Clinical Trials /

Androgen Ablation Therapy With or Without Niraparib After Radiation Therapy for the Treatment of High-Risk Localized or Locally Advanced Prostate Cancer

NCT04947254

Description:

This phase II trial studies the effect of androgen ablation therapy with or without niraparib after standard of care radiation therapy in treating patients with prostate cancer that has not spread to other parts of the body (localized) or that has spread to nearby tissue or lymph nodes (locally advanced). Androgen ablation therapy (also known as hormone therapy) lowers the levels of male hormones called androgens in the body. Androgens stimulate prostate cancer cells to grow. There are 2 types of androgen ablation therapy given in this study: AAP + ADT and Apa + ADT. AAP + ADT is the treatment combination of the drugs abiraterone acetate and prednisone (AAP) given with androgen deprivation therapy (ADT, also known as androgen deprivation therapy or androgen suppression medication, which is used as standard of care to lower testosterone levels in men with high risk localized or metastatic prostate cancer). Apa + ADT is the treatment combination of the drug apalutamide (Apa) given with ADT. Androgen ablation therapy with or without niraparib after radiation therapy may help to control the disease in patients with prostate cancer.

Related Conditions:
  • Prostate Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Androgen Ablation Therapy With or Without Niraparib After Radiation Therapy for the Treatment of High-Risk Localized or Locally Advanced Prostate Cancer
  • Official Title: Phase II Trial of Primary Radiotherapy With Androgen Ablation With or Without Adjuvant Niraparib for Selected High-Risk Locoregional Prostate Cancer

Clinical Trial IDs

  • ORG STUDY ID: 2020-1039
  • SECONDARY ID: NCI-2021-05724
  • SECONDARY ID: 2020-1039
  • NCT ID: NCT04947254

Conditions

  • Prostate Carcinoma
  • Stage IIC Prostate Cancer AJCC v8
  • Stage III Prostate Cancer AJCC v8
  • Stage IIIA Prostate Cancer AJCC v8
  • Stage IIIB Prostate Cancer AJCC v8
  • Stage IIIC Prostate Cancer AJCC v8
  • Stage IVA Prostate Cancer AJCC v8

Interventions

DrugSynonymsArms
Abiraterone AcetateCB7630, ZytigaGroup B (Apa, ADT, XRT, AAP, niraparib)
Antiandrogen TherapyADT, Androgen Deprivation Therapy, Androgen Deprivation Therapy (ADT), Anti-androgen Therapy, Anti-androgen Treatment, Antiandrogen Treatment, Hormone Deprivation Therapy, Hormone-Deprivation TherapyGroup A (Apa, ADT, XRT)
ApalutamideARN 509, ARN-509, ARN509, Erleada, JNJ 56021927, JNJ-56021927Group A (Apa, ADT, XRT)
NiraparibMK-4827, MK4827Group B (Apa, ADT, XRT, AAP, niraparib)
Prednisone.delta.1-Cortisone, 1, 2-Dehydrocortisone, Adasone, Cortancyl, Dacortin, DeCortin, Decortisyl, Decorton, Delta 1-Cortisone, Delta-Dome, Deltacortene, Deltacortisone, Deltadehydrocortisone, Deltasone, Deltison, Deltra, Econosone, Lisacort, Meprosona-F, Metacortandracin, Meticorten, Ofisolona, Orasone, Panafcort, Panasol-S, Paracort, Perrigo Prednisone, PRED, Predicor, Predicorten, Prednicen-M, Prednicort, Prednidib, Prednilonga, Predniment, Prednisone Intensol, Prednisonum, Prednitone, Promifen, Rayos, Servisone, SK-PrednisoneGroup B (Apa, ADT, XRT, AAP, niraparib)

Purpose

This phase II trial studies the effect of androgen ablation therapy with or without niraparib after standard of care radiation therapy in treating patients with prostate cancer that has not spread to other parts of the body (localized) or that has spread to nearby tissue or lymph nodes (locally advanced). Androgen ablation therapy (also known as hormone therapy) lowers the levels of male hormones called androgens in the body. Androgens stimulate prostate cancer cells to grow. There are 2 types of androgen ablation therapy given in this study: AAP + ADT and Apa + ADT. AAP + ADT is the treatment combination of the drugs abiraterone acetate and prednisone (AAP) given with androgen deprivation therapy (ADT, also known as androgen deprivation therapy or androgen suppression medication, which is used as standard of care to lower testosterone levels in men with high risk localized or metastatic prostate cancer). Apa + ADT is the treatment combination of the drug apalutamide (Apa) given with ADT. Androgen ablation therapy with or without niraparib after radiation therapy may help to control the disease in patients with prostate cancer.

Detailed Description

      PRIMARY OBJECTIVE:

      I. Determine the efficacy of addition of adjuvant niraparib to maximal androgen signaling
      ablation (AAP + ADT) versus maximal androgen signaling ablation alone (Apa + ADT) following
      definitive radiation therapy (XRT) for biomarker-selected men with poor histopathologic
      response to neoadjuvant androgen signaling ablative therapy.

      SECONDARY OBJECTIVES:

      I. Determine the safety and tolerability of adjuvant niraparib with androgen ablation versus
      androgen ablation alone following definitive XRT in the study population.

      II. Determine the impact of the addition of adjuvant niraparib to maximal androgen signaling
      ablation (AAP + ADT) versus maximal androgen signaling ablation alone (Apa + ADT) following
      definitive XRT for biomarker-selected men with good and poor histopathologic response to
      neoadjuvant androgen signaling ablative therapy on overall survival III. Determine the impact
      of the niraparib + AAP + ADT and Apa+ADT treatment on eugonadal (non-castrate levels of
      testosterone) progression free survival.

      IV. Determine the impact of favorable versus unfavorable histologic response on
      progression-free survival (PFS) in men who received maximal androgen signaling ablation prior
      to definitive radiation.

      CORRELATIVE OBJECTIVE:

      I. Collect and archive solid and liquid tumor samples, as well as normal blood samples for
      germline deoxyribonucleic acid (DNA), immune, and metabolic profiles from all study patients
      for later hypothesis generating associations. Assess the relationship of histopathologic
      score with circulating markers and clinical outcomes of progression free survival for
      biomarker discovery.

      OUTLINE:

      PART 1 NEOADJUVANT PHASE (CYCLES 1-3): Patients receive apalutamide orally (PO) once daily
      (QD) on days 1-28, and physician's choice ADT. Treatment repeats every 28 days for up to 3
      cycles in the absence of disease progression or unacceptable toxicity.

      PART 2 RADIATION PHASE (CYCLES 4-6): Within 30 days of completing Part 1, patients undergo
      radiation therapy. Patients also receive apalutamide PO QD on days 1-28 and physician's
      choice ADT. Treatment repeats every 28 days for up to 3 cycles in the absence of disease
      progression or unacceptable toxicity.

      PART 3 ADJUVANT PHASE (CYCLES 7 AND BEYOND): Patients with favorable response after Part 2
      continue Apa + ADT. Patients with unfavorable response after Part 2 are randomized to 1 of 2
      groups.

      GROUP A: Patients receive apalutamide PO QD on days 1-28 and physician's choice ADT.
      Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or
      unacceptable toxicity.

      GROUP B: Patients receive abiraterone acetate PO QD, prednisone PO twice daily (BID),
      physician's choice ADT, and niraparib PO QD. Treatment repeats every 28 days for up to 12
      cycles in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up within 14 days, at 30-90 days,
      and then every 3 months for 3 years.
    

Trial Arms

NameTypeDescriptionInterventions
Group A (Apa, ADT, XRT)Active ComparatorPART 1 NEOADJUVANT PHASE (CYCLES 1-3): Patients receive PO QD on days 1-28, and physician's choice ADT. Treatment repeats every 28 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. PART 2 RADIATION PHASE (CYCLES 4-6): Within 30 days of completing Part 1, patients undergo radiation therapy. Patients also receive apalutamide PO QD on days 1-28 and physician's choice ADT. Treatment repeats every 28 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. PART 3 ADJUVANT PHASE (CYCLES 7 AND BEYOND): Patients receive apalutamide PO QD on days 1-28 and physician's choice ADT. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
  • Antiandrogen Therapy
  • Apalutamide
Group B (Apa, ADT, XRT, AAP, niraparib)ExperimentalPART 1 NEOADJUVANT PHASE (CYCLES 1-3): Patients receive PO QD on days 1-28, and physician's choice ADT. Treatment repeats every 28 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. PART 2 RADIATION PHASE (CYCLES 4-6): Within 30 days of completing Part 1, patients undergo radiation therapy. Patients also receive apalutamide PO QD on days 1-28 and physician's choice ADT. Treatment repeats every 28 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. PART 3 ADJUVANT PHASE (CYCLES 7 AND BEYOND): Patients receive abiraterone acetate PO QD, prednisone PO BID, physician's choice ADT, and niraparib PO QD. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
  • Abiraterone Acetate
  • Antiandrogen Therapy
  • Apalutamide
  • Niraparib
  • Prednisone

Eligibility Criteria

        Inclusion Criteria:

          -  Completion of informed consent prior to any study specific procedures

          -  Patients must agree to tissue collection for correlative studies at the specified
             timepoints

          -  Male aged 18 years and above

          -  Histologically or cytologically confirmed prostate carcinoma

          -  Localized or regional high-risk disease as defined by at least one of the following
             features: Prostate specific antigen (PSA) > 20 ng/mL, T3a or higher, grade group 4-5
             (i.e. Gleason score > 8) as per National Comprehensive Cancer Network (NCCN) Prostate
             Cancer Version 2.2020 for high risk or very high risk prostate cancer, and/or regional
             lymph nodes positive for prostate cancer

          -  Planned for definitive treatment of local regional prostate cancer using XRT and
             androgen ablation

          -  Willing to undergo ongoing medical castration to maintain testosterone levels of =< 50
             ng/dL (=< 2.0 nM) throughout systemic treatment or have undergone bilateral
             orchiectomy

          -  Eastern Cooperative Oncology Group (ECOG) performance status of =< 2

          -  Hemoglobin >= 10.0 g/dL (measured within 7 days prior to treatment registration)

          -  Absolute neutrophil count (ANC) >= 1.5 x 10^9/L (measured within 7 days prior to
             treatment registration)

          -  White blood cells (WBC) > 3 x 10^9/L (measured within 7 days prior to treatment
             registration)

          -  No features suggestive of myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML)
             on peripheral blood smear

          -  Platelet count >= 100 x 10^9/L (measured within 7 days prior to treatment
             registration)

          -  Total bilirubin =< 1.5 x institutional upper limit of normal (ULN) (except for
             patients with known Gilbert's disease) (measured within 7 days prior to treatment
             registration). (Note: In subjects with Gilbert's syndrome, if total bilirubin is > 1.5
             x ULN, measure direct and indirect bilirubin and if direct bilirubin is =< 1.5 x ULN,
             subject may be eligible.)

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and
             alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 2.5 x
             institutional upper limit of normal (measured within 7 days prior to treatment
             registration)

          -  Calculated creatinine clearance (Cockcroft-Gault Equation) >= 30 mL/min (measured
             within 7 days prior to treatment registration)

          -  Serum Albumin > 3.0 (measured within 7 days prior to treatment registration)

          -  Serum potassium >= 3.5 mmol/L (measured within 7 days prior to treatment registration)

          -  Able to swallow study drugs whole as a tablet/capsule

          -  Patients who have partners of childbearing potential (e.g. female that has not been
             surgically sterilized or who are not amenorrheic for >= 12 months) must be willing to
             use two methods of birth control including adequate barrier protection during the
             study and for 3 months after last dose of niraparib, abiraterone acetate, and/or
             apalutamide administration. In addition men should not donate sperm during this
             period. Please note that the efficacy of hormonal contraception may be decreased if
             administered with niraparib, abiraterone acetate, and/or apalutamide

          -  Patient is willing and able to comply with the protocol for the duration of the study
             including undergoing treatment and scheduled visits and examinations including follow
             up

          -  Medications known to lower the seizure threshold must be discontinued or substituted
             at least 4 weeks prior to study entry

        Exclusion Criteria:

          -  Any prior systemic treatment for prostate cancer with the exception of ADT started
             within 3 months of trial enrollment. Any prior PARP inhibitor therapy

          -  Patients who have prostate cancer with distant metastatic disease

          -  Patients who have had prior major surgery (prostatectomy) or radiotherapy for the
             treatment of prostate cancer

          -  Any unresolved toxicity (Common Terminology Criteria for Adverse Events [CTCAE] grade
             >= 2) from previous anti-cancer therapies

          -  History or current diagnosis of MDS/AML, and/or history of any malignancy [other than
             the one treated in this study] which has a >= 30% probability of recurrence within 24
             months (except for adequately treated non-melanoma skin cancer, curatively treated
             in-situ cancer of the cervix or Ta urothelial carcinomas)

          -  Active uncontrolled infection (patients completing a course of antibiotic or antiviral
             therapy whose infection is deemed to be controlled may be allowed on study after
             discussion with the principal investigator [PI]; the PI will serve as the final
             arbiter regarding eligibility)

          -  Active or symptomatic viral hepatitis or chronic liver disease

          -  Active pneumonitis or extensive bilateral lung disease of non-malignant etiology

          -  Any underlying medical or psychiatric condition, which in the opinion of the
             Investigator, will make the administration of study drug hazardous or obscure the
             interpretation of adverse events. Examples include, but are not limited to superior
             vena cava syndrome, extensive bilateral lung disease on high resolution computed
             tomography (HRCT) scan, uncontrolled seizures, history of allogeneic organ transplant,
             history of primary immunodeficiency or any psychiatric disorder that prohibits
             obtaining informed consent

          -  Patients unable to swallow orally administered medication and patients with
             gastrointestinal disorders likely to interfere with absorption of study medication

          -  Patients with a known hypersensitivity to niraparib, apalutamide, and/or abiraterone
             acetate

          -  Prisoners or subjects who are involuntarily incarcerated

          -  Subjects who are compulsorily detained for treatment of either a psychiatric or
             physical (e.g. infectious disease) illness

          -  Seizure or known condition that may pre-dispose to seizure (e.g. prior stroke within
             1year to randomization, brain arteriovenous malformation, Schwannoma, meningioma, or
             other benign central nervous system [CNS] or meningeal disease which may require
             treatment with surgery or radiation therapy)

          -  Severe or unstable angina, myocardial infarction (within 6 months prior to
             enrollment), symptomatic congestive heart failure, arterial or venous thromboembolic
             events (e.g., pulmonary embolism, cerebrovascular accident including transient
             ischemic attacks), uncontrolled hypertension, or clinically significant ventricular
             arrhythmias within 6 months prior to randomization

          -  Current evidence of any of the following:

               -  Gastrointestinal disorder affecting absorption

               -  Active uncontrolled infection (e.g., human immunodeficiency virus [HIV] or viral
                  hepatitis)

               -  Any chronic medical condition requiring a higher dose of corticosteroid than 10
                  mg prednisone/prednisolone once daily

               -  Avoid concomitant strong CYP3A4 inducers during abiraterone acetate treatment. If
                  a strong CYP3A4 inducer must be co-administered, increase the abiraterone acetate
                  dosing frequency

               -  Avoid co-administration of abiraterone acetate with CYP2D6 substrates that have a
                  narrow therapeutic index. If an alternative treatment cannot be used, exercise
                  caution and consider a dose reduction of the concomitant CYP2D6 substrate

               -  Baseline moderate and severe hepatic impairment (Child-Pugh class B & C)

               -  Any condition that in the opinion of the investigator, would preclude
                  participation in this study
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Male
Healthy Volunteers:No

Primary Outcome Measures

Measure:Composite radiographic progression-free survival(rPFS) and biochemical (PSA) progression-free survival (PFS)
Time Frame:From randomization until progression, death, or last assessment without progression, whichever comes first, assessed at 3 years
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Incidence and severity of adverse events (AEs)
Time Frame:Up to 3 years
Safety Issue:
Description:Adverse events will be recorded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 along with date and attribution to study treatment.
Measure:Incidence and severity of serious adverse events (SAEs)
Time Frame:Up to 3 years
Safety Issue:
Description:Graded by NCI CTCAE version 5.0.
Measure:Overall survival
Time Frame:From randomization until death or last contact, whichever comes first, assessed up to 3 years
Safety Issue:
Description:
Measure:Eugonadal progression-free survival
Time Frame:From randomization until progression, death, or last assessment without progression, whichever comes first, assessed up to 3 years
Safety Issue:
Description:Assessed as composite radiographic PFS (rPFS) and biochemical (prostate specific antigen [PSA]) PFS among patients with non-castrate level testosterone. Eugonadal is defined as non-castrate levels of testosterone (> 50 ng/mL).
Measure:Progression-free survival
Time Frame:From randomization until progression, death, or last assessment without progression, whichever comes first, assessed up to 3 years
Safety Issue:
Description:Defined as composite rPFS and biochemical (PSA) PFS in those with unfavorable histologic response versus favorable histologic response in men who received maximal androgen signaling ablation prior to definitive radiation. PFS will be calculated from histologic response assessment between Parts 1 and 2.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

August 9, 2021