Clinical Trials /

177Lu-PSMA-R2 in Patients With PSMA Positive Progressive, Metastatic, Castration Resistant Prostate Cancer

NCT03490838

Description:

This Phase 1/2 study is intended to investigate the safety, tolerability, and radiation dosimetry of 177Lu-PSMA-R2 and further assess preliminary efficacy data in patients with metastatic castration-resistant prostate cancer (mCRPC). The Phase 1 portion of the study will determine the recommended dose of 177Lu-PSMA-R2 for radio-ligand therapy (RLT) of mCRPC, and the Phase 2 portion will expand into approximately 60 patients documenting the preliminary activity (anti-tumor response) of repeated treatments administered, continuing safety assessments and collecting QoL data.

Related Conditions:
  • Prostate Adenocarcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: 177Lu-PSMA-R2 in Patients With PSMA Positive Progressive, Metastatic, Castration Resistant Prostate Cancer
  • Official Title: A Phase 1/2 Open-label, Multi-center, Dose-escalation Study of Safety, Tolerability, Pharmacokinetics, Dosimetry, and Response to Repeat Dosing of 177Lu-PSMA-R2 Radio-ligand Therapy in Patients With Prostate Specific Membrane Antigen (PSMA) Positive (68Ga-PSMA-R2) Progressive Metastatic Castration-resistant Prostate Cancer, Following Previous Systemic Treatment

Clinical Trial IDs

  • ORG STUDY ID: A206T-G01-001
  • SECONDARY ID: 2017-004034-29
  • SECONDARY ID: CAAA602A12101
  • NCT ID: NCT03490838

Conditions

  • Prostatic Neoplasm

Interventions

DrugSynonymsArms
177Lu-PSMA-R2Phase I: Dose Escalation Cohort 1

Purpose

This Phase 1/2 study is intended to investigate the safety, tolerability, and radiation dosimetry of 177Lu-PSMA-R2 and further assess preliminary efficacy data in patients with metastatic castration-resistant prostate cancer (mCRPC). The Phase 1 portion of the study will determine the recommended dose of 177Lu-PSMA-R2 for radio-ligand therapy (RLT) of mCRPC, and the Phase 2 portion will expand into approximately 60 patients documenting the preliminary activity (anti-tumor response) of repeated treatments administered, continuing safety assessments and collecting QoL data.

Trial Arms

NameTypeDescriptionInterventions
Phase I: Dose Escalation Cohort 1Experimental3.70 GBq (100 mCi) x 3 times
  • 177Lu-PSMA-R2
Phase I: Dose Escalation Cohort 2Experimental7.40 GBq (200 mCi) up to 4 times
  • 177Lu-PSMA-R2
Phase I: Dose Escalation Cohort 3Experimental11.1 GBq (300 mCi) up to 4 times
  • 177Lu-PSMA-R2
Phase I: Dose Escalation Cohort 4Experimental14.8 GBq (400 mCi) up to 4 times
  • 177Lu-PSMA-R2
Phase I: Dose Escalation Cohort 5Experimental18.5 GBq (500 mCi) up to 4 times
  • 177Lu-PSMA-R2
Phase I: Dose Escalation Cohort 6Experimental18.5 GBq (500 mCi) up to 3 times
  • 177Lu-PSMA-R2
Phase II: Dose Expansion CohortExperimentalDose to be chosen from Phase I
  • 177Lu-PSMA-R2

Eligibility Criteria

        Inclusion Criteria:

          -  Male patients, 18 years of age or older

          -  Signed and dated written ICF by the patient or legally acceptable representative prior
             to any study-specific procedures

          -  Histologically confirmed adenocarcinoma of the prostate

          -  Serum testosterone levels < 50 ng/L after surgical or continued chemical castration

          -  Metastatic disease documented by CT/MRI or bone scan (not older than 28 days at
             enrollment) revealing at least one metastatic lymph-node, visceral metastasis and/or
             bone metastasis

          -  Positive 68Ga-PSMA-R2 PET/CT scan for central eligibility assessment. Patients who
             receive 68Ga-PSMA-R2 as part of separate clinical protocol are eligible (must meet all
             study eligibility criteria)

          -  Documented disease progression on or after prior systemic treatment administered for
             the advanced disease including CYP 17 inhibitors and/or androgen-pathway inhibitors
             (i.e. abiraterone and/or enzalutamide when available) and no more than one line of
             chemotherapy for the advanced disease, or patients who were ineligible (unfit) to
             receive chemotherapy. Disease progression defined as increasing serum PSA (per PCWG3),
             radiological progression or ≥ 2 new bone lesions. (Chemical castration is required
             unless surgically orchiectomized.)

          -  At least 28 days elapsed between last anti-cancer treatment administration and the
             initiation of study treatment (except for Luteinizing Hormone-releasing Hormone [LHRH]
             or Gonadotropin-releasing Hormone [GnRH]), or resolution of all previous treatment
             related toxicities to CTCAE version 5.0 grade of ≤ 1 (except for chemotherapy induced
             alopecia and grade 2 peripheral neuropathy or grade 2 urinary frequency which are
             allowed). Prior major surgery must be at least 12 weeks prior to study entry.

          -  Eastern cooperative oncology group (ECOG) performance status of 0-2 with a life
             expectancy ≥ 6 months

          -  Adequate bone marrow reserve and organ function as demonstrated by complete blood
             count, and biochemistry in blood and urine at baseline

               1. Platelet count of >100 x109/L

               2. White blood cell (WBC) count 3,000/mL

               3. Neutrophil count of > 1,500/mL

               4. Hemoglobin ≥ 10 g/dL

               5. Serum creatinine < 1.5 x upper limit normal (ULN) or estimated glomerular
                  filtration rate (GFR) > 50 mL/min based upon Chronic Kidney Disease-Epidemiology
                  Collaboration (CKD-EPI) equation. Patients with estimated GFR between 50 - 60
                  mL/min at baseline will require a 99mTc-DTPA GFR test and only patients with
                  non-obstructive pathology will be included in the study.

               6. Total bilirubin < 3 x ULN (except if confirmed history of Gilbert's disease)

               7. Baseline serum albumin > 30 g/L

               8. Aspartate aminotransferase (AST) < 3 times the ULN

          -  For male patients with partners of childbearing potential, agreement to use barrier
             contraceptive method (condom) and to continue its use for 6 months from receiving the
             last dose of IP

        Exclusion Criteria:

          -  Pathological finding consistent with small cell, neuroendocrine carcinoma of the
             prostate or any other histology different than adenocarcinoma

          -  Previously administered chemotherapy or 223Ra-therapy within the context of diffuse
             bone or bone-marrow involvement (i.e. "superscan" defined as bone scintigraphy in
             which there is excessive skeletal radioisotope uptake [>20 bone lesions] in relation
             to soft tissues along with absent or faint activity in the genitourinary tract due to
             diffuse bone/ bone marrow metastases)

          -  Current severe urinary incontinence, hydronephrosis, severe voiding dysfunction, any
             level of urinary obstruction requiring indwelling/condom catheters

          -  Spinal cord compression or brain metastases

          -  Uncontrolled pain that results in patient's lack of compliance with the imaging
             procedures

          -  Uncontrolled cardiovascular history, defined as:

               -  Congestive heart failure (New York Heart Association [NYHA] II, III, IV)

               -  Mean resting corrected QT interval (QTc) >450 millisecond (msec), obtained from 3
                  ECGs recordings, using the screening clinic ECG machine-derived QTc value.

               -  Any clinically relevant abnormalities in rhythm, conduction, or morphology of
                  resting ECG (e.g., complete left bundle branch block, third-degree heart block,
                  second-degree heart block, PR interval >250 msec).

               -  Any factor increasing the risk of QTc prolongation or risk of arrhythmic events
                  such as heart failure, hypokalemia, congenital long QT syndrome, family history
                  of long QT syndrome, or unexplained sudden death under 40 years of age in
                  first-degree relatives, or any concomitant medication known to prolong the QT
                  interval.

          -  Other known co-existing malignancies except non-melanoma skin cancer unless
             definitively treated and proven no evidence of recurrence for 5 years.

          -  History of deep vein thrombosis and/or pulmonary embolism within 4 weeks of
             enrollment.

          -  Known incompatibility to CT or PET scans.

          -  Any evidence of severe or uncontrolled systemic or psychiatric diseases, including
             uncontrolled hypertension and active bleeding diatheses, which in the Investigator's
             opinion makes it undesirable for the patient to participate in the trial or which
             would jeopardize compliance with the protocol

          -  Active infection including human immunodeficiency virus (HIV) and untreated hepatitis
             B, and hepatitis C. Screening for chronic conditions is not required.

          -  Patients who have received any investigational treatment agent within the last 28
             days.

          -  Known allergies, hypersensitivity, or intolerance to the IP or its excipients

          -  Known history of myelodysplastic syndrome/leukemia at any time

          -  Patient is unlikely to comply with study procedures, restrictions and requirements and
             judged by the Investigator that the patient is not suitable for participation in the
             study.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Male
Healthy Volunteers:No

Primary Outcome Measures

Measure:Phase I: Incidence of dose limiting toxicities (DLTs) during first cycle of study treatment.
Time Frame:Up to 8 weeks after the first 177Lu-PSMA-R2 dose
Safety Issue:
Description:A dose-limiting toxicity (DLT) is defined as a clinically relevant adverse event or abnormal laboratory value where the relationship to study treatment cannot be ruled out, and which is unrelated to disease, disease progression, intercurrent illness, or concomitant medications that occurs within the DLT monitoring period and meets any of the criteria included in Table 5 (Dose Escalation And Stopping Rules).

Secondary Outcome Measures

Measure:Phase I and II: Incidence of Adverse Events (AEs) rate
Time Frame:From randomization till 30 days safety follow-up, assessed up to 5 years (estimated final OS analysis)
Safety Issue:
Description:The distribution of adverse events will be done via the analysis of frequencies for treatment emergent Adverse Event (TEAEs), Serious Adverse Event (TESAEs) and Deaths due to AEs, through the monitoring of relevant clinical and laboratory safety parameters.
Measure:Phase I and II: Objective Response Rate (ORR)
Time Frame:From date of randomization till 30 days safety fup, assessed up to 5 years (estimated final OS analysis)
Safety Issue:
Description:ORR is defined as the proportion of participants with Best Overall Response (BOR) of Complete Response (CR) or Partial Response (PR) according to PCWG3 modified RECIST 1.1.
Measure:Phase I and II: Duration of Response (DoR)
Time Frame:From date of randomization until date of progression or date of death from any cause, whichever come first, assessed up to 5 years (estimated final OS analysis)
Safety Issue:
Description:DOR is defined as the duration of time between the date of first documented response (CR or PR) in soft tissue according to PCWG3 modified RECIST 1.1, and the date of first documented progression or death due to any cause.
Measure:Phase I and II: Prostate-Specific Antigen 30 (PSA30) response rate
Time Frame:Week 13 (12 weeks after the first 177Lu-PSMA-R2 injection)
Safety Issue:
Description:PSA response rate 30 is defined as the proportion of participants who have a greater or equal 30% in PSA from Baseline that is confirmed by a second PSA measurement 4 weeks later, as per Prostate Cancer Working Group 3 (PCWG3) modified RECIST 1.1 criteria.
Measure:Phase I: Prostate-Specific Antigen 50 (PSA50) response rate
Time Frame:Week 13 (12 weeks after the first 177Lu-PSMA-R2 injection)
Safety Issue:
Description:PSA response rate 50 is defined as the proportion of participants who have a greater or equal 50% in PSA from Baseline that is confirmed by a second PSA measurement 4 weeks later, as per Prostate Cancer Working Group 3 (PCWG3) modified RECIST 1.1 criteria.
Measure:Phase 1: 177Lu-PSMA-R2 plasma concentration
Time Frame:Days 1 through 8 post-treatment
Safety Issue:
Description:
Measure:Phase I: Maximum plasma concentration (Cmax) of 177Lu-PSMA-R2
Time Frame:Day 1 (before the start of infusion, at the mid-point, and just before the end of infusion, then at post infusion at approximately 5, 15, 30 minutes, 1, 2, 4, 6, 8, 24, 40 (+/- 4 hours), 48 hours), Day 4 (+2 days) and Day 8 post end of infusion
Safety Issue:
Description:Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Cmax will be listed and summarized using descriptive statistics.
Measure:Phase I: Minimum plasma concentration (Cmin) of 177Lu-PSMA-R2
Time Frame:Day 1 (before the start of infusion, at the mid-point, and just before the end of infusion, then at post infusion at approximately 5, 15, 30 minutes, 1, 2, 4, 6, 8, 24, 40 (+/- 4 hours), 48 hours), Day 4 (+2 days) and Day 8 post end of infusion
Safety Issue:
Description:Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Cmin will be listed and summarized using descriptive statistics.
Measure:Phase I: Area under the plasma concentration-time curve (AUC) of 177Lu-PSMA-R2
Time Frame:Day 1 (before the start of infusion, at the mid-point, and just before the end of infusion, then at post infusion at approximately 5, 15, 30 minutes, 1, 2, 4, 6, 8, 24, 40 (+/- 4 hours), 48 hours), Day 4 (+2 days) and Day 8 post end of infusion
Safety Issue:
Description:Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. AUC will be listed and summarized using descriptive statistics.
Measure:Phase 1: Dosimetry
Time Frame:Days 1 through 8 post-treatment
Safety Issue:
Description:Radiation (Gy, Gy/MBq) update by critical organs and metastatic lesions
Measure:Phase I and II: Patient Reported Outcomes (PRO) of Mouth Dryness using Xerostomia Questionnaire
Time Frame:Prior to dosing on Day 1 and every 12 weeks until 1 year after disease progression or early study termination whichever comes first
Safety Issue:
Description:The Xerostomia questionnaire is a questionnaire used to describe mouth dryness and its effects on daily life. It consists of 8 questions with each question score ranging from 0 ("never"/"none") to 10 ("worst"). The sum of the 8 scores produces a total score (score range from 0-80). A low score corresponds to a good quality of life while a high score means a poor quality of life due to the dry mouth.
Measure:Phase I and II: Patient Reported Outcomes (PRO) of Eye Dryness using Xerophthalmia Questionnaire
Time Frame:Prior to dosing on Day 1 and every 12 weeks until 1 year after disease progression or early study termination whichever comes first
Safety Issue:
Description:The Xerophthalmia questionnaire is a questionnaire used to describe eye dryness and its effects on daily life. It consists of 3 questions. The first 2 questions scores range from 1 ("never") to 4 ("constantly") and the last question is a Yes/No question about previous dry eye diagnosis. The sum of the scores of the first 2 questions produces a total score (score range from 2-8). A low score corresponds to a good quality of life while a high score means a poor quality of life due to the dry eye.
Measure:Phase I and II: Brief Pain Inventory-short Form (PBI-SF)
Time Frame:Prior to dosing on Day 1 and every 12 weeks until 1 year after disease progression or early study termination whichever comes first
Safety Issue:
Description:The BPI-SF is a publicly available instrument to assess the pain and includes severity and interference scores. BPI-SF is an 11-item self report questionnaire that is designed to assess the severity and impact of pain on daily functions of a participant. Pain severity score is a mean value for BPI-SF questions 3, 4, 5 and 6 (questions inquiring about the extent of pain, where the extent is ranked from 0 [no pain] to 10 [pain as bad as you can imagine]). Pain severity progression is defined as an increase in score of 30% or greater from baseline without decrease in analgesic use.
Measure:Phase II: Disease Control Rate (DCR)
Time Frame:From date of randomization till 30 days safety fup, assessed up to 5 years (estimated final OS analysis)
Safety Issue:
Description:DCR is defined as the proportion of participants with Best Overall Response (BOR) of Complete Response (CR) or Partial Response (PR) or Stable Disease (SD) in soft tissue according to PCWG3 modified RECIST 1.1.
Measure:Phase II: Radiographic Progression Free Survival (rPFS)
Time Frame:From date of randomization until date of radiographic progression or date of death from any cause, whichever comes first, assessed up to 50 months (estimated final OS analysis)
Safety Issue:
Description:rPFS is defined as the time to radiographic progression by PCWG3-modified RECIST v1.1 or death.
Measure:Phase II: Overall Survival (OS)
Time Frame:From date of randomization until date of death from any cause, assessed up to 5 years (estimated final OS analysis)
Safety Issue:
Description:OS is defined as the time to death for any cause.
Measure:Phase II: Time to Prostate Specific Antigen (PSA) progression
Time Frame:From date of randomization until date of death from any cause, assessed up to 5 years (estimated final OS analysis)
Safety Issue:
Description:PSA progression is defined as the time from the date of first dose of 177Lu-PSMA-R2 injection to the first date that a >= 25% increase in PSA and an absolute increase of 2 ng/mL or more from the nadir was documented and confirmed by a second consecutive value obtained 3 or more weeks later.
Measure:Phase II: Change from Baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) Score
Time Frame:Prior to dosing on Day 1 and every 12 weeks until 1 year after disease progression or early study termination whichever comes first
Safety Issue:
Description:The EORTC QLQ-C30 contains 30 questions assessed by the participant. There are 9 multiple-item scales: 5 scales that assess aspects of functioning (physical, role functioning, cognitive, emotional, and social); 3 symptom scales (Fatigue, Pain, and Nausea and Vomiting); and a global health status/Quality of Life (QOL) scale. There are 5 single-item measures assessing additional symptoms (i.e., dyspnea, loss of appetite, insomnia, constipation, and diarrhea) and a single item concerning perceived financial impact of the disease. All but two questions have 4 point scales ranging from "Not at all" to "Very much." The two questions concerning global health status/ QOL have 7 point scales with ratings ranging from "Very poor" to "Excellent." For each of the 14 domains, final scores are transformed such that they range from 0-100, where higher scores indicate improvement.
Measure:Phase II: Change from Baseline in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Prostate Module (EORTC QLQ-PR25) Score
Time Frame:Prior to dosing on Day 1 and every 12 weeks until 1 year after disease progression or early study termination whichever comes first
Safety Issue:
Description:The EORTC QLQ-PR25 is a prostate cancer module for the assessment of health-related quality of life (HRQoL). It consists of 25 questions distributed on 6 domains: urinary symptoms (8 items), incontinence aid (1 item), bowel symptoms (4 items), hormonal treatment-related symptoms (HTRS) (6 items), sexual activity (2 items), and sexual functioning (4 items). Questions use a 4 point scale (1 'Not at all' to 4 'Very much'). All raw domain scores are linearly transformed to a 0-100 scale, with higher scores reflecting either more symptoms (urinary, bowel, hormonal treatment-related symptoms) or higher levels of activity or functioning (sexual).

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Advanced Accelerator Applications

Trial Keywords

  • Genital Neoplasms, Male
  • Urogenital Neoplasms
  • Neoplasms by Site
  • Neoplasms
  • Prostatic Diseases
  • Cancer of Prostate
  • Cancer of the Prostate
  • Neoplasms, Prostate
  • Neoplasms, Prostatic
  • Prostate Cancer
  • Prostate Neoplasms
  • Prostatic Cancer
  • Prostate-Specific Membrane Antigen
  • PSMA
  • PSMA radioligand therapy

Last Updated

July 13, 2021