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Phase III Study of DCVAC/PCa Added to Standard Chemotherapy for Men With Metastatic Castration Resistant Prostate Cancer (VIABLE)

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ClinicalTrials.gov Identifier: NCT02111577
Recruitment Status : Completed
First Posted : April 11, 2014
Results First Posted : April 6, 2021
Last Update Posted : April 6, 2021
Sponsor:
Information provided by (Responsible Party):
Sotio a.s.

Study Description
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Brief Summary:
The VIABLE study sought to confirm the hypothesis that the combination of docetaxel with DCVAC/PCa followed by a maintenance therapy with DCVAC/PCa would improve overall survival in patients with metastatic castration-resistant prostate cancer.

Condition or disease Intervention/treatment Phase
Metastatic Castration-resistant Prostate Cancer Biological: DCVAC/PCa Biological: Placebo Phase 3

Detailed Description:
This was a randomized, double blind, placebo-controlled, multicenter, international, parallel-group phase III study. Patients with metastatic castration-resistant prostate cancer who were candidates to receive standard of care first-line chemotherapy with docetaxel plus prednisone were randomized 2:1 into one of two arms: an investigational arm (DCVAC/PCa) and a control arm (placebo) in addition to chemotherapy (docetaxel plus prednisone).
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1182 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: A Randomized, Double Blind, Multicenter, Parallel-group, Phase III Study to Evaluate Efficacy and Safety of DCVAC/PCa Versus Placebo in Men With Metastatic Castration Resistant Prostate Cancer Eligible for 1st Line Chemotherapy
Actual Study Start Date : May 26, 2014
Actual Primary Completion Date : January 28, 2020
Actual Study Completion Date : January 28, 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arms and Interventions
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Arm Intervention/treatment
Experimental: DCVAC/PCa with standard of care chemotherapy
Combination therapy with DCVAC/PCa and standard of care chemotherapy (docetaxel and prednisone)
 Biological: DCVAC/PCa
DCVAC/PCa concurrently with docetaxel plus prednisone every 3 weeks (± 7 days). DCVAC/PCa was administered at least 7 days before or and at least 7 days after the nearest chemotherapy (days 8-15 of chemotherapy cycles). After discontinuation of chemotherapy for any reason, each following dose of DCVAC/PCa was given every 4 weeks (-7/+14 days) for up to a total of 15 doses.
Other Name: Stapuldencel
Placebo Comparator: Placebo with standard of care chemotherapy
Combination therapy with placebo and standard of care chemotherapy (docetaxel and prednisone) as comparator
 Biological: Placebo
Placebo concurrently with docetaxel plus prednisone every 3 weeks (± 7 days). Placebo was administered at least 7 days before or and at least 7 days after the nearest chemotherapy (days 8-15 of chemotherapy cycles). After discontinuation of chemotherapy for any reason, each following dose of placebo was given every 4 weeks (-7/+14 days) for up to a total of 15 doses.


Outcome Measures
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Primary Outcome Measures :
  1. Overall Survival, Intention-to-treat Population [ Time Frame: From randomization to death due to any cause, up to 58 months ]
    Overall survival is defined as the time from randomization until death due to any cause.


Secondary Outcome Measures :
  1. Overall Survival, Per Protocol Population [ Time Frame: From randomization to death due to any cause, up to 58 months ]
    Overall survival is defined as the time from randomization until death due to any cause.

  2. Overall Survival, Intention-to-treat Population, Abiraterone as Prior Therapy [ Time Frame: From randomization to death due to any cause, up to 58 months ]
    Overall survival is defined as the time from randomization until death due to any cause.

  3. Overall Survival, Intention-to-treat Population, Enzalutamide as Prior Therapy [ Time Frame: From randomization to death due to any cause, up to 58 months ]
    Overall survival is defined as the time from randomization until death due to any cause.

  4. Overall Survival, Intention-to-treat Population, no Prior Abiraterone or Enzalutamide [ Time Frame: From randomization to death due to any cause, up to 58 months ]
    Overall survival is defined as the time from randomization until death due to any cause.

  5. Radiological Progression-free Survival, Intention-to-treat Population [ Time Frame: Time from randomization to the date of the earliest objective evidence of either radiographic progression of bone lesions, radiographic progression of soft tissue lesions, or death due to any cause, up to 58 months ]
    Progressive disease on bone scans was defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan.

  6. Radiological Progression-free Survival, Per Protocol Population [ Time Frame: Time from randomization to the date of the earliest objective evidence of either radiographic progression of bone lesions, radiographic progression of soft tissue lesions, or death due to any cause, up to 58 months ]
    Progressive disease on bone scans was defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan.

  7. Time to PSA Progression, Intention-to-treat Population [ Time Frame: Time from randomization to the date of objective evidence of PSA progression (PSA absolute increase ≥ 2 ng/mL and ≥ 25% above nadir or baseline values providing confirmation by a second consecutive value obtained at least 3 weeks later), up to 39 months ]
    The evidence of PSA progression is defined as: time from randomization to the date of PSA absolute increase ≥ 2 ng/mL and ≥ 25% above nadir or baseline values confirmed by a second consecutive value obtained at least 3 weeks later.

  8. Time to PSA Progression, Per Protocol Population [ Time Frame: Time from randomization to the date of objective evidence of PSA progression (PSA absolute increase ≥ 2 ng/mL and ≥ 25% above nadir or baseline values providing confirmation by a second consecutive value obtained at least 3 weeks later), up to 39 months ]
    The evidence of PSA progression is defined as: time from randomization to the date of PSA absolute increase ≥ 2 ng/mL and ≥ 25% above nadir or baseline values confirmed by a second consecutive value obtained at least 3 weeks later.

  9. Time to First Skeletal-related Event, Intention-to-treat Population [ Time Frame: Time from randomization to the date of the first skeletal-related event, up to 58 months ]

    Skeletal-related events included:

    • Radiation therapy to bone
    • Pathologic bone fracture
    • Spinal cord compression
    • Surgery to bone
    • Change in antineoplastic therapy to treat bone pain

  10. Time to First Skeletal-related Event, Per Protocol Population [ Time Frame: Time from randomization to the date of the first skeletal-related event, up to 58 months ]

    Skeletal-related events included:

    • Radiation therapy to bone
    • Pathologic bone fracture
    • Spinal cord compression
    • Surgery to bone
    • Change in antineoplastic therapy to treat bone pain

  11. Time to Radiological Progression or Skeletal-related Event, Intention-to-treat Population [ Time Frame: Time from randomization to the date of the first radiological progression or skeletal-related event, up to 58 months ]

    Progressive disease on bone scans defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan.

    Skeletal-related events included:

    • Radiation therapy to bone
    • Pathologic bone fracture
    • Spinal cord compression
    • Surgery to bone
    • Change in antineoplastic therapy to treat bone pain

  12. Time to Radiological Progression or Skeletal-related Event, Per Protocol Population [ Time Frame: Time from randomization to the date of the first radiological progression or skeletal-related event, up to 58 months ]

    Progressive disease on bone scans defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan.

    Skeletal-related events included:

    • Radiation therapy to bone
    • Pathologic bone fracture
    • Spinal cord compression
    • Surgery to bone
    • Change in antineoplastic therapy to treat bone pain

  13. Proportion of Patients With Skeletal-related Events, Intention-to-treat Population [ Time Frame: From randomization to the end of the study, up to 57 months ]

    Progressive disease on bone scans defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan.

    Skeletal-related events included:

    • Radiation therapy to bone
    • Pathologic bone fracture
    • Spinal cord compression
    • Surgery to bone
    • Change in antineoplastic therapy to treat bone pain

  14. Proportion of Patients With Skeletal-related Events, Per Protocol Population [ Time Frame: From randomization to the end of the study, up to 57 months ]

    Progressive disease on bone scans defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan.

    Skeletal-related events included:

    • Radiation therapy to bone
    • Pathologic bone fracture
    • Spinal cord compression
    • Surgery to bone
    • Change in antineoplastic therapy to treat bone pain


Eligibility Criteria
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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:

  • Male 18 years and older.
  • Histologically or cytologically confirmed prostate adenocarcinoma.

  • Presence of skeletal, or soft-tissue/visceral/nodal metastases according to one of the following criteria:

    • Confirmed pathological fracture related to the disease OR
    • Confirmation of distant bone and/or soft-tissue and/or visceral metastases on CT or MRI scan or bone scintigraphy OR
    • Positive pathology report of metastatic lesion

  • Disease progression despite androgen-deprivation therapy (ADT) as indicated by:

    • Prostate-specific antigen (PSA) increase that is ≥ 2 ng/mL and ≥ 25% above the minimum PSA as reached during ADT or above the pre-treatment level, if no response was observed and which is confirmed by a second value 1 or more weeks later OR
    • Progression of measurable lymph nodes (short axis ≥ 15 mm) or visceral lesion measurable per RECIST v1.1 criteria, confirmation by an independent review facility (IRF) required OR
    • Two or more new lesions appearing on bone scan/imaging compared with a previous scan (confirmation by IRF required)
  • Maintenance of castrate conditions: patients, who have not had a surgical orchiectomy, must continue with hormone therapy with gonadotropin releasing hormone/ luteinizing hormone-releasing hormone (GnRH/LHRH) agonists or antagonists to reach levels of serum testosterone of ≤ 1.7 nmol/L (50 ng/dL). The duration of the castration period must be at least 4 months before screening as evidenced by combination of clinical/laboratory data (see section 6.8.1).

  • Laboratory criteria:

    • White blood cells (WBC) greater than 4,000/mm3 (4.0 x109/L)
    • Neutrophil count greater than 1,500/mm3 (1.5 x109/L).
    • Hemoglobin of at least 10 g/dL (100 g/L).
    • Platelet count of at least 100,000/mm3 (100 x 109/L).
    • Total bilirubin within normal limits (benign hereditary hyperbilirubinemias, e.g. Gilbert's syndrome, are permitted).
    • Serum alanine aminotransferase, aspartate aminotransferase, and creatinine < 1.5x times the upper limit of normal (ULN).
  • Life expectancy of at least 6 months based on Investigator's judgment.
  • Eastern Cooperative Oncology Group (ECOG) Performance status 0-2.
  • At least 4 weeks after surgery or radiotherapy before randomization.
  • A minimum of 28 days beyond initiation of bisphosphonate or denosumab therapy before randomization.
  • Recovery from primary local surgical treatment, radiotherapy or orchiectomy before randomization.
  • Signed informed consent including patient's ability to comprehend its contents.

Exclusion criteria:

  • Confirmed brain and/or leptomeningeal metastases (other visceral metastases are acceptable).
  • Current symptomatic spinal cord compression requiring surgery or radiation therapy.
  • Prior chemotherapy for prostate cancer.

  • Patient co-morbidities:

    • Subjects who are not indicated for chemotherapy treatment with first line Standard of Care chemotherapy (docetaxel and prednisone).
    • HIV positive, human T-lymphotropic virus positive.
    • Active hepatitis B (active hepatitis B), active hepatitis C (HCV), active syphilis.
    • Evidence of active bacterial, viral or fungal infection requiring systemic treatment.

    • Clinically significant cardiovascular disease including:

      • symptomatic congestive heart failure.
      • unstable angina pectoris.
      • serious cardiac arrhythmia requiring medication.
      • uncontrolled hypertension.
      • myocardial infarction or ventricular arrhythmia or stroke within a 6 months before screening, known left ventricular ejection fraction (LVEF) < 40% or serious cardiac conduction system disorders, if a pacemaker is not present.
    • Pleural and pericardial effusion of any NCI CTCAE grade.
    • Peripheral neuropathy having a NCI CTCAE ≥ grade 2.
    • History of malignant disease (with the exception of non-melanoma skin tumors) in the preceding five years.
    • Active autoimmune disease requiring treatment.
    • History of severe forms of primary immune deficiencies.
    • History of anaphylaxis or other serious reaction following vaccination.
    • Known hypersensitivity to any constituent of the DCVAC/PCa or placebo product.
    • Uncontrolled co-morbidities including, psychiatric or social conditions which, in the Investigator's opinion, would prevent participation in the trial.
  • Systemic corticosteroids at doses greater than 40 mg hydrocortisone daily or equivalent for any reason other than treatment of PCa within 6 months before randomization.
  • Ongoing systemic immunosuppressive therapy for any reason.
  • Treatment with anti-androgens, inhibitors of adrenal-produced androgens or other hormonal tumor-focused treatment performed on the day of randomization (except for GnRH/LHRH agonists or antagonists) to exclude possible anti-androgen withdrawal response. This criterion is not applicable to subjects who have never responded to anti-androgen treatment, as there is no risk of anti-androgen withdrawal response.
  • Treatment with immunotherapy against PCa within 6 months before randomization.
  • Treatment with radiopharmaceutical within 8 weeks before randomization.
  • Participation in a clinical trial using non-immunological experimental therapy within 4 weeks before randomization.
  • Participation in a clinical trial using immunological experimental therapy (e.g., monoclonal antibodies, cytokines or active cellular immunotherapies) within 6 months before randomization.
  • Refusal to sign the informed consent.
Contacts and Locations
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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): NCT02111577


Locations
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Sponsors and Collaborators
Sotio a.s.
Investigators
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Principal Investigator: Nicholas J. Vogelzang US Oncology Research/Comprehensive Cancer Centers of Nevada
  Study Documents (Full-Text)

Documents provided by Sotio a.s.:
Study Protocol  [PDF] March 8, 2018
Statistical Analysis Plan  [PDF] December 13, 2019

More Information
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Additional Information:

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Responsible Party: Sotio a.s.
ClinicalTrials.gov Identifier: NCT02111577    
Other Study ID Numbers: SP005
2012-002814-38 ( EudraCT Number )
First Posted: April 11, 2014    Key Record Dates
Results First Posted: April 6, 2021
Last Update Posted: April 6, 2021
Last Verified: March 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Sotio a.s.:
Immunotherapy
Metastatic
Castration-resistant
 Prostate cancer
Biological
Vaccine
Additional relevant MeSH terms:
Layout table for MeSH terms
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
 Neoplasms by Site
Neoplasms
Prostatic Diseases