Radiation Medication (Radium-223 Dichloride) Versus Radium-223 Dichloride Plus Radiation Enhancing Medication (M3814) Versus Radium-223 Dichloride Plus M3814 Plus Avelumab (a Type of Immunotherapy) for Advanced Prostate Cancer Not Responsive to Hormonal Therapy
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| ClinicalTrials.gov Identifier: NCT04071236 |
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Recruitment Status :
Recruiting
First Posted : August 28, 2019
Last Update Posted : May 12, 2023
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Sponsor:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
National Cancer Institute (NCI)
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Brief Summary:
This phase I/II trial studies the best dose of M3814 when given together with radium-223 dichloride or with radium-223 dichloride and avelumab and to see how well they work in treating patients with castrate-resistant prostate cancer that had spread to other places in the body (metastatic). M3814 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radioactive drugs, such as radium-223 dichloride, may carry radiation directly to tumor cells and not harm normal cells. Immunotherapy with monoclonal antibodies, such as avelumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. This study is being done to find out the better treatment between radium-223 dichloride alone, radium-223 dichloride in combination with M3814, or radium-223 dichloride in combination with both M3814 and avelumab, to lower the chance of prostate cancer growing or spreading in the bone, and if this approach is better or worse than the usual approach for advanced prostate cancer not responsive to hormonal therapy.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Castration-Resistant Prostate Carcinoma Metastatic Malignant Neoplasm in the Lymph Nodes Metastatic Prostate Carcinoma Stage IV Prostate Cancer AJCC v8 | Drug: Avelumab Drug: Peposertib Other: Quality-of-Life Assessment Other: Questionnaire Administration Radiation: Radium Ra 223 Dichloride | Phase 1 Phase 2 |
Show detailed description
| Study Type : | Interventional (Clinical Trial) |
| Estimated Enrollment : | 90 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | A Phase I and Randomized Phase II Trial of Radium-223 Dichloride, M3814, &Amp; Avelumab in Advanced Metastatic Castrate-Resistant Prostate Cancer (mCRPC) |
| Actual Study Start Date : | December 26, 2019 |
| Estimated Primary Completion Date : | January 31, 2024 |
| Estimated Study Completion Date : | January 31, 2024 |
Resource links provided by the National Library of Medicine
MedlinePlus Genetics related topics:
Prostate cancer
MedlinePlus related topics:
Prostate Cancer
| Arm | Intervention/treatment |
|---|---|
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Active Comparator: Arm A (radium-223 dichloride)
Patients receive radium-223 dichloride IV over 1 minute on day 1. Treatment repeats every 28 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.
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Other: Quality-of-Life Assessment
Ancillary studies
Other Name: Quality of Life Assessment Other: Questionnaire Administration Ancillary studies Radiation: Radium Ra 223 Dichloride Given IV
Other Names:
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Active Comparator: Arm B (radium-223 dichloride, nedisertib)
Patients receive radium-223 dichloride as in Arm A and peposertib PO or BID on days 3-26. Treatment repeats every 28 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.
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Drug: Peposertib
Given PO
Other Names:
Other: Quality-of-Life Assessment Ancillary studies
Other Name: Quality of Life Assessment Other: Questionnaire Administration Ancillary studies Radiation: Radium Ra 223 Dichloride Given IV
Other Names:
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Experimental: Arm C (radium-223 dichloride, nedisertib, avelumab)
Patients receive radium-223 dichloride IV as in Arm A and peposertib PO QD or BID as in Arm B. Patients also receive avelumab IV over 60 minutes on days 1 and 15 of cycles 2-6. Treatment repeats every 28 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.
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Drug: Avelumab
Given IV
Other Names:
Drug: Peposertib Given PO
Other Names:
Other: Quality-of-Life Assessment Ancillary studies
Other Name: Quality of Life Assessment Other: Questionnaire Administration Ancillary studies Radiation: Radium Ra 223 Dichloride Given IV
Other Names:
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Primary Outcome Measures :
- Dose-limiting toxicity (Phase 1) [ Time Frame: Up to 28 days ]Adverse events will be summarized as count and percentages, overall as well as by dose level/regimen, by severity, and by patient characteristics.
- Radiographic progression free survival (rPFS) (Phase 2) [ Time Frame: Date of randomization to date of scan showing either skeletal or extraskeletal progression following Prostate Cancer Clinical Trials Working Group 3 methodology or death, assessed up to 2 years ]Empirical survival probabilities will be estimated by the Kaplan-Meier (KM) product limit method by arms and the survival difference between arms will be compared by 1-sided log rank test.
Secondary Outcome Measures :
- PFS [ Time Frame: From date of randomization to the event of disease recurrence/progression or death due to any cause, assessed up to 2 years ]Will be similarly analyzed using the KM method, log rank test and univariate and multivariate Cox model as described for rPFS.
- Overall survival (OS) [ Time Frame: From date of randomization to date of death due to any cause, assessed up to 2 years ]OS will be similarly analyzed using the KM method, log rank test and univariate and multivariate Cox model as described for rPFS.
- Symptomatic skeletal event (SSE) [ Time Frame: Up to 2 years post treatment ]Wiil be assessed per standardized case report form distinguishing between pathologic and non-pathologic fractures. SSE rate will be estimated using the KM estimates with 95% confidence interval.
- Incidence of toxicity and adverse events [ Time Frame: Up to 2 years post treatment ]Will be graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Other Outcome Measures:
- Quality of life [ Time Frame: Up to 2 years post treatment ]The Patient Reported Outcomes-Common Terminology Criteria for Adverse Events (PRO-CTCAE) data will be evaluated for data quality, to characterize baseline symptom status of patients on study and the change over time, to explore the development of symptomatic adverse events (AEs) and the change over time, and to explore the patient scores with clinician graded AEs. PRO-CTCAE data will be summarized descriptively as the number (percent) of patients reporting each grade for individual items. Comparisons between the two treatment arms will be performed on a per question basis.
- Biomarker analysis [ Time Frame: Up to 2 years post treatment ]Gleason score at baseline will be grouped as =< 6, 7 and >= 8. Prostate specific antigen (PSA) at baseline will be classified as =< 10, 10~20 and > 20 ng/mL. Categorical Gleason score, PSA will be summarized by counts and percentages. Fisher's exact test will be used to examine the distribution of Gleason score and PSA. Descriptive statistics will be used to summarize quantitative imaging/biomarker by arm. Multivariate Cox model will be applied to data across arms to examine the effect of Gleason score, pretreatment PSA, clinical stage etc. incorporated with adjusted hazard ratio reported with 95% confidence interval.
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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:
- PHASE 1: Eastern Cooperative Oncology Group (ECOG) performance status =< 1 (Karnofsky >= 70%)
- PHASE 2: ECOG performance status =< 2 (Karnofsky >= 60%)
- Unless a patient has had orchiectomy by surgery, the patient is expected to be on antiandrogen therapy (ADT) for "medical castration". ADT needs to be maintained throughout the study. Testosterone level should be checked, and kept consistently lower than 50 ng/dL, similar to that obtained with bilateral orchiectomy
- Progressive castration-resistant prostate cancer with two or more skeletal metastases identified by 99mTC bone scintigraphy. One or more lymph node metastases allowed, but not mandatory. Lymph node metastases in each individually must measure less than 3 cm in the longest dimension. Visible visceral organ metastases are not allowed. A diagnosis of prostate cancer must have been histologically confirmed at any time point
- Baseline prostatic specific antigen (PSA) level of 1 ng/mL or higher with evidence of progressively increasing PSA values (two consecutive increases over the previous reference value)
- Progression after at least one of the following: abiraterone, enzalutamide, apalutamide, darolutamide, or taxane chemotherapy (docetaxel, cabazitaxel). There is no maximum number of prior therapies. Prior immunotherapies (for example, Sipuleucel-T or pembrolizumab) do not exclude the patient from participation
- Age >= 18 years. Castrate-resistant prostate cancer (CRPC) affects older adults and is rarely encountered in children and adolescents
- Life expectancy >= 6 months
- Albumin > 2.5 mg/dL
- Hemoglobin > 9 mg/dL
- Leukocytes >= 3,000/mcL
- Absolute neutrophil count >= 1,500/mcL
- Platelets >= 100,000/mcL
- Total bilirubin =< 1.5 x institutional upper limit of normal (ULN) (with the exception of < 3 mg/dL for patients with Gilbert's disease)
- Aspartate aminotransferase (AST)(serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase [SGPT]) =< 3 x institutional ULN
- Creatinine =< 1.5 x institutional ULN OR
- Glomerular filtration rate (GFR) >= 40 mL/min/1.73 m^2
- Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy (with no medications prohibited by this protocol [e.g. drug-drug interactions]) with undetectable viral load within 6 months are eligible for this trial
- For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy (with no medications prohibited by this protocol [e.g. drug-drug interactions]), if indicated
- Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load (with no medications prohibited by this protocol [e.g. drug-drug interactions])
- Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
- Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional classification. To be eligible for this trial, patients should be class 2B or better
- Concomitant use of physiologic corticosteroids is allowed
- Concomitant use of bisphosphonates is allowed (use of bone health agents is mandatory - either denosumab [preferred] or bisphosphonates)
- The effects of radium-223 dichloride, M3814, and avelumab on the developing human fetus are unknown. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 6 months after completion of Radium-223 dichloride, M3814, and avelumab administration
- Ability to understand and the willingness to sign a written informed consent document. Participants with impaired decision-making capacity (IDMC) who have a legally-authorized representative (LAR) and/or family member available will also be eligible
- Patients must be able to swallow orally administered medication
- Patients with asymptomatic, treated brain metastases are permitted if there is no evidence of progression for at least 4 weeks after central nervous system (CNS)-directed treatment, as ascertained by clinical examination and brain imaging (magnetic resonance imaging [MRI] or computed tomography [CT] scan) during the screening period
Exclusion Criteria:
- Active autoimmune conditions or patients on chronic immunosuppression due to underlying autoimmune condition
- Patients who have had chemotherapy or radiotherapy within 4 weeks prior to entering the study
- Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities > grade 1) with the exception of alopecia
- Prior therapy with radionuclides (e.g., strontium, samarium, rhenium, radium)
- Patients who are receiving any other investigational agents
- Patients who have had previous hemibody external radiation
- Patients who have had systemic radiotherapy with radioisotopes
- Patients who have imminent/established spinal cord compression, pathological fracture in weight bearing bones or bone lesion with soft tissue component unless treated as appropriate with radiation and/or surgery before starting on trial
- Patients who have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to radium-223 dichloride, M3814, or avelumab
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Patients unable to discontinue medications or substances that are potent inhibitors, inducers or sensitive substrates of CYP3A4/5 or CYP2C19 prior to study treatment are ineligible.
- Medications or substances that are strong inhibitors of CYP3A4/5 or CYP2C19 must be discontinued at least 1 week prior to first M3814 dose.
- Medications or substances that are strong inducers of CYP3A4/5 or CYP2C19 must be stopped at least 3 weeks prior to the first M3814 dose.
- Drugs mainly metabolized by CYP3A with a narrow therapeutic index (as judged by the Investigator or authorized designee) must be discontinued at least 1 day prior to first M3814 dose.
- Note: Because the lists of these agents are constantly changing, it is important to regularly consult a frequently- updated medical reference. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the- counter medicine or herbal product.
- Patients with uncontrolled intercurrent illness
- Patients with psychiatric illness/social situations that would limit compliance with study requirements
- Patients must not have an active infection requiring systemic treatment
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Patients must not use immunosuppressive medication =< 7 days of registration, EXCEPT for the following:
- Intranasal, inhaled, topical steroids, or local steroid injection (e.g., intra-articular injection)
- Systemic corticosteroids at physiologic doses =< 10 mg/day of prednisone or equivalent
- Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication)
- Patients who cannot discontinue concomitant H2 blockers or proton-pump inhibitors (PPIs). Patients may confer with the study doctor to determine if such medications can be discontinued. These must be discontinued >= 5 days prior to study treatment. Patients do not need to discontinue calcium carbonate
- Patients receiving sorivudine or any chemically related analogues (such as brivudine) are excluded
- Patients with a known history or present osteonecrosis of the jaw
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): NCT04071236
Locations
Show 24 study locations
Sponsors and Collaborators
National Cancer Institute (NCI)
Investigators
| Principal Investigator: | Hiram Gay | Yale University Cancer Center LAO |
| Responsible Party: | National Cancer Institute (NCI) |
| ClinicalTrials.gov Identifier: | NCT04071236 |
| Other Study ID Numbers: |
NCI-2019-05620 NCI-2019-05620 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ) 202006062 10301 ( Other Identifier: Yale University Cancer Center LAO ) 10301 ( Other Identifier: CTEP ) UM1CA186689 ( U.S. NIH Grant/Contract ) UM1CA186704 ( U.S. NIH Grant/Contract ) |
| First Posted: | August 28, 2019 Key Record Dates |
| Last Update Posted: | May 12, 2023 |
| Last Verified: | February 2023 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | Yes |
| Plan Description: | NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page. |
| URL: | https://grants.nih.gov/policy/sharing.htm |
| Studies a U.S. FDA-regulated Drug Product: | Yes |
| Studies a U.S. FDA-regulated Device Product: | No |
Additional relevant MeSH terms:
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Carcinoma Prostatic Neoplasms Neoplasms Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Genital Neoplasms, Male Urogenital Neoplasms Neoplasms by Site Genital Diseases, Male Genital Diseases Urogenital Diseases Prostatic Diseases |
Male Urogenital Diseases Avelumab Radium Ra 223 dichloride Antibodies, Monoclonal Peposertib Antineoplastic Agents, Immunological Antineoplastic Agents Immunologic Factors Physiological Effects of Drugs Protein Kinase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action |