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NBTXR3 Nanoparticles and EBRT or EBRT With Brachytherapy in the Treatment of Prostate Adenocarcinoma

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ClinicalTrials.gov Identifier: NCT02805894
Recruitment Status : Recruiting
First Posted : June 20, 2016
Last Update Posted : June 4, 2018
Sponsor:
Information provided by (Responsible Party):
Nanobiotix

Brief Summary:
This study is a Phase 1/2 open-label involving 2 groups of patients newly diagnosed with either unfavorable intermediate risk or high risk prostate adenocarcinoma. One group will receive only EBRT and the other group will receive a Brachytherapy boost and EBRT.Both groups will receive treatment with androgen deprivation. There will be 2 consecutive steps, a dose escalation and a subsequent dose expansion part.

Condition or disease Intervention/treatment Phase
Prostate Cancer Drug: NBTXR3 activated by IMRT only Drug: NBTXR3 activated by Brachytherapy & IMRT Phase 1 Phase 2

Detailed Description:

This is a Phase 1/2 prospective, open-label, two cohorts, non-randomized trial consisting of two consecutive steps, a dose escalation and a subsequent dose expansion part.

PART 1 DOSE ESCALATION: subjects with newly diagnosed Unfavorable Intermediate

Risk (UIR) or High Risk (HR) prostate adenocarcinoma, will participate in a dose escalation of NBTXR3 activated by two different radiation schedules. NBTXR3 will be administered by intra-prostate injection and then activated 10 days later either by:

  • EBRT delivered as 45 Gy in 25 fractions of 1.8 Gy each; to the prostate and seminal vesicles, followed by 34.2 Gy in 19 fractions to the prostate and proximal seminal vesicles , over 9-10 weeks, utilizing intensity modulated radiotherapy (IMRT) with daily image guidance aligned to implanted fiducial markers (COHORT A) or,
  • Brachytherapy Boost and EBRT delivered as a single fraction of 15 Gy in one day to the prostate by High Dose Rate Brachytherapy followed by EBRT (initiated within 2-4 weeks after completion of Brachytherapy), delivered as 45 Gy in 25 fractions of 1.8 Gy to the prostate and seminal vesicles utilizing intensity modulated radiotherapy (IMRT) with daily image guidance aligned to implanted fiducial markers (COHORT B)

PART 2 DOSE EXPANSION: Two parallel cohorts of subjects, A and B, 20 subjects per cohort, will be treated at either the RD1 (Recommended Dose of NBTXR3 given as intraprostate injection and activated by EBRT) or RD2 (Recommended Dose of NBTXR3 given as intra-prostate injection and activated by Brachytherapy Boost and EBRT), as determined in the Phase I dose escalation of the trial.

All subjects will receive androgen deprivation therapy (ADT) LHRH / GnRH agonist beginning 8 weeks before the NBTXR3 administration and for 24 months in subjects with (HR) prostate adenocarcinoma. The duration of ADT in subjects with (UIR) disease will be of 6 months.

Subjects will receive a single intra-prostate injection of NBTXR3 which will be delivered to the prostate via transperineal injection under TRUS guidance injection. NBTXR3 injection will be performed on Day 1 and will be assessed for safety, intra-prostate availability and presence of NBTXR3 in the peripheral circulation.

COHORT A: External beam radiation therapy will be delivered to the prostate starting within 9 days after the NBTXR3 injection (Day 10). Total dose of 79.2 Gy, delivered as 25 fractions of 1.8 Gy to the prostate and seminal vesicles (45 Gy), followed by 34.2 Gy in 19 fractions to the prostate and proximal seminal vesicles, delivered over 9-10 weeks, utilizing intensity modulated radiotherapy (IMRT) with daily image guidance aligned to implanted fiducial markers COHORT B: HDR Brachytherapy implantation will be performed within 9 days after NBTXR3 injection (Day 10). Brachytherapy Boost delivered as a single fraction of 15 Gy in one day to the prostate by High Dose Rate Brachytherapy followed by EBRT (initiated within 2-4 weeks after completion of Brachytherapy) delivered as 45 Gy in 25 fractions of 1.8 Gy to the prostate and seminal vesicles utilizing intensity modulated radiotherapy (IMRT) with daily image guidance aligned to implanted fiducial markers.

Subjects will be followed for safety assessment until the end of the study. Before the onset of study treatment, subjects must have a histologic diagnosis of either Unfavorable Intermediate Risk (UIR) or High Risk (HR) prostate adenocarcinoma.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 96 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I-II Dose-escalation Study of NBTXR3 Activated by EBRT or EBRT With Brachytherapy in Patients With Newly Diagnosed Unfavorable Intermediate or High Risk Prostate Adenocarcinoma Treated With Androgen Deprivation
Actual Study Start Date : November 2016
Estimated Primary Completion Date : November 2020
Estimated Study Completion Date : November 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: NBTXR3 activated by IMRT only

Part I Dose Escalation

NBTXR3 will be administered by intra-prostate injection and then activated 10 days later by:

- EBRT delivered as 45 Gy in 25 fractions of 1.8 Gy each; to the prostate and seminal vesicles, followed by 34.2 Gy in 19 fractions to the prostate and proximal seminal vesicles , over 9-10 weeks, utilizing intensity modulated radiotherapy (IMRT) with daily image guidance aligned to implanted fiducial markers (COHORT A)

Drug: NBTXR3 activated by IMRT only
Single local administration of NBTXR3 by injection into the prostate gland prior to the IMRT treatment
Other Name: Hafnium Oxide nanoparticles

Experimental: NBTXR3 activated by Brachytherapy & IMRT

Part I Dose Escalation

NBTXR3 will be administered by intra-prostate injection and then activated 10 days later by:

- Brachytherapy Boost and EBRT delivered as a single fraction of 15 Gy in one day to the prostate by High Dose Rate Brachytherapy followed by EBRT (initiated within 2-4 weeks after completion of Brachytherapy), delivered as 45 Gy in 25 fractions of 1.8 Gy to the prostate and seminal vesicles utilizing intensity modulated radiotherapy (IMRT) with daily image guidance aligned to implanted fiducial markers (COHORT B)

Drug: NBTXR3 activated by Brachytherapy & IMRT
Single local administration of NBTXR3 by injection into the prostate gland prior to the Brachytherapy & IMRT treatment
Other Name: Hafnium Oxide nanoparticles




Primary Outcome Measures :
  1. Maximum Tolerated Dose and early Dose Limiting Toxicities (DLT) of NBTXR3 [ Time Frame: 24 months ]
  2. Recommended Dose(s) of NBTXR3 [ Time Frame: 24 months ]


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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:

  • Age ≥ 18
  • Histologically confirmed adenocarcinoma of the prostate gland by needle core samples with assigned Gleason score
  • Subjects ADT naive or subjects who are already on ADT treatment and scheduled to receive radiation therapy for their adenocarcinoma of prostate are eligible. An 8-week course of ADT is required to be completed prior to NBTXR3 administration and initiation of radiation therapy .
  • Pelvic and para-aortic lymph nodes must be negative on CT-scan or MRI of the abdomen and pelvis performed within 12 weeks prior to enrollment into the study
  • Prostate adenocarcinoma with High Risk (HR) and Unfavorable Intermediate Risk (UIR) for recurrence classification as determined by one of the following combinations:

    o High risk (HR): subjects with one or more of the following risk factors:

  • Clinical stage: T3/T4
  • Gleason score (GS): 8-10
  • PSA > 20
  • N0

    o Unfavorable Intermediate Risk (UIR): subjects with no HR features but with one or more of the following adverse risk factors:

  • At least 2 of the following 3 factors: Gleason score(GS) 3+4=7 and/or PSA 10-20 and/or T2b/c
  • Gleason score (GS) 4+3=7
  • Greater than 50% of biopsy cores positive and at least one other risk factor: Gleason score (GS) 7 and/or PSA 10-20 and/or T2b/c
  • No evidence of bone metastases (M0) on bone scan within 120 days prior to registration (PET/CT is an acceptable substitute). Equivocal bone scan findings are allowed if bone CT or MRI of hot spots are negative for metastasis
  • Baseline serum PSA value performed with an FDA-approved assay within 120 days prior to registration. Study entry PSA should not be obtained within 10-day period following prostate biopsy or following initiation of hormonal therapy
  • ECOG performance status must be 0 or 1
  • Adequate function of bone marrow:
  • Hemoglobin > 100 g/L
  • Absolute Neutrophils > 1.5 x 109/L
  • Platelets > 100 x 109/L,
  • Adequate function of kidney:
  • Serum creatinine < 1.5 x ULN
  • Adequate function of liver:
  • AST ≤ 3.0 x ULN
  • ALT ≤ 3.0 x ULN
  • Total bilirubin ≤ 1.5 x ULN
  • Non-Childbearing Potential: Male subjects and their partners must meet one of the following criteria to be considered of non-childbearing potential:

    • Males have undergone sterilization with appropriately confirmed absence of sperm in the post-vasectomy ejaculate, or
    • Heterosexually active males and their partners of childbearing potential must agree or use at least 2 forms of highly effective methods of contraception, including at least 1 barrier method. Highly effective methods of contraception are those that, alone or in combination, result in a failure rate of <1% per year when used consistently and correctly (i.e., perfect use). Contraception must include male condom or female condom used with a spermicide (i.e., foam, gel, film, cream, suppository) as well as established use of oral, injected or implanted hormonal methods of contraception, correctly placed intrauterine device or intrauterine system.

Exclusion Criteria:

  • Written Informed Consent not obtained, signed and dated
  • History of colorectal surgery, or repeated endoscopic examinations/interventions related to anorectal diseases or proximal urethral stricture requiring dilatation
  • Prostate size volume ≥90 cc
  • Brachytherapy with EBRT in subjects whose prostate volume is >60cc
  • Severe, active co-morbidity, defined as follows:
  • Inflammatory bowel disease, active rectal diverticulitis, Crohn's disease affecting the rectum, anal stenosis or ulcerative colitis. (Nonactive diverticulitis and Crohn's disease not affecting the rectum are allowed)
  • Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months
  • Myocardial infarction within the last 6 months
  • Acute bacterial or fungal infection requiring intravenous antibiotics at the time of randomization
  • Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC (Centers for Disease Control) definition
  • Prior invasive malignancy, except non-melanoma skin cancer, carcinoma in-situ of the bladder or head and neck region, unless disease free for a minimum of 2 years
  • Subjects with congenital long QT syndrome or subjects taking Class IA, Class III or Class IC anti-arrhythmic medications will require a cardiologist's evaluation prior to eligibility assessment. subjects with cardiovascular diseases can be included as long as the benefits of androgen deprivation therapy outweigh the potential risk of cardiovascular events
  • Uncontrolled lung disease
  • Subjects with any evidence of distant metastases
  • subjects with any contraindication to pelvic radiotherapy including, but not limited to, previous pelvic radiotherapy or brachytherapy
  • Presence of bilateral hip replacement prostheses
  • Hormonal therapy (luteinizing hormone-releasing hormone [LHRH] agonist or oral anti-androgen) exceeding 4 months prior to registration
  • Declared high-risk for anesthesia by attending anesthesiologist, cardiologist, or other physician
  • Complete initial work up earlier than 12 weeks prior to subject registration
  • Subjects unable to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures
  • Subjects participating in another clinical investigation at the time of signature of the informed consent.

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): NCT02805894


Contacts
Contact: Elsa Borghi, MD elsa.borghi@nanobiotix.com

Locations
United States, Massachusetts
Dana Farber Cancer Institute/Brigham and Women's Hospital Recruiting
Boston, Massachusetts, United States, 02115
Contact: Paul Nguyen, MD    617-525-3184    Paul_Nguyen@DFCI.HARVARD.EDU   
Contact: Ninjin Boldbaatar    (617) 525-3185    Ninjin_Boldbaatar@DFCI.HARVARD.EDU   
United States, Pennsylvania
Thomas Jefferson University Hospital Recruiting
Philadelphia, Pennsylvania, United States, 19107
Contact: Adam Dicker, MD    215-955-8619    Adam.Dicker@Jefferson.edu   
Contact: Christine Hubert    (215)955-8619    Christine.Hubert@Jefferson.edu   
Sponsors and Collaborators
Nanobiotix
Investigators
Principal Investigator: Adam Dicker, MD Thomas Jefferson University Hospital Philadelphia, PA
Principal Investigator: Paul Nguyen, MD Dana-Farber Cancer Institute

Responsible Party: Nanobiotix
ClinicalTrials.gov Identifier: NCT02805894     History of Changes
Other Study ID Numbers: NBTXR3-104
First Posted: June 20, 2016    Key Record Dates
Last Update Posted: June 4, 2018
Last Verified: September 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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