Description:
This phase II trial studies how well trametinib works in treating patients with
hormone-resistant prostate cancer that is growing or getting worse and has spread to other
parts of the body. Trametinib may stop the growth of tumor cells by blocking some of the
enzymes needed for cell growth.
Title
- Brief Title: Trametinib in Treating Patients With Progressive Metastatic Hormone-Resistant Prostate Cancer
- Official Title: A Single-Arm, Open-Label, Two-Stage Phase II Study of the MEK 1/2 Inhibitor Trametinib in Men With Progressive Metastatic Castrate Resistant Prostate Cancer
Clinical Trial IDs
- ORG STUDY ID:
16-001044
- SECONDARY ID:
NCI-2016-01201
- SECONDARY ID:
16-001044
- NCT ID:
NCT02881242
Conditions
- Hormone-Resistant Prostate Cancer
- Metastatic Prostate Carcinoma
- Recurrent Prostate Carcinoma
- Stage IV Prostate Cancer
Interventions
Drug | Synonyms | Arms |
---|
Trametinib | GSK1120212, JTP-74057, MEK Inhibitor GSK1120212, Mekinist | Treatment (trametinib) |
Purpose
This phase II trial studies how well trametinib works in treating patients with
hormone-resistant prostate cancer that is growing or getting worse and has spread to other
parts of the body. Trametinib may stop the growth of tumor cells by blocking some of the
enzymes needed for cell growth.
Detailed Description
PRIMARY OBJECTIVES I. To assess the activity of trametinib in metastatic castration resistant
prostate cancer (mCRPC) that has progressed on either enzalutamide or abiraterone acetate.
SECONDARY OBJECTIVES I. Durability of prostate specific antigen (PSA) response as measured by
the time to PSA progression as defined by Prostate Cancer Working Group 2 guidelines for PSA
progression.
II. Maximal PSA response. III. Quality of life by Functional Assessment of Cancer Therapy-
Prostate (FACT-P).
IV. Time to initiation of alternative antineoplastic therapy. V. Time to radiographic
progression. VI. Objective response rate according to Response Evaluation Criteria in Solid
Tumors (RECIST) guidelines.
VII. Overall survival measured as time from enrollment until death. VIII. Safety and
tolerability. IX. Analysis of trametinib target engagement of mitogen-activated extracellular
signal-related kinase (MEK1/2) is assessed by presence of p-ERK, the primary phosphorylation
target of activated MEK1/2, in pre-treatment and at progression radiographically directed
metastatic tumor biopsies by immunohistochemistry evaluation of p-ERK. Markers of cell
proliferation (Ki67) and apoptosis (p27) will also be assessed.
XI. Investigation of molecular correlates to resistance and sensitivity to trametinib using
pre-treatment and at progression metastatic biopsies.
XII. Discovery of one or a set of possible discriminative networks that are associated with a
response to trametinib.
XII. Enrichment for patients in the second phase who have tumors exhibiting genomic features
associated with a response to trametinib.
XIV. Analyses of circulating tumor deoxyribonucleic acid (ctDNA) for genomic aberrations
correlated to treatment response.
OUTLINE:
Patients receive trametinib orally (PO) once daily (QD). Treatment continues in the absence
of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 2 and 4 weeks, and then
every 4 weeks thereafter.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (trametinib) | Experimental | Patients receive trametinib PO QD. Treatment continues in the absence of disease progression or unacceptable toxicity. | |
Eligibility Criteria
Inclusion Criteria:
- Willing and able to give informed consent
- Histologically confirmed prostate cancer (not exclusive of adenocarcinoma)
- mCRPC that has progressed on at least 1 therapy progression (defined as Prostate
Cancer Working Group 2 [PCWG2] or at investigators' discretion) approved for treatment
of mCRPC, one of which must include abiraterone acetate and/or enzalutamide
- Metastatic tumor that has been biopsied
- Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
- Willing to undergo biopsy of a metastatic lesion at the time of progression
- Patients must have ongoing therapy to maintain serum testosterone < 50 ng/dL
- Absolute neutrophil count > 1,500/uL during screening evaluation
- Platelet count > 100,000/uL during screening evaluation
- Hemoglobin > 9 g/dL during screening evaluation
- Total bilirubin within the reference range during screening evaluation
- Alanine aminotransferase (ALT) within the reference range during screening evaluation
- Aspartate aminotransferase (AST) within the reference range during screening
evaluation
- Creatinine < (1.5 mg/dL) during screening evaluation (> 1.5 is allowed if epidermal
growth factor receptor [EGFR] > 45 mL/min/1.73 m^2)
- International normalized ratio (INR) < 1.3 (or < 3 if on warfarin or other
anticoagulants) during screening evaluation
- Left ventricular ejection fraction (LVEF) >= 45% as measured by echocardiogram during
screening evaluation
- Electrocardiogram (EKG) without clinically significant abnormality
Exclusion Criteria:
- A history of retinal vein occlusion (RVO) or risks factors for RVO
- A history of retinal pigment epithelial detachment (RPED) or risk factors for RPED
- Clinically significant abnormality on ophthalmologic examination during screening
evaluation
- Clinically significant cardiovascular disease including:
- LVEF < 45% measured by echocardiogram
- History of acute coronary syndromes (including myocardial infarction and unstable
angina), coronary angioplasty, or stenting within 6 months
- Uncontrolled angina within 3 months
- New York Heart Association (NYHA) class III or IV congestive heart failure
- Clinically significant abnormality on EKG
- History of clinically significant ventricular arrhythmias (e.g., ventricular
tachycardia, ventricular fibrillation, torsades de pointes)
- Patients with intra-cardiac defibrillators or permanent pacemakers
- Presence of a comorbid disease or medical condition that would impair the ability of
the patient to receive or comply with the study protocol
- History of interstitial lung disease or pneumonitis
- Use of any medication or herbal products that may have hormonal anti-prostate cancer
activity and/or are known to modulate PSA levels (e.g., saw palmetto) or systemic
corticosteroids greater than the equivalent of 10 mg of prednisone per day within 4
weeks of enrollment
- Prior use of trametinib or other mitogen activated protein kinase (MAPK) inhibitor in
any context
- Known or suspected brain metastasis or active leptomeningeal disease or spinal cord
compression
- Gastrointestinal disorder affecting absorption (e.g., gastrectomy, active peptic ulcer
disease within last 3 months, inflammatory bowel disease)
- Any major surgery, extensive radiotherapy, chemotherapy with delayed toxicity,
biologic therapy, or immunotherapy within 30 days of enrollment and/or daily or weekly
chemotherapy without the potential for delayed toxicity within 14 days of enrollment
- Hospitalization within 30 days of enrollment for cancer related events
- History of another malignancy within the previous 5 years other than curatively
treated non-melanoma skin cancer
- Use of an investigational agent within 4 weeks of enrollment
- Use of any medications known to affect the serum androgen level
- Any condition or reason that, in the opinion of the investigator, interferes with the
ability of the patient to participate in the trial, which places the patient at undue
risk, or complicates the interpretation of safety data
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Male |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | PSA response rate |
Time Frame: | At 12 weeks |
Safety Issue: | |
Description: | Will be defined as decline in PSA of 30% or more, any decline of PSA of 50% or more, partial or complete response at 12 weeks, and freedom from radiographic progression at 24 weeks. |
Secondary Outcome Measures
Measure: | Change in markers of cell proliferation (Ki67) and apoptosis (p27), assessed by immunohistochemistry |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | Mixed effects logistic regression models to assess changes in markers over time, correlations between markers over time and associations between markers and treatment response (conditional logistic regression) will be used. |
Measure: | Change in trametinib target engagement of MEK1/2 defined by the presence of p-ERK, assessed by immunohistochemistry |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | Mixed effects logistic regression models to assess changes in markers over time, correlations between markers over time and associations between markers and treatment response (conditional logistic regression) will be used. |
Measure: | Durability of PSA response as measured by time to PSA progression as defined by PCWG2 guidelines |
Time Frame: | Up to 30 months |
Safety Issue: | |
Description: | |
Measure: | Incidence of adverse events, graded according to the Common Terminology Criteria for Adverse Events version 4.0 |
Time Frame: | Up to 30 months |
Safety Issue: | |
Description: | |
Measure: | Maximal PSA response |
Time Frame: | Up to 30 months |
Safety Issue: | |
Description: | |
Measure: | Molecular correlates defined by gene expression, assessed using ribonucleic acid-sequencing, and mutational events, assessed using DNA exome-seq |
Time Frame: | Up to 24 weeks |
Safety Issue: | |
Description: | Statistical bootstrap and Pearsons Correlation will be used to determine the relationship of phenotype to mutations and clinical variables. Fisher exact tests and logistic regression models will be used to evaluate the relationships between specific variations and treatment response. |
Measure: | Objective radiographic response rate according to RECIST guidelines |
Time Frame: | Up to 24 weeks |
Safety Issue: | |
Description: | |
Measure: | Overall survival |
Time Frame: | Time from enrollment until death, assessed for up to 30 months |
Safety Issue: | |
Description: | |
Measure: | Quality of life, assessed by FACT-P |
Time Frame: | Up to 30 months |
Safety Issue: | |
Description: | |
Measure: | Time to initiation of alternative anti-neoplastic therapy |
Time Frame: | Up to 30 months |
Safety Issue: | |
Description: | |
Measure: | Time to radiographic progression |
Time Frame: | Up to 24 weeks |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Jonsson Comprehensive Cancer Center |
Last Updated
June 24, 2021