Description:
The objective of this study is to determine the maximum safe dose of Ra-223 in combination
with fractionated (split doses) docetaxel when given to subjects and to determine the best
administering dose. The study will look at side effects that may happen while taking the
combination treatment. A total of approximately 18 subjects will take part in the dose
escalation part of the study and an additional 25 subjects will participate in the expansion
cohort. This study will be conducted across four centers in the United States.
Title
- Brief Title: Fractionated Docetaxel and Radium 223 in Metastatic Castration-Resistant Prostate Cancer
- Official Title: A Phase I Trial of Fractionated Docetaxel and Radium 223 in Metastatic Castration-Resistant Prostate Cancer (CRPC)
Clinical Trial IDs
- ORG STUDY ID:
IIR-US-2016-3279
- NCT ID:
NCT03737370
Conditions
- Metastatic Castrate Resistant Prostate Cancer
Interventions
Drug | Synonyms | Arms |
---|
Docetaxel | Fractionated Docetaxel | Dose escalation |
Purpose
The objective of this study is to determine the maximum safe dose of Ra-223 in combination
with fractionated (split doses) docetaxel when given to subjects and to determine the best
administering dose. The study will look at side effects that may happen while taking the
combination treatment. A total of approximately 18 subjects will take part in the dose
escalation part of the study and an additional 25 subjects will participate in the expansion
cohort. This study will be conducted across four centers in the United States.
Detailed Description
The primary objective of this study is to assess the safety and toxicity of a fractionated
docetaxel schedule in combination with standard Ra-223.
Secondary Objectives include: assessment of progression-free survival, time to treatment
failure, overall survival, ability of subjects to complete 6 cycles of the combination
therapy, assessment of Prostate Specific Antigen (PSA) kinetics and objective responses
(measurable disease), assessment of quality of life and assessment of bone bio-marker
outcomes.
The study features a 4-week lead-in period with docetaxel monotherapy to assess for docetaxel
intolerance. The lead-in period is then followed by combination therapy with Ra-223 every 4
weeks for 6 cycles in a traditional Phase I dose-escalation design.
A provision has been made to include prophylactic granulocyte colony stimulating factor
(G-CSF) cohorts after the lead-in period if neutropenia is the dose limiting toxicity at
either dose level.
The investigators hypothesize that the fractionated dosing of docetaxel will significantly
mitigate the hematologic toxicity, preserve antineoplastic activity and allow for maintenance
of the 4-weekly Ra-223 schedule.
Trial Arms
Name | Type | Description | Interventions |
---|
Dose escalation | Experimental | There are four dose cohorts (1, 1a, 2, 2a) in this arm and two dose levels of docetaxel (40mg/m^2 [level 1] and 50mg/m^2 [level 2]). Dosing of Radium 223 remains the same in all cohorts (55 KBq/kg given every 28 days for 6 cycles).
Maximum tolerated dose (MTD) of docetaxel will be assessed. MTD is defined as the highest dose-level, among those tested, associated with a rate of less than a 33% dose limiting toxicity (DLT). | |
Dose expansion | Experimental | If the maximum tolerated dose (MTD) of docetaxel is found in arm 1, this dose level will be expanded to include an additional 25 subjects to confirm the safety and explore the preliminary anti-cancer effect. If the MTD is not identified, the study will be stopped and the expansion cohort will not be accrued. | |
Eligibility Criteria
Inclusion Criteria:
1. Histologically or cytologically confirmed adenocarcinoma of the prostate
2. Documented metastatic castration resistant disease with PSA progression, radiographic
progression, or both, despite medical or surgical castration
3. Two or more bone metastases detected on skeletal scintigraphy
4. Eligible for docetaxel chemotherapy
5. ECOG Performance Status 0-2
6. Adequate organ function:
1. Hemoglobin > 10 g/dL
2. Absolute Neutrophil Count ≥ 1,500 K/mL
3. Platelet count ≥ 150,000 x 10^9/L
4. Total bilirubin ≤ 1.5x upper limit of normal range, excluding Gilbert syndrome
5. Serum AST ≤ 1.5 x upper limit of normal range
6. Serum ALT ≤ 1.5 x upper limit of normal range
7. Estimated glomerular filtration rate (GFR) > 30mL/min
8. Ongoing castration (androgen deprivation therapy or prior orchiectomy)
9. Male subjects with female sexual partners of childbearing potential must agree to use
at least one highly effective methods of birth control.
10. Ability to understand and willingness to sign an informed consent form prior to
initiation of any study procedures.
11. Age ≥ 18 years
Exclusion Criteria:
1. Prior radionuclide therapy for CRPC
2. Prior docetaxel for CRPC. (Permitted if given for castration sensitive disease > 6
months prior).
3. Antiandrogen therapy within 4 weeks of enrollment. However, patients with primary
failure of secondary anti-androgen therapy OR symptomatic progression, objective
progression and/or biochemical evidence of rising PSA less than 4 weeks after
discontinuation of anti-androgen therapy will not have anti-androgen withdrawal
responses and will not be excluded.
4. Preexisting peripheral neuropathy grade 2 or higher.
5. Other serious medical condition as judged by the investigator.
6. Active second malignancy that requires therapy.
7. Known brain or leptomeningeal metastases
8. Concurrent enrollment in any other investigational anticancer therapy
9. Treatment with any myelosuppressive agent within 30 days of enrollment
10. Presence of bulky visceral metastases, defined as any of the following:
1. ≥ 4 lung lesions (at least 1cm each in size in the longest diameter) or pulmonary
lymphangitic metastasis
2. Liver metastases with sum of lesion diameters totaling ≥ 5cm
11. Evidence of neuroendocrine or small cell differentiation on prior biopsy
12. History of severe hypersensitivity reactions to docetaxel or to drugs formulated with
polysorbate 80
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Incidence of Dose Limiting Toxicities (DLT) |
Time Frame: | Up to 29 Days |
Safety Issue: | |
Description: | DLT is defined as a subject in any cohort experiencing any of the following adverse events during cycle 1 of treatment, until cycle 2 day 1 of treatment: Thrombocytopenia (platelets < 75 x 10^9/L on C1D15 or < 100 x 10^9/L on C2D1), Neutropenia (ANC < 1000 K/mL on C1D15 or ANC < 1500 K/mL on C2D1), Grade 3 (by CTCAE v4) fatigue lasting ≥ 7 days, other non-hematologic toxicity ≥ grade 3, lasting ≥ 48 hours at least possibly related to treatment, or any toxicity (non-hematologic or hematologic) at least possibly related to treatment requiring dose reduction or dose interruption. |
Secondary Outcome Measures
Measure: | Efficacy, assessed as non-progression/progression rate according to prostate cancer working group (PCWG2) criteria |
Time Frame: | From date of randomization until the date of first documented progression or death from any cause, whichever came first, assessed up to 25 years |
Safety Issue: | |
Description: | Time to progression of disease, calculated as a time-to-event endpoint |
Measure: | Progression Free Survival (PFS) |
Time Frame: | Up to 25 years |
Safety Issue: | |
Description: | Progression free survival is defined as the interval from first dose date of study drug to the earlier of the first documentation of definitive disease progression (assessed per PCWG2) or death from any cause |
Measure: | Time to Treatment Failure (TTTF) |
Time Frame: | Up to 25 years |
Safety Issue: | |
Description: | A measurement from the date of randomization to the first event which meets the criteria for disease progression (assessed per PCWG2 criteria) or death from any cause |
Measure: | Overall Survival |
Time Frame: | Up to 25 years |
Safety Issue: | |
Description: | Overall survival is defined as the interval from first dose date of study drug to death from any cause. |
Measure: | Proportion of Randomized Subjects to Complete Combination Therapy on Schedule per Protocol |
Time Frame: | Up to 28 weeks |
Safety Issue: | |
Description: | The number of subjects who were able to receive both lead-in doses of docetaxel and all 6 cycles of combination docetaxel and Ra223 on time (+/- 7 days). |
Measure: | Response to treatment, as assessed by prostate-specific antigen (PSA) Kinetics and Objective Responses |
Time Frame: | From date of randomization until the date of first documented progression or death from any cause, whichever came first, assessed up to 25 years |
Safety Issue: | |
Description: | Measurable disease calculated at each time point in which the data is collected. We will use mixed effect models to explore the temporal trajectories for the outcome changes over time in response to the treatment. |
Measure: | Satisfaction, as assessed by Quality of Life Questionnaires |
Time Frame: | From date of randomization until the date of first documented progression or death from any cause, whichever came first, assessed up to 25 years |
Safety Issue: | |
Description: | Measured by the Brief Pain Inventory (BPI) and Functional Assessment of Cancer Therapy (FACT-G) Questionnaires |
Measure: | Response to Treatment, as assessed by Bone Bio-marker Outcomes |
Time Frame: | Up to 28 weeks |
Safety Issue: | |
Description: | Measurement of bone-specific alkaline phosphatase and urine N-telopeptides (laboratory testing) |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Tufts Medical Center |
Trial Keywords
Last Updated
February 1, 2021