ModraDoc006/r vs Docetaxel IV in Metastatic Prostate Cancer

A Multicentre Phase 2b Trial to Evaluate the Efficacy and Tolerability of ModraDoc006/r in Subjects With Metastatic Castration Resistant Prostate Cancer (mCRPC), Suitable for Treatment With a Taxane

This is a multicenter phase 2b study to evaluate the efficacy and tolerability of ModraDoc006 in combination with ritonavir (denoted ModraDoc006/r) in patients with metastatic castration-resistant prostate cancer, suitable for treatment with a taxane.

Study Overview

• Status: Completed
• Conditions: Castration-resistant Prostate Cancer; Prostate Cancer Metastatic
• Intervention / Treatment: Drug: ModraDoc006/r; Drug: Docetaxel in Parenteral Dosage Form

Detailed Description

This is an open label 1:1 randomized Phase 2b trial to determine the efficacy and tolerability of oral ModraDoc006/r versus i.v. docetaxel in mCRPC subjects. Cohort 1 will receive i.v. docetaxel at 75 mg/m2 every 3 weeks (Q3W). Cohort 2 will receive 30 mg ModraDoc006 in combination with 200 mg ritonavir in the morning and 20 mg ModraDoc006 in combination with 100 mg ritonavir in the evening (7-12 hours after the morning dose), on Day 1, 8 and 15 of a 21-day cycle (BIDW). All patients will also receive 5 mg oral prednisone twice daily. Treatment in both cohorts will continue until disease progression, unacceptable toxicity, or discontinuation for any other reason. The end of the trial is defined as the time point when all subjects have discontinued trial treatment and have been given follow-up for safety measurements according to the trial assessment schedule.

• Study Type: Interventional
• Enrollment (Actual): 135
• Phase: Phase 2

Contacts and Locations

Study Locations

• Czechia
  • Liberec, Czechia
    • Nemocnice Liberec
  • Prague, Czechia
    • Urologicke oddeleni FTN
• Germany
  • Göttingen, Germany
    • Universitätsmedizin Göttingen
  • Nürtingen, Germany
    • Studienpraxis Urologie
  • Tübingen, Germany
    • Universitätsklinikum Tübingen
• Hungary
  • Budapest, Hungary, 6000
    • Orszagos Onkologiai Intezet (National Institute of Oncology)
  • Debrecen, Hungary
    • Debreceni Egyetem Klinikai Kozpont
  • Győr, Hungary
    • Petz Aladar Megyei Oktato Korhaz
  • Szolnok, Hungary, 9700
    • Jasz-Nagykun-Szolnok Megyei - Hetenyi Geza Korhaz - Rendelointezet - Onkologiai Kozpont
• Poland
  • Konin, Poland
    • Przychodnia Lekarska "Komed"
  • Warszawa, Poland
    • Centrum Onkologii - Instytut im. Marii Skłodowskiej-Curie
  • Łódź, Poland
    • Instytut Centrum Zdrowia Matki Polki
• Russian Federation
  • Barnaul, Russian Federation
    • Regional State Budgetary Healthcare Institution "Altai Regional Oncology Dispensary"
  • Chelyabinsk, Russian Federation
    • Limited Liability Company "EVIMED
  • Ekaterinburg, Russian Federation
    • Sverdlovsk Regional Clinical Hospital No. 1
  • Krasnoyarsk, Russian Federation
    • Regional State Budget Institution "Krasnoyarsk Territorial Clinical Hospital n.a. A.I.Kryzhanovskogo"
  • Moscow, Russian Federation
    • Federal State Institution "Russian Cancer Research Center named after N. N. Blokhin" RAMS
  • Novosibirsk, Russian Federation
    • CJSC Medical Center "AVICENNA"
  • Obninsk, Russian Federation
    • Federal state budget institution "National medical research radiological center " of the Ministry of healthcare of the Russian Federation, branch - A. Tsyb Medical Radiological Research Center
  • Omsk, Russian Federation
    • Clinical Oncological Dispensary of Omsk Region
  • Saint Petersburg, Russian Federation
    • Pavlov First Saint Petersburg State Medical University
  • Saint Petersburg, Russian Federation
    • National Medical Research Center of Oncology N.A. N.N. Petrov
  • Saint Petersburg, Russian Federation
    • Leningrad Region Onco Dispensary
  • Saint Petersburg, Russian Federation
    • Limited Liability Company "Klinika Andros [Andros Clinic]"
• United States
  • Michigan
    • Detroit, Michigan, United States, 48201
      • Karmanos Cancer Institute
  • Nevada
    • Las Vegas, Nevada, United States, 89119
      • Comprehensive Cancer Centers of Nevada
  • Oregon
    • Portland, Oregon, United States, 97213
      • Providence Cancer Institute
  • South Carolina
    • Myrtle Beach, South Carolina, United States, 29572
      • Carolina Urologic Research Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age ≥ 18 years

2. Histologically or cytologically proven prostate cancer with evidence of progressive mCRPC, defined as:

   1. Castrate levels of testosterone, defined as ≤ 50 ng/dL (or ≤ 0.50 ng/mL or 1.73 nmol/L)
   2. Evidence of progressive metastatic disease as defined by radiographic disease progression or Prostate Specific Antigen (PSA) progression
   3. With an indication for systemic treatment with docetaxel according to the standard of care
3. Measurable tumour lesions, defined as pelvic and/or extra-pelvic nodal lesions ≥1.5 cm in the short axis or visceral lesions ≥1.0 cm in the longest dimensions and measurable according to RECIST v1.1, bone metastasis as evaluated with 99mTc-methylene diphosphonate (MDP) radionuclide bone scintigraphy
4. Resolution of toxicity of prior therapy to < grade 2 (except for alopecia), as defined by CTCAE v5.0

5. Adequate haematological, renal and hepatic functions:

   1. Hemoglobin ≥ 6.0 mmol/l (>9.6 g/dL)
   2. Absolute Neutrophil Count (ANC) ≥ 1.5 x 109 /L
   3. Platelet count ≥ 100 x 109 /L
   4. Hepatic function defined by serum bilirubin ≤ Upper Limit of Normal (ULN), Alanine Amino Transferase (ALAT) and Aspartate Amino Transferase (ASAT) ≤ 1.5 x ULN concomitant with alkaline phosphatase ≤ 2.5 × ULN.
   5. Renal function defined by serum creatinine ≤ 1.5 x ULN or creatinine clearance ≥ 50 ml/min (by Cockcroft-Gault formula, or MDRD).
6. World Health Organisation Performance Status (WHO-PS) of 0-2
7. Estimated life expectancy of at least 12 weeks
8. Able and willing to swallow oral medication
9. Able and willing to undergo radiologic scans (CT scan)
10. Able and willing to give written informed consent according to local guidelines

Exclusion Criteria:

1. Any treatment with investigational drugs, chemotherapy or immunotherapy within 4 weeks prior to receiving the first dose of investigational treatment. Palliative radiotherapy (1x8 Gy dose) is allowed before and during the study, but not in the week prior to start of study treatment.
2. Subjects who have had prior treatment with taxanes.
3. Subjects with symptomatic brain metastases. Subjects asymptomatic in the absence of corticosteroids and anticonvulsant therapy for ≥6 weeks are eligible. Radiotherapy for brain metastasis must have been completed ≥6 weeks prior to start of trial. Brain metastasis must be stable with verification by imaging (e.g. brain MRI or CT completed at screening, demonstrating no current evidence of progressive brain metastases). Subjects are not permitted to receive anti-epileptic drugs or corticosteroid treatment indicated for brain metastasis. Subjects with a history of leptomeningeal metastases are not eligible.
4. Current malignancies other than mCRPC with exception of adequately treated basal or squamous cell carcinoma of the skin, or adequately treated non-muscular invasive bladder cancer.
5. Absence of highly effective method of contraception as of cycle one day one (C1D1). Men enrolled in this trial must agree to use a highly effective contraceptive method throughout the study.
6. Uncontrolled hypertension (systolic > 150 mm Hg and/or diastolic > 100 mm Hg)
7. Unresolved (>grade 0 as defined by CTCAE version 5.0) gastrointestinal toxicities (pre-existing mucositis, diarrhea or nausea/vomiting)
8. Grade ≥ 2 motor ≥ 2 motor or sensory neuropathy symptoms (as defined by CTCAE version 5.0)
9. Known hypersensitivity to any of the study drugs or excipients or taxanes
10. Concomitant use of P-glycoprotein (P-gp , MDR), Cytochrome P450 (CYP)3A, Organic Anion-Transporting Polypeptide (OATP)1B1, OATP1B3 and Multidrug resistance-associated protein 2 (MRP2) modulating drugs such as Ca+- entry blockers (verapamil, dihydropyridines), cyclosporine, quinidine and grapefruit juice, concomitant use of HIV medications, other protease inhibitors, (non) nucleoside analogues, or St. John's wort
11. Bowel obstruction or motility disorder that may influence the resorption of drugs as judged by the treating physician
12. Major surgical procedures within 21 days prior to providing informed consent
13. Active acute or chronic infection, which is not controlled by appropriate medication (at the discretion of the treating physician)
14. Known positivity for Human Immunodeficiency Virus HIV-1 or HIV-2 type
15. Patients with known active infection of hepatitis B/C (HBC), or E (patients who are anti-HBC positive but HBsAg negative are eligible to participate in this study)
16. Clinically significant (i.e. active) cardiovascular disease defined as stroke, transient ischemic attack (TIA), myocardial infarction, unstable angina, or congestive heart failure within ≤ 6 months prior to first trial treatment
17. Evidence of any other medical conditions (such as treatment-resistant peptic ulcer disease, erosive oesophagitis or gastritis, infectious or inflammatory bowel disease, diverticulitis, or pulmonary embolism within 4 weeks of randomization, or psychiatric illness, drug or alcohol abuse, physical examination or laboratory findings) that may interfere with the planned treatment, affect subject compliance or place the subject at high risk of treatment-related complications
18. Legal incapacity

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Docetaxel IV; This study arm will receive docetaxel at 75 mg/m2 given i.v. as a one-hour infusion on day 1 every 21 days plus 5 mg oral prednisone twice daily.	Drug: Docetaxel in Parenteral Dosage Form; Treatment with IV docetaxel at 75 mg/m2 given as a one-hour infusion on day 1 every 21 days plus 5 mg oral prednisone twice daily; Other Names: Taxotere
Experimental: ModraDoc006/r; This cohort will receive ModraDoc006/r 30 mg oral docetaxel in combination with 200 mg ritonavir in the morning and 20 mg oral docetaxel in combination with 100 mg ritonavir in the evening (7-12 hours after the morning dose), on Day 1, 8 and 15 of a 21-day cycle, plus 5 mg oral prednisone twice daily.	Drug: ModraDoc006/r; Treatment with twice daily once weekly (BIDW) ModraDoc006 (oral docetaxel) 10mg tablets in combination with ritonavir 100mg tablets; Other Names: oral docetaxel formulation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Radiographic Progression Free Survival (rPFS)	Evaluation of rPFS that will be observed as measured by Prostate Cancer Clinical Trials Working Group 3 (PCWG3) criteria, in patients with metastatic prostate cancer after treatment with ModraDoc006/r or docetaxel IV. Radiographic disease progression was defined by the local assessment of: Progressive disease by RECIST v1.1. for soft tissue disease; Or the appearance of 2 or more new bone lesions on bone scan (PCWG3)	Time from the date of randomization to the date of the first radiologic progression (per PCWG3 criteria) or death from any cause, whichever occurred first, an average of 1 year.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adverse Event Profile (Safety)	The hematological and non-hematological safety profile of ModraDoc006/r will be assessed by clinical and laboratory evaluations according to CTCAE v5.0.	Evaluation of all adverse events during the complete study treatment until 28 days after the last intake, an average of 1 year.
Overall Response Rate (ORR)	Percentage of patients evaluable for radiological response (ERR) per Prostate Cancer Working Group 3 (PCWG3)-modified Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by CT/MRI with best overall response of either Complete Response (CR), i.e. disappearance of all target lesions, or Partial Response (PR), i.e. ≥30% decrease in the sum of the longest diameter of target lesions. PCGW3-modified RECIST 1.1 criteria implements the requirement for confirmation of progression at least 6 weeks later for bone lesions at all measurement time points, and for soft tissue lesions after the first measurement (after 2 months) only. Tumor measurements were scheduled after every 8 treatment weeks for the first 24 weeks (i.e. during Week 9, Week 17 and Week 25) and every 12 weeks thereafter.	From baseline during the complete study treatment, including follow-up visit 28 days after the last treatment, an average of 1 year.
Disease Control Rate (DCR)	Disease control rate is calculated by the percentage of patients with Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), ≥30% decrease in the sum of the longest diameter of target lesions; and Stable Disease (SD), ≤20% increase to <30% decrease in the sum of the longest diameter of target lesions per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by CT/MRI. Disease control rate is presented by treatment group for patients that were evaluable for radiological response for the overall study.	From baseline through study completion, an average of 1 year
Duration of Response (DOR)	DOR is defined as the median time in months from documentation of first tumor response to the first objective evidence of radiologic progression, as measured per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by CT/MRI, in the subpopulation of patients experiencing a Complete Response (CR), i.e. Disappearance of all target lesions; and Partial Response (PR), i.e. ≥30% decrease in the sum of the longest diameter of target lesions.	From baseline through study completion, an average of 1 year
Time to Progression (TTP)	Time to Progression is defined as the time from the date of randomization to the date of the first radiologic progression per PCWG3 criteria.	Time from the date of randomization to the date of the first radiologic progression, an average of 1 year.
PSA Response Rate	PSA decline of >50% from baseline with confirmatory read ≥3 weeks later, based on the Prostate Cancer Working Group 3 (PCWG3) criteria recommendations.	From baseline through study completion, an average of 1 year
PSA-PFS	Prostate-Specific Antigen Progression-Free Survival (PSA-PFS) according to Prostate Cancer Working Group 3 (PCWG3) guidance. Prostate-specific antigen progression was defined as per PCWG3 guidance: If a patient presented first a decline from baseline, progression was defined as the first PSA increase that was ≥25% and ≥2 ng/mL above the nadir, and which was confirmed by a consecutive second value ≥3 weeks later that fulfilled the same criteria (i.e., a confirmed rising trend); If a patient did not present a decline from baseline, progression was defined as the first PSA increase that was ≥25% and ≥2 ng/mL increased from baseline beyond 12 weeks.	Time from the date of randomization to the date of the first prostate-specific antigen progression or death from any cause, whichever occurred first, an average of 1 year.
Time to PSA Progression	Time to PSA progression was defined as the time from the date of randomization to the PSA progression as defined by Prostate Cancer Working Group 3 (PCWG3). Prostate-specific antigen progression was defined as per PCWG3 guidance: If a patient presented first a decline from baseline, progression was defined as the first PSA increase that was ≥25% and ≥2 ng/mL above the nadir, and which was confirmed by a consecutive second value ≥3 weeks later that fulfilled the same criteria (i.e., a confirmed rising trend); If a patient did not present a decline from baseline, progression was defined as the first PSA increase that was ≥25% and ≥2 ng/mL increased from baseline beyond 12 weeks.	From baseline through study completion, an average of 1 year
Number of Participants Who Experienced a First Skeletal-Related Event	Number of Participants who Experienced a first Skeletal-Related Event (SRE), i.e. the occurrence of the first skeletal-related event (i.e. radiation therapy or surgery to bone, clinically apparent pathological bone fracture, spinal cord compression, or change of antineoplastic therapy to treat bone pain); from the time of randomisation to the first occurrence. Note: Due to small number of SREs the median time to SRE was not evaluable in this patient population.	From baseline through study completion, an average of 1 year

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Health-Related Quality of Life Response	An overall Health-Related Quality of Life (HRQoL) improvement was defined by a 10-point or greater increase (= lower score) in the Functional Assessment of Cancer Therapy-global (FACT-G) total score assessment at a post-baseline assessment compared with baseline, at least once during the study. The FACT-G questionnaire contains 27-items to measure four domains of HRQoL on a 5 point Likert-type scale in cancer patients: Physical Well-Being (7 items; score range 0-28), Social/Family Well-Being (7 items; score range 0-28), Emotional Well-Being (6 items; score range 0-24), Functional Well-Being (7 items; score range 0-28). Higher scores and increases from baseline indicate higher quality of life.	From baseline through to end of Cycle 10 (each cycle was 21 days)
Summary of Improvement by Individual Health- Related Quality of Life Domains	Improvement for individual patients in Health-Related Quality of Life (HRQoL) domains was defined by a ≥3-point increase in the score of a 5 point Likert-like scale at a post-baseline assessment compared with baseline, at least once during study for Functional Assessment of Cancer Therapy (FACT)-G, -P and -T. Improvement was derived using all assessments collected per protocol schedule, i.e. Baseline, End of Cycle 3, 6 and 10 (or End of Treatment if sooner). Higher scores represent better HRQoL. FACT-G = global scale, measures four domains of HRQoL in cancer patients: Physical Well-Being (7 items; score range 0-28), Social/Family Well-Being (7 items; range 0-28), Emotional Well-Being (6 items; range 0-24), Functional Well-Being (7 items; range 0-28). Total score (range 0-108) FACT-P = prostate cancer sub scale (12 items; score range 0-48). Total score (FACT-G total score + FACT-P), range 0-156) FACT-T = taxane specific domain score (16 items, range 0 to 64), Total score (0-172)	Improvement assessed at any timepoint from baseline through to End of Cycle 10 (each cycle was 21 days)
Overall Health-Related Utility	Mean change from baseline to the End of Cycle 10 in the European Quality of Life Dimension-Five Level Scale (EQD5) is presented. For the EQD5, mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were scored on a 5-point scale: no problems (1), slight problems (2), moderate problems (3), severe problems (4), and extreme problems (5). Lower scores and decreases from baseline indicate improved quality of life. A visual analog scale (VAS) was used for the patient to evaluate their health state at a particular visit; the scale was numbered from 0 (representing the worst health imaginable) to 100 (representing the best health imaginable), higher scores and increases from baseline indicate improved health.	Assessed from baseline to End of Cycle 10 (each cycle was 21 days)
World Health Organization Performance Status (Eastern Cooperative Oncology Group) at End of Treatment	Eastern Cooperative Oncology Group (ECOG) scores at the time of end on treatment visit are presented. 0 = Normal activity; = Symptoms, but nearly ambulatory; = Symptomatic, but in bed <50% of the day; = Needs to be in bed >50% of the day, but not bedridden; = Unable to get out of bed; = Dead	Score assessed at end of treatment visit (up to 2 years).

Collaborators and Investigators

• Sponsor: Modra Pharmaceuticals
• Investigators: Study Director: M Keessen, MSc, MBA, Modra Pharmaceuticals

Study record dates

Study Major Dates

• Study Start (Actual): July 17, 2019
• Primary Completion (Actual): November 29, 2021
• Study Completion (Actual): November 29, 2021

Study Registration Dates

• First Submitted: July 17, 2019
• First Submitted That Met QC Criteria: July 19, 2019
• First Posted (Actual): July 22, 2019

Study Record Updates

• Last Update Posted (Actual): April 17, 2024
• Last Update Submitted That Met QC Criteria: March 20, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Genital Neoplasms, Male; Prostatic Diseases; Urogenital Diseases; Male Urogenital Diseases; Genital Diseases, Male; Genital Diseases; Prostatic Neoplasms; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Docetaxel
• Other Study ID Numbers: M18MDP

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No