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Trial of Pembrolizumab in Metastatic Castration Resistant Prostate Cancer (PERSEUS1)

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ClinicalTrials.gov Identifier: NCT03506997
Recruitment Status : Recruiting
First Posted : April 24, 2018
Last Update Posted : December 24, 2018
Sponsor:
Collaborator:
Merck Sharp & Dohme Corp.
Information provided by (Responsible Party):
Institute of Cancer Research, United Kingdom

Brief Summary:
PERSEUS1 is an open-label, single arm, phase II trial evaluating the efficacy of Pembrolizumab in metastatic castration resistant prostate cancer (mCRPC) patients (Part A) with a biomarker enrichment stage (Part B) if efficacy is shown in part A.

Condition or disease Intervention/treatment Phase
Castration-resistant Prostate Cancer Drug: Pembrolizumab Phase 2

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 100 participants
Intervention Model: Single Group Assignment
Intervention Model Description: Two stage Simon Minimax design phase II trial, with 90% power and 5% type I error to discard treatment if <20% responses are observed and detect activity >40%
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: PERSEUS1: Phase II Trial of the Immune Checkpoint Inhibitor Pembrolizumab for Patients Suffering From Metastatic Prostate Cancer
Actual Study Start Date : November 27, 2018
Estimated Primary Completion Date : September 1, 2023
Estimated Study Completion Date : September 1, 2025

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
Experimental: Pembrolizumab
Pembrolizumab will be given at a dose of 200mg IV every 3 weeks for a maximum of two years
Drug: Pembrolizumab
Pembrolizumab 200mg given as a 30 minute intravenous (IV) infusion, on day 1 of each 3 week cycle. Patients may continue with pembrolizumab treatment as long as they remain free from intolerable toxicity for a maximum of two years, if in the Investigator's opinion they are receiving clinical benefit, and/or they do not meet any discontinuation criteria.
Other Name: Keytruda; MK-3475




Primary Outcome Measures :
  1. To evaluate tumour response [ Time Frame: 6 months post trial entry ]

    Responses will be defined on the basis of the following outcomes; if any of these occur patients will be considered to have responded:

    • Objective response by iRECIST 1.1;or
    • CTC count conversion from >5 to <5
    • PSA decline of ≥50%. Responses will need confirmation by a second consecutive value obtained four or more weeks after the first value indicated a response. Evaluable patients with no confirmed response as defined above will be classified as non-responders. Response will be evaluated 6 months post-trial entry. The last value of PSA, CTC count, CT scan/bone scan/WB-MRI on or up to 28 days before the date of first study treatment will be used as the baseline value for this assessment.


Secondary Outcome Measures :
  1. Radiological progression-free survival (rPFS) [ Time Frame: From date of randomisation until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 100 months ]
    rPFS will be measured from the date of trial entry to the first occurrence of radiological progression or death from any cause. If no event exists then rPFS will be censored at the last scheduled disease assessment on study.

  2. Time to radiological progression [ Time Frame: From date of randomisation until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 100 months ]
    Death from prostate cancer or any other cause without prior radiological evidence of progression will not count as an event. If no event exists, then time to radiological progression will be censored at the last scheduled disease assessment on study or date of disease whichever occurs earlier.

  3. Progression free survival [ Time Frame: From date of randomisation until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 100 months ]
    If no event exists, then PFS will be censored at the last scheduled disease assessment on study

  4. Time to PSA progression [ Time Frame: From date of randomisation until the date of first documented PSA progression or date of death from any cause, whichever came first, assessed up to 100 months ]
    PSA progression is defined according to the PCWG3 guidelines and is the date that a ≥ 25% increase and an absolute increase of ≥ 2 ng/mL above the nadir (baseline if no decline) is documented. This must be confirmed by a second consecutive value obtained 4 or more weeks later.

  5. Duration of PSA response [ Time Frame: From date of first decline by at least 50% until the time time there is an increase of 25% of PSA nadir or date of death from any cause, whichever came first, assessed up to 100 months ]
    calculated from the time the PSA value first declines by at least 50% of the cycle 1 day 1 (baseline) value (must be confirmed by a second value) until the time there is an increase of 25% of PSA nadir, provided the absolute increase is at least 2 ng/mL. The increase must be confirmed by a second consecutive measurement that is at least 25% above the nadir. If the PSA never shows a 25% increase over the nadir value, then the patient will be assessed at the last PSA measurement. PSA objective response rate (PSA-ORR) is calculated as the proportion of evaluable patients who achieve a PSA response.

  6. Overall survival [ Time Frame: From date of randomisation until the date of death from any cause, assessed up to 100 months ]
    Survival time of living patients will be censored on the last date a patient is known to be alive or lost to follow-up.

  7. Safety and tolerability defined by CTC-AE, V 4.0 criteria. [ Time Frame: From date of randomisation until the end of treatment or date of death from any cause, whichever came first, assessed up to 36 months ]
    Adverse events will be summarised by grade according to the worst grade experienced. In addition, the most frequently observed AEs will be summarised.


Other Outcome Measures:
  1. Exploratory: • Molecular endpoints from both diagnostic archival FFPE tumour tissue (when available) and fresh mCRPC tumour tissue [ Time Frame: From date of randomisation until the end of trial or date of death from any cause, whichever came first, assessed up to 100 months ]
    PD-1, PDL-1 and PDL-2 expression

  2. Exploratory: • Molecular endpoints from both diagnostic archival FFPE tumour tissue (when available) and fresh mCRPC tumour tissue [ Time Frame: From date of randomisation until the end of trial or date of death from any cause, whichever came first, assessed up to 100 months ]
    T-Reg infiltration (CD4+ CD25+ FoxP3+)

  3. Exploratory: • Molecular endpoints from both diagnostic archival FFPE tumour tissue (when available) and fresh mCRPC tumour tissue [ Time Frame: From date of randomisation until the end of trial or date of death from any cause, whichever came first, assessed up to 100 months ]
    CD3, CD8, lymphocyte infiltration

  4. Exploratory: • Molecular endpoints from both diagnostic archival FFPE tumour tissue (when available) and fresh mCRPC tumour tissue [ Time Frame: From date of randomisation until the end of trial or date of death from any cause, whichever came first, assessed up to 100 months ]
    Presence of mismatch repair defect as determined by immunohistochemistry or microsatellite instability (MSI).

  5. Exploratory: • Molecular endpoints from both diagnostic archival FFPE tumour tissue (when available) and fresh mCRPC tumour tissue [ Time Frame: From date of randomisation until the end of trial or date of death from any cause, whichever came first, assessed up to 100 months ]
    Mutational load (number of mutations per MB of DNA sequenced)

  6. Exploratory: next generation sequencing data [ Time Frame: From date of randomisation until the end of trial or date of death from any cause, whichever came first, assessed up to 100 months ]
    NGS data from tumour DNA and RNA including analyses of neoepitopes by targeted panel NGS and exome/transcriptome analyses when feasible.

  7. Exploratory: Immunophenotyping endpoint [ Time Frame: From date of randomisation until the end of trial or date of death from any cause, whichever came first, assessed up to 100 months ]
    WBC immunotyping

  8. Exploratory:Whole blood mRNA expression profiling [ Time Frame: From date of randomisation until the end of trial or date of death from any cause, whichever came first, assessed up to 100 months ]
    Whole blood mRNA expression profiling

  9. Exploratory: Immune cell genomics including T-cell receptor sequencing [ Time Frame: From date of randomisation until the end of trial or date of death from any cause, whichever came first, assessed up to 100 months ]
    Immune cell genomics including T-cell receptor sequencing



Information from the National Library of Medicine

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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:

  1. Male, aged 18 years or older.
  2. Histologically confirmed metastatic castrate resistant adenocarcinoma of the prostate. If the patient does not have a prior histological diagnosis then the planned baseline fresh biopsy may be used for both the purpose of confirming the histological diagnosis prior to trial entry and for subsequent biomarker analysis. All patients must be willing to have fresh biopsies to obtain tumour tissue for biomarker analysis.
  3. Identified high mutational load (defined as 11 or more mutations per targeted panel - see Section 5.5 below) on next generation sequencing and/or a DNA repair defect that can increase mutation load including MMR deficiency and/or high MSI by next generation sequencing.
  4. Patients with no measurable disease and only widespread bone disease must have a CTC count >5.
  5. Willing and able to comply with the follow-up schedule and the requirements of the biomarker studies including the paired fresh tumour biopsies.
  6. Written informed consent.
  7. Prior treatment with at least one of the approved treatments for mCRPC (i.e. Abiraterone, Enzalutamide, Docetaxel, Cabazitaxel, Radium 223).
  8. At least 28-days washout at trial entry since the completion of prior therapy, including major surgery, chemotherapy and other investigational agents. For hormonal treatment and radiotherapy refer to the guidelines below:

    • At least 28-days since the completion of prior flutamide treatment. Patients whose PSA did not decline in response to antiandrogens given as a second line or later intervention will only require a 14-day washout prior to Cycle 1, Day 1.

    • At least 42-days since the completion of prior bicalutamide (Casodex) and nilutamide (Nilandron) treatment. Patients whose PSA did not decline for at least 3-months in response to antiandrogens given as second line or later intervention will require only a 14-day washout period prior to Cycle 1 Day 1.
    • At least 14-days from any radiotherapy with the exception of a single fraction of radiotherapy for the purposes of palliation (confined to one field) is permitted.
  9. Documented prostate cancer progression as assessed by the investigator with one of the following:

    • PSA progression defined by a minimum of three rising PSA levels with an interval of ≥ 1-week between each determination. The PSA value at the Screening visit should be ≥ 2 µg/L (2 ng/ml) if there is no measurable disease; patients on systemic glucocorticoids for control of symptoms must have documented PSA progression by PCWG3 while on the same dose of systemic glucocorticoids prior to commencing Cycle1 Day1 of treatment.

    • Radiographic progression of soft tissue disease by iRECIST criteria or of bone metastases by PCWG3 criteria with two or more confirmed new bone lesions on a bone scan/wb-MRI with or without PSA progression.

  10. Surgically or medically castrated, with testosterone levels of <50 ng/dL (<2.0 nM). If the patient is being treated with LHRH agonists (patient who have not undergone orchiectomy), this therapy must have been initiated at least 4 weeks prior to Cycle 1 Day 1 and must be continued throughout the study.
  11. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-2.
  12. Albumin ≥25 g/L.
  13. Patient and the patient's partner of reproductive potential who are sexually active, must agree to use adequate methods of contraception during the course of the study and for 120 days after the last dose of study drug (see appendix A3 for accepted methods of contraception).
  14. QT interval corrected for heart rate according to Fridericia's formula (QTcF) <470 msec or <480 msec with bundle branch block.
  15. Patients with primary hypothyroidism can be considered eligible if thyroid stimulating hormone (TSH) at the screening visit is within normal range while patient is under hormonal treatment.
  16. Subjects must have adequate bone marrow, hepatic and renal function documented within 7-days of trial entry defined as:

Haemoglobin (Hb) ≥ 9.0 g/dL Absolute neutrophil count (ANC) ≥ 1.5 x 10^9/L Platelet count ≥ 100 x 10^9/L International normalised ratio (INR) ≤ 1.5x upper limit of normal (ULN) Or: Prothrombin time ≤ 1.5x upper limit of normal (ULN) Serum bilirubin (for patients with total bilirubin >1.5x ULN) Or: Direct bilirubin ≤ 1.5x ULN ≤1.5x ULN Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5x ULN (for patients with liver metastases ≤ 5x ULN is permissible) Serum creatinine ≤1.5 x ULN Or: Calculated creatinine clearance >40mL/min for patients with creatinine levels above institutional normal. For GFR estimation, the Cockcroft and Gault equation should be used: creatinine clearance = (((140 - age) x mass (kg)) x 1.23) / serum creatinine (µ mol⁄L)

Exclusion Criteria:

  • 1. Patients with a history of prior treatment with anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, anti-OX-40, anti-CD40, or anti-CTLA-4 antibodies.

    2. Patients who have received any of the following concomitant therapies: IL-2, interferon or other non-study immunotherapy regimens; immunosuppressive agents; other investigational therapies; or chronic use of systemic corticosteroids (used in the management of cancer or non-cancer-related illnesses) within 1 week prior to first dose. A dose of 10mg of prednisolone or equivalent will be allowed if clinically indicated.

    3. Patients who have received any non-oncology vaccine therapy used for prevention of infectious diseases including seasonal vaccinations for up to 28-days prior to the expected start or after any dose of pembrolizumab. Examples include, but are not limited to, the following: measles, mumps, rubella, chicken pox, yellow fever, seasonal flu, H1N1 flu, rabies, BCG, and typhoid vaccine.

    4. Patients receiving growth factors including, but not limited to, granulocyte colony stimulating factor (G-CSF), granulocyte macrophage-colony stimulating factor (GM-CSF), erythropoietin, within 14-days of study drug administration. Use of such agents while on study is also prohibited. Prior use of growth factors should be documented in the patient's medical history.

    5. Uncontrolled intercurrent cardiovascular disease as symptomatic congestive heart failure (New York Heart Association Class III or IV heart disease), unstable angina pectoris, cardiac arrhythmia, poorly controlled hypertension (defined as systolic blood pressure of ≥150mmHg or diastolic blood pressure of >100 mmHg based on a mean of three measurements at approximately 2-minute intervals).

    6. Any psychiatric illness/social situations that would limit compliance with study requirements.

    7. Any acute toxicity due to prior chemotherapy and / or radiotherapy that has not resolved to a NCI-CTCAE v4 grade ≤1 with the exception of chemotherapy induced alopecia and grade 2 peripheral neuropathy.

    8. Prior malignancy diagnosed within the previous 2-years with a >30% probability of recurrence within 12-months, with the exception of non-melanoma skin cancer, and in-situ or non-muscle invasive bladder cancer.

    9. Patients with myelodysplastic syndrome or acute myeloid leukaemia. 10. Patients with known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to trial treatment. This exception does not include carcinomatous meningitis which is excluded regardless of clinical stability.

    11. Patients with symptomatic or impending cord compression unless appropriately treated beforehand and clinically stable and asymptomatic.

    12. Any chronic respiratory disease. 13. Any immunological disorder requiring treatment with immunosuppressive treatments:

    • High dose of steroids (low dose of steroids as 10mg of prednisolone or equivalent are allowed if the patient is not able to discontinue this treatment; patient needs to be on a stable dose for at least 4-weeks before the enrolment);

    • Cytotoxic agents (such as alkylating agents or antimetabolites);
    • Antibodies (polyclonal antibodies; monoclonal antibodies different from pembrolizumab);
    • Drugs acting on immunophilins (cyclosporin, tacrolimus, sirolimus);
    • Other drugs (interferons, TNF binding proteins, mycophenolate). 14. History of any autoimmune disease: patients with a history of inflammatory bowel disease, including ulcerative colitis and Crohn's Disease, are excluded from this study, as are patients with a history of symptomatic disease (e.g., rheumatoid arthritis, systemic progressive sclerosis [scleroderma], systemic lupus erythematosus, autoimmune vasculitis [e.g., Wegener's Granulomatosis]); CNS or motor neuropathy considered of autoimmune origin (e.g., Guillain-Barre syndrome and myasthenia gravis, multiple sclerosis). Patients with controlled Graves' disease will be allowed.

      15. Known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies). 16. Known active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is detected).

      17. History of congenital platelet function defect (e.g., Bernard-Soulier syndrome, Chediak-Higashi syndrome, Glanzmann thrombasthenia, storage pool defect).

      18. Patients with history of (non-infectious) pneumonitis that required steroids or current pneumonitis.

      19. Initiating bisphosphonate therapy or adjusting bisphosphonate dose/regimen within 30 days prior to Cycle 1 Day 1. Patients on a stable bisphosphonate regimen are eligible and may continue.

      20. Presence of a condition or situation, which, in the investigator's opinion, may put the patient at significant risk, may confound the study results, or may interfere significantly with the patient's participation in the study.


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): NCT03506997


Contacts
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Contact: Stephanie M Burnett, BSc 02087224261 ext 4261 perseus-icrctsu@icr.ac.uk
Contact: Ajit Sarvadikar 020 8722 4329 ext 4329 perseus-icrctsu@icr.ac.uk

Locations
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United Kingdom
The Royal Marsden Hospital Recruiting
Sutton, Surrey, United Kingdom, SM2 5PT
Contact: Johann De Bono         
Sponsors and Collaborators
Institute of Cancer Research, United Kingdom
Merck Sharp & Dohme Corp.
Investigators
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Principal Investigator: Johann de Bono The Institute of Cancer Research/The Royal Marsden NHSFT

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Responsible Party: Institute of Cancer Research, United Kingdom
ClinicalTrials.gov Identifier: NCT03506997     History of Changes
Other Study ID Numbers: ICR-CTSU/2016/10060
2017-000931-15 ( EudraCT Number )
First Posted: April 24, 2018    Key Record Dates
Last Update Posted: December 24, 2018
Last Verified: December 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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

Keywords provided by Institute of Cancer Research, United Kingdom:
Immune checkpoint inhibitor
Pembrolizumab

Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Pembrolizumab
Antineoplastic Agents, Immunological
Antineoplastic Agents