Description:
This partially randomized phase I/II trial studies the side effects and best dose of
enzalutamide and mifepristone when given together and to see how well they work in treating
patients with metastatic hormone resistant prostate cancer. Androgens can cause the growth of
prostate cancer cells. Antihormone therapy, such as enzalutamide and mifepristone, may lessen
the amount of androgens made by the body. It is not yet known whether enzalutamide is more
effective with or without mifepristone in treating patients with prostate cancer.
Title
- Brief Title: Enzalutamide and Mifepristone in Treating Patients With Metastatic Hormone Resistant Prostate Cancer
- Official Title: A Phase I/II Trial of Enzalutamide Plus the Glucocorticoid Receptor Antagonist Mifepristone for Patients With Metastatic Castration Resistant Prostate Cancer (CRPC)
Clinical Trial IDs
- ORG STUDY ID:
IRB13-0979
- SECONDARY ID:
NCI-2013-02151
- SECONDARY ID:
CDMRP-PC121149
- SECONDARY ID:
IRB13-0979
- SECONDARY ID:
P30CA014599
- NCT ID:
NCT02012296
Conditions
- Hormone-resistant Prostate Cancer
- Recurrent Prostate Cancer
- Stage IV Prostate Cancer
Interventions
Drug | Synonyms | Arms |
---|
enzalutamide | MDV3100, selective androgen receptor modulator MDV3100, XTANDI | Treatment (enzalutamide) |
mifepristone | Mifegyne, Mifeprex, RU-38486 | Treatment (enzalutamide, mifepristone) |
Purpose
This partially randomized phase I/II trial studies the side effects and best dose of
enzalutamide and mifepristone when given together and to see how well they work in treating
patients with metastatic hormone resistant prostate cancer. Androgens can cause the growth of
prostate cancer cells. Antihormone therapy, such as enzalutamide and mifepristone, may lessen
the amount of androgens made by the body. It is not yet known whether enzalutamide is more
effective with or without mifepristone in treating patients with prostate cancer.
Detailed Description
PRIMARY OBJECTIVES:
I. To establish the safe and pharmacologically active doses of mifepristone and enzalutamide
to use in combination. (Phase I) II. To determine if mifepristone in combination with
enzalutamide prolongs time to prostate-specific antigen (PSA) progression compared to
enzalutamide alone in patients with metastatic castration resistant prostate cancer. (Phase
II)
SECONDARY OBJECTIVES:
I. To evaluate the effect of mifepristone on endocrine biomarkers such as serum cortisol and
thyrotropin.
II. To determine the effect of mifepristone on enzalutamide clearance and steady state
enzalutamide exposure.
III. To determine if mifepristone affects PSA response rate when added to enzalutamide.
IV. To determine if mifepristone when added to mifepristone prolongs radiographic and
clinical progression free survival according to standard working group criteria.
V. To explore the role of glucocorticoid receptor (GR) and androgen receptor (AR) protein
expression within circulating tumor cells as a pharmacodynamic biomarker for mifepristone and
enzalutamide in castration resistant prostate cancer (CRPC).
VI. To explore the expression of GR and down-stream AR/GR targets in metastatic tumor
specimen prior to combination drug administration and at clinical progression.
OUTLINE: This is a phase I, dose-escalation study followed by a phase II study.
PHASE I: Patients receive enzalutamide orally (PO) on days 1-57 and mifepristone PO on days
29-57. Treatment continues in the absence of disease progression or unacceptable toxicity.
PHASE II: Patients receive enzalutamide PO for 12 weeks per standard of care. Patients are
then randomized to 1 of 2 treatment arms.
ARM I: Patients receive enzalutamide PO per standard of care.
ARM II: Patients receive enzalutamide PO and mifepristone PO.
In both arms, treatment continues in the absence of disease progression or unacceptable
toxicity.
After completion of study treatment, patients are followed up for 1 year.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (enzalutamide) | Active Comparator | Patients receive enzalutamide PO per standard of care. | |
Treatment (enzalutamide, mifepristone) | Experimental | Patients receive enzalutamide PO and mifepristone PO. | |
Eligibility Criteria
Inclusion Criteria:
- Histologically or cytologically confirmed prostate cancer
- Evidence of castrate testosterone level < 50 ng/dL (or surgical castration)
- For Phase I portion of the study: evidence of disease progression:
- 2 or more new lesions on bone scan or
- Progressive disease on computed tomography (CT)/magnetic resonance imaging (MRI)
according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria
or
- Rising PSA: PSA evidence for progressive prostate cancer consists of a minimum
PSA level of at least 2 ng/ml, which has subsequently risen on at least 2
successive occasions, at least 2 weeks apart
- For Phase II portion of the study:
- Subjects must be on enzalutamide for metastatic CRPC and within the first 12
weeks of enzalutamide at 160mg/day
- Record of subject's enzalutamide start date and baseline PSA (within 28 days of
starting) before starting enzalutamide available
- Subjects must have documented clinically stable disease or better during the screening
period of the study as defined by all of the following:
- PSA =<1.25 times the PSA at start of enzalutamide
- Lack of radiographic progression as defined by Response Evaluation Criteria in
Solid Tumors (RECIST) 1.1 and Prostate Cancer Working Group Criteria
- Clinically stable as confirmed by treating physician
- Any prior therapy for castrate disease is acceptable except prior specific cytochrome
P450 family 17 (CYP17) antagonists (e.g. abiraterone acetate, orteronel) or prior
second generation AR antagonists (e.g. enzalutamide or ARN509) which are excluded
other than enzalutamide as specified for phase II portion; a minimum washout of 28
days for any other anticancer therapy prior to first dose of study drug is required
(only applicable for phase I)
- Any other radiotherapy or radionuclide require 28-day washout prior to first dose of
study drug
- Denosumab or zoledronic acid are allowed
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2
- Total bilirubin =< 1.5 x the upper limit of normal
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
[SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
=< 2.5 x institutional upper limit of normal
- Ability to understand and the willingness to sign a written informed consent document
Exclusion Criteria:
- Therapy with other hormonal therapy, including any dose of megestrol acetate (Megace),
finasteride (Proscar), dutasteride (Avodart), or any herbal product known to decrease
PSA levels (e.g., saw palmetto and PC-SPES), or any systemic corticosteroid within 2
weeks prior to first dose of study drug
- Inability to swallow capsules or known gastrointestinal malabsorption
- History of other malignancies, with the exception of: adequately treated non-melanoma
skin cancer, adequately treated superficial bladder cancer, stage 1 or 2 solid tumor
malignancies who are without evidence of disease, or other solid tumors curatively
treated with no evidence of disease for >= 5 years from enrollment
- Blood pressure that is not controlled despite > 2 oral agents (systolic blood pressure
[SBP] > 160 and diastolic blood pressure [DBP] > 90 documented during the screening
period with no subsequent blood pressure readings < 160/100)
- History of seizure disorder or active use of anticonvulsants
- Corrected QT interval (QTc) on electrocardiogram (EKG) > 450 msec
- Serious intercurrent infections or non-malignant medical illnesses that are
uncontrolled
- Active psychiatric illness/social situations that would limit compliance with protocol
requirements
- New York Heart Association (NYHA) class II, NYHA class III, or IV congestive heart
failure (any symptomatic heart failure)
- Concurrent therapy with strong inhibitors or inducers of cytochrome P450 family 3,
subfamily A, polypeptide 4 (CYP3A4) or cytochrome P450 family 2, subfamily C,
polypeptide 8 (CYP2C8) due to concerning possible drug-drug interactions
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | N/A |
Eligible Gender: | Male |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Recommended phase II dose defined as the highest mifepristone dose in combination with enzalutamide such that < 33% experience dose-limiting toxicity graded by National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (Phase I) |
Time Frame: | Up to 28 days |
Safety Issue: | |
Description: | Adverse events will be summarized by grade and type and compared between groups using chi-square or Fisher's exact tests. |
Secondary Outcome Measures
Measure: | Overall survival (Phase II) |
Time Frame: | Up to 1 year |
Safety Issue: | |
Description: | Kaplan-Meier curves will be generated and the two treatment arms compared using a logrank test. Median time to event in each group will be estimated along with 90% confidence intervals using the method of Brookmeyer and Crowley. Cox proportional hazards regression models will be fit to assess and adjust for the effects of baseline covariates. |
Measure: | Radiographic PFS (Phase II) |
Time Frame: | Time from start of treatment to time of progression or death, whichever occurs first, assessed up to 1 year |
Safety Issue: | |
Description: | The stratified log-rank will be used to compare the two treatment arms with respect to PFS. The Kaplan-Meier approach will be used to estimate PFS distribution and the proportional hazards model will be used to assess the importance of treatment arm in predicting PFS. |
Measure: | Pharmacokinetic (PK) parameters of enzalutamide and mifepristone |
Time Frame: | Baseline; at days 29, 36, 43, 50, and 57 of Phase I; and on days 1 and 28 of Phase II |
Safety Issue: | |
Description: | PK parameters will be summarized using standard descriptive methods (means, standard deviations, medians and ranges). |
Measure: | AR expression within circulating tumor cells (CTCs) |
Time Frame: | Up to 30 days after completion of study treatment |
Safety Issue: | |
Description: | The median/range, mean/standard deviation of expression (relative fluorescence) for AR will be summarized for each patient (intra-patient variability) and for the entire population (inter-patient variability). The components of variability will be estimated using analysis of variance. In addition percent nuclear/cytoplasmic/both cellular localization will be calculated. |
Measure: | GR expression within CTCs |
Time Frame: | Up to 30 days after completion of study treatment |
Safety Issue: | |
Description: | The median/range, mean/standard deviation of expression (relative fluorescence) for GR will be summarized for each patient (intra patient variability) and for the entire population (inter-patient variability). The components of variability will be estimated using analysis of variance. In addition percent nuclear/cytoplasmic/both cellular localization will be calculated. |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | University of Chicago |
Last Updated
December 10, 2018