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Phase I Trial of Apalutamide Plus Abiraterone Acetate, Docetaxel, and Prednisone in Patients With mCRPC

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ClinicalTrials.gov Identifier: NCT02913196
Recruitment Status : Recruiting
First Posted : September 23, 2016
Last Update Posted : January 14, 2019
Sponsor:
Collaborator:
Janssen Scientific Affairs, LLC
Information provided by (Responsible Party):
Weill Medical College of Cornell University

Brief Summary:

This is a multi-center, Phase I study of apalutamide in combination with abiraterone acetate, docetaxel and prednisone in patients with metastatic mastrate resistant prostate cancer (mCRPC).

This study is designed to determine the dose that apalutamide can be administered safely in combination with abiraterone acetate, docetaxel and prednisone.


Condition or disease Intervention/treatment Phase
Prostate Cancer Metastatic Drug: Apalutamide Drug: Abiraterone acetate Drug: Docetaxel Drug: Prednisone Phase 1

Detailed Description:

Subjects are enrolled in up to three 3-6-subject cohorts and are administered combination (apalutamide, abiraterone acetate and docetaxel plus prednisone) according to a dose-escalation schedule. The first dose of docetaxel infusion begins on Day 1 Cycle 1. Daily oral apalutamide, abiraterone acetate plus twice-daily oral prednisone begins on Day 1 Cycle 1. Docetaxel 1-hour infusions are administered intravenously every 3 weeks (Q3W), preceded by oral dexamethasone. While a subject is receiving chemotherapy, a treatment cycle is defined as 21 days. Dose limiting toxicity (DLT) determination is based on toxicities observed within the initial 2 cycles defined as 6 weeks. DLT will be assessed before the start of the third docetaxel infusion. Once a combination dose is determined to be safe (i.e. no more than 2 of 6 subjects experience DLT), the next cohort will enroll. Subjects remain at their allocated combination dose until the maximum tolerated dose (MTD) is determined.

The primary objective is to determine a safe dose combination of apalutamide plus abiraterone acetate, docetaxel, prednisone in subjects with mCRPC.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I Trial of Apalutamide Plus Abiraterone Acetate, Docetaxel, and Prednisone in Patients With Metastatic Castrate Resistant Prostate Cancer (mCRPC)
Study Start Date : December 2016
Estimated Primary Completion Date : December 2020
Estimated Study Completion Date : March 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: All patients
Apalutamide, 120 mg (cohort 1), 240 mg (cohort 2), 180 mg (cohort 3) Abiraterone Acetate 1000mg Prednisone 10mg Docetaxel 75 mg/m2
Drug: Apalutamide

Orally available, small molecule, nonsteroidal potent and selective antagonist of the androgen receptor.

Cohort 1 dose: 120 mg QD Cohort 2 dose: 240 mg QD Cohort 3 dose: 180 mg QD

Other Name: ARN-509

Drug: Abiraterone acetate

Abiraterone acetate is the prodrug of the active drug abiraterone. Once absorbed after oral administration, abiraterone acetate is rapidly converted to the active form, abiraterone.

Dose: 1000 mg QD

Other Name: Zytiga

Drug: Docetaxel

Taxane cytotoxic chemotherapy with demonstrated survival benefit in those with advanced prostate cancer.

Dose: 75 mg/m2 Q3W

Other Name: Taxotere

Drug: Prednisone
Dose: 5 mg BID
Other Name: Deltasone




Primary Outcome Measures :
  1. Number of participants with treatment-related adverse events as assessed by CTCAE v4.0. [ Time Frame: Until PSA progression or study completion (~36 months) ]
    Determining a safe dose combination and related toxicities of apalutamide plus abiraterone acetate, docetaxel, prednisone in subjects with mCRPC.


Other Outcome Measures:
  1. To evaluate exploratory biomarkers predictive of response and resistance in subjects treated with apalutamide in combination with abiraterone acetate, docetaxel plus prednisone [ Time Frame: Until PSA progression or study completion (~36 months) ]
  2. To evaluate the antitumor effect of combination therapy with apalutamide, abiraterone acetate, docetaxel and prednisone [ Time Frame: Until PSA progression or study completion (~36 months) ]


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

Inclusion Criteria:

  1. Histologically or cytologically confirmed adenocarcinoma of prostate
  2. Documented progressive metastatic CRPC based on at least one of the following criteria:

    1. PSA progression according to Prostate Cancer Working Group 3 (PCWG3) criteria
    2. Objective radiographic progression in soft tissue, according to modified Response Evaluation Criteria In Solid Tumors (RECIST) or bone scans
  3. ECOG performance status of 0-2
  4. Have serum testosterone < 50 ng/dL. Subjects must continue primary androgen deprivation with an LHRH/GnRH analogue (agonist/antagonist) if they have not undergone orchiectomy.
  5. Age >18 years.
  6. Patients must have normal organ and marrow function as defined below:

    • Absolute neutrophil count >1,500/cells/mm3
    • Hemoglobin ≥10.0 g/dL (independent of transfusion and/or growth factors within 3 months prior to randomization)
    • Platelet count >100,000 x 109/uL (independent of transfusion and/or growth factors within 3 months prior to randomization)
    • Serum creatinine <1.5 x upper limit of normal (ULN) or calculated creatinine clearance ≥ 60 mL/min/1.73 m2 by Cockcroft-Gault
    • Serum albumin ≥3.5 g/dL
    • Serum potassium ≥3.5 mmol/L
  7. Patients must be able to take oral medication without crushing, dissolving or chewing tablets
  8. Ability to understand and the willingness to sign a written informed consent document.
  9. Medications known to lower the seizure threshold (see list under prohibited medications) must be discontinued or substituted at least 4 weeks prior to study drug initiation.

Exclusion Criteria:

  1. Liver Function

    • If total bilirubin is >1.5 x ULN (NOTE: in subjects with Gilbert's syndrome, if total bilirubin is >1.5 x ULN, measure direct and indirect bilirubin and if direct bilirubin is within normal range, subject may be eligible) or
    • Alanine (ALT) or aspartate (AST) aminotransferase >1.5xULN (or >5xULN for subject with liver metastasis) concomitant with alkaline phosphatase >2.5xULN (or >5xULN for subjects with bone or liver metastases) or
    • Alanine (ALT or aspartate (AST) aminotransferase >2.5xULN (or >5xULN for subjects with liver metastasis
  2. Use of investigational drugs (including vaccines) or implantation of invasive medical device ≤4 weeks of Cycle 1, Day 1 or current enrollment in investigational drug or device study
  3. Prior exposure to apalutamide. Prior exposure to abiraterone acetate and/or other CYP17 inhibitors, enzalutamide is allowed (but not preferred) only during the dose escalation period.
  4. Prior chemotherapy for advanced prostate cancer. Prior chemotherapy for any other disease within 3 years.
  5. Prior systemic beta-emitting bone-seeking radioisotopes (i.e. strontium-90).
  6. Pre-existing neuropathy ≥Grade 2
  7. Systemic azole treatment (e.g. Fluconazole, itracanozole) ≤2 weeks of Cycle 1 Day 1
  8. Use of potent inducers or inhibitors of CYP3A4 activity ≤2 weeks prior to Day 1 Cycle 1
  9. History of adrenal insufficiency or hyperaldosteronism
  10. Active or symptomatic viral hepatitis
  11. Chronic liver disease.
  12. Brain metastases or leptomeningeal disease
  13. Known allergies, hypersensitivity or intolerance to abiraterone acetate, apalutamide, docetaxel, dexamethasone, prednisone, or their excipients
  14. Use of herbal, alternative and food supplements (i.e. PC-Spes, Saw Palmetto, St John Wort, etc) must be discontinued before treatment start. Daily Multi-vitamin, calcium and Vitamin D is allowed
  15. Surgery or local prostatic intervention within 30 days of first dose. [Note: Any clinically relevant sequelae from surgery must have resolved prior to Day 1 Cycle 1]
  16. Radiation therapy for treatment of prostate cancer ≤4 weeks of Day 1 Cycle 1
  17. Current evidence of any of the following:

    • Uncontrolled hypertension (defined as blood pressure of >150 mmHg systolic and/or >100 mmHg diastolic on medication)
    • Gastrointestinal disorder affecting absorption
    • Active infection (e.g., human immunodeficiency virus [HIV] or viral hepatitis) or other medical condition that would make prednisone/prednisolone (corticosteroid) use contraindicated
    • Any chronic medical condition requiring a higher dose of corticosteroid than 10 mg prednisone/prednisolone once daily
    • Any condition that in the opinion of the investigator, would preclude participation in this study.
    • Patients with baseline severe hepatic impairment (Child Pugh Class C)
  18. Severe or unstable angina, myocardial infarction, symptomatic congestive heart failure, arterial or venous thromboembolic events (e.g., pulmonary embolism, cerebrovascular accident including transient ischemic attacks), or clinically significant ventricular arrhythmias within 6 months prior to treatment start or New York Heart Association (NYHA) Class II to IV heart disease
  19. Seizure or known condition that may pre-dispose to seizure (including but not limited to prior stroke, transient ischemic attack, loss of consciousness within 1 year prior to randomization, brain arteriovenous malformation; or intracranial masses such as schwannomas and meningiomas that are causing edema or mass effect).
  20. Having partners of childbearing potential and not willing to use a method of birth control deemed acceptable by the principle investigator and chairperson during the study and for 1 week after last study drug administration

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): NCT02913196


Contacts
Contact: GUONC Research Team guonc@med.cornell.edu

Locations
United States, Nebraska
GU Research Network/Urology Cancer Center Recruiting
Omaha, Nebraska, United States, 68130
Contact: Heather Mittelstedt    402-991-8468    hmittelstedt@gucancer.com   
Principal Investigator: Luke Nordquist, MD         
United States, New York
Columbia University Medical Center Not yet recruiting
New York, New York, United States, 10032
Contact: Anja Noble    212-342-1357    an2790@cumc.columbia.edu   
Principal Investigator: Charles Drake, MD         
Weill Cornell Medical College Recruiting
New York, New York, United States, 10065
Contact: GUONC Research Team       guonc@med.cornell.edu   
Principal Investigator: Ana M Molina, MD         
Sponsors and Collaborators
Weill Medical College of Cornell University
Janssen Scientific Affairs, LLC
Investigators
Principal Investigator: Scott Tagawa, MD Weill Medical College of Cornell University

Responsible Party: Weill Medical College of Cornell University
ClinicalTrials.gov Identifier: NCT02913196     History of Changes
Other Study ID Numbers: 1509016578
First Posted: September 23, 2016    Key Record Dates
Last Update Posted: January 14, 2019
Last Verified: January 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Docetaxel
Prednisone
Abiraterone Acetate
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Anti-Inflammatory Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal
Steroid Synthesis Inhibitors
Enzyme Inhibitors
Hormone Antagonists
Cytochrome P-450 Enzyme Inhibitors