Description:
This is a prospective, open-label, randomized, cross-over, pilot study of reprogramming
therapy in patients with recurrent PCa based on rising PSA only. The primary objectives are
to compare the disease progression-free rate at the end of 12 weeks between 5-AZA+ATRA and no
therapy and to assess safety of the 5-AZA and ATRA combination. All study enrollees will
receive Lupron. After one month, they will be assigned in a 1:1 randomization to either the
'5-AZA+ATRA' group or the 'no therapy' group. Patients in the '5-AZA + ATRA' group will
receive treatment on a 28-day cycle, in the absence of prohibitive toxicities, for 3 cycles.
Patients will initially be observed for 3 cycles under either no therapy or combination
therapy, before crossing over to receive the opposite treatment for another 3 cycles in the
absence of prohibitive toxicities. After the treatment period, all patients will be followed
for a total of 24 months from the start of the study or until the events leading to
discontinuation are observed.
Title
- Brief Title: A Pilot Study of 5-AZA and ATRA for Prostate Cancer With PSA-only Recurrence After Local Treatment
- Official Title: A Pilot Study of the Combination of 5-azacitidine (5-AZA) and All-trans Retinoic Acid (ATRA) for Prostate Cancer (PCa) With PSA-only Recurrence After Definitive Local Treatment
Clinical Trial IDs
- ORG STUDY ID:
GCO 16-0752
- NCT ID:
NCT03572387
Conditions
- Prostatic Neoplasms
- Prostate Neoplasms
- Prostate Cancer
Interventions
Drug | Synonyms | Arms |
---|
5-Azacitidine | 5-AZA | (5-AZA) + (ATRA) combination |
all trans retinoic acid | ATRA | (5-AZA) + (ATRA) combination |
Lupron | | (5-AZA) + (ATRA) combination |
Purpose
This is a prospective, open-label, randomized, cross-over, pilot study of reprogramming
therapy in patients with recurrent PCa based on rising PSA only. The primary objectives are
to compare the disease progression-free rate at the end of 12 weeks between 5-AZA+ATRA and no
therapy and to assess safety of the 5-AZA and ATRA combination. All study enrollees will
receive Lupron. After one month, they will be assigned in a 1:1 randomization to either the
'5-AZA+ATRA' group or the 'no therapy' group. Patients in the '5-AZA + ATRA' group will
receive treatment on a 28-day cycle, in the absence of prohibitive toxicities, for 3 cycles.
Patients will initially be observed for 3 cycles under either no therapy or combination
therapy, before crossing over to receive the opposite treatment for another 3 cycles in the
absence of prohibitive toxicities. After the treatment period, all patients will be followed
for a total of 24 months from the start of the study or until the events leading to
discontinuation are observed.
Trial Arms
Name | Type | Description | Interventions |
---|
(5-AZA) + (ATRA) combination | Experimental | Combination of 5-Azacitidine (5-AZA) + all trans retinoic acid (ATRA) group after one month of Lupron, group will receive treatment on a 28-day cycle, in the absence of prohibitive toxicities, for 3 cycles. | - 5-Azacitidine
- all trans retinoic acid
- Lupron
|
Lupron only | Active Comparator | No treatment after one month of Lupron | |
Eligibility Criteria
Inclusion Criteria:
- Histologically confirmed adenocarcinoma of the prostate
- Rising PSA
- PSADT ≤ 10 months prior to initiation of ADT
- No evidence of regional or active distant metastases, except for regional metastasis
where salvage radiation therapy is not an option
- Indication for ADT after receiving definitive local therapy
- Males ≥ 18 years.
- ECOG performance status of ≤ 2
- Men must agree to use a condom and not father a child or donate sperm for the duration
of the study and for 90 days after completion of therapy
- Ability to understand and the willingness to sign a written informed consent
- Ability to adhere to the study visit schedule and requirements of the protocol
Exclusion Criteria:
- Patients who have received ADT and/or other chemotherapy within 3 months prior to
entering the study.
- Patients who have had radiotherapy or surgery within 4 weeks prior to entering the
study. Minimally-invasive procedures for the purpose of diagnosis or staging of the
disease are permitted.
- Patients may not be receiving any other investigational agents.
- Patients with known brain metastases should be excluded from this clinical trial
because of their poor prognosis and because they often develop progressive neurologic
dysfunction that would confound the evaluation of neurologic and other adverse events.
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to 5-AZA and ATRA.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements.
- Significant active cardiac disease within the previous 6 months
- Inadequate organ and marrow function as defined below:
- leukocytes ≤ 3,000/mcL
- absolute neutrophil count ≤ 1,500/mcL
- platelets ≤ 100,000/mcl
- total bilirubin above normal institutional limits
- AST(SGOT)/ALT(SPGT) ≥ 2.5 X institutional upper limit of normal
- creatinine above normal institutional limits
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: | Baseline and 24 weeks |
Safety Issue: | |
Description: | Proportion of patients with PSA response, as defined by PSA decreased > 30% from baseline. |
Secondary Outcome Measures
Measure: | Proportion of patients with prolongation of PSA doubling time (PSADT) post-treatment (compared to baseline) |
Time Frame: | 24 weeks |
Safety Issue: | |
Description: | PSADT measured at baseline and after treatment with 3 cycles of Aza and ATRA |
Measure: | Measurement of TGFβ2 dormancy biomarker levels |
Time Frame: | up to 24 months |
Safety Issue: | |
Description: | The measurement of dormancy biomarker levels in relation to disease states: tumor progression and disease progression. |
Measure: | Measurement of BMP7 dormancy biomarker levels |
Time Frame: | up to 24 months |
Safety Issue: | |
Description: | The measurement of dormancy biomarker levels in relation to disease states: tumor progression and disease progression. |
Measure: | Measurement of BMP4 dormancy biomarker levels |
Time Frame: | up to 24 months |
Safety Issue: | |
Description: | The measurement of dormancy biomarker levels in relation to disease states: tumor progression and disease progression. |
Measure: | Measurement of GAS6 dormancy biomarker levels |
Time Frame: | up to 24 months |
Safety Issue: | |
Description: | The measurement of dormancy biomarker levels in relation to disease states: tumor progression and disease progression. |
Measure: | Measurement of retinoic acid dormancy biomarker levels |
Time Frame: | up to 24 months |
Safety Issue: | |
Description: | The measurement of dormancy biomarker levels in relation to disease states: tumor progression and disease progression. |
Measure: | Measurement of NR2F1 dormancy biomarker levels |
Time Frame: | up to 24 months |
Safety Issue: | |
Description: | The measurement of dormancy biomarker levels in relation to disease states: tumor progression and disease progression. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Icahn School of Medicine at Mount Sinai |
Trial Keywords
- Prostate Neoplasms
- Prostatic Neoplasms
- 5-Azacitidine
- all-trans retinoic acid
- PSA
Last Updated
February 23, 2021