Trial of QLH12016 in Patients With Metastatic Castration Resistant Prostate Cancer

Inclusion Criteria:

1. Voluntarily participate and sign a written informed consent form
2. Male, aged ≥ 18 years
3. ECOG：0-1
4. Expected survival time of at least 3 months
5. Prostate adenocarcinoma confirmed by histological or cytological without neuroendocrine or small cell characters
6. Continuous treatment with luteinizing hormone releasing hormone analogue or luteinizing hormone releasing hormone antagonist (drug castration), or previous bilateral orchiectomy (surgical castration); Subjects who did not receive bilateral orchiectomy must plan to maintain effective luteinizing hormone releasing hormone analog or luteinizing hormone releasing hormone antagonist treatment throughout the study period
7. testosterone≤50 ng/dL or 1.7 nmol/L
8. CRPC is defined as the occurrence of one or more of the following three events in a subject while undergoing castration treatment: ① PSA progression, defined as at least two increases in PSA levels (PSA value>1 ng/mL, interval of at least 1 week, consecutive 2 times, increase>50% from baseline); ② Disease progression as defined in RECIST v1.1; ③ The progression of skeletal diseases as defined by the PCWG3 standard, where bone scans reveal ≥ 2 or more new lesions
9. Metastatic lesion with imaging evidence. At least one target lesion exists
10. Received 1-2 lines of new endocrine therapy (such as enzalutamide, abiolone, etc.) after developing castration resistance（ArmA-C）
11. Received 0-1 line chemotherapy treatment (such as docetaxel) during the hormone sensitive period and the castration resistance period（ArmA-C）
12. Arm B: with specific biomarkers; Arm C: without specific biomarkers; Arm D: received 0 or 1 line of new endocrine therapy, and no chemotherapy during hormone sensitive and castration resistant stages
13. The functional level of important organs must meet the following requirements (no blood components, hematopoietic stimulating factors, cell growth factors, leukemic drugs, platelet enhancing drugs, etc. are allowed to be used within 7 days before obtaining laboratory examination): Absolute neutrophil count ≥ 1.5 × 10^9/L; Platelets ≥ 100 × 10^9/L; Hemoglobin ≥ 100 g/L; Serum albumin ≥ 30 g/L; AST and ALT ≤ 2.5 × Upper limit of normal reference value (ULN), if accompanied by liver metastasis, ALT and AST ≤ 5 × ULN; Total bilirubin ≤ 1.5 × ULN (Gilbert syndrome≤ 3 × ULN); Serum creatinine ≤ 1.5 × ULN, if >1.5 × ULN, then the creatinine clearance rate (CLcr) ≥ 50 mL/min; LVEF>50%
14. Effective contraceptive measures from signing the informed consent to 90 days after the last use of the study drug
15. Recover from all AEs of previous anti-cancer treatment (i.e. ≤ grade 1, according to CTCAE v5.0), excluding alopecia (any grade) and peripheral sensory nerve ≤ grade 2, hypomagnesemia or lymphocytopenia, as well as other abnormalities that the benefit of receiving treatment is greater than the risk

Exclusion Criteria:

1. Metastasis of the central nervous system (CNS), leptomeningeal metastasis or spinal cord compression caused by metastasis (exceeding the physiological alternative dose) requiring hormone treatment
2. Radiation therapy that has irradiated more than 25% of the bone marrow was performed within 4 weeks. Palliative radiation therapy is allowed to alleviate pain caused by bone metastasis during the study period
3. Treatment with similar drugs
4. Received other clinical trial drugs or major surgeries within 4 weeks (sufficient wound healing after major surgeries must undergo clinical evaluation)
5. Systemic anti-cancer treatment within the first 2 weeks (bicalutamide, Mitomycin C or Nitroso urea 6 weeks, enzalutamide 5 weeks, and abiolone 4 weeks). Medications that maintain castration are allowed.
6. Planned bilateral orchiectomy during the study treatment
7. Inability to swallow, chronic diarrhea and bowel obstruction, or other factors affecting drug administration and absorption
8. Epilepsy or disease that can induce seizure within 12 months (including a history of transient ischemic attack, stroke, brain trauma with disorders of consciousness, etc.)
9. History of psychotropic substance abuse, alcoholism, or drug use, neurological or mental disorders, including dementia or hepatic encephalopathy
10. Any of the following conditions occurs within 12 months: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass grafting, symptomatic congestive heart failure (New York Heart Association III or IV), cerebrovascular accident, transient ischemic attack, symptomatic pulmonary embolism or other thromboembolic diseases with clinical significance
11. Any of the following conditions within 6 months: congenital long QT syndrome, torsade de pointes ventricular tachycardia, arrhythmia (including persistent ventricular tachyarrhythmia and Ventricular fibrillation), left anterior half block (double vessel block) or persistent arrhythmia above NCI-CTCAE grade 2, Atrial fibrillation of any level (in the case of Asymptomatic isolated Atrial fibrillation, grade ≥ 2)
12. Cardiovascular diseases under poor control, including angina pectoris, pulmonary hypertension or serious cardiac rhythm or conduction abnormalities
13. QTcF>450 ms
14. Active, uncontrolled bacterial, fungal, or viral infections, including but not limited to: 1) Active hepatitis B virus (HBV), hepatitis C virus (HCV) infected persons (hepatitis B surface antigen [HBsAg] positive or hepatitis B core antibody [HBcAb] positive, HBV DNA virus copy number ≥ 500 IU/mL, HCV antibody positive and HCV RNA higher than the detection limit of the analysis method); 2) Syphilis required treatment; 3) History of congenital immunodeficiency or organ transplantation, or HIV (HIV) positive
15. Clinically uncontrollable third space effusion, such as pleural effusion, peritoneal effusion, pericardial effusion, etc. that cannot be controlled by drainage or other measures and cannot be included in the group according to the judgment of the investigator
16. Other malignant tumors within 5 years (excluding cured basal cell skin cancer, papillary thyroid cancer, etc.)
17. Concomitant diseases seriously endangering the safety of the subject or affect the completion of the study, such as hypertension (systolic pressure ≥ 160 mmHg and/or diastolic pressure ≥ 100 mmHg) that cannot be controlled by two or more antihypertensive drugs, diabetes not well controlled, etc
18. History of hypertensive crisis or hypertensive encephalopathy
19. Allergy to any study drug component
20. Gastrointestinal perforation, gastrointestinal or non gastrointestinal fistula, or abdominal abscess within 6 months
21. Any life-threatening bleeding event within 3 months, including the need for blood transfusion treatment, surgery or local treatment, and continuous medication treatment
22. Subjects who may increase research related risks, interfere with the interpretation of research results, or are deemed unsuitable for inclusion by the researcher