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Metastatic Castration-resistant Prostate Cancer | Phase 2 Trial of Carfilzomib for Metastatic Castration-resistant Prostate Cancer Following Treatment

Metastatic Castration-resistant Prostate Cancer research study

What is the primary objective of this study?

This study will test how effective the drug, Carfilzomib, reduces progression of prostate cancer in patients who have previously received chemotherapy and androgen inhibitors. Carfilzomib is approved for multiple myeloma but is not approved for prostate cancer. Therefore, it is considered investigational. Other approved methods of treatment for metastatic prostate cancer have demonstrated only modest benefits. Novel and tolerable agents are necessary to make further gains and extend overall survival.

Who is eligible to participate?

Inclusion Criteria: - Histologically proven adenocarcinoma of the prostate - Metastatic disease - Progressive disease (PSA, radiologic, symptomatic) following abiraterone acetate and/or Enzalutamide (prior sipuleucel-T and chemotherapy are allowed); PSA progression is defined as baseline increase followed by any PSA increase ≥1 week apart. - Voluntary written informed consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care. - Patients, even if surgically sterilized (i.e., status post-vasectomy) must agree to one of the following: practice effective barrier contraception during the entire study treatment period and through a minimum of 30 days after the last dose of study drug, or completely abstain from heterosexual intercourse if female partner of childbearing age. - An elevated PSA level of >2ng/mL for patients progressing by PSA criteria is required (last confirmatory sample must be >2ng/mL) - Currently on androgen ablation hormone therapy (an LHRH agonist/antagonist or orchiectomy) with testosterone level <50ng/dL) - Has an ECOG Performance status of 0 - 2 - LVEF ≥40% on 2-D transthoracic echocardiogram (ECHO); Multi-gated Acquisition Scan (MUGA) is acceptable if ECHO is not available. - ≥19 years of age - Resolution of all acute toxic effects of prior chemotherapy or surgical procedures to NCI CTCAE Version 4.03 Grade <1, in the opinion of the treating physician. - Ability to understand and the willingness to sign a written informed consent document Exclusion Criteria: - Patient has a platelet count of <100,000/mm3, or absolute neutrophil count of <1500/mm3 or Hemoglobin <8.0gm/dL - Patient has a calculated or measured creatinine clearance of <30mL/minute - Patient has total bilirubin >2 x ULN (upper limit of normal), or AST, ALT >3.5 x ULN - Patient has ≥ Grade 2 peripheral neuropathy within 14 days before enrollment - Myocardial infarction within 6 months prior to enrollment or has NYHA Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Before study entry, any ECG abnormality at screening has to be documented by the investigator as not medically relevant. - Participation in clinical trials with other investigational agents not included in this trial, within 14 days of the start of this trial and throughout the duration of this trial. - Serious medical or psychiatric illness likely to interfere with participation in this clinical study. - Diagnosed or treated for another malignancy within 3 years of enrollment, with the exception of: a) adequately treated basal cell carcinoma, squamous cell skin cancer, or thyroid cancer; b) carcinoma in situ of the breast; c) cancer considered cured by surgical resection or unlikely to impact survival during the duration of the study, such as localized transitional cell carcinoma of the bladder or benign tumors of the adrenal or pancreas. - Known HIV, hepatitis B and hepatitis C infection - Uncontrolled hypertension or uncontrolled diabetes within 14 days prior to randomization - Prior treatment with bortezomib - Known history of allergy to Captisol® (a cyclodextrin derivative used to solubilize Carfilzomib) - Has received prior radiation to >50% of the bone marrow - Has had significant bleeding/thrombosis in previous 4 weeks - Has received treatment with radiation therapy, surgery, chemotherapy, or an investigational agent within 4 weeks prior to registration, (6 weeks for radiation therapy, radionuclides, nitrosoureas, or Mitomycin C) or who have not recovered from adverse events due to agents administered more than 4 weeks earlier - Has evidence of uncontrolled CNS involvement (previous radiation and off steroids is acceptable) - Patients may not be receiving any other investigational agents - Has a serious uncontrolled intercurrent medical or psychiatric illness, including serious infection - Is unable to comply with study requirements - 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.

Which medical condition, disease, disorder, syndrome, illness, or injury is researched?

Metastatic Castration-resistant Prostate Cancer

Study Interventions

Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.

Drug:CarfilzomibCarfilzomib will be administered on days 1, 2, 8, 9, 15, 16 within each 4 week cycle.

Drug:DexamethasoneAdministered prior to administration of Study drug

Drug:AcyclovirAdministered orally twice daily

Study Arms

Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.

CarfilzomibCarfilzomib is administered twice-weekly on consecutive days (days 1, 2, 8, 9, 15, 16) as a 30-minute intravenous infusion for 3 weeks every 4 weeks (1 cycle) with dexamethasone given as pre-medication. The dose of carfilzomib is 20 mg/m2 on days 1 and 2 of cycle 1 and is then escalated in succeeding weeks and cycles to 56 mg/m2 if no dose limiting toxicities occur. Acyclovir is given orally at 400 mg twice daily during therapy but may be discontinued at some point. Therapy will continue until side effects become unacceptable, the disease progresses, or the doctor withdraws the patient.

Study Status

Completed

Start Date: April 2014

Completed Date: July 14, 2017

Phase: Phase 2

Type: Interventional

Design:

Primary Outcome: Progression-free survival (PFS)

Secondary Outcome: Prostate-Specific Antigen (PSA) changes

Study sponsors, principal investigator, and references

Principal Investigator: Guru Sonpavde, MD

Lead Sponsor: University of Alabama at Birmingham

Collaborator: Amgen

More information:https://clinicaltrials.gov/show/NCT02047253

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