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A Study to Evaluate the Potential Increased Risk of Seizures Among Metastatic Castration-Resistant Prostate Cancer (mCRPC) Patients Treated With Enzalutamide (UPWARD)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01977651
Recruitment Status : Completed
First Posted : November 7, 2013
Last Update Posted : January 14, 2020
Medivation LLC, a wholly owned subsidiary of Pfizer Inc.
Information provided by (Responsible Party):
Astellas Pharma Inc ( Astellas Pharma Global Development, Inc. )

Brief Summary:
The objective of this study is to evaluate the incidence of seizures and monitor the safety of enzalutamide treatment in subjects with metastatic castration-resistant prostate cancer known to have risk factor(s) for seizure.

Condition or disease Intervention/treatment Phase
Metastatic Castration-resistant Prostate Cancer (mCRPC) Drug: enzalutamide Phase 4

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 424 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Multicenter, Single-arm, Open-label, Postmarketing Safety Study to Evaluate the Risk of Seizure Among Subjects With Metastatic Castration-Resistant Prostate Cancer (mCRPC) Treated With Enzalutamide Who Are at Potential Increased Risk of Seizure
Actual Study Start Date : September 25, 2013
Actual Primary Completion Date : February 1, 2016
Actual Study Completion Date : January 11, 2019

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Enzalutamide 160 mg
Participants will receive 160 mg of enzalutamide orally once a day, for 4 months.
Drug: enzalutamide
Participants will receive 4 capsules (40 mg each) of enzalutamide orally once a day, for a total daily dose of 160 mg. Treatment will be given with or without food and as close as possible to the same time each day.
Other Names:
  • Xtandi
  • MDV3100

Primary Outcome Measures :
  1. The Percentage of Evaluable Participants With at Least One Confirmed Seizure as Adjudicated by the Independent Adjudication Committee (IAC) [ Time Frame: Day 1 up to Week 17 (End of Treatment) ]
    Evaluable participant is defined as a participant with a confirmed seizure during the 4-month treatment period of the study or a participant who completes at least 3 months (75%) of the planned treatment.

Information from the National Library of Medicine

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, Learn About Clinical Studies.

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Subject has histologically confirmed metastatic adenocarcinoma of the prostate.
  • Subject has ongoing androgen deprivation therapy with a Gonadotropin-releasing hormone (GnRH) analogue (agonist or antagonist) or bilateral orchiectomy (i.e., surgical or medical castration).
  • Subject has disease progression by at least one of the following:

    1. Prostate-Specific Antigen (PSA) progression defined by a minimum of 2 rising PSA levels with an interval of at least 1 week between each draw;
    2. Bone disease progression as defined by Prostate Cancer Working Group 2 guidelines (at least 2 new lesions) on bone scan; or
    3. Soft tissue disease progression as defined by RECIST 1.1
  • For subjects who have not had an orchiectomy, there must be a plan to maintain effective GnRH-analogue therapy for the duration of the study.
  • Subject must have failed at least one course of androgen deprivation therapy (ADT), i.e., treatment with GnRH analogues.
  • Subject has an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.
  • Subject has been evaluated by a local neurologist prior to study entry who has determined the subject has at least one risk factor for seizure including:

    1. past history of seizure due to any cause except a single febrile seizure in childhood. Patients with a history of seizures should not have had a seizure within 12 months of Screening and must have had no anticonvulsants for 12 months prior to Screening,
    2. history of cerebrovascular accident (CVA) or transient ischemic attack (TIA),
    3. history of traumatic brain or head injury with loss of consciousness
    4. unexplained loss of consciousness within the last 12 months,
    5. presence of a space occupying lesion in the brain including previously treated brain metastasis(es) or primary central nervous system (CNS) tumor,
    6. history of arteriovenous malformations of the brain,
    7. history of brain infection (i.e., abscess, meningitis, or encephalitis),
    8. current use of medication that may lower seizure threshold
    9. presence of Alzheimer's disease, meningioma, leptomeningeal disease from prostate cancer.
  • Subject is able to swallow the study drug and comply with study requirements.
  • Subject agrees not to participate in another interventional study while on treatment.
  • Male subject and his female partner who is of childbearing potential must use two acceptable methods of birth control (one of which must include a condom as a barrier method of contraception) starting at Screening and continuing throughout the study period and for 3 months after final study drug administration.

    1. Two acceptable forms of birth control include:

    1. Condom (barrier method of contraception), AND
    2. One of the following acceptable forms of contraception is required:

      1. Established use of oral, injected or implanted hormonal methods of contraception.
      2. Placement of an intrauterine device (IUD) or intrauterine system (IUS).
      3. Barrier methods of contraception: Occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/suppository).
      4. Vasectomy or surgical castration at least 6 months prior to Screening.
  • Male subject must use a condom, if having sex with a pregnant woman.
  • Male subject must not donate sperm starting at Screening and throughout the study period and for at least 3 months after final drug administration.

Exclusion Criteria:

  • Subject with a history of exposure to enzalutamide.
  • Subject has severe concurrent disease, infection, or co-morbidity that, in the judgment of the Investigator, would make the subject inappropriate for enrollment.
  • Subject is currently being treated with anti-epileptics.
  • Subject has a history of seizure within the past 12 months of Screening as assessed by neurology examination and history.
  • Subject with rapidly progressing visceral disease who has not received and is thought to be able to tolerate cytotoxic chemotherapy. (However, subject who has previously received cytotoxic chemotherapy is permitted).
  • Subject has clinical signs suggestive of high or imminent risks for pathological fracture, spinal cord compression and/or cauda equina syndrome.
  • Subject's absolute neutrophil count is < 1500/microliter (µL), platelet count is < 100,000/µL) or hemoglobin is < 5.6 millimoles(mmol)/liter (L) (9 grams (g)/deciliter (dL) at Screening.
  • Subject's total bilirubin is ≥ 1.5 x upper limit of normal (ULN) (except for subjects with documented Gilbert's disease) or alanine aminotransferase (ALT) or aspartate aminotransferase (AST) is ≥ 2.5x upper limit of normal (ULN) at Screening.
  • Subject's estimated creatinine clearance (Cer) is less than 30 milliliter (mL)/minute (min) by the Cockcroft and Gault formula (Creatinine Clearance (mL/min) = (140 - age)(weight (wt) kilogram (kg) / 72 x serum creatinine (milligram (mg)/100 mL) [Cockcroft, 1976] at Screening.
  • Subject has uncontrolled hypertension as indicated by a resting systolic blood pressure > 160 millimeter of mercury (mmHg) or diastolic blood pressure > 100 millimeter of mercury (mmHg) at Screening.
  • Subject has received an investigational agent within 4 weeks or 5 half lives whichever is longer prior to Day 1.
  • Subject has shown a hypersensitivity reaction to the active pharmaceutical ingredient or any of the capsule components, including Labrasol, butylated hydroxyanisole, and butylated hydroxytoluene.

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 identifier (NCT number): NCT01977651

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Sponsors and Collaborators
Astellas Pharma Global Development, Inc.
Medivation LLC, a wholly owned subsidiary of Pfizer Inc.
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Study Director: Sr. Medical Director Astellas Pharma Global Development, Inc.

Additional Information:
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Responsible Party: Astellas Pharma Global Development, Inc. Identifier: NCT01977651    
Other Study ID Numbers: 9785-CL-0403
2013-003022-92 ( EudraCT Number )
U1111-1157-0224 ( Registry Identifier: World Health Organization (WHO) )
First Posted: November 7, 2013    Key Record Dates
Last Update Posted: January 14, 2020
Last Verified: January 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Access to anonymized individual participant level data collected during the study, in addition to study-related supporting documentation, is planned for studies conducted with approved product indications and formulations, as well as compounds terminated during development. Studies conducted with product indications or formulations that remain active in development are assessed after study completion to determine if Individual Participant Data can be shared. Conditions and exceptions are described under the Sponsor Specific Details for Astellas on
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Clinical Study Report (CSR)
Time Frame: Access to participant level data is offered to researchers after publication of the primary manuscript (if applicable) and is available as long as Astellas has legal authority to provide the data.
Access Criteria: Researchers must submit a proposal to conduct a scientifically relevant analysis of the study data. The research proposal is reviewed by an Independent Research Panel. If the proposal is approved, access to the study data is provided in a secure data sharing environment after receipt of a signed Data Sharing Agreement.
Keywords provided by Astellas Pharma Inc ( Astellas Pharma Global Development, Inc. ):
Central Nervous System
metastatic castration-resistant prostate cancer (mCRPC)
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Genital Diseases, Male
Prostatic Diseases
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms