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Sipuleucel-T With or Without Radiation Therapy in Treating Patients With Hormone-Resistant Metastatic Prostate Cancer

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ClinicalTrials.gov Identifier: NCT01807065
Recruitment Status : Active, not recruiting
First Posted : March 8, 2013
Last Update Posted : December 13, 2017
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
City of Hope Medical Center

Brief Summary:
This randomized phase II trial studies how well giving sipuleucel-T with or without radiation therapy works in treating patients with hormone-resistant metastatic prostate cancer. Vaccines may help the body build an effective immune response to kill tumor cells. Radiation therapy uses high energy x rays to kill tumor cells. It is not yet known whether giving sipuleucel-T vaccine is more effective with or without radiation therapy in treating prostate cancer

Condition or disease Intervention/treatment Phase
Adenocarcinoma of the Prostate Bone Metastases Hormone-resistant Prostate Cancer Recurrent Prostate Cancer Soft Tissue Metastases Stage IV Prostate Cancer Biological: sipuleucel-T Radiation: external beam radiation therapy Other: laboratory biomarker analysis Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To assess the feasibility, based on percent able or willing to receive all three infusions of sipuleucel-T immunotherapy, when combining sipuleucel-T with radiation therapy to a single site of metastasis delivered one week prior to beginning of sipuleucel-T therapy.

SECONDARY OBJECTIVES:

I. To assess the effect of radiation therapy to single metastasis on immune response (antibody and T-cell proliferation to prostate acid phosphate [PAP] and fusion protein PA2024) generated by sipuleucel-T immunotherapy.

II. To assess the effect of external beam radiotherapy to single metastasis on prostate specific antigen (PSA) response to therapy with sipuleucel-T.

III. To assess the effect of external beam radiotherapy to single metastasis on radiographic response rate to therapy with sipuleucel-T.

IV. To assess the time from the onset of therapy with sipuleucel-T +/- radiation to the need for subsequent therapy for prostate cancer.

V. To assess the toxicity associated with sipuleucel-T +/- radiation.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM A: Patients receive sipuleucel-T intravenously (IV) over 60 minutes days 22, 36, and 50.

ARM B: Patients undergo external beam radiation therapy in weeks 1-2. Patients also receive sipuleucel-T as in Arm A.

In both arms, treatment continues in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up until week 60.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 50 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomized Phase II Trial of Sipuleucel T Immunotherapy Preceded by Sensitizing Radiation Therapy and Sipuleucel-T Alone in Patients With Castrate Resistant Metastatic Prostate Cancer
Study Start Date : June 7, 2013
Estimated Primary Completion Date : January 2019
Estimated Study Completion Date : January 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
Experimental: Arm A (sipuleucel-T)
Patients receive sipuleucel-T IV over 60 minutes days 22, 36, and 50.
Biological: sipuleucel-T
Given IV
Other Names:
  • APC 8015
  • Provenge

Other: laboratory biomarker analysis
Correlative studies

Experimental: Arm B (radiation therapy, sipuleucel-T)
Patients undergo external beam radiation therapy in weeks 1-2. Patients also receive sipuleucel-T as in Arm A.
Biological: sipuleucel-T
Given IV
Other Names:
  • APC 8015
  • Provenge

Radiation: external beam radiation therapy
Undergo external beam radiation therapy
Other Name: EBRT

Other: laboratory biomarker analysis
Correlative studies




Primary Outcome Measures :
  1. Percent able, or willing to receive all three infusions of sipuleucel-T immunotherapy, when combining sipuleucel-T with radiation therapy to a single site of metastasis delivered one week prior to beginning of sipuleucel-T therapy [ Time Frame: Up to week 8 ]

Secondary Outcome Measures :
  1. Incidence of toxicities, graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v4.0 [ Time Frame: Up to 60 weeks ]
  2. Measurements of immune responses to PAP, PA2024 and PSA and radiologic responses to therapy [ Time Frame: Up to 60 weeks ]
    A Fisher's exact test with a 0.200 one-sided significant level will be used.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Histologically documented adenocarcinoma of the prostate
  • Life expectancy of >= 6 months, Eastern Cooperative Oncology Group (ECOG) performance status =< 2
  • Metastatic disease as evidenced by soft tissue and/or bony metastases on baseline bone scan and/or computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen or pelvis
  • Castration resistant prostatic adenocarcinoma; subjects must have current or historical evidence of disease progression despite castrated level of testosterone (< 50 ng/dL) achieved by orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist or antagonist therapy; disease progression has to be demonstrated by PSA progression OR progression of measurable disease OR progression of non-measurable disease as defined below:

    • PSA: Two consecutive rising PSA values, at least 7 days apart
    • Measurable disease: >= 20% increase in the sum of the longest diameters of all measurable lesions or the development of any new lesions; the change will be measured against the best response to castration therapy or against the pre-castration measurements if there was no response
    • Non-measurable disease:

      • Soft tissue disease: The appearance of 1 or more lesions, and/or unequivocal worsening of non-measurable disease when compared to imaging studies acquired during castration therapy or against the pre-castration studies if there was no response
      • Bone disease: Appearance of 2 or more new areas of abnormal uptake on bone scan when compared to imaging studies acquired during castration therapy or against the pre-castration studies if there was no response; increased uptake of pre-existing lesions on bone scan does not constitute progression
  • White blood cell (WBC) >= 2,500 cells/uL
  • Absolute neutrophil count (ANC) >= 1,000 cells/uL
  • Platelet count >= 75,000 cells/uL
  • Hemoglobin (HgB) >= 9.0 g/dL
  • Creatinine =< 2.5 mg/dL
  • Total bilirubin =< 2 x institutional upper limit of normal (ULN)
  • Aspartate aminotransferase (AST, serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT, serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional ULN
  • Prior chemotherapy with 0-2 regimens is allowed
  • Prior radiation therapy to prostate or prostate bed is allowed provided it occurred > 3 months before enrollment to the study

Exclusion Criteria:

  • The presence of liver, or known brain metastases, malignant pleural effusions, or malignant ascites
  • Moderate or severe symptomatic metastatic disease, defined as a requirement for treatment with opioid analgesics for cancer-related pain within 21 days prior to registration
  • Eastern Cooperative Oncology Group (ECOG) performance status > 2
  • Treatment with chemotherapy within 3 months of registration
  • Treatment with any of the following medications or interventions within 28 days of registration:

    • Systematic corticosteroids; use of inhaled, intranasal, and topical steroids is acceptable
    • Any other systemic therapy for prostate cancer (except for medical castration)
  • History of external beam radiation therapy to metastatic sites within 1 year of enrollment to the study
  • Participation in any previous study involving sipuleucel-T
  • Pathologic long-bone fractures, imminent pathologic long-bone fracture (cortical erosion on radiography > 50%) or spinal cord compression
  • Concurrent other malignancy with the exception of:

    • Cutaneous squamous cell and basal carcinomas
    • Adequately treated stage 1-2 malignancy
    • Adequately treated stage 3-4 malignancy that has been in remission for >= 2 years at the time of registration
  • A requirement for systemic immunosuppressive therapy for any reason
  • Any infection requiring parenteral antibiotic therapy or causing fever (temperature > 100.5 degrees Fahrenheit [F] or 38.1 degrees Celsius [C]) within 1 week prior to registration
  • Any medical intervention or other condition which, in the opinion of the principal investigator could compromise adherence with study requirements or otherwise compromise the study's objectives

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01807065


Locations
United States, California
City of Hope Medical Center
Duarte, California, United States, 91010
South Pasadena Cancer Center
Pasadena, California, United States, 91030
United States, Utah
Huntsman Cancer Institute, Univ. of Utah
Salt Lake City, Utah, United States, 84112
Sponsors and Collaborators
City of Hope Medical Center
National Cancer Institute (NCI)
Investigators
Principal Investigator: Cy Stein, MD, PhD City of Hope Medical Center

Responsible Party: City of Hope Medical Center
ClinicalTrials.gov Identifier: NCT01807065     History of Changes
Other Study ID Numbers: 12367
NCI-2013-00542 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
First Posted: March 8, 2013    Key Record Dates
Last Update Posted: December 13, 2017
Last Verified: December 2017

Additional relevant MeSH terms:
Prostatic Neoplasms
Adenocarcinoma
Neoplasm Metastasis
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplastic Processes
Pathologic Processes