Clinical Trials /

Maximizing Responses to Anti-PD1 Immunotherapy With PSMA-targeted Alpha Therapy in mCRPC

NCT04946370

Description:

This is a phase I/II study investigating the combination of 225Ac-J591 (a drug that can deliver radiation to prostate cancer cells) with pembrolizumab (immunotherapy, a drug that increases the immune system's ability to destroy cancer cells). This study will assess whether 225Ac-J591 + pembrolizumab + androgen receptor pathway inhibitor (ARPI) is more effective against prostate cancer than pembrolizumab + ARPI alone.

Related Conditions:
  • Prostate Adenocarcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Maximizing Responses to Anti-PD1 Immunotherapy With PSMA-targeted Alpha Therapy in mCRPC
  • Official Title: Phase I/II Trial of Pembrolizumab and Androgen-receptor Pathway Inhibitor With or Without 225Ac-J591 for Progressive Metastatic Castration Resistant Prostate Cancer

Clinical Trial IDs

  • ORG STUDY ID: 20-08022500
  • NCT ID: NCT04946370

Conditions

  • Prostate Cancer

Interventions

DrugSynonymsArms
225Ac-J591Pembrolizumab + 225Ac-J591 + ARPI
PembrolizumabPembrolizumab + 225Ac-J591 + ARPI
Androgen receptor pathway inhibitorPembrolizumab + 225Ac-J591 + ARPI

Purpose

This is a phase I/II study investigating the combination of 225Ac-J591 (a drug that can deliver radiation to prostate cancer cells) with pembrolizumab (immunotherapy, a drug that increases the immune system's ability to destroy cancer cells). This study will assess whether 225Ac-J591 + pembrolizumab + androgen receptor pathway inhibitor (ARPI) is more effective against prostate cancer than pembrolizumab + ARPI alone.

Detailed Description

      This clinical trial is for men with progressive metastatic castration-resistant prostate
      cancer (mCRPC). The primary objectives of the study are to determine the optimal dose of
      225Ac-J591 when combined with pembrolizumab (phase I) and then to assess whether the
      combination of 225Ac-J591, pembrolizumab, and androgen receptor pathway inhibitor (ARPI) is
      more effective against prostate cancer than pembrolizumab and ARPI alone. 225Ac-J591 is a
      radionuclide conjugate involving Actinium-225 linked to J591, an antibody that recognizes
      prostate-specific membrane antigen (PSMA) on the surface of cancer cells; 225Ac-J591 is able
      to deliver powerful radiation to cancer cells. Pembrolizumab is a drug that strengthens the
      body's immune response to cancer cells. In the phase I portion of the study, two cohorts of
      up to 6 patients each will receive combined therapy: ARPI (standard dosing schedule),
      pembrolizumab (400 mg every 6 weeks), 225Ac-J591 (single dose, either 65 or 90 KBq/kg).
      Following a minimum of 12 weeks of safety follow-up, the study team will determine which
      225Ac-J591 dose is better. In the phase II portion, patients will be randomized to
      pembrolizumab + ARPI with or without 225Ac-J591. The primary endpoint for phase II will be
      response - a composite of PSA, circulating tumor cell (CTC) count, and imaging changes.
      Patients who achieve at least one of the criteria will be considered responders. Imaging (CT
      scan, bone scan) will occur every 12 weeks. Additionally, participants will undergo
      68Ga-PSMA-11 PET/CT scan prior to therapy and at 12 weeks. Patients are able to receive
      pembrolizumab every 6 weeks for maximum 18 cycles (approximately 2 years).
    

Trial Arms

NameTypeDescriptionInterventions
Pembrolizumab + 225Ac-J591 + ARPIExperimentalPatients will receive one dose of 225Ac-J591 (single dose, either 65 or 90 Kbq/kg) in combination with pembrolizumab (400mg every 6 weeks) and ARPI (standard dose schedule, examples of ARPI include enzalutamide and apalutamide).
  • 225Ac-J591
  • Pembrolizumab
  • Androgen receptor pathway inhibitor
Pembrolizumab + ARPIExperimentalPatients will receive pembrolizumab (400mg every 6 weeks) and ARPI (standard dose schedule) without 225Ac-J591.
  • Pembrolizumab
  • Androgen receptor pathway inhibitor

Eligibility Criteria

        Inclusion Criteria:

          -  Male participants who are at least 18 years of age on the day of signing informed
             consent with histologically confirmed diagnosis of prostate adenocarcinoma.

          -  A male participant must agree to use a contraception during the treatment period and
             for at least 4 months after the last dose of study treatment and refrain from donating
             sperm during this period.

          -  Documented progressive metastatic CRPC based on Prostate Cancer Working Group 3
             (PCWG3) criteria, which includes at least one of the following criteria: PSA
             progression, Objective radiographic progression in soft tissue, New bone lesions

          -  ECOG performance status of 0-1

          -  Have serum testosterone < 50 ng/dL. Subjects must continue primary androgen
             deprivation with an LHRH/GnRH analogue (agonist/antagonist) if they have not undergone
             orchiectomy.

          -  Have previously been treated with at least one of the following in any disease state:
             Androgen receptor signaling inhibitor (such as enzalutamide), CYP 17 inhibitor (such
             as abiraterone acetate). These drugs may have been initiated in the metastatic hormone
             sensitive or non-metastatic (M0) CRPC setting provided they meet criteria for
             progressive mCRPC at study entry.

          -  Age > 18 years

          -  Patients must have normal organ and marrow function as defined: Absolute neutrophil
             count >2,000 cells/mm3, Hemoglobin ≥9 g/dL, Platelet count >150,000 x 109/mcL, Serum
             creatinine <1.5 x upper limit of normal (ULN) or calculated creatinine clearance ≥ 50
             mL/min/1.73 m2 by Cockcroft-Gault, Serum total bilirubin <1.5 x ULN (unless due to
             Gilbert's syndrome in which case direct bilirubin must be normal), Serum AST and ALT
             <3 x ULN in absence of liver metastases; < 5x ULN if due to liver metastases (in both
             circumstances bilirubin must meet entry criteria), Serum internalized normalized ratio
             (INR) OR prothrombin time (PT) AND activated partial thromboplastin time (aPTT) must
             be <1.5 x ULN unless participant is receiving anticoagulant therapy as long as PT or
             aPTT is within therapeutic range of intended use of anticoagulants.

          -  Ability to understand and the willingness to sign a written informed consent document.

        Exclusion Criteria:

          -  Prior receipt of chemotherapy for castration-resistant prostate cancer. Prior receipt
             of docetaxel chemotherapy in the hormone sensitive setting or for localized disease is
             acceptable.

          -  Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti PD L2 agent or with
             an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4,
             OX 40, CD137).

          -  Has active autoimmune disease that has required systemic treatment in the past 2 years
             (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive
             drugs). Replacement therapy (eg., thyroxine, insulin, or physiologic corticosteroid
             replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a
             form of systemic treatment and is allowed.

          -  Prior bone-seeking beta-emitting radioisotopes (e.g. Sm-153, Sr-89) or investigational
             PSMA-targeted therapy; prior radium-223 is allowed provided last dose administered >12
             weeks prior to C1D1 on this study

          -  Has a history of a second malignancy, unless potentially curative treatment has been
             completed with no evidence of malignancy for 2 years.

          -  Known history of myelodysplastic syndrome

          -  Has a known history of Human Immunodeficiency Virus (HIV) infection

          -  Has a known history of Hepatitis B (defined as Hepatitis B surface antigen [HBsAg]
             reactive) or known active Hepatitis C virus (defined as HCV RNA [qualitative] is
             detected) infection.

          -  Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy
             (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of
             immunosuppressive therapy within 7 days prior to the first dose of study drug.

          -  Is currently participating in or has participated in a study of an investigational
             agent or has used an investigational device within 4 weeks prior to the first dose of
             study intervention.

          -  Has received prior systemic anti-cancer therapy including investigational agents
             within 4 weeks or <5 half-lives prior to enrollment.

          -  Has known active CNS metastases and/or carcinomatous meningitis. Participants with
             previously treated brain metastases may participate provided they are radiologically
             stable, i.e. without evidence of progression for at least 4 weeks by repeat imaging
             (note that the repeat imaging should be performed during study screening), clinically
             stable and without requirement of steroid treatment for at least 14 days prior to
             first dose of study intervention.

          -  Diagnosis of deep vein thrombosis and/or pulmonary embolus within 1 month of C1D1

          -  Has a history or current evidence of any condition, therapy, or laboratory abnormality
             that might confound the results of the study, interfere with the subject's
             participation for the full duration of the study, or is not in the best interest of
             the subject to participate, in the opinion of the treating investigator

          -  Has received radiotherapy within 4 weeks of start of study treatment. Participants
             must have recovered from all radiation-related toxicities, not require
             corticosteroids, and not have had radiation pneumonitis. A 1-week washout is permitted
             for palliative radiation (≤2 weeks of radiotherapy) to non-CNS disease.

          -  Patients on stable dose of bisphosphonates or denosumab, which have been started no
             less than 4 weeks prior to treatment start, may continue on this medication, however
             patients are not allowed to initiate bisphosphonate/Denosumab therapy during the
             DLT-assessment period of the study. These drugs may be added after week 12.

          -  Unless azoospermia is present (whether due to surgery or underlying medical
             condition), having partners of childbearing potential and not willing to use a method
             of birth control deemed acceptable by the principal investigator and chairperson
             during the study and for 4 months after last study drug administration.

          -  Is expecting to conceive or father children within the projected duration of the
             study, starting with the screening visit through 120 days after the last dose of trial
             treatment

          -  Has received a live vaccine within 30 days. Examples of live vaccines include, but are
             not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken
             pox), yellow fever, rabies, Bacillus Calmette-Guérin (BCG), and typhoid vaccine.
             Seasonal influenza vaccines for injection are generally killed virus vaccines and are
             allowed; however, intranasal influenza vaccines (eg, FluMist®) are live attenuated
             vaccines and are not allowed.

          -  Has severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its excipients.

          -  Has a history of (non-infectious) pneumonitis that required steroids or has current
             pneumonitis.

          -  Has an active infection requiring systemic therapy at the time of treatment initiation

          -  Has a known history of active TB (Bacillus Tuberculosis)

          -  Has known psychiatric or substance abuse disorders that would interfere with
             cooperation with the requirements of the trial

          -  Has had an allogenic tissue/solid organ transplant
      
Maximum Eligible Age:99 Years
Minimum Eligible Age:18 Years
Eligible Gender:Male
Healthy Volunteers:No

Primary Outcome Measures

Measure:Proportion of patients with dose-limiting toxicity (DLT) following treatment with pembrolizumab and 225Ac-J591
Time Frame:From visit 1 through 12 weeks on study
Safety Issue:
Description:Primary outcome for phase I; DLTs will be measured by utilizing the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. There will be 12 weeks of safety follow-up following visit 1.

Secondary Outcome Measures

Measure:Change in overall survival following treatment
Time Frame:Survival will be collected from Day 1 and up to 100 months
Safety Issue:
Description:Overall survival will be captured through in-clinic or telephone contact with subjects
Measure:Change in biochemical progression-free survival
Time Frame:Will be collected at the time of visit 1 and up to 100 months
Safety Issue:
Description:PSA progression will be defined as a rise of > 25% above either the pretreatment level or the nadir PSA level (whichever is lowest). PSA must increase by > 2 ng/ml to be considered progression.
Measure:Change in radiographic progression-free survival
Time Frame:Patients will undergo imaging at screening and then every 12 weeks, for up to 100 months
Safety Issue:
Description:Response evaluation criteria in solid tumors RECIST (Version 1.1) criteria with prostate cancer working group 3 (PCWG3) modifications will be used.
Measure:Change in proportion with 1-year progression-free survival
Time Frame:Will be collected at the time of visit 1 through 1 year on study
Safety Issue:
Description:By imaging (RECIST 1.1 criteria with prostate cancer working group 3 modifications) or biochemical (PSA) criteria
Measure:Change in proportion with >30% PSA decline
Time Frame:Will be collected at the time of visit 1 and up to 100 months
Safety Issue:
Description:Baseline (pre-treatment) PSA levels will be compared to PSA nadir on study
Measure:Change in proportion with >50% PSA decline
Time Frame:Will be collected at the time of visit 1 and up to 100 months
Safety Issue:
Description:Baseline (pre-treatment) PSA levels will be compared to PSA nadir on study
Measure:Change in proportion with >90% PSA decline
Time Frame:Will be collected at the time of visit 1 and up to 100 months
Safety Issue:
Description:Baseline (pre-treatment) PSA levels will be compared to PSA nadir on study

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Weill Medical College of Cornell University

Last Updated

August 18, 2021