Clinical Trials /

LEE011 (Ribociclib) in Combination With Docetaxel Plus Prednisone in mCRPC

NCT02494921

Description:

This is a Phase Ib/II open label clinical trial in patients with metastatic castration resistant prostate cancer. The objective of the phase Ib portion of the study is to establish the maximum tolerated dose (MTD) and dose limiting toxicities (DLT) of docetaxel (75 mg/m2 IV q21 days) and prednisone (5mg orally BID) in combination with ribociclib in escalating oral daily doses in patients with metastatic CRPC with prior resistance to abiraterone and/or enzalutamide who have not undergone prior chemotherapy for metastatic disease. Up to three cohorts will be enrolled to determine the MTD and DLT profile of this combination during Phase 1b. Dose escalation will follow the standard 3+3 design. The dosing schedule is being chosen to allow patients to be exposed to the most efficacious dosing schedule of docetaxel (75 mg/m2 every 3 weeks). If there is excess toxicity observed with the treatment combination at the first dose level (dose level I), an alternative dosing schema may be pursued with weekly docetaxel treatment (35 mg/m2 weekly), which has demonstrated activity in mCRPC and decreased risk of cytopenias compared with every 3 week dosing schedule. The Phase II portion (N = 29) of the study is a single arm, two stage, open-label study of ribociclib (dosed at the RP2D) in combination with docetaxel and prednisone to determine the efficacy and further define the safety of the treatment combination. Patients will be treated with the combination of ribociclib plus docetaxel + prednisone for up to 9 cycles. If there is no evidence of radiographic or clinical disease progression after 9 cycles of protocol therapy, patients may continue on single agent maintenance ribociclib until the time of disease progression. Patients will have the option of starting maintenance ribociclib after 6 cycles of docetaxel if stable disease or better on re-staging scans. The dose of ribociclib used during maintenance will be the same dose as that immediately preceding cessation of docetaxel treatment.

Related Conditions:
  • Prostate Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: LEE011 (Ribociclib) in Combination With Docetaxel Plus Prednisone in mCRPC
  • Official Title: A Phase 1b/2 Study of the Oral CDK4/6 Inhibitor LEE011 (Ribociclib) in Combination With Docetaxel Plus Prednisone in Metastatic Castration Resistant Prostate Cancer

Clinical Trial IDs

  • ORG STUDY ID: 145515
  • SECONDARY ID: NCI-2015-01797
  • NCT ID: NCT02494921

Conditions

  • Prostate Cancer

Interventions

DrugSynonymsArms
DocetaxelTreatment
RibociclibTreatment
PrednisoneTreatment
FilgrastimTreatment

Purpose

This is a Phase Ib/II open label clinical trial in patients with metastatic castration resistant prostate cancer. The objective of the phase Ib portion of the study is to establish the maximum tolerated dose (MTD) and dose limiting toxicities (DLT) of docetaxel (75 mg/m2 IV q21 days) and prednisone (5mg orally BID) in combination with ribociclib in escalating oral daily doses in patients with metastatic CRPC with prior resistance to abiraterone and/or enzalutamide who have not undergone prior chemotherapy for metastatic disease. Up to three cohorts will be enrolled to determine the MTD and DLT profile of this combination during Phase 1b. Dose escalation will follow the standard 3+3 design. The dosing schedule is being chosen to allow patients to be exposed to the most efficacious dosing schedule of docetaxel (75 mg/m2 every 3 weeks). If there is excess toxicity observed with the treatment combination at the first dose level (dose level I), an alternative dosing schema may be pursued with weekly docetaxel treatment (35 mg/m2 weekly), which has demonstrated activity in mCRPC and decreased risk of cytopenias compared with every 3 week dosing schedule. The Phase II portion (N = 29) of the study is a single arm, two stage, open-label study of ribociclib (dosed at the RP2D) in combination with docetaxel and prednisone to determine the efficacy and further define the safety of the treatment combination. Patients will be treated with the combination of ribociclib plus docetaxel + prednisone for up to 9 cycles. If there is no evidence of radiographic or clinical disease progression after 9 cycles of protocol therapy, patients may continue on single agent maintenance ribociclib until the time of disease progression. Patients will have the option of starting maintenance ribociclib after 6 cycles of docetaxel if stable disease or better on re-staging scans. The dose of ribociclib used during maintenance will be the same dose as that immediately preceding cessation of docetaxel treatment.

Trial Arms

NameTypeDescriptionInterventions
TreatmentExperimentalDocetaxel: 75 mg/m^2; Day 1 of 21-Day Cycle Ribociclib: 200 mg/day; Days 2-14 of 21-Day Cycle Prednisone: 5 mg, oral, twice a day Filgrastim: as clinically indicated
  • Docetaxel
  • Ribociclib
  • Prednisone
  • Filgrastim
Alternate TreatmentExperimentalDocetaxel: 35 mg/m^2; Days 1, 8 , 15 of 21-Day Cycle Ribociclib: 200 mg/day; Days 2-14 of 21-Day Cycle Prednisone: 5 mg, oral, twice a day Filgrastim: as clinically indicated
  • Docetaxel
  • Ribociclib
  • Prednisone
  • Filgrastim

Eligibility Criteria

        Inclusion Criteria:

          -  Histologically confirmed prostate cancer. Small cell/neuroendocrine differentiated
             allowed but not required for study participation.

          -  Progressive metastatic prostate cancer (as defined below in Item #5) despite castrate
             levels of testosterone (< 50 ng/dL).

          -  Patients may have either non-measurable disease OR measurable disease

          -  Progressive disease during (or within 4 weeks of completion) with abiraterone,
             enzalutamide, and/or ARN-509 based on any one of the following:

               1. For patients with measurable disease, progression by the RECIST criteria.

               2. PSA evidence for progressive prostate cancer consists of a PSA level of at least
                  2 ng/ml which has risen on at least 2 successive occasions, at least one week
                  apart. If the confirmatory PSA (#3) value is less (i.e., #3b) than the screening
                  PSA (#2) value, then an additional test for rising PSA (#4) will be required to
                  document progression for the purposes of eligibility.

               3. Radionuclide bone scan: At least two new foci consistent with metastatic lesions

          -  Testosterone < 50 ng/dL. Patients must continue primary androgen deprivation with a
             luteinizing hormone-releasing hormone (LHRH) analogue if they have not undergone
             orchiectomy.

          -  Patients treated with first generation anti-androgen as most recent systemic therapy
             (bicalutamide, nilutamide) must have at least 4 weeks elapsed from treatment
             discontinuation to start of protocol therapy with evidence of disease progression by
             PCWG2 criteria following discontinuation of prior anti-androgen.

          -  Eastern Cooperative Oncology Group (ECOG) Performance Status 0 or 1.

          -  Patient has adequate bone marrow and organ function as defined by the following
             laboratory values:

          -  Absolute neutrophil count ≥ 1.5 × 109/L.

          -  Platelets ≥ 100 × 109/L.

          -  Hemoglobin ≥ 9 g/dl.

          -  Potassium, total calcium (corrected for serum albumin), magnesium, sodium and
             phosphorus within normal limits for the institution or corrected to within normal
             limits before first dose of study medication.

          -  International normalized ratio (INR) ≤ 1.5 unless on direct thrombin inhibitor at time
             of study entry.

          -  Serum creatinine ≤ 1.5mg/dL or estimated creatinine clearance ≥ 50 ml/min

          -  In the absence of liver metastases, alanine aminotransferase (ALT) and aspartate
             aminotransferase (AST) <2.5 x upper limit of normal (ULN). If the patient has liver
             metastases, ALT and AST <5 x ULN

          -  Total bilirubin < ULN; or total bilirubin ≤3.0 x ULN or direct bilirubin ≤1.5 x ULN in
             patients with well-documented Gilbert's Syndrome.

          -  No other systemic therapies for prostate cancer within 28 days or 5 half-lives,
             whichever is shorter, prior to day 1 of study therapy.

          -  Sexually active males must use a condom during intercourse while taking the drug and
             for 30 days after stopping treatment and should not father a child in this period. A
             condom is required to be used also by vasectomized men in order to prevent delivery of
             the drug via seminal fluid. Fertile males must use a condom with spermicide (double
             barrier method).

          -  Age ≥ 18 years

          -  Written informed consent must be obtained prior to any screening procedures and
             according to local guidelines.

        Exclusion Criteria:

          -  Patient has a known hypersensitivity to ribociclib or any of its excipients, or prior
             treatment with cyclin-dependent kinase (CDK) 4/6 inhibitor.

          -  Prior chemotherapy for metastatic castration-resistant prostate cancer. Chemotherapy
             administered in the castration-sensitive setting is allowed provided last dose of
             chemotherapy was greater than 6 months prior to study entry

          -  Patient has a concurrent malignancy or malignancy within 3 years of randomization,
             with the exception of adequately treated, basal cell skin cancer, squamous cell
             carcinoma, non-melanomatous skin cancer or curatively resected cervical cancer.

          -  Patients with central nervous system (CNS) involvement unless they meet ALL of the
             following criteria:

          -  At least 4 weeks from prior therapy completion (including radiation and/or surgery) to
             starting the study treatment

          -  Clinically stable CNS tumor at the time of screening and not receiving steroids and/or
             enzyme-inducing anti-epileptic medications for brain metastases.

          -  Baseline screening for CNS metastases is not required unless presence of signs and/or
             symptoms of involvement

          -  Patient is not able to swallow oral medication and/or has impairment of
             gastrointestinal (GI) function or GI disease that may significantly alter the
             absorption of the study drugs (e.g., ulcerative diseases, uncontrolled nausea,
             vomiting, diarrhea, malabsorption syndrome, or significant small bowel resection).

          -  Clinically significant, uncontrolled heart disease and/or recent events including any
             of the following:

          -  History of acute coronary syndromes (including myocardial infarction, unstable angina,
             coronary artery bypass grafting, coronary angioplasty or stenting) or symptomatic
             pericarditis within 12 months prior to screening

          -  History of documented congestive heart failure (New York Heart Association functional
             classification III-IV)

          -  Patient has a left ventricular ejection fraction (LVEF) < 50% as determined by
             Multiple Gated acquisition (MUGA) scan or echocardiogram (ECHO) obtained during
             Screening.

          -  History of any cardiac arrhythmias, e.g., ventricular, supraventricular, nodal
             arrhythmias, or conduction abnormality within 12 months of screening. Patients with
             rate-controlled atrial fibrillation or flutter are permitted.

          -  Bradycardia (heart rate < 50 bpm at rest), by ECG or pulse, at screening

          -  Congenital long QT syndrome or family history of long QT syndrome

          -  Any of the following abnormalities on screening 12-lead ECG:

          -  QT interval with Fridericia's correction (QTcF) > 450 msec

          -  Bradycardia (heart rate < 50 bpm at rest)

          -  Tachycardia (heart rate > 100 bpm at rest)

          -  PR interval > 220msec,

          -  QRS interval >109 msec

          -  Documented cardiomyopathy

          -  Systolic blood pressure >160 mmHg or <90 mmHg at screening

          -  AST and/or ALT > 1.5 x ULN with concomitant alkaline phosphatase > 2.5 x ULN

          -  Patient receiving any of the following medications within 7 days of day 1 of study
             treatment.

          -  Known strong inducers or inhibitors of CYP3A4/5, including grapefruit, grapefruit
             hybrids, pummelos, star-fruit, and Seville oranges

          -  That have a narrow therapeutic window and are predominantly metabolized through
             CYP3A4/5.

          -  That have a known risk to prolong the QT interval or induce Torsades de Pointes.

          -  Herbal preparations/medications

          -  Patient is currently receiving or has received systemic corticosteroids ≤2 weeks prior
             to starting study drug at a dose greater than the equivalent of 10 mg prednisone/day,
             or who have not fully recovered from the side effects of such treatment

          -  The following uses of corticosteroids are permitted: single doses, topical
             applications (e.g., for rash), inhaled sprays (e.g., for obstructive airways
             diseases), eye drops or local injections (e.g., intra-articular).

          -  Patient is currently receiving warfarin or other coumarin-derived anticoagulant for
             treatment, prophylaxis or otherwise. Therapy with heparin, direct thrombin inhibitors,
             low molecular weight heparin (LMWH) or fondaparinux is allowed.

          -  Participation in a prior investigational study within 30 days prior to enrollment or
             within 5 half-lives of the investigational product, whichever is longer

          -  Major surgery within 14 days prior to starting study drug or has not recovered from
             major side effects (tumor biopsy is not considered as major surgery).

          -  Patient who has received radiotherapy ≤4 weeks or limited field radiation for
             palliation ≤2 weeks prior to starting study drug, and who has not recovered to grade 1
             or better from related side effects of such therapy (exceptions include alopecia),
             and/or in whom ≥25% of the bone marrow was irradiated.

          -  Patient has a known history of HIV infection (testing not required)

          -  Patient has not recovered from all toxicities related to prior anticancer therapies to
             NCI-CTCAE version 4.03 to less than or equal to Grade 1 (Exception to this criterion:
             patients with any grade of alopecia are allowed to enter the study).

          -  Patients with chronic liver disease with a Child-Pugh score B or C.

          -  Patients with serious intercurrent infections, or nonmalignant medical illnesses that
             are uncontrolled or whose control may be jeopardized by the complications of this
             therapy.

          -  Patients with severe psychiatric illness/social situations that would limit compliance
             with study requirements in the judgment of study investigator.

          -  History of bleeding diathesis. Patients receiving anti-coagulation must be able safely
             interrupt treatment for tumor biopsy (Phase 2 only)

          -  Patient has a history of non-compliance to medical regimen or inability to grant
             consent
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Male
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximally Tolerated Dose (MTD) measured by CTCAE v.4.03
Time Frame:Up to 2 years (Phase 1b only)
Safety Issue:
Description:CTCAE v.4.03

Secondary Outcome Measures

Measure:Median Progression-Free Survival
Time Frame:Up to 2 years
Safety Issue:
Description:RECIST v1.1
Measure:Objective Response Rate
Time Frame:Up to 2 years
Safety Issue:
Description:RECIST v.1.1
Measure:Median Duration of Response measured by RECIST v.1.1
Time Frame:Up to 2 years
Safety Issue:
Description:RECIST v.1.1
Measure:Prostate-Specific Antigen (PSA) Response Rate
Time Frame:Up to 2 years
Safety Issue:
Description:Blood draw
Measure:PSA Progression-Free Survival
Time Frame:Up to 2 years
Safety Issue:
Description:Prostate Cancer Working Group 2 (PCWG2) Criteria
Measure:Adverse Events
Time Frame:Up to 2 years
Safety Issue:
Description:CTCAE v.4.03

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Rahul Aggarwal

Trial Keywords

  • Metastatic
  • Castration-Resistant

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