Clinical Trials /

Niclosamide and Enzalutamide in Treating Patients With Castration-Resistant, Metastatic Prostate Cancer

NCT02532114

Description:

This phase I trial studies the side effects and best dose of niclosamide when given together with enzalutamide in treating patients with castration resistant prostate cancer that has spread from the primary site to other places in the body. Androgens such as testosterone can cause the growth of prostate cancer cells. Drugs like enzalutamide block androgens from driving tumor growth; however, when androgen receptor splice variants are present, these drugs may not be effective. Niclosamide may decrease the amount of androgen receptor splice variant present within tumor cells, thus promoting the anti-tumor effects of enzalutamide. Giving niclosamide together with enzalutamide may be a better treatment for prostate cancer.

Related Conditions:
  • Prostate Carcinoma
Recruiting Status:

Completed

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Niclosamide and Enzalutamide in Treating Patients With Castration-Resistant, Metastatic Prostate Cancer
  • Official Title: A Phase I Study of Niclosamide in Combination With Enzalutamide in Men With Castration-Resistant Prostate Cancer

Clinical Trial IDs

  • ORG STUDY ID: 9390
  • SECONDARY ID: NCI-2015-01246
  • SECONDARY ID: CC9390
  • SECONDARY ID: 9390
  • SECONDARY ID: P30CA015704
  • SECONDARY ID: P50CA097186
  • NCT ID: NCT02532114

Conditions

  • Castration Levels of Testosterone
  • Castration-Resistant Prostate Carcinoma
  • Metastatic Prostate Carcinoma
  • Recurrent Prostate Carcinoma
  • Stage IV Prostate Adenocarcinoma

Interventions

DrugSynonymsArms
EnzalutamideASP9785, MDV3100, XtandiTreatment (niclosamide, enzalutamide)
NiclosamideTreatment (niclosamide, enzalutamide)

Purpose

This phase I trial studies the side effects and best dose of niclosamide when given together with enzalutamide in treating patients with castration resistant prostate cancer that has spread from the primary site to other places in the body. Androgens such as testosterone can cause the growth of prostate cancer cells. Drugs like enzalutamide block androgens from driving tumor growth; however, when androgen receptor splice variants are present, these drugs may not be effective. Niclosamide may decrease the amount of androgen receptor splice variant present within tumor cells, thus promoting the anti-tumor effects of enzalutamide. Giving niclosamide together with enzalutamide may be a better treatment for prostate cancer.

Detailed Description

      PRIMARY OBJECTIVES:

      I. Determine the safety and tolerability of three-times-daily (TID) oral niclosamide combined
      with enzalutamide in men with castration-resistant prostate cancer (CRPC) that has progressed
      on abiraterone (abiraterone acetate).

      SECONDARY OBJECTIVES:

      I. Determine the effect of niclosamide plus enzalutamide on androgen receptor splice variant
      (AR-V) expression as determined by quantitative
      reverse-transcriptase-polymerase-chain-reaction (qRT-PCR).

      II. Determine the pharmacokinetic profile of three-times-daily (TID) oral niclosamide in men
      with castration-resistant prostate cancer (CRPC) that has progressed on abiraterone.

      III. Determine the prostate specific antigen (PSA) response rate (i.e. proportion of subjects
      with >= 50% decline in PSA from pre-study baseline) after 28-days of niclosamide plus
      enzalutamide.

      IV. Determine the effect of niclosamide plus enzalutamide on protein expression and the
      transcriptional program of circulating tumor cells.

      OUTLINE: This is a dose-escalation study of niclosamide.

      Patients receive niclosamide orally (PO) TID and enzalutamide PO daily. Treatment continues
      for 28 days in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up at days 58 and 88.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (niclosamide, enzalutamide)ExperimentalPatients receive niclosamide PO TID and enzalutamide PO daily. Treatment continues for 28 days in the absence of disease progression or unacceptable toxicity.
  • Enzalutamide
  • Niclosamide

Eligibility Criteria

        Inclusion Criteria:

          -  Have signed an informed consent document indicating that the subject understands the
             purpose of and procedures required for the study and are willing to participate in the
             study

          -  Be willing/able to adhere to the prohibitions and restrictions specified in this
             protocol

          -  Eastern Cooperative Oncology Group (ECOG) performance status =< 2

          -  Documented histologically confirmed adenocarcinoma of the prostate

          -  Patient must have evidence of castration resistant prostate cancer as evidenced by a
             confirmed rising PSA (per Prostate Cancer Working Group 2 [PCWG2] criteria) and a
             castrate serum testosterone level (i.e. =< 50 mg/dL)

          -  Patient must be eligible for treatment with enzalutamide

          -  Patient must have previously progressed on abiraterone (either by PCWG2 criteria or
             Response Evaluation Criteria in Solid Tumors [RECIST] criteria)

          -  Documented metastatic disease on bone scan, computed tomography (CT) scan or magnetic
             resonance imaging (MRI)

        Exclusion Criteria:

          -  Have known allergies, hypersensitivity, or intolerance to enzalutamide or niclosamide
             or their excipients

          -  Ongoing systemic therapy (other than a gonadotropin releasing hormone [GnRH]
             agonist/antagonist) for prostate cancer including, but not limited to:

               -  Cytochrome P450, family 17 (CYP-17) inhibitors (e.g. ketoconazole, abiraterone)

               -  Antiandrogens (e.g. bicalutamide, nilutamide)

               -  Second generation antiandrogens (e.g. ARN-509)

                    -  Note: patients receiving ongoing treatment with enzalutamide will be allowed
                       to join the study

               -  Immunotherapy (e.g. sipuleucel-T, ipilimumab)

               -  Chemotherapy (e.g. docetaxel, cabazitaxel)

               -  Radiopharmaceutical therapy (e.g. radium-223, strontium-89, samarium-153)

          -  Have any condition that, in the opinion of the investigator, would compromise the
             well-being of the subject or the study or prevent the subject from meeting or
             performing study requirements

          -  Any psychological, familial, sociological, or geographical condition that could
             potentially interfere with compliance with the study protocol and follow-up schedule

          -  Severe hepatic impairment (Child-Pugh class C)

          -  Severe renal impairment (creatinine clearance =< 30 ml/min)

          -  History of prior seizures

          -  Central nervous system metastases

          -  Symptomatic patients who, in the opinion of the investigator, may benefit from
             docetaxel-based chemotherapy
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Male
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of dose-limiting toxicities, graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0
Time Frame:Up to 28 days
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Half-life of niclosamide
Time Frame:0.5, 1, 1.5, 2, 3, 4, 6, and 8 hours and 15 days after the first dose of niclosamide
Safety Issue:
Description:Mean niclosamide concentration versus time will be plotted for each dose cohort. Half-life will be reported as a mean for each dose cohort along with the observed ranges.
Measure:Maximum concentration of niclosamide
Time Frame:0.5, 1, 1.5, 2, 3, 4, 6, and 8 hours and 15 days after the first dose of niclosamide
Safety Issue:
Description:Mean niclosamide concentration versus time will be plotted for each dose cohort. maximum concentration will be reported as a mean for each dose cohort along with the observed ranges.
Measure:Minimum concentration of niclosamide
Time Frame:0.5, 1, 1.5, 2, 3, 4, 6, and 8 hours and 15 days after the first dose of niclosamide
Safety Issue:
Description:Mean niclosamide concentration versus time will be plotted for each dose cohort. Minimum concentration will be reported as a mean for each dose cohort along with the observed ranges.
Measure:PSA response rate
Time Frame:Baseline to up to 28 days
Safety Issue:
Description:The percent change in PSA will be presented as a waterfall plot, with the rate of PSA response (i.e. >= 50% decline in PSA from baseline) reported as percentages with 95% confidence intervals.
Measure:Steady state concentration of niclosamide
Time Frame:0.5, 1, 1.5, 2, 3, 4, 6, and 8 hours and 15 days after the first dose of niclosamide
Safety Issue:
Description:Mean niclosamide concentration versus time will be plotted for each dose cohort. Steady state concentration will be reported as means for each dose cohort along with the observed ranges.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:University of Washington

Last Updated

April 18, 2018