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Study to Evaluate CORT125281 in Combination With Enzalutamide in Patients With mCRPC

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ClinicalTrials.gov Identifier: NCT03437941
Recruitment Status : Recruiting
First Posted : February 19, 2018
Last Update Posted : December 3, 2018
Sponsor:
Information provided by (Responsible Party):
Corcept Therapeutics

Brief Summary:
This is an open-label, Phase 1/2a dose escalation study with an expansion phase to evaluate the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD), and preliminary efficacy of CORT125281 in combination with enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) to identify a recommended dose (RD) for Phase 2 studies.

Condition or disease Intervention/treatment Phase
Metastatic Castration-Resistant Prostate Cancer Drug: CORT125281 Drug: Enzalutamide (Xtandi) Phase 1 Phase 2

Detailed Description:

CORT125281 is a selective glucocorticoid receptor (GR) antagonist. In this study, CORT125281 will be administered orally in combination with enzalutamide to patients with metastatic castration-resistant prostate cancer (mCRPC) to evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics, and preliminary efficacy of the regimen. The study consists of two phases: a dose-escalation phase and an expansion phase. The dose escalation phase is designed to determine DLTs, MTD/biologically active doses and the RD of CORT125281 plus enzalutamide in patients with mCRPC. Once the recommended dose has been determined, the following expansion cohorts will be enrolled and treated with CORT125281 plus enzalutamide at the recommended dose level.

  1. Patients who have progressed during treatment with abiraterone, and have received no other androgen receptor (AR)-blocking therapies
  2. Patients who have progressed during treatment with enzalutamide or other second-generation AR inhibitors.

The effect of food on CORT125281 PK will be assessed in a portion of the patients enrolled in the Expansion Phase. The expansion cohorts will be enrolled in parallel.

In each phase of the study, routine assessments of safety and tolerability will be performed using adverse event (AE) monitoring, measurement of vital signs, recording 12 lead electrocardiogram (ECG), physical examination and clinical laboratory safety tests, and samples will be collected to determine standard PK parameters for CORT125281, enzalutamide, and their major metabolites. PD, quality of life evaluations and preliminary evaluations of anti-tumor activity of CORT125281 with enzalutamide will be performed throughout the study.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 80 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 1/2a Dose-Escalation and Expansion Study to Evaluate the Safety, Tolerability, and Pharmacokinetics of CORT125281 With Enzalutamide in Patients With Metastatic Castration-Resistant Prostate Cancer
Actual Study Start Date : December 15, 2017
Estimated Primary Completion Date : March 31, 2021
Estimated Study Completion Date : July 31, 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
Experimental: Dose Escalation
Patients will be treated with enzalutamide monotherapy once daily for 28 days followed by combination treatment with CORT125281 at escalating dose levels and enzalutamide once daily in 28-day dosing cycles.
Drug: CORT125281
CORT125281 is supplied as capsules for oral dosing

Drug: Enzalutamide (Xtandi)
Enzalutamide will be taken orally

Experimental: Dose Expansion - Cohort A
Patients who have progressed during treatment with abiraterone and no other AR-blocking therapies will be treated with CORT125281 and enzalutamide.
Drug: CORT125281
CORT125281 is supplied as capsules for oral dosing

Drug: Enzalutamide (Xtandi)
Enzalutamide will be taken orally

Experimental: Dose Expansion - Cohort A Food Effect
Sub-Cohort (first 10 patients enrolled into Cohort A). Patients enrolled into this subcohort will receive a single dose of CORT125281 at Cycle 1 Day -7 and a single dose of CORT125281 at Cycle 1 Day 1 30 minutes after a standard breakfast to assess the effect of food on PK parameters. Patients will then begin CORT125281 in combination with enzalutamide on Cycle 1 Day 2 and continue in 28-day dosing cycles.
Drug: CORT125281
CORT125281 is supplied as capsules for oral dosing

Drug: Enzalutamide (Xtandi)
Enzalutamide will be taken orally

Experimental: Dose Expansion - Cohort B
Patients who progressed during treatment with enzalutamide or second-generation AR-blocking therapies will be treated with a daily dose of CORT125281 and enzalutamide.
Drug: CORT125281
CORT125281 is supplied as capsules for oral dosing

Drug: Enzalutamide (Xtandi)
Enzalutamide will be taken orally




Primary Outcome Measures :
  1. Maximum Tolerated Dose [ Time Frame: 10 months ]
    Determine the maximum tolerated dose (MTD) and/or biologically active doses of CORT125281 in combination with enzalutamide to identify the recommended dose (RD) for Phase 2 studies based on the number of patients with dose limiting toxicities (DLTs) of CORT125281 in combination with enzalutamide


Secondary Outcome Measures :
  1. Number of participants with treatment-related adverse events as assessed by CTCAE v4.0 [ Time Frame: 24 months ]
    The safety of each treatment group will be assessed by evaluating the incidence of treatment-related adverse events according to CTCAE v4.03

  2. AUC 0-last Pharmacokinetic (PK) parameter [ Time Frame: Cycle 1 Day 1 through Cycle 3 Day 1 ]
    Area under the plasma concentration-time curve calculated using linear trapezoidal summation from time 0 to time last, where "last" is the time of the last measurable concentration

  3. AUC 0-24hr PK parameter [ Time Frame: Cycle 1 Day 1 through Cycle 3 Day 1 ]
    Area under the plasma concentration-time curve from 0 to 24 hours, calculated using linear trapezoidal summation

  4. AUC 0-infinity PK parameter [ Time Frame: Cycle 1 Day 1 through Cycle 3 Day 1 ]
    Area under the plasma concentration-time curve from 0 to infinity, calculated using the formula: AUC0-ing = AUC0-last + Clast/ λz, where λz is the apparent terminal elimination rate constant (whenever possible)

  5. Cmax PK parameter [ Time Frame: Cycle 1 Day 1 through Cycle 3 Day 1 ]
    Maximum observed plasma concentration

  6. Cmin,ss PK parameter [ Time Frame: Cycle 1 Day 1 through Cycle 3 Day 1 ]
    Minimum observed plasma concentration, at predose at steady-state

  7. CL/F PK parameter [ Time Frame: Cycle 1 Day 1 through Cycle 3 Day 1 ]
    Apparent oral clearance

  8. Tmax PK parameter [ Time Frame: Cycle 1 Day 1 through Cycle 3 Day 1 ]
    Time of the maximum plasma concentration (obtained without interpolation)

  9. λz PK parameter [ Time Frame: Cycle 1 Day 1 through Cycle 3 Day 1 ]
    Terminal elimination rate constant (whenever possible)

  10. Effect of food on the Cmax PK of CORT125281 [ Time Frame: Cycle 1 Day -7 ]
    Comparison of the fed state versus the fasted state comparison for the maximum observed plasma concentration (Cmax)

  11. Effect of food on the AUC0-t PK of CORT125281 [ Time Frame: Cycle 1 Day -7 ]
    Comparison of the fed state versus fasted state comparison for area under the plasma concentration-time curve

  12. Effect of food on the AUCinf PK of CORT125281 [ Time Frame: Cycle 1 Day -7 ]
    Comparison of the fed state versus fasted state comparison for area under the plasma concentration-time curve to infinity

  13. Objective Response Rate (ORR) [ Time Frame: 12 months from the enrollment of the final subject ]
    Determine the ORR by comparing the proportion of the patients who have either a complete response (CR) or partial response (PR)

  14. Reduction in prostate-specific antigen (PSA) [ Time Frame: 12 months from the enrollment of the final subject ]
    Determine the proportion of patients with a reduction in PSA level by >50%

  15. Time to symptomatic skeletal event (SSE) [ Time Frame: 12 months from the enrollment of the final subject ]
    Determine the time to SSE defined as symptomatic fracture, radiation or surgery to bone, or spinal cord compression

  16. Radiographic progression-free survival (rPFS) [ Time Frame: Baseline to 12 months ]
    Determine rPFS defined as the time interval from first dose of study drug (CORT125281 and/or enzalutamide) to the date when the first site of disease is found to progress on CT, MRI, or radionucleotide bone scan per PCWG3, or death whichever occurs first; including the proportion of patients progression-free at 4, 6, and 12 months

  17. Time to prostate-specific antigen (PSA) progression [ Time Frame: Baseline to 12 months ]
    Assess time to PSA progression, including the proportion of patients progression free at 4, 6, and 12 months

  18. Time to clinical progression [ Time Frame: Baseline to 12 months ]
    Assess time to clinical progression, including the proportion of patients progression free at 4, 6, and 12 months

  19. Duration of Response (DOR) [ Time Frame: 12 months from the enrollment of the final subject ]
    Determine the DOR by the time from the first occurrence of a documented objective tumor response to the time of radiographic progression (per investigator using RECIST v1.1) or death from any cause on study, whichever occurs first

  20. Overall Survival (OS) [ Time Frame: 12 months from the enrollment of the final subject ]
    Determine OS by the time from the first dose of study drug (CORT125281 and/or enzalutamide) to the date of death from any cause



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.


Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Gender Based Eligibility:   Yes
Gender Eligibility Description:   Only patients with histologically confirmed metastatic castration-resistant prostate cancer will be considered for the study.
Accepts Healthy Volunteers:   No
Criteria

Major Inclusion Criteria:

  • Able to understand the purpose and risks of the study; willing and able to adhere to scheduled visits, treatment plans, laboratory tests, and other study evaluations and procedures, and provide written informed consent
  • Males ≥18 years of age at the time of signing consent
  • Histologically confirmed metastatic adenocarcinoma of the prostate without histological neuroendocrine differentiation or small cell features
  • Prior surgical or chemical castration with serum testosterone <1.7 nmol/L (50 ng/dL). If the method of castration is use of a luteinizing hormone releasing hormone (LHRH) analogue,there must be a plan to maintain effective LHRH analogue treatment for the duration of the trial
  • Progressive disease by PSA or imaging after most recent prior therapy. PSA ≥1 ng/mL, if a confirmed rise in PSA is the only indication of progression. Progression by PSA requires rising PSA over a previous reference value by at least 2 measurements obtained ≥ 1 week apart. PSA measurements can be collected during or after most recent prior therapy.
  • Consent to have all protocol required pharmacodynamic biomarker samples, including the pretreatment and on treatment paired tumor biopsies (mandatory for a subset of patients).
  • Consent to provide mandatory pharmacogenomic blood sample.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
  • Adequate baseline organ function within 14 days prior to the first dose of enzalutamide and/or CORT125281
  • Patients receiving systemic corticosteroids greater than 2-weeks in duration within 3 months of study entry or with clinical evidence of adrenal insufficiency must have evidence of adequate adrenal function based upon morning plasma cortisol concentration or ACTH (cosyntropin) stimulation test
  • If a patient engages in sexual intercourse with a woman of childbearing potential, a condom and another form of birth control must be used during and for 100 days after completing treatment with CORT125281 or enzalutamide. A condom is required during and for 100 days after completing treatment with enzalutamide if a patient is engaged in sexual activity with a pregnant woman. Patients must also agree to avoid sperm donation during the study and for at least 100 days after the final treatment administration.
  • Expansion Phase: Patients must have progressed while receiving an androgen-directed therapy, as follows:
  • Cohort A: Patients must have progressed during treatment with abiraterone
  • Cohort B: Patients must have progressed during treatment with enzalutamide or second-generation AR-blocking therapies. Patients progressing on enzalutamide immediately prior to enrolling in this study must be on stable doses of enzalutamide 160 mg once daily (QD). These patients will continue enzalutamide without interruption during the screening period (no wash-out period required).

Major Exclusion Criteria:

  • Received chemotherapy, non-palliative radiotherapy, immunotherapy, or any investigational cancer therapies within 21 days prior to the first dose of CORT125281, or treatment with such therapies is planned during protocol treatment. Concomitant anticancer therapy is not permitted during the enzalutamide Lead-in Period during dose escalation.
  • More than two prior cytotoxic chemotherapy regimens for the treatment of mCRPC

Dose Escalation Phase and Expansion Phases will exclude patients for the following:

  • Dose Escalation Phase

    • Progressed during treatment with enzalutamide prior to Cycle 1 Day -28 (only applies to patients receiving enzalutamide Lead-in) or
    • Received prior 2nd generation anti-androgen and require urgent disease response or stabilization
  • Expansion Phase Cohort A:
  • Received prior treatment with enzalutamide, or
  • Received prior 2nd generation anti-androgen and require urgent disease response or stabilization
  • Expansion Phase Cohort B: Require urgent disease response or stabilization
  • Ongoing or anticipated therapy with hormone therapy (other than LHRH antagonist), including any dose of megestrol acetate (Megace), finasteride (Proscar), dutasteride (Avodart) or received abiraterone within 28 days prior to the first dose of CORT125281
  • Contraindication or precaution for enzalutamide
  • Parenchymal brain metastases
  • Any clinically significant uncontrolled condition that may increase the risk to the study patient or that the Investigator considers places the patient at unacceptable risk
  • Received herbal products or alternative therapies that may decrease PSA levels or that may have hormonal anti-prostate cancer activity (e.g., saw palmetto, PC-SPES, PC- HOPE, St. John's wort, selenium supplements, grape seed extract, etc.) within 28 days of study treatment initiation or plans to initiate treatment with these products/alternative therapies during the entire duration of the study
  • Received systemic glucocorticoids within 21 days prior to the first dose of CORT125281, or requirement for chronic or frequently used systemic glucocorticoids for medical conditions (e.g., rheumatoid arthritis, immunosuppression after organ transplantation). Short courses (<5 days) for non-cancer related reasons are allowed if clinically required (such as prophylaxis for CT).
  • Concurrent therapy with strong inhibitors or inducers of CYP3A4 or CYP2C8 or with sensitive substrates of CYP3A4, CYP2C9 or CYP2C19

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): NCT03437941


Contacts
Contact: Corcept Therapeutics 650-327-3270 corceptstudy601@corcept.com

Locations
United States, Arizona
Honor Health Recruiting
Scottsdale, Arizona, United States, 85258
Contact: Michael Gordon, MD    623-238-7630      
United States, New York
Memorial Sloan Kettering Cancer Center Recruiting
New York, New York, United States, 10065
Contact: Michael Morris, MD    646-422-4469      
United States, Oregon
Oregon Health and Science University Recruiting
Portland, Oregon, United States, 97239
Contact: Tomasz Beer, MD    503-494-1080      
United Kingdom
University College Hospital London Recruiting
London, England, United Kingdom, NW1
Contact: Mark Linch, MD, PhD    020 3447 9287      
University of Southampton Recruiting
Southampton, England, United Kingdom, SO16 6YD
Contact: Simon Crabb, MD, PhD    023 8120 5170      
Royal Marsden NHS Foundation Trust Recruiting
Sutton, Surrey, United Kingdom, SM2 5PT
Contact: Johann De Bono, MD, PhD    0800 180 81 82      
Sponsors and Collaborators
Corcept Therapeutics
Investigators
Study Director: Stacie Shepherd, MD, PhD Corcept Therapeutics

Responsible Party: Corcept Therapeutics
ClinicalTrials.gov Identifier: NCT03437941     History of Changes
Other Study ID Numbers: CORT125281-601
First Posted: February 19, 2018    Key Record Dates
Last Update Posted: December 3, 2018
Last Verified: November 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Corcept Therapeutics:
Prostate Cancer
Castration-Resistant Prostate Cancer
Glucocorticoid receptor
Antagonist
mCRPC
enzalutamide
androgen receptor

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases