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

• ClinicalTrials.gov Identifier: NCT03437941
• Recruitment Status: Completed
• First Posted: February 19, 2018
• Last Update Posted: May 6, 2023
• Sponsor: Corcept Therapeutics
• Information provided by (Responsible Party): Corcept Therapeutics

Study Description

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); Drug: Placebo	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-determination phase and an expansion phase. The dose determination phase is designed to determine dose-limiting toxicities and the RD of CORT125281 plus enzalutamide in patients with mCRPC. Once the recommended dosing regimen has been determined, the following expansion cohorts will be enrolled and treated with CORT125281 plus enzalutamide at the recommended dose level.

Abi-Resistant Cohort: Patients who have progressed during treatment with abiraterone, and have received no other androgen receptor (AR)-blocking therapies

ARant-Resistant Cohort: 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 two expansion cohorts will be enrolled in parallel.

In each phase of the study, routine assessments of safety and tolerability will be performed 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 Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 39 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• 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
• Actual Primary Completion Date: January 9, 2023
• Actual Study Completion Date: January 9, 2023

Arms and Interventions

Arm	Intervention/treatment
Experimental: Dose Determination Segment 1; 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 - Abi-Resistant Cohort; 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 - Abi-Resistant Cohort 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 - ARant-Resistant Cohort; 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
Experimental: Dose Determination Segment 2 (Double-Blind) - Arm A; Patients randomized to this cohort will receive enzalutamide and a titrated dose of CORT125281. Enzalutamide will be continued at the dose currently tolerated by the patient at screening.	Drug: CORT125281; CORT125281 is supplied as capsules for oral dosing; Drug: Enzalutamide (Xtandi); Enzalutamide will be taken orally
Experimental: Dose Determination Segment 2 (Double-Blind) - Arm B; Patients randomized to this cohort will receive enzalutamide, placebo, and CORT125281.	Drug: CORT125281; CORT125281 is supplied as capsules for oral dosing; Drug: Enzalutamide (Xtandi); Enzalutamide will be taken orally; Drug: Placebo; Placebo capsules to match the appearance of the CORT125281

Outcome Measures

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

Eligibility Criteria

• 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 adenocarcinoma of the prostate with metastatic disease
• Dose-Determination Phase Segment 1 and Expansion Phase: Progressive disease as defined 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 the most recent prior therapy.

• Dose-Determination Phase Segment 2: Currently receiving enzalutamide with a rising PSA as follows:

  1. Rising PSA: 25% increase over nadir and an absolute value of >1 ng/mL by at least 2 measurements obtained ≥1 week apart. PSA measurements can be collected during or after the most recent prior therapy.
  2. Patients must have received enzalutamide for a minimum of 12 weeks and be on stable doses of enzalutamide ≥80 mg QD for at least 4 weeks prior to Cycle 1 Day 1. Patients will continue enzalutamide without interruption during the Screening Period (no wash-out period). This will be the enzalutamide starting dose for combination with CORT125281 beginning on Cycle 1 Day 1.
  3. M0 disease is allowed

• Expansion Phase: Patients must have progressed while receiving an androgen-directed therapy as follows:

  1. Abi-Resistant Cohort: Patients must have progressed during treatment with abiraterone.
  2. ARant-Resistant Cohort: 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. These patients will continue enzalutamide without interruption during the Screening Period (no wash-out period required).
• Baseline tumor assessment performed within 28 days prior to the first dose of study treatment (CORT125281 and/or on-study enzalutamide, whichever is earliest)
• 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
• 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 (Dose-Determination Segment 1 only)
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
• Adequate baseline organ function within 14 days prior to the first dose of study treatment (on-study enzalutamide and/or CORT125281, whichever is earliest)
• 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 with spermicide and another form of birth control must be used during and for 100 days after the final dose of study treatment (CORT125281 or enzalutamide, whichever is latest). 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.

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-Determination Phase Segment 1
• More than two prior cytotoxic chemotherapy regimens for the treatment of mCRPC

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

• Dose-Determination Phase (Segment 1 only)
• 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 Abi-Resistant Cohort:

  • Received prior treatment with enzalutamide, or
  • Received prior 2nd generation anti-androgen and require urgent disease response or stabilization
• Expansion Phase ARant-Resistant Cohort: Require urgent disease response or stabilization
• Ongoing or anticipated therapy with hormone therapy (other than LHRH analogue), 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 or inhaled 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

Contacts and Locations

Locations

United States, Arizona

Scottsdale

Scottsdale, Arizona, United States, 85258

United States, Michigan

Detroit

Detroit, Michigan, United States, 48201

United States, New York

New York

New York, New York, United States, 10065

United States, Oregon

Portland

Portland, Oregon, United States, 97239

United States, Wisconsin

Madison

Madison, Wisconsin, United States, 53792

United Kingdom

London

London, England, United Kingdom, NW1

Southampton

Southampton, England, United Kingdom, SO16 6YD

Sutton

Sutton, Surrey, United Kingdom, SM2 5PT

Sponsors and Collaborators

Corcept Therapeutics

Investigators

• Study Director: William Guyer, PharmD; Corcept Therapeutics
• Study Director: Grace Mann, PhD; Corcept Therapeutics

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Serritella AV, Shevrin D, Heath EI, Wade JL, Martinez E, Anderson A, Schonhoft J, Chu YL, Karrison T, Stadler WM, Szmulewitz RZ. Phase I/II Trial of Enzalutamide and Mifepristone, a Glucocorticoid Receptor Antagonist, for Metastatic Castration-Resistant Prostate Cancer. Clin Cancer Res. 2022 Apr 14;28(8):1549-1559. doi: 10.1158/1078-0432.CCR-21-4049.

• Responsible Party: Corcept Therapeutics
• ClinicalTrials.gov Identifier: NCT03437941
• Other Study ID Numbers: CORT125281-601
• First Posted: February 19, 2018
• Last Update Posted: May 6, 2023
• Last Verified: May 2023

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; Genital Diseases; Urogenital Diseases; Prostatic Diseases; Male Urogenital Diseases