Pemetrexed as Second-Line Therapy in Treating Patients With Hormone Refractory Prostate Cancer

A Phase II Study of Pemetrexed (Alimta) as Second-Line Therapy for Hormone Refractory Prostate Cancer: Hoosier Oncology Group GU03-67

Docetaxel-based therapy has been shown to prolong survival as first-line therapy for patients with hormone refractory prostate cancer (HRPC), and has become the standard of care. The beneficial effects of any therapy in HRPC may be diverse and include reduction in tumor bulk (when measurable), reduction in prostate-specific antigen PSA, reduction in symptoms (particularly pain), or stabilization of disease. Clear reductions in tumor bulk or PSA may provide objective evidence of a treatment effect, and stabilization of disease may be just as clinically meaningful in patients who are actively progressing prior to starting therapy. Pemetrexed has shown a broad array of activity in many diseases that until now were thought to be non-responsive to chemotherapy in the second-line setting.

This trial is designed to further assess the efficacy, safety, tolerability, and pharmacogenetics of pemetrexed as a single agent in subjects with HRPC whose disease has progressed following one prior taxane-based chemotherapy regimen for HRPC.

Study Overview

• Status: Completed
• Conditions: Prostate Cancer
• Intervention / Treatment: Drug: Pemetrexed; Dietary supplement: Folic Acid; Dietary supplement: Vitamin B12

Detailed Description

OUTLINE: This is a multi-center study.

• Pemetrexed 500mg/m2 will be administered intravenously over approximately 10-minutes on Day 1 of a 21-day cycle.
• Folic Acid (350-1000 mcg. PO daily) will be taken by patients to reduce toxicity. At least 5 daily doses of folic acid must be taken during the 7-day period preceding the first dose of pemetrexed, and dosing should continue during the full course of therapy and for 21 days after the last dose of pemetrexed.
• Vitamin B12 (1000 µg) will be administered as an intramuscular injection during the week preceding the first dose of pemetrexed and every 3 cycles thereafter. Subsequent vitamin B12 injections may be given the same day as pemetrexed.

Performance Status: Karnofsky Performance Status 70-100

Life expectancy > 12 weeks

Hematopoietic:

• Absolute Neutrophil Count (ANC) > 1500/mm3
• Platelet count > 100,000/mm3
• Hemoglobin > 9 g/dL

Hepatic:

• Bilirubin < 1.5 X upper limit of normal (unless due to Gilbert's disease)
• Alkaline phosphatase and Alanine Transanimase (ALT) (SGPT) < 3 X upper limit of normal (ULN); may be < 5 X ULN for patients with liver metastases. Alkaline phosphatase may be any value for patients with bone metastases.

Renal:

• Calculated creatinine clearance >45 mL/min based on the standard Cockroft and Gault formula

Cardiovascular:

• No congestive heart failure requiring therapy or New York Heart Association (NYHA) class II or greater or active angina or known myocardial infarction within 12 months prior to study
• No unstable angina, uncontrolled congestive heart failure, or unstable symptomatic arrhythmia requiring medication within 6 months prior to being registered for protocol therapy
• Subjects with chronic atrial arrhythmia, i.e., atrial fibrillation, paroxysmal supraventricular tachycardia, or controlled hypertension are eligible

Pulmonary:

• Not specified

• Study Type: Interventional
• Enrollment (Actual): 49
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Illinois
    • Galesburg, Illinois, United States, 61401
      • Medical & Surgical Specialists, LLC
  • Indiana
    • Elkhart, Indiana, United States, 46515
      • Elkhart Clinic
    • Fort Wayne, Indiana, United States, 46815
      • Fort Wayne Oncology & Hematology, Inc
    • Indianapolis, Indiana, United States, 46202
      • Indiana University Cancer Center
    • Indianapolis, Indiana, United States, 46202
      • Quality Cancer Center (MCGOP)
    • Indianapolis, Indiana, United States, 46256
      • Community Regional Cancer Center
    • Lafayette, Indiana, United States, 47904
      • Arnett Cancer Care
    • Muncie, Indiana, United States, 47303
      • Medical Consultants, P.C.
    • South Bend, Indiana, United States, 46601
      • Northern Indiana Cancer Research Consortium
    • Terre Haute, Indiana, United States, 47804
      • AP&S Clinic
  • Michigan
    • Jackson, Michigan, United States, 49201
      • Center for Hematology/Oncology of S. Michigan
  • Nebraska
    • Omaha, Nebraska, United States, 68114
      • Methodist Cancer Center
  • New Jersey
    • Mt. Holly, New Jersey, United States, 08060
      • Hematology Oncology Associates S.J., P.A.
  • Pennsylvania
    • Drexel Hill, Pennsylvania, United States, 19026
      • Consultants in Medical Oncology & Hematology
    • Philadelphia, Pennsylvania, United States, 19106
      • Pennsylvania Oncology-Hematology Associates

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• Histologically documented adenocarcinoma of the prostate
• Clinically refractory or resistant to hormone therapy as assessed by progression following at least one hormonal therapy (orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist)
• One prior taxane based chemotherapy regimen for HRPC
• Documented progression of disease after one taxane based prior chemotherapy regimen for HRPC. Progression is defined as at least one of the following:
• An increase in PSA > 50% over nadir value on prior Taxane-based therapy
• Progression of measurable disease as defined by RECIST
• Progression of bone disease as defined by the appearance of one or more new bone lesions or worsening symptoms
• Orchiectomy or testosterone levels < 50 ng/dL maintained by LHRH agonist
• Prior chemotherapy, or other experimental anticancer agents must be completed > 4 weeks prior to being registered for protocol therapy
• Palliative radiotherapy must be completed at least 14 days prior to registration.

Exclusion Criteria:

• Intravenous radio-isotopes therapy must be completed at least 6 weeks prior to registration
• No brain metastasis that are untreated and/or not controlled and/or still requiring corticosteroids
• No history of other malignancies within 5 years prior to being registered for protocol therapy, except for adequately treated basal or squamous cell skin cancer
• No history of uncontrolled psychiatric illness or serious systemic disease, including active infection, uncontrolled hypertension
• No surgery or significant traumatic injury within 21 days prior to being registered for protocol therapy
• Patients must be willing to interrupt aspirin or other non-steroidal anti-inflammatory agents for a 5-day period (8 day period for long acting agents such as piroxicam)
• Patients must be willing to take folic acid or vitamin B12 supplementation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Investigational Treatment; Pemetrexed 500 mg/m2 IV over 10 minutes, day 1 of 21-day cycle; Oral Folic Acid, once per day for 7 days preceding pemetrexed dose, continued daily, and for 21 days after the last dose of pemetrexed.; Vitamin B12, 1000ug intramuscular injection 7 days preceding pemetrexed dose, and every three cycles thereafter on the same day of pemetrexed administration

Drug: Pemetrexed; Pemetrexed 500 mg/m2 IV over 10 minutes, day 1 of 21-day cycle; Other Names: Alimta; Dietary supplement: Folic Acid; All participants received oral Folic Acid 350-100ug once per day for 7 days preceding the first pemetrexed dose and continuing throughout the study and and for 21 days after the last dose of pemetrexed.; Dietary supplement: Vitamin B12; All patients received vitamin B12 1000ug intramuscular injection the week preceding the first pemetrexed dose and received additional 1000ug intramuscular injections every three cycles thereafter on the same day of pemetrexed administration.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Best Overall PSA Response	Best overall Prostate-Specific Antigen (PSA) response PSA response is defined by a greater than or equal to 50% decline in PSA confirmed by a second PSA value at least 4 weeks after the first PSA response timepoint PSA Stable Disease is defined as less than a 50% decline in PSA and less than a 50% increase in PSA from baseline PSA progression is defined as greater than or equal to a 50% increase in PSA compared to baseline	Start of treatment until disease progression/recurrence (for life)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Survival		From study enrollment until death (for life)
OBJECTIVE Overall Response Rate	Response Evaluation Criteria in Solid Tumors (RECIST). Objective overall response rate is defined as Complete Response (CR) + Partial Response (PR) Per RECIST: CR= Disappearance of all target and non-target lesions and normalization of tumor marker level PR= Disappearance of all target lesions and persistence of non-target lesion(s) or maintenance of tumor marker level above normal limits OR at least a 30% decrease in the sum of the longest diameter, taking as reference the baseline sum longest diameter and disappearance of all non-target lesions or persistence of non-target lesion(s) or maintenance of tumor marker level above normal limits	Start of treatment until disease progression/recurrence (for life)
Rate of Clinical Benefit	A clinical benefit is defined as an improvement for at least 3 consecutive weeks in at least one of the following parameters without any sustained worsening in any other: > 50% reduction in analgesic consumption or > 50% reduction in pain intensity or > 20 point gain in performance status.	Any time among evaluable subjects (for life)
Safety and Tolerability	Safety and Tolerability was evaluated by reporting the percentage of patient who experienced grade 3 or 4 toxicities using Common Terminology Criteria for Adverse Events CTCAE v3.0 criteria. CTCAE grades the severity of an adverse event from 1-5 where 1=least severe and 5=death.	18 months
RFC1 G80A Genotype	Samples for RFC1 G80A pharmacogenetic analysis were collected at screening	Screening
Time to Progression	Progression per Response Evaluation Criteria in Solid Tumors (RECIST) or Prostate-Specific Antigen (PSA) Progression RECIST PD=at least a 20% increase in the sum of the longest diameter (LD) of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions or Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions PSA progression=increase in PSA to >50% above lowest level recorded on study. Two consecutive increases required at least 4 weeks apart, but time to progression will be determined at time of first PSA showing increase > 50% above baseline *Note, upper confidence interval was not reached*	Study enrollment until progression per RECIST or PSA (for life)
Time to Prostate-Specific Antigen (PSA)/Serological Progression	Serological Progression (sPD) - increase in PSA to >50% above lowest level recorded on study. Two consecutive increases required at least 4 weeks apart, but time to progression will be determined at time of first PSA showing increase > 50% above baseline	From study enrollment to progression per PSA criteria (for life)

Collaborators and Investigators

• Sponsor: Christopher Sweeney, MBBS
• Collaborators: Eli Lilly and Company; Walther Cancer Institute
• Investigators: Study Chair: Christopher Sweeney, M.B.B.S., Hoosier Oncology Group, LLC

Publications and helpful links

General Publications

• Hahn NM, Zon RT, Yu M, Ademuyiwa FO, Jones T, Dugan W, Whalen C, Shanmugam R, Skaar T, Sweeney CJ. A phase II study of pemetrexed as second-line chemotherapy for the treatment of metastatic castrate-resistant prostate cancer (CRPC); Hoosier Oncology Group GU03-67. Ann Oncol. 2009 Dec;20(12):1971-6. doi: 10.1093/annonc/mdp244. Epub 2009 Jul 15.

Helpful Links

• Hoosier Oncology Group Home Page

Study record dates

Study Major Dates

• Study Start: February 1, 2005
• Primary Completion (Actual): March 1, 2009
• Study Completion (Actual): March 1, 2009

Study Registration Dates

• First Submitted: September 12, 2005
• First Submitted That Met QC Criteria: September 14, 2005
• First Posted (Estimate): September 22, 2005

Study Record Updates

• Last Update Posted (Estimate): July 29, 2016
• Last Update Submitted That Met QC Criteria: June 18, 2016
• Last Verified: June 1, 2016

More Information

Terms related to this study

• Keywords: Prostate Cancer
• Additional Relevant MeSH Terms: Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Genital Neoplasms, Male; Prostatic Diseases; Prostatic Neoplasms; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Nucleic Acid Synthesis Inhibitors; Enzyme Inhibitors; Antineoplastic Agents; Micronutrients; Vitamins; Vitamin B Complex; Hematinics; Folic Acid Antagonists; Folic Acid; Vitamin B 12; Hydroxocobalamin; Pemetrexed
• Other Study ID Numbers: HOG GU03-67

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No