Clinical Trials /

Nivolumab in Prostate Cancer With DNA Repair Defects (ImmunoProst Trial)

NCT03040791

Description:

Prostate Cancer (PC) is the most frequent cancer in men, accounting for 21% of new cases of cancer in men in the United States. Among the four most incident tumors (breast, lung and colorectal cancer); prostate cancer is the only that does not have any predictive biomarker to guide the treatment. Even though the molecular heterogeneity of PC is well-documented, treatment has not been molecularly stratified and the need for genetic prognostic and predictive markers is critical. DNA repair defects (DRD), mainly in the Homologous Recombination (HR) pathway (such as BRCA1, BRCA2, ATM and CHEK2) are emerging as potential biomarkers in prostate cancer. It is well known BRCA1 and BRCA2 carriers have better Progression-Free Survival (PFS) and Overall Survival (OS) than non-carriers in ovarian cancer. Differently than ovarian tumors that BRCA mutations provides a good prognosis, PC patients who harbor HR defects have a higher Gleason score 6, an increased risk of recurrence and poor prognosis. The predictive role of DRD in PC was demonstrated in a recent trial using Olaparib, a PARP inhibitor, in DRD carriers. This trial showed 88% of response rate with Olaparib, a PARP inhibitor that acts in HR pathway by synthetic lethality. Recent data demonstrated important association between HR deficient high-grade serous ovarian cancer (HGSOC), high neoantigen load and high expression of PD-1/PD-L1 compared with HR proficient HGSOCs 10. This study showed that BRCA1 and BRCA2 mutations increase the number of tumor-infiltrating lymphocytes (TILs) and confer a better prognosis. The unprecedented success of immunotherapy in malignant disorders has provided evidence that the patient's immune system can be improved to attack established tumors, mainly melanoma, non-small cell lung cancer and kidney cancer. A high mutational burden increases the likelihood of the development of specific neoepitopes that would confer clinical benefit from CTLA-4 and PD-1 blockade. These data showed that specific DNA repair defects increase the mutational burden, the expression of PD-1/PD-L1 and TILs; and could improve the response to immunotherapy in cancer. This rationale was already tested in a trial that evaluated the PD-1 checkpoint inhibitor Pembrolizumab in mismatch-repair deficient patients, a kind of DNA repair defect by definition. This important trial showed that this DRD predicted clinical benefit of immune checkpoint blockade in many types of cancer, especially colorectal cancer.

Related Conditions:
  • Prostate Adenocarcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Nivolumab in Prostate Cancer With DNA Repair Defects (ImmunoProst Trial)
  • Official Title: Nivolumab in Prostate Cancer With DNA Repair Defects (ImmunoProst Trial)

Clinical Trial IDs

  • ORG STUDY ID: 64121317.4.1001.5330
  • NCT ID: NCT03040791

Conditions

  • Prostate Cancer

Interventions

DrugSynonymsArms
NivolumabBMS-936558Nivolumab

Purpose

Prostate Cancer (PC) is the most frequent cancer in men, accounting for 21% of new cases of cancer in men in the United States. Among the four most incident tumors (breast, lung and colorectal cancer); prostate cancer is the only that does not have any predictive biomarker to guide the treatment. Even though the molecular heterogeneity of PC is well-documented, treatment has not been molecularly stratified and the need for genetic prognostic and predictive markers is critical. DNA repair defects (DRD), mainly in the Homologous Recombination (HR) pathway (such as BRCA1, BRCA2, ATM and CHEK2) are emerging as potential biomarkers in prostate cancer. It is well known BRCA1 and BRCA2 carriers have better Progression-Free Survival (PFS) and Overall Survival (OS) than non-carriers in ovarian cancer. Differently than ovarian tumors that BRCA mutations provides a good prognosis, PC patients who harbor HR defects have a higher Gleason score 6, an increased risk of recurrence and poor prognosis. The predictive role of DRD in PC was demonstrated in a recent trial using Olaparib, a PARP inhibitor, in DRD carriers. This trial showed 88% of response rate with Olaparib, a PARP inhibitor that acts in HR pathway by synthetic lethality. Recent data demonstrated important association between HR deficient high-grade serous ovarian cancer (HGSOC), high neoantigen load and high expression of PD-1/PD-L1 compared with HR proficient HGSOCs 10. This study showed that BRCA1 and BRCA2 mutations increase the number of tumor-infiltrating lymphocytes (TILs) and confer a better prognosis. The unprecedented success of immunotherapy in malignant disorders has provided evidence that the patient's immune system can be improved to attack established tumors, mainly melanoma, non-small cell lung cancer and kidney cancer. A high mutational burden increases the likelihood of the development of specific neoepitopes that would confer clinical benefit from CTLA-4 and PD-1 blockade. These data showed that specific DNA repair defects increase the mutational burden, the expression of PD-1/PD-L1 and TILs; and could improve the response to immunotherapy in cancer. This rationale was already tested in a trial that evaluated the PD-1 checkpoint inhibitor Pembrolizumab in mismatch-repair deficient patients, a kind of DNA repair defect by definition. This important trial showed that this DRD predicted clinical benefit of immune checkpoint blockade in many types of cancer, especially colorectal cancer.

Detailed Description

      This is a Phase II, two-stage, multi-center, single-arm, and open-label trial of Nivolumab
      (BMS-936558) in patients with metastatic castration-resistant prostate cancer (mCRPC) who
      have progressed to a taxane-based chemotherapy regimen previously. Eligible patients must
      have ECOG 0-2 and material for biomarker analysis. Prior enzalutamide, abiraterone and
      cabazitaxel are permitted but not necessary to enrollment. The germline and somatic DRD
      (BRCA1, BRCA2, ATM, PTEN, CHEK2, RAD51C, RAD51D, PALB2, MLH1, MSH2, MSH6, PMS2.) will be
      assessed by T-NGS of metastatic sites or by liquid biopsy. The primary endpoint is PSA 50
      response rate (PSA50, following the Prostate Cancer Working Group 3 criteria). The trial will
      meet its endpoint if ≥ 3/29 men achieve a PSA50 response. The secondary endpoints will
      include progression-free survival (PFS), overall survival, radiologic PFS, PSA response rate
      at 6 and 12 months.
    

Trial Arms

NameTypeDescriptionInterventions
NivolumabExperimentalAll patients will receive Nivolumab 240 mg every 14 days until progression or unacceptable toxicity
  • Nivolumab

Eligibility Criteria

        Inclusion Criteria:

          1. Histologically confirmed adenocarcinoma of the prostate with tumor tissue available
             for molecular analyses. If archival tissue for biomarker analysis is not available
             then the patient must be willing to have a further biopsy to obtain tumor tissue for
             histological diagnosis.

          2. Metastatic Castrate-resistant prostate cancer (mCRPC), defined by:

               -  Disease progression despite androgen deprivation therapy (ADT) and may present as
                  either a continuous rise in serum prostate-specific antigen (PSA) levels, the
                  progression of pre-existing disease, and/or the appearance of new metastases.

               -  Surgically or medically castrated, with testosterone levels of < 50 ng/dL (< 2.0
                  nM). If the patient is being treated with GnRH or LHRH agonists or antagonists
                  (patient who have not undergone orchiectomy), this therapy should be maintained.

          3. Documented prostate cancer progression, during treatment with Docetaxel, as assessed
             by the investigator with one of the following:

               -  PSA progression is defined according the PCWG3 criteria: PSA increase, that is ≥
                  50% and ≥ 2 ng/mL above the nadir, and which is confirmed by a second value ≥ 3
                  weeks later (confirmed the rising trend).

               -  Radiographic progression of visceral lesions or soft tissue disease by modified
                  RECIST 1.1 criteria.

               -  Progression of bone metastasis is defined according the Appendix B: Prostate
                  Cancer Clinical Trials Working Group 3 (Adapted) two or more documented new bone
                  lesions on a bone scan with or without PSA progression. Confirmation of ambiguous
                  results by other imaging modalities (eg, CT or MRI) is obligatory. If Docetaxel
                  chemotherapy is used more than once, this will be considered as one regimen.

          4. Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 2 Appendix A:
             Performance Status Criteria

          5. Life expectancy > 24 weeks.

          6. Age ≥ 18 years

          7. At least 28 days since the completion of any prior anti-cancer therapy (except for
             LHRH agonists or antagonists), including chemotherapy (taxane-based). Additionally,
             clinically relevant treatment toxicities should have resolved to grade 1 or less prior
             to start study treatment.

          8. For hormonal treatment must be followed the guideline below:

               -  No antiandrogens are allowed during the study period. The use of antiandrogens
                  before study entry is permitted, but at least 28 days since the completion of
                  prior antiandrogen are required (washout period).

               -  Corticosteroids dose > Prednisolone 10 mg/day (or equivalent) are allowed only if
                  clinically indicated for medical conditions. At least 28 days since the
                  completion of prior corticotherapy are required (washout period).

          9. Agreeable to have all the biomarker studies including the fresh tumor biopsies if
             needed.

         10. Patients must have adequate organ function within 1 weeks prior enrollment to and
             evidenced by:

               -  Hemoglobin ≥ 9.0 g/dL

               -  WBC > 2.000/mm3

               -  Absolute neutrophil count ≥ 1.500/mm3

               -  Platelet count ≥ 100.000/mm3

               -  Creatinine Clearance ≥ 30 mL/min. Creatinine Clearance (CrCl) must be calculated
                  at screening using the Cockcroft-Gault formula:

               -  Bilirubin < 3 x upper limit of normal (ULN) except for patients with known
                  Gilbert's syndrome.

               -  Aspartate transaminase (AST) (SGOT) < 3.0 x ULN.

               -  Alanine transaminase (ALT) (SGPT) < 3.0 x ULN.

               -  No cardiac disease defined by as active angina, symptomatic congestive heart
                  failure, or myocardial infarction within previous six months.

        Exclusion Criteria:

          -  Patients with any active known or suspected autoimmune disease. Patients with
             vitiligo, type I diabetes mellitus, controlled autoimmune hypothyroidism, psoriasis
             not requiring systemic treatment, or other conditions under control are permitted to
             enroll.

          -  Patients with conditions that needs systemic corticosteroids dose > Prednisolone 10
             mg/day (or equivalent) or other immunosuppressive medications within 28 days prior to
             the first dose of study drug. Inhaled steroids are permitted if necessary.

          -  Patients with any known active chronic liver disease.

          -  Patients who have prior history of malignancy treated with curative intention in the
             past 2 years with the exception of basal cell carcinoma and squamous cell carcinoma of
             the skin, which were allowed in any case. Patients with other malignancies that do not
             fulfill the prior criteria could be considered for recruitment if they do not
             represent a competitive cause of death and have a low potential to progress to
             metastatic progression. Patients in this condition may be enrolled in the trial if
             approved after review by principal investigator.

          -  Known history of testing positive for human immunodeficiency virus (HIV), known
             acquired immunodeficiency syndrome (AIDS), or any positive test for hepatitis B or
             hepatitis C virus representing acute or chronic disease.

          -  Preceding treatment with an anti-PD-1, anti-PD-L1 or anti-CTLA-4 antibody, or any
             other antibody or drug specifically targeting T-cell co-stimulation or checkpoint
             pathways.

          -  Major surgery less than 28 days prior to the first dose of study drug.

          -  Radiation therapy less than 14 days prior to the first dose of study drug.
      
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:through study completion, an average of 1 year
Safety Issue:
Description:PSA partial response is defined as a ≥ 50% decline in PSA from cycle 1 day 1 (baseline) PSA value. This PSA decline must be confirmed as sustained by a second PSA value obtained ≥ 3 weeks later.

Secondary Outcome Measures

Measure:Time to PSA progression
Time Frame:through study completion, an average of 1 year
Safety Issue:
Description:
Measure:PSA Response Rate at 6 and 12 months
Time Frame:through study completion, an average of 1 year
Safety Issue:
Description:
Measure:Radiological progression-free survival (rPFS)
Time Frame:through study completion, an average of 1 year
Safety Issue:
Description:
Measure:Time to Radiographic Progression
Time Frame:through study completion, an average of 1 year
Safety Issue:
Description:
Measure:Progression free survival (PFS)
Time Frame:through study completion, an average of 1 year
Safety Issue:
Description:
Measure:Overall survival
Time Frame:through study completion, an average of 1 year
Safety Issue:
Description:

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:Hospital Moinhos de Vento

Trial Keywords

  • prostate cancer

Last Updated

August 26, 2021