Description:
The purpose of this study is to determine the efficacy of BAT in men with metastatic
castrate-resistant prostate cancer (mCRPC) and homologous recombination deficiency (HRD).
Bipolar androgen therapy will be administered to men confirmed to have HRD on tumour tissue
and/or circulating tumour DNA analysis on pre-screening. In addition, the combination with
carboplatin will be tested in me that are HRD negative
Title
- Brief Title: Bipolar Androgen Therapy +/- Carboplatin in mCRPC With/Without Homologous Recombination Deficiency
- Official Title: High Dose Testosterone +/- Carboplatin in Men With Advanced Prostate Cancer With/Without Homologous Recombination Deficiency
Clinical Trial IDs
- ORG STUDY ID:
HiTECH
- NCT ID:
NCT03522064
Conditions
- Castration-resistant Prostate Cancer
- Homologous Recombination Deficiency
Interventions
Drug | Synonyms | Arms |
---|
Testosterone Enanthate 100 MG/ML Injectable Solution | Primoteston Depot | High dose testosterone |
Testosterone Enanthate 100 MG/ML Injectable Solution / Carboplatin AUC 5 | | High dose testosterone + Carbolplatin (non HRD) |
Purpose
The purpose of this study is to determine the efficacy of BAT in men with metastatic
castrate-resistant prostate cancer (mCRPC) and homologous recombination deficiency (HRD).
Bipolar androgen therapy will be administered to men confirmed to have HRD on tumour tissue
and/or circulating tumour DNA analysis on pre-screening. In addition, the combination with
carboplatin will be tested in me that are HRD negative
Detailed Description
Androgen deprivation therapy (ADT) remains the mainstay of prostate cancer treatment. Though
an effective therapy initially, the side effects of ADT are numerous and treatment resistance
is inevitable. Castrate-refractory prostate cancer (CRPC) progresses via adaptive mechanisms
that allow ongoing androgen receptor (AR) signalling despite castrate levels of androgens.
The concept of cycling between supra- and sub physiological levels of testosterone has been
tested recently in studies of "bipolar androgen therapy" (BAT) in which patients are given
high dose testosterone in combination with androgen deprivation therapy (ADT) via an LHRH
agonist/antagonist. Studies of BAT using IM testosterone have been promising both in terms of
PSA responses and quality of life improvements. Additionally, these early phase studies
suggest the potential for re-sensitisation to novel anti-androgen therapies.
Though responses have been positive in these early studies a proportion of men fail to
respond and data to guide patient selection is lacking. There are data to suggest that
patients with DNA repair deficits may be particularly responsive to BAT. Whether these
changes serve as predictors of response is unknown as the effect of BAT on the tumour, its
microenvironment and peripheral circulating tumour DNA has not been studied in detail.
Information on treatment effects may be key to appropriate patient selection for this
treatment.
The aim of this study is to assess homologous repair deficiency as a predictive biomarker of
response to bipolar androgen therapy in men with metastatic castrate-refractory prostate
cancer and to study the effects of this treatment on ctDNA and intra-tumoural gene
expression.
In addition, based on the pre-clinical studies, the combination with carboplatin will be
tested in men that are HRD negative
Trial Arms
Name | Type | Description | Interventions |
---|
High dose testosterone | Experimental | 500mg IM enanthate every 4 weeks in combination with ongoing LHRH agent (unless post-orchidectomy). | - Testosterone Enanthate 100 MG/ML Injectable Solution
|
High dose testosterone + Carbolplatin (non HRD) | Experimental | 500mg IM enanthate every 4 weeks in combination with ongoing LHRH agent (unless post-orchidectomy) plus Carboplatin AUC 5 | - Testosterone Enanthate 100 MG/ML Injectable Solution
- Testosterone Enanthate 100 MG/ML Injectable Solution / Carboplatin AUC 5
|
Eligibility Criteria
Inclusion Criteria:
1. Males with histologically confirmed adenocarcinoma of the prostate
2. Confirmed HRD (Homologous recombination defect) in germline and/or somatic DNA
analysis (tumour or blood), by a validated assay (see Appendix 1). Mutations in HR
genes not listed in appendix 1 will be considered in literature suggests
pathogenicity. A maximum of 10 uncharacterised or heterozygous mutations will be
included.
3. Age ≥ 18 years
4. ECOG performance status ≤ 1
5. Rising PSA confirmed on two sequential tests ≥1 week apart and a minimum value of 2
ug/L despite castrate levels of testosterone
6. Serum testosterone < 1.7 nmol/L and on an LHRH agent or post orchidectomy ≥ 1 year.
7. Washout of ≥ 4 weeks from prior line of treatment, radiotherapy or surgery (aside from
LHRH agent)
8. Adequate bone marrow function (platelets > 100 x 109/L, ANC > 1.5 x 109/L, Hb >100)
9. Adequate liver function (ALT/AST < 1.5 x ULN, bilirubin < 2 x ULN)
10. Adequate renal function (creatinine clearance > 50 ml/min)
11. Adequate cardiac function and reserve after cardiology assessment
12. Archived tissue sample available or willingness to undergo fresh biopsy
13. Willing and able to comply with all study requirements, including treatment, timing
and/or nature of required assessments
14. Signed, written informed consent
Exclusion Criteria:
1. Contraindications to investigational product
2. Pain due to metastatic prostate cancer requiring opioid analgesics
3. Evidence of disease progression in sites or extent that, in the opinion of the
investigator, would put the patient at risk from testosterone therapy and its
potential for initial tumour flare (eg: femoral metastasis at risk of fracture,
ureteric obstruction due to nodal disease or cord compression due to spinal
metastases).
4. Previous treatment with platinum chemotherapy and/or a PARP inhibitor. However up to 8
men with prior treatment to these agents will be included as an exploratory cohort.
5. Life expectancy of less than 3 months.
6. Brain metastases or leptomeningeal disease
7. History of thromboembolic event and not currently on anticoagulation
8. Prior myocardial infarction or unstable angina within 2 years of study entry
9. Haematocrit ≥ 50%, untreated severe obstructive sleep apnoea or poorly controlled
heart failure (NYHA >1)
10. History of another malignancy within 5 years prior to registration. Patients with a
past history of adequately treated carcinoma-in-situ, basal cell carcinoma of the
skin, squamous cell carcinoma of the skin, or superficial transitional cell carcinoma
of the bladder are eligible. Patients with a history of other malignancies are
eligible if they have been continuously disease free for at least 5 years after
definitive primary treatment.
11. Concurrent illness, including severe infection that may jeopardize the ability of the
patient to undergo the procedures outlined in this protocol with reasonable safety.
12. Presence of any psychological, familial, sociological or geographical condition
potentially hampering compliance with the study protocol and follow-up schedule,
including alcohol dependence or drug abuse.
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: | 1 year |
Safety Issue: | |
Description: | >/= 50% fall from baseline PSA |
Secondary Outcome Measures
Measure: | Time to PSA progression |
Time Frame: | 1 year |
Safety Issue: | |
Description: | Time to increase in PSA >/=25% from baseline or nadir confirmed on subsequent test >1 week later |
Measure: | Quality of Life |
Time Frame: | 1 year |
Safety Issue: | |
Description: | FACT-P |
Measure: | Radiological Response Rate |
Time Frame: | 1 year |
Safety Issue: | |
Description: | RECIST or PCWG3 Criteria |
Measure: | Safety and Tolerability (Frequency of adverse events as assessed by NCI CTCAE v4.0) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | Frequency of adverse events as assessed by NCI CTCAE v4.0 |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | St Vincent's Hospital, Sydney |
Trial Keywords
- Castrate-resistant prostate cancer
- bipolar androgen therapy
- homologous recombination deficiency
- BRCA
Last Updated
March 26, 2021