacitidine, Docetaxel and Prednisone Combination. [ Time Frame: Up to 1.5 years ] [ Designated as safety issue: Yes ]
    Determination of a safe and potentially efficacious phase II dose of azacitidine in combination with docetaxel and prednisone that can be used for the treatment of hormone refractory metastatic prostate cancer.

  • Number of Participants Achieving Prostate-specific Antigen (PSA) Response. [ Time Frame: Up to 4.5 years. ] [ Designated as safety issue: No ]
    Number of participants achieving prostate-specific antigen (PSA) response according to Prostate Cancer Working Group 1 (PCWG1) criteria. PSA response according to PCWG1 is defined as an least 50 percent decline in PSA level from baseline that was maintained for at least three weeks.

  • Number of Participants Achieving Complete Response (CR) or Partial Response (CR) to Protocol Therapy. [ Time Frame: Up to 4.5 years ] [ Designated as safety issue: No ]
    Number of participants achieving Complete Response (CR) or Partial Response to protocol therapy according to Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 Criteria.


Secondary Outcome Measures:
  • Duration of Response [ Time Frame: Up to 4.5 years. ] [ Designated as safety issue: No ]
    Length of time from the date of first observation of complete response (CR) or partial response (PR), to the date of first observation of disease progression.

  • Progression-Free Survival (PFS) [ Time Frame: Up to 4.5 years ] [ Designated as safety issue: No ]
    The time from the date of start of treatment until the first documented or confirmed disease progression, or death related to prostate cancer, whichever is earlier.

  • Overall Survival (OS) [ Time Frame: Up to 4.5 years. ] [ Designated as safety issue: No ]
    The time from the date of initiation of study treatment until date of death from any cause.

  • Number of Participants Experiencing Adverse Events After Beginning Protocol Therapy. [ Time Frame: Up to 4.5 years ] [ Designated as safety issue: Yes ]

Enrollment: 22
Study Start Date: May 2007
Study Completion Date: June 2015
Primary Completion Date: June 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Phase 1 - Aza + Doc Dose Escalation
Azacitidine (Aza) and Docetaxel (Doc) with dose escalation/de-escalation design, and Prednisone, with growth factor support; GADD45α methylation and expression analysis, with optional growth factor support (pegfilgrastim/filgrastim).
Drug: Azacitidine
Intravenous infusion over 30 minutes Days 1 - 5 of each 3 weekly cycle.
Other Name: Vidaza®
Drug: Docetaxel
Intravenous infusion over 1 hour on day 6 of each 3 weekly cycle.
Other Name: Taxotere®
Drug: Prednisone
Patient will receive prednisone 5mg twice a day from Day 1 to 21 of each cycle.
Genetic: GADD45α methylation and expression analysis

Peripheral blood samples from patients will be collected as described in section 8.1 (total of 4 blood samples). DNA will be isolated from serum, bisulfite treated and evaluated for methylation by bisulfite genomic sequencing.

Patients with accessible prostate tissue or metastases will undergo biopsy prior to treatment if they consent to do so.

Drug: Pegfilgrastim
Growth factor support.Granulocyte-colony stimulating factor (G-CSF)
Other Name: Neulasta
Drug: Filgrastim
Growth factor support. Granulocyte-colony stimulating factor (G-CSF)
Other Name: Neupogen
Experimental: Phase 2 - Aza + Doc RPTD
Recommended Phase Two Dose (RPTD) of Azacitidine and Docetaxel; and Prednisone; with optional growth factor support (pegfilgrastim/filgrastim).
Drug: Azacitidine
Intravenous infusion over 30 minutes Days 1 - 5 of each 3 weekly cycle.
Other Name: Vidaza®
Drug: Docetaxel
Intravenous infusion over 1 hour on day 6 of each 3 weekly cycle.
Other Name: Taxotere®
Drug: Prednisone
Patient will receive prednisone 5mg twice a day from Day 1 to 21 of each cycle.
Genetic: GADD45α methylation and expression analysis

Peripheral blood samples from patients will be collected as described in section 8.1 (total of 4 blood samples). DNA will be isolated from serum, bisulfite treated and evaluated for methylation by bisulfite genomic sequencing.

Patients with accessible prostate tissue or metastases will undergo biopsy prior to treatment if they consent to do so.

Drug: Pegfilgrastim
Growth factor support.Granulocyte-colony stimulating factor (G-CSF)
Other Name: Neulasta
Drug: Filgrastim
Growth factor support. Granulocyte-colony stimulating factor (G-CSF)
Other Name: Neupogen

Detailed Description:

Study design A phase I/II clinical trial in patients with hormone refractory metastatic prostate cancer.

Primary objective phase I component of study:

To determine a safe and potentially efficacious phase II dose of azacitidine in combination with docetaxel and prednisone that can be used for the treatment of hormone refractory metastatic prostate cancer.

Primary objective phase II component of study:

To determine the therapeutic efficacy of combined therapy of azacitidine, docetaxel, and prednisone, in the treatment of hormone refractory metastatic prostate cancer. The primary measure of therapeutic efficacy is response, defined as prostate-specific antigen (PSA) response, complete response (CR), or partial response (PR).

Secondary endpoints are toxicity, duration of response, progression-free survival, and overall survival.

  Eligibility

Ages Eligible for Study:   18 Years to 120 Years
Genders Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

INCLUSION CRITERIA:

  • Patient who had histologically confirmed adenocarcinoma of the prostate.
  • Patient must have radiologically documented metastatic disease.
  • Patients should have received at least 12 weeks of docetaxel chemotherapy or a cumulative docetaxel dose of 300 mg/m2 and have disease progression on docetaxel-based therapy. Patients must have progressed after prior hormonal therapy (e.g. medical or surgical castration) as defined by a castrate level of testosterone (less than 50 ng/mL). If patient underwent medical castration, it must be continued during the study.
  • Progressive disease may be documented by:

    • Non-measurable disease:

      • Serum PSA progression defined as a rise in at least 2 consecutive serum PSA values, each obtained at least 1 week apart and an absolute value greater than 2.0 ng/ml or,
      • Appearance of two or more new lesions on bone scan.
      • Patients with treated epidural lesions and no other epidural progression will be eligible.
    • Measurable disease

      • Documented progression of disease by Response Evaluation Criteria In Solid Tumors (RECIST) criteria demonstrating at least one visceral or soft tissue metastatic lesion (including new lesion).
      • Nodal or visceral progression will be sufficient for trial entry independent of PSA
      • Only lymph nodes ≥ 2 cm in diameter will be used to assess for a change in size.
      • Previously irradiated lesions, primary prostatic lesion, and bone lesions will be considered non-measurable disease.
  • Patient is 18 years or older.
  • Patient had a Karnofsky Performance Status (KPS) of at least 70% or Eastern Cooperative Oncology Group (ECOG) Performance Status score of 0-2.
  • Life expectancy of > 6 months.
  • Patient with adequate organ function as defined as

    • Absolute Neutrophils Count greater than 1500 cells/mm3
    • Platelets greater than 100,000 cells/mm3
    • Hemoglobin greater than 8 g/dL,
    • Adequate liver function as documented by:

      • Total Bilirubin </= 1.5 times the upper limit of the normal range for the laboratory (ULN). Higher levels are acceptable if these can be attributed to active hemolysis or ineffective erythropoiesis.
      • AST and ALT </= 2.5 ULN. (In determining eligibility the more abnormal of the two values (AST or ALT) should be used.)
    • Serum creatinine </= 2.0 mg/dl or </= 1.5 x institutional upper limit of normal.
  • Male patient must be willing to use an acceptable barrier method for contraception; and must agree not to father a child whilst receiving treatment with Azacitidine and up to six months after last dose.
  • Patients may have a history of prior malignancy (≥ 5 years prior) provided that the patient is currently disease free and off all therapy for that malignancy. Patients with non-melanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection.
  • Patients must be informed of the investigational nature of the treatment and must give signed written and informed consent.

EXCLUSION CRITERIA:

  • Patients who have received strontium 89 (metastron®), Samarium 153 (quadramet®) radiation therapy within 8 weeks of enrollment.
  • Evidence of significant active infection during screening for eligibility.
  • Patients who have had a psychiatric illness that could potentially interfere with completion of treatment according to protocol.
  • Patients who had chemotherapy or radiotherapy within 4 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier. There is no wash-out period for patients who received Zytiga.
  • Patient who had brain metastases.
  • Patient who had history of allergic reactions attributed to compound or similar chemical or biological composition to azacitidine (Vidaza®) or docetaxel or other drugs formulated with polysorbate 80 or mannitol.
  • Patient had major surgical procedure within 28 days before Day 1 of treatment.
  • Hepatic malignancy.
  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: NCT00503984

Locations
United States, Florida
University of Miami Sylvester Comprehensive Cancer Center
Miami, Florida, United States, 33136
Sponsors and Collaborators
University of Miami
Investigators
Principal Investigator: Rakesh Singal, MD University of Miami Sylvester Comprehensive Cancer Center
  More Information

Additional Information:
Publications:
Responsible Party: Rakesh Singal, Associate Professor, University of Miami
ClinicalTrials.gov Identifier: NCT00503984     History of Changes
Other Study ID Numbers: 20061143  SCCC-2006080  WIRB-20070344  20140376 
Study First Received: July 17, 2007
Results First Received: December 9, 2015
Last Updated: December 9, 2015
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Miami:
Adenocarcinoma of the prostate
Recurrent prostate cancer
Stage IV prostate cancer
Pain

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Diseases, Male
Genital Neoplasms, Male
Neoplasms
Neoplasms by Site
Prostatic Diseases
Urogenital Neoplasms
Azacitidine
Docetaxel
Lenograstim
Mitogens
Prednisone
Adjuvants, Immunologic
Anti-Inflammatory Agents
Antimetabolites
Antimetabolites, Antineoplastic
Antimitotic Agents
Antineoplastic Agents
Antineoplastic Agents, Hormonal
Enzyme Inhibitors
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Immunologic Factors
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs
Therapeutic Uses
Tubulin Modulators

ClinicalTrials.gov processed this record on February 04, 2016