Study of Abiraterone Acetate Plus ADT Versus APALUTAMIDE Versus Abiraterone and APALUTAMIDE in Patients With Advanced Prostate Cancer With Non-castrate Testosterone Levels

Phase II Randomized Study of Abiraterone Acetate Plus ADT Versus APALUTAMIDE Versus Abiraterone and APALUTAMIDE in Patients With Advanced Prostate Cancer With Non-castrate Testosterone Levels

Sponsors

Lead Sponsor: Latin American Cooperative Oncology Group

Collaborator: Janssen Pharmaceuticals

Source Latin American Cooperative Oncology Group
Brief Summary

Evaluation of the activity, safety and patients reported outcome of ADT plus abiraterone, abiraterone plus APALUTAMIDE (a second-generation antiandrogen) or APALUTAMIDE alone in hormone naïve locally advanced or metastatic prostate cancer which ADT was indicated.

Detailed Description

Based on the current guidelines, ADT alone or combined with is antiandrogens are considered the appropriate active therapy for the patient population planned for this study. Recent data showed that chemotherapy also benefit patients in this setting. Even though, there is a clear unmet medical need for alternative treatment option in metastatic hormone sensitive prostate cancer (mHSPC). Treatments that can delay disease progression, and are associated with less comorbidities would be of significant clinical benefit in this patient population. The study is designed to assess the efficacy and safety of abiraterone plus APALUTAMIDE (a second-generation antiandrogen) or APALUTAMIDE alone without castration side effects and the other arm a combination of ADT and abiraterone; this last arm is to reflect an Abiraterone ongoing pivotal trial (LATITUDE), that assess the efficacy of adding abiraterone to castration in this setting of patients. Abiraterone had already showed clinical benefit in CRPC patients without prior chemotherapy.

Overall Status Recruiting
Start Date October 11, 2017
Completion Date December 2020
Primary Completion Date October 9, 2019
Phase Phase 2
Study Type Interventional
Primary Outcome
Measure Time Frame
Number of patients that achieves an undetectable PSA level, defined as ≤ 0.2 ng/mL Week 25
Secondary Outcome
Measure Time Frame
PSA progression rate Week 25
Comparison of PSA progression rate Week 25
PSA response of 50 and 80% Week 25
Comparison of PSA response of 50 and 80% Week 25
Maximum PSA declines Baseline up to week 25 to 52
Overall PSA change Baseline up to week 25 to 52
Hormonal levels during treatment Baseline up to week 25
Comparison of hormonal levels during treatment Baseline up to week 25
Evaluation of bone mineral density according to RECIST 1.1 Week 25
Comparison of bone mineral density according to RECIST 1.1 between three experimental groups Week 25
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0 Baseline to 2 years of follow-up
Number of participants with pain progression assessed by BPI-SF of three experimental arms Baseline up to week 25
Number of participants in opioid use during treatment among three experimental arms Baseline up to week 25
Comparison of pain progression assessed by opioid use Baseline up to week 25
Comparison of pain progression assessed by BPI-SF questionnaire Baseline up to week 25
Quality of life assessed by FACT-P questionnaire Baseline up to week 25
Comparison of quality of life assessed by FACT-P questionnaire Baseline up to week 25
Radiographic progression-free survival (rPFS) Week 25
Enrollment 126
Condition
Intervention

Intervention Type: Drug

Intervention Name: Apalutamide

Description: APALUTAMIDE 240-mg orally once daily (4 x 60-mg tablets) will be administered on a continual basis. For the purpose of scheduling the study assessments and treatment compliance a treatment cycle is defined as 28 days.

Intervention Type: Drug

Intervention Name: Abiraterone

Description: Abiraterone acetate 1,000 mg (four 250 mg tablets) should be taken orally once daily, in combination with oral dose prednisone 5mg twice daily continuously. For the purpose of scheduling the study assessments and treatment compliance a treatment cycle is defined as 28 days

Intervention Type: Drug

Intervention Name: ADT

Description: Dosing of goserelin (dose and frequency of administration) will be consistent with the prescribing information and should only be adjusted if clinically indicated to achieve and maintain subcastrate concentrations of testosterone (50 ng/dL or 1.7 nM).

Arm Group Label: Abiraterone acetate + Prednisone + ADT (Goserelin)

Other Name: Goserelin

Intervention Type: Drug

Intervention Name: Prednisone

Description: Subjects will receive prednisone 10mg/day.

Arm Group Label: Abiraterone acetate + Prednisone + APALUTAMIDE

Eligibility

Criteria:

Inclusion Criteria:

1. Histologically confirmed prostate adenocarcinoma;

2. Hormone naïve patients with indication to ADT in the following settings:

- Advanced loco-regional disease not amenable to curative local therapy (surgery or radiotherapy): T category T3/4 or node positive

- Biochemical relapse after primary treatment (surgery or radiotherapy): patients in whom primary therapy is not appropriate or feasible with Previously treated with radical surgery and/or radiotherapy, now relapsing with at least one of the criteria: PSA >= 4 ng/ml and rising with doubling time less than 10 months. or PSA >= 20 ng/ml or N+ or M+

- Newly diagnosed metastatic disease: Tany Nany M+

3. Patient is asymptomatic or moderately symptomatic regarding bone symptoms, i.e., no need for palliative radiation or radionuclide therapy;

4. Non-castration level of testosterone > 230ng/dL (> 8 nmol/L);

5. Baseline level of prostatespecific antigen (PSA) > 2ng/dL;

6. ECOG performance status of 0 to 2;

7. Adequate hematologic, hepatic and renal function:

1. hemoglobin > 10 g/dL, neutrophils > 1.5×109 / L, platelets> 100×109 / L;

2. total bilirubin < 1.5x upper limit of normal (ULN); alanine (ALT) and aspartate (AST) aminotransferase < 2.5 x ULN;

3. serum creatinine < 1.5x ULN; potassium > 3.5 mM;

8. No previous cancer (except treated basal-cell skin cancer);

9. Written informed consent obtained prior to any study procedure;

10. Men age 18 years and older;

11. Agrees to use a condom and another effective method of birth control if he is having sex with a woman of childbearing potential or agrees to use a condom if he is having sex with a woman who is pregnant.

Exclusion Criteria:

1. Prostate adenocarcinoma with neuroendocrine differentiation or small cell histology;

2. Biochemical recurrence without evidence of clinical or radiological disease;

3. Use of hormonal therapy or chemotherapy prior to randomization. Exception is courses of hormone therapy for localised disease must have been completed at least 12 months previously. It can have been given as adjuvant or neoadjuvant therapy.

4. Prior radiation therapy for a primary tumour within the 3 months before enrollment or for the treatment of metastases;

5. Known or suspected brain or skull metastases or leptomeningeal metastatic disease;

6. Any concurrent severe and/or uncontrolled medical conditions which could compromise participation in the study;

7. Administration of an investigational therapeutic or invasive surgical procedure (not including surgical castration) within 28 days of Cycle 1 Day 1 or currently enrolled in an investigational study;

8. Active or symptomatic viral hepatitis or chronic liver disease; ascites or bleeding disorders secondary to hepatic dysfunction;

9. Current or prior treatment with anti-epileptic medications for the treatment of seizures;

10. Impaired cardiac function, including any of the following:

1. Uncontrolled hypertension (systolic blood pressure ≥160 mmHg or diastolic BP ≥95 mmHg);

2. Clinically significant heart disease as evidenced by myocardial infarction, or arterial thrombotic events or history of cardiac failure in the past 6 months, severe or unstable angina, or New York Heart Association (NYHA) Class II-IV heart disease;

3. Existing atrial fibrillation with or without pharmacotherapy. Other cardiac arrhythmia requiring pharmacotherapy;

4. History of seizure or condition that may predispose to seizure (including, but not limited to prior stroke, transient ischemic attack or loss of consciousness ≤1 year prior to randomization; brain arteriovenous malformation; or intracranial masses such as schwannomas and meningiomas that are causing edema or mass effect);

11. Specific underlying conditions for oral agents. For example: impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of abiraterone or APALUTAMIDE (e.g., ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection)

12. General excluded medications (e.g., relevant to cytochrome P450 interactions)

1. Use of prescription drugs within 14 days prior to dosing or over-the-counter (OTC) medication within 7 days prior to dosing;

2. Consumption of grapefruit product or St John's wort within 7 days prior to dosing;

3. G-CSF, GM-CSF, erythropoietin, etc;

4. Coumadin;

5. Drugs which may cause QT prolongation;

6. Known sensitivity to drugs or metabolites from similar classes;

7. Known or suspected contraindications or hypersensitivity to APALUTAMIDE, bicalutamide or GnRH agonists or any of the components of the formulations;

13. Any condition or situation which, in the opinion of the investigator, would put the subject at risk, may confound study results, or interfere with the subject's participation in this study.

Gender: Male

Minimum Age: 18 Years

Maximum Age: N/A

Healthy Volunteers: No

Overall Official
Overall Contact

Last Name: Laura Voelcker

Phone: 55 51 3384 5334

Email: [email protected]

Location
Facility: Status: Contact: Investigator:
Clínica AMO | Salvador, Bahia, Brazil Recruiting Bruno Setenta Vanessa Dybal Principal Investigator
CRIO | Fortaleza, Ceará, Brazil Recruiting Monica Gomes Eduardo Cronemberger Principal Investigator
Hospital Erasto Gaertner | Curitiba, Paraná, Brazil Recruiting Ana Karoline Spoladore Murilo de Almeida Luz Principal Investigator
Liga Norte Riograndense de Oncologia | Natal, Rio Grande Do Norte, Brazil Recruiting Caterine Gomes Andrea de Santana Gomes Principal Investigator
Hospital de Caridade de Ijuí | Ijuí, Rio Grande Do Sul, Brazil Recruiting Daniele Noronha Fábio Franke Principal Investigator
CPO - Pucrs | Porto Alegre, Rio Grande Do Sul, Brazil Recruiting Virginia Webber André Fay Principal Investigator
Oncologia Rede D'Or S.A. | Rio de Janeiro, RJ, 22281 100, Brazil Recruiting Leandro Camara Daniel Herchenhorn Principal Investigator
Hospital de Câncer de Barretos | Barretos, São Paulo, Brazil Recruiting Ana Camila Alfano Ricardo Zylberberg Principal Investigator
Centro de Pesquisa Clínica em Hematologia e Oncologia - CEPHO | Santo André, São Paulo, Brazil Recruiting Andressa Tamashiro Daniel Cubero Principal Investigator
Grupo COI | Rio de Janeiro, Brazil Recruiting Débora Victorino Fábio Peixoto Principal Investigator
Beneficiencia Portuguesa de São Paulo/Hospital São José | São Paulo, Brazil Recruiting Patricia Molina Fernando Maluf, MD Principal Investigator
Hospital Israelita Albert Einstein | São Paulo, Brazil Recruiting Roberta Possato Oren Smaletz Principal Investigator
IBCC | São Paulo, Brazil Recruiting Juliana Fenerich Mauri Felipe Jose Silva Melo Cruz Principal Investigator
ICESP | São Paulo, Brazil Recruiting Bárbara Penna David Muniz Principal Investigator
Location Countries

Brazil

Verification Date

February 2020

Responsible Party

Type: Sponsor

Keywords
Has Expanded Access No
Condition Browse
Number Of Arms 3
Arm Group

Label: Abiraterone acetate + Prednisone + ADT (Goserelin)

Type: Active Comparator

Description: Abiraterone administered at a single 1000 mg daily oral dose (4 x 250-mg tablets) Prednisone administered at a 5 mg twice daily oral dose Goserelin administered as subcutaneous injections of 10.8mg every 3 months

Label: APALUTAMIDE monotherapy

Type: Experimental

Description: o APALUTAMIDE administered at a single 240 mg daily oral dose (4 x 60 mg tablets)

Label: Abiraterone acetate + Prednisone + APALUTAMIDE

Type: Experimental

Description: Abiraterone administered at a single 1000 mg daily oral dose (4 x 250 mg tablets) Prednisone administered at a 5 mg twice daily oral dose APALUTAMIDE administered at a single 240 mg daily oral dose (4 x 60 mg tablets)

Study Design Info

Allocation: Randomized

Intervention Model: Parallel Assignment

Primary Purpose: Treatment

Masking: None (Open Label)

Source: ClinicalTrials.gov