Clinical Trials /

Abiraterone Acetate, Prednisone, and Apalutamide With or Without Ipilimumab or Cabazitaxel and Carboplatin in Treating Patients With Metastatic Castration-Resistant Prostate Cancer

NCT02703623

Description:

This randomized phase II trial studies the side effects and how well abiraterone acetate, prednisone, and apalutamide work with or without ipilimumab or cabazitaxel and carboplatin in treating patients with castration-resistant prostate cancer that has spread to other places in the body. Androgens can cause the growth of prostate cancer cells. Drugs, such as abiraterone acetate and apalutamide may lessen the amount of androgens made by the body. Immunotherapy with monoclonal antibodies, such as ipilimumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as prednisone, cabazitaxel, and carboplatin work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving abiraterone acetate, prednisone, and apalutamide with or without ipilimumab or cabazitaxel and carboplatin may be a better way to treat patients with castration-resistant prostate cancer that has spread to other places in the body.

Related Conditions:
  • Prostate Adenocarcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Abiraterone Acetate, Prednisone, and Apalutamide With or Without Ipilimumab or Cabazitaxel and Carboplatin in Treating Patients With Metastatic Castration-Resistant Prostate Cancer
  • Official Title: A Dynamic Allocation Modular Sequential Trial of Approved and Promising Therapies in Men With Metastatic Castrate Resistant Prostate Cancer

Clinical Trial IDs

  • ORG STUDY ID: 2014-0386
  • SECONDARY ID: NCI-2016-00670
  • SECONDARY ID: 2014-0386
  • NCT ID: NCT02703623

Conditions

  • Castration Levels of Testosterone
  • Castration-Resistant Prostate Carcinoma
  • Metastatic Prostate Carcinoma
  • PSA Progression
  • Stage IV Prostate Adenocarcinoma AJCC v7

Interventions

DrugSynonymsArms
Abiraterone AcetateCB7630, ZytigaArm 2A (abiraterone acetate, prednisone, apalutamide)
ApalutamideARN 509, ARN-509, ARN509, JNJ 56021927, JNJ-56021927Arm 2A (abiraterone acetate, prednisone, apalutamide)
CabazitaxelJevtana, RPR-116258A, Taxoid XRP6258, XRP-6258Arm 3(abiraterone, prednisone, ARN509,cabazitaxel,carboplatin)
CarboplatinBlastocarb, Carboplat, Carboplatin Hexal, Carboplatino, Carbosin, Carbosol, Carbotec, CBDCA, Displata, Ercar, JM-8, Nealorin, Novoplatinum, Paraplatin, Paraplatin AQ, Paraplatine, Platinwas, RibocarboArm 3(abiraterone, prednisone, ARN509,cabazitaxel,carboplatin)
IpilimumabAnti-Cytotoxic T-Lymphocyte-Associated Antigen-4 Monoclonal Antibody, BMS-734016, MDX-010, MDX-CTLA4, YervoyArm 2B (abiraterone acetate, prednisone, ARN-509, ipilimumab)
Prednisone.delta.1-Cortisone, 1, 2-Dehydrocortisone, Adasone, Cortancyl, Dacortin, DeCortin, Decortisyl, Decorton, Delta 1-Cortisone, Delta-Dome, Deltacortene, Deltacortisone, Deltadehydrocortisone, Deltasone, Deltison, Deltra, Econosone, Lisacort, Meprosona-F, Metacortandracin, Meticorten, Ofisolona, Orasone, Panafcort, Panasol-S, Paracort, PRED, Predicor, Predicorten, Prednicen-M, Prednicort, Prednidib, Prednilonga, Predniment, Prednisonum, Prednitone, Promifen, Servisone, SK-PrednisoneArm 2A (abiraterone acetate, prednisone, apalutamide)

Purpose

This randomized phase II trial studies the side effects and how well abiraterone acetate, prednisone, and apalutamide work with or without ipilimumab or cabazitaxel and carboplatin in treating patients with castration-resistant prostate cancer that has spread to other places in the body. Androgens can cause the growth of prostate cancer cells. Drugs, such as abiraterone acetate and apalutamide may lessen the amount of androgens made by the body. Immunotherapy with monoclonal antibodies, such as ipilimumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as prednisone, cabazitaxel, and carboplatin work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving abiraterone acetate, prednisone, and apalutamide with or without ipilimumab or cabazitaxel and carboplatin may be a better way to treat patients with castration-resistant prostate cancer that has spread to other places in the body.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To estimate the overall survival (OS) of men with metastatic castration-resistant prostate
      cancer (mCRPC) who have SATISFACTORY features after to 8 weeks of maximal androgen receptor
      (AR)-inhibitory therapy and receive treatment with abiraterone acetate, prednisone and
      apalutamide plus or minus ipilimumab.

      II. To estimate the OS of men with mCRPC who have UNSATISFACTORY features after to up to 8
      weeks of maximal androgen receptor (AR)-inhibitory therapy and receive treatment with
      abiraterone acetate, prednisone, apalutamide, cabazitaxel and carboplatin.

      III. To determine the TOXICITY PROFILE of the following combinations in men with mCRPC:

      IIIa. Abiraterone acetate, prednisone, apalutamide. IIIb. Abiraterone acetate, prednisone,
      apalutamide and ipilimumab. IIIc. Abiraterone acetate, prednisone, apalutamide, cabazitaxel
      and carboplatin.

      IV. To determine whether the BASELINE "AR RESPONSE SIGNATURE" correlates with SATISFACTORY or
      UNSATISFACTORY features after up to 8-weeks of treatment with abiraterone, prednisone and
      apalutamide.

      SECONDARY OBJECTIVES:

      I. To "pick the winner" in terms of time to treatment failure (TTF) between the following two
      combinations, in men with mCRPC and satisfactory features after 8 weeks of maximal
      AR-inhibitory therapy:

      Ia. Abiraterone acetate, prednisone, apalutamide. Ib. Abiraterone acetate, prednisone,
      apalutamide and ipilimumab. II. To determine the TTF in men with mCRPC and unsatisfactory
      features after up to 8 weeks of maximal AR-inhibitory therapy ted with abiraterone acetate,
      prednisone, apalutamide, cabazitaxel and carboplatin.

      III. To determine whether the "baseline AR response signature" predicts for benefit by
      prognostic grouping (satisfactory/unsatisfactory) and treatment arm.

      IV. To investigate therapy-specific marker signatures (immune based, bone based and
      anaplastic) and their link to outcome.

      V. To collect and archive bone marrow biopsy, bone marrow aspirate, serum, plasma, and tissue
      samples in study patients for later hypothesis generating associations.

      OUTLINE: After an 8-week lead-in phase, patients with satisfactory decline in serum markers
      are randomized to 1 of 2 arms (Arm 2A or 2B), and patients with unsatisfactory decline in
      serum markers are assigned to Arm 3.

      LEAD-IN PHASE: Patients receive abiraterone acetate orally (PO) daily, prednisone PO twice
      daily (BID), and apalutamide PO daily for 8 weeks in the absence of disease progression or
      unexpected toxicity.

      ARM 2A: Patients receive abiraterone acetate PO daily, prednisone PO BID, and apalutamide PO
      daily in the absence of disease progression or unexpected toxicity.

      ARM 2B: Patients receive abiraterone acetate PO daily, prednisone PO BID, and apalutamide PO
      daily. Patients also receive ipilimumab intravenously (IV) over 90 minutes on day 1 of
      courses 4-7. Courses repeat every 3 weeks in the absence of disease progression or unexpected
      toxicity.

      ARM 3: Patients receive abiraterone acetate PO daily, prednisone PO BID, and apalutamide PO
      daily. Patients also receive cabazitaxel IV over 60 minutes and carboplatin IV over 60
      minutes on day 1 of courses 4-13. Courses repeat every 3 weeks in the absence of disease
      progression or unexpected toxicity.

      After completion of study treatment, patients are followed up at 14 and 30 days, and then
      every 6 months thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Arm 2A (abiraterone acetate, prednisone, apalutamide)ExperimentalPatients receive abiraterone acetate PO daily, prednisone PO BID, and apalutamide PO daily in the absence of disease progression or unexpected toxicity.
  • Abiraterone Acetate
  • Apalutamide
  • Prednisone
Arm 2B (abiraterone acetate, prednisone, ARN-509, ipilimumab)ExperimentalPatients receive abiraterone acetate PO daily, prednisone PO BID, and apalutamide PO daily. Patients also receive ipilimumab IV over 90 minutes on day 1 of courses 4-7. Courses repeat every 3 weeks in the absence of disease progression or unexpected toxicity.
  • Abiraterone Acetate
  • Apalutamide
  • Ipilimumab
  • Prednisone
Arm 3(abiraterone, prednisone, ARN509,cabazitaxel,carboplatin)Active ComparatorPatients receive abiraterone acetate PO daily, prednisone PO BID, and apalutamide PO daily. Patients also receive cabazitaxel IV over 60 minutes and carboplatin IV, over 60 minutes on day 1 of courses 4-13. Courses repeat every 3 weeks in the absence of disease progression or unexpected toxicity.
  • Abiraterone Acetate
  • Apalutamide
  • Cabazitaxel
  • Carboplatin
  • Prednisone

Eligibility Criteria

        Inclusion Criteria:

          -  Willing and able to provide written informed consent

          -  Histologically or cytologically confirmed adenocarcinoma of the prostate

          -  Presence of metastatic disease documented on imaging studies (bone scan, computed
             tomography [CT] and/or magnetic resonance imaging [MRI] scans)

          -  Patients must have documented evidence of progressive disease as defined by any of the
             following:

               -  Prostate-specific antigen (PSA) progression: minimum of 2 rising values (3
                  measurements) obtained a minimum of 7 days apart with the last result being at
                  least >= 1.0 ng/mL;

               -  New or increasing non-bone disease (Response Evaluation Criteria in Solid Tumors
                  [RECIST] 1.1);

               -  Positive bone scan with 2 or more new lesions (Prostate Cancer Clinical Trials
                  Working Group [PCWG]3)

          -  Surgically or ongoing medically castrated, with baseline testosterone levels of =< 50
             ng/dL (=< 2.0 nM)

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

          -  Hemoglobin >= 7.5 g/dL in the presence of bone marrow involvement independent of
             transfusion and/or growth factors within 3 months prior to enrollment

          -  Platelet count >= 100,000/uL independent of transfusion and or growth factors within 3
             months prior to enrollment

          -  Serum albumin >= 3.0 g/dL

          -  Medications known to lower the seizure threshold must be discontinued or substituted
             at least 4 weeks prior to study entry

          -  Absolute neutrophil count (ANC) >= 1,500/mm^3

          -  Calculated creatinine clearance (Cockcroft-Gault equation) >= 40 mL/min

          -  Serum potassium >= institutional lower limit of normal (ILLN)

          -  Serum magnesium >= ILLN

          -  Serum bilirubin < 1.5 x institutional upper limit of normal (IULN) (except for
             patients with known Gilbert's disease)

          -  Serum aspartate aminotransferases (AST) or alanine aminotransferases (ALT) < 2.5 x
             IULN for patients without liver metastases; for patients with liver metastases AST or
             ALT < 5 x IULN is allowed

          -  Able to swallow study drugs whole as a tablet/capsule

          -  Male subject with a female partner of childbearing potential or pregnant must agree to
             use two acceptable methods of contraception and not to donate sperm from time of
             screening until 3 months after the last dose of study treatments

          -  Patients must agree to tissue collection for correlative studies (including
             participation in PA13-0291 and PA13-0247 for MD Anderson participants) at the
             specified timepoints

        Exclusion Criteria:

          -  Any prior treatment with: ipilimumab

          -  Treatment within 28 days of cycle1 day1: any other systemic therapy for prostate
             cancer (with the exception of luteinizing hormone-releasing hormone [LHRH] agonists
             and LHRH antagonists for testosterone suppression, and bisphosphonates and RANK-ligand
             inhibitors for bone metastases which are allowed); any other investigational product

          -  Treatment within 12 months of cycle 1 day 1 with any Cyp17-lyase inhibitor, any 2nd
             generation AR antagonist (e.g. enzalutamide), cabazitaxel or carboplatin

          -  Patients treated with any Cyp17-lyase inhibitor, any 2nd generation AR antagonist
             (e.g. enzalutamide), cabazitaxel or carboplatin whose disease progressed while on
             treatment or within 3 months of its discontinuation; patients who have received any of
             these treatments more than 12 months from study entry and whose disease did not
             progress while on treatment or within 3 months of its discontinuation are allowed on
             study

          -  Patients whose disease is refractory (defined as evidence of disease progression while
             on drug or within 3 months of its discontinuation) to more than 2 lines of
             chemotherapy; any number of chemotherapies to which the patient's disease is not
             refractory are allowed, as long as time on treatment did not exceed 6 months (counted
             from day 1 of cycle 1 to day 1 of the last cycle of treatment)

          -  Flutamide (Eulexin) treatment within 4 weeks of cycle 1, day 1 and bicalutamide
             (Casodex) or nilutamide (Nilandron) within 6 weeks of cycle 1 day 1 (exceptions: if
             progression is documented prior to this time interval, or if patient is deemed by the
             treating physician to be highly unlikely to respond to AR inhibitor withdrawal (e.g.
             if PSA did not decline for 3 months in response to AR inhibitor given as a second line
             or later intervention, or if patient has symptoms attributable to disease progression)
             only a 3 day washout prior to cycle 1, day 1 will be required for any of them

          -  Radiation therapy for treatment of the primary tumor within 6 weeks of cycle 1, day 1;
             patients who have received palliative radiation and recovered are eligible

          -  Any chronic medical condition requiring a higher dose of corticosteroid than 10mg
             prednisone/prednisolone daily; use of inhaled, intranasal, intra-articular and topical
             steroids is acceptable, as is a short course (i.e. =< 1 day) of corticosteroids to
             prevent a reaction to the IV contrast used for CT scans

          -  Active infection (requiring oral or IV antibiotics or antiviral therapy) or other
             medical condition that would make prednisone/prednisolone (corticosteroid) use
             contraindicated; known history of testing positive for human immunodeficiency virus
             (HIV) or known acquired immunodeficiency syndrome (AIDS)

          -  A malignancy (other than the one treated in this study) which required radiotherapy or
             systemic treatment within the past 5 years, or has a >= 30% probability of recurrence
             within 24 months (except for non-melanoma skin cancer or Ta urothelial carcinomas)

          -  Uncontrolled hypertension (systolic blood pressure [BP] >= 140 mmHg or diastolic BP >=
             90 mmHg); patients with a history of hypertension are allowed provided blood pressure
             is controlled by anti-hypertensive treatment

          -  Prolonged corrected QT (QTc) interval on pre-entry electrocardiogram (>= 450 msec)

          -  Known active or symptomatic viral hepatitis or chronic liver disease

          -  Clinically significant heart disease as evidenced by myocardial infarction, or
             arterial thrombotic events in the past 6 months, severe or unstable angina, history of
             clinically significant ventricular arrhythmias (such as ventricular tachycardia,
             ventricular fibrillation, or torsades de pointes), New York Heart Association (NYHA)
             class III-IV heart disease or cardiac ejection fraction measurement of < 40% at
             baseline

          -  Autoimmune disease: patients with a history of inflammatory bowel disease (including
             Crohn's disease and ulcerative colitis) and autoimmune disorders such as rheumatoid
             arthritis, autoimmune thyroiditis, autoimmune hepatitis, systemic progressive
             sclerosis [scleroderma and variants], systemic lupus erythematosus, autoimmune
             vasculitis [e.g., Wegener's granulomatosis] or autoimmune neuropathies (such as
             Guillain-Barre syndrome) are excluded from this study; vitiligo and adequately
             controlled endocrine deficiencies such as hypothyroidism are not exclusionary

          -  Patients who have had a history of illness which put them at current risk for bowel
             perforation such as acute diverticulitis, intra-abdominal abscess, gastrointestinal
             (GI) obstruction and abdominal carcinomatosis

          -  History of seizure or known condition that may pre-dispose to seizure (including but
             not limited to prior stroke or, loss of consciousness within 1 year prior to
             randomization, brain arteriovenous malformation; or intracranial masses such as
             schwannomas and meningiomas that are causing edema or mass effect)

          -  Gastrointestinal disorder affecting absorption

          -  Any underlying medical or psychiatric condition, which in the opinion of the
             investigator, will make the administration of study drug hazardous or obscure the
             interpretation of adverse events

          -  Untreated symptomatic spinal cord compressions

          -  Prisoners or subjects who are involuntarily incarcerated

          -  Subjects who are compulsorily detained for treatment of either a psychiatric or
             physical (eg, infectious disease) illness
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Male
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall survival (OS)
Time Frame:Up to 4 years
Safety Issue:
Description:Will be reported for each arm. Estimated by Bayesian posterior estimates along with the 95% credible intervals and presented using Kaplan-Meier curves.

Secondary Outcome Measures

Measure:Time to treatment failure (TTF)
Time Frame:Up to 4 years
Safety Issue:
Description:Estimated by Bayesian posterior estimates along with the 95% credible intervals and presented using Kaplan-Meier curves.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

November 12, 2020