Study of AZD5305 When Given in Combination With New Hormonal Agents in Patients With Metastatic Prostate Cancer (PETRANHA)

A Multi-arm, Open-label Phase I/IIa Study to Assess the Safety, Tolerability, Pharmacokinetics, Pharmacodynamics and Preliminary Efficacy of AZD5305 in Combination With New Hormonal Agents in Patients With Metastatic Prostate Cancer (PETRANHA)

This study will evaluate the safety, tolerability, pharmacokinetics (PK), pharmacodynamics, and preliminary efficacy of AZD5305 when given in combination with new hormonal agents (NHAs) in patients with Metastatic Prostate Cancer.

Study Overview

• Status: Recruiting
• Conditions: Metastatic Prostate Cancer
• Intervention / Treatment: Drug: AZD5305; Drug: Enzalutamide; Drug: Abiraterone Acetate; Drug: Darolutamide; Drug: Apalutamide

Detailed Description

The study consists of 2 parts, Part A and Part B. Part A consists of the dose escalation cohorts and will include patients with metastatic castration resistant prostate cancer (mCRPC) or metastatic castration-sensitive prostate cancer (mCSPC); Part B consists of dose expansion cohorts and will include patients with mCSPC only.

Part A comprises 4 individual arms each evaluating the safety, tolerability, and preliminary efficacy of AZD5305 in combination with a specific new hormonal agent (NHA). Part B comprises up to 4 individual arms (arms to be opened at Sponsor's discretion) each investigating the preliminary efficacy and aims to further build on the safety data for the combination of AZD5305 with a specific NHA.

Approximately 783 patients will be enrolled and screened to ensure the required number of evaluable patients in each part and arm are enrolled. For Part A, 356 patients may be screened to obtain up to approximately 308 patients that can be assigned to study treatments across all study arms (1 to 4). For Part B dose expansion cohorts, up to 427 patients may be screened to obtain up to approximately 360 patients that can be assigned to study treatments across all study arms (1 to 4).

Study treatment administration will continue until disease progression, initiation of alternative anticancer therapy, unacceptable toxicity, withdrawal of consent, or other reasons to discontinue study treatment occur.

• Study Type: Interventional
• Enrollment (Estimated): 172
• Phase: Phase 2; Phase 1

Contacts and Locations

• Study Contact: Name: AstraZeneca Clinical Study Information Center; Phone Number: 1-877-240-9479; Email: information.center@astrazeneca.com

Study Locations

• Australia
  • Camperdown, Australia, 2050
    • Recruiting
    • Research Site
  • Darlinghurst, Australia, 2010
    • Recruiting
    • Research Site
  • East Melbourne, Australia, 3002
    • Recruiting
    • Research Site
  • Heidelberg, Australia, 3084
    • Recruiting
    • Research Site
  • Melbourne, Australia, 3004
    • Recruiting
    • Research Site
  • St. Leonards, Australia, 2065
    • Recruiting
    • Research Site
• Italy
  • Candiolo, Italy, 10060
    • Recruiting
    • Research Site
  • Milano, Italy, 20133
    • Recruiting
    • Research Site
  • Milano, Italy, 20141
    • Recruiting
    • Research Site
  • Orbassano, Italy, 10043
    • Recruiting
    • Research Site
  • Padova, Italy, 35128
    • Recruiting
    • Research Site
  • Pavia, Italy, 27100
    • Recruiting
    • Research Site
• United Kingdom
  • Cambridge, United Kingdom, CB2 0QQ
    • Recruiting
    • Research Site
  • Glasgow, United Kingdom, G12 0YN
    • Recruiting
    • Research Site
  • Hampshire, United Kingdom, SO16 6YD
    • Withdrawn
    • Research Site
  • Manchester, United Kingdom, M20 4BX
    • Recruiting
    • Research Site
  • Newcastle Upon Tyne, United Kingdom, NE7 7JA
    • Withdrawn
    • Research Site
  • Plymouth, United Kingdom, PL6 8DH
    • Recruiting
    • Research Site
• United States
  • California
    • San Diego, California, United States, 92123
      • Withdrawn
      • Research Site
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • Recruiting
      • Research Site
  • Michigan
    • Detroit, Michigan, United States, 48202
      • Recruiting
      • Research Site
    • Detroit, Michigan, United States, 48201
      • Recruiting
      • Research Site
  • New York
    • Syracuse, New York, United States, 13210
      • Recruiting
      • Research Site
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19111
      • Withdrawn
      • Research Site
  • South Carolina
    • Myrtle Beach, South Carolina, United States, 29572
      • Recruiting
      • Research Site
  • Texas
    • Houston, Texas, United States, 77030
      • Recruiting
      • Research Site
    • Houston, Texas, United States, 77094
      • Recruiting
      • Research Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 130 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

For whole study:

• Age ≥ 18 at the time of screening.
• Histologically confirmed diagnosis of metastatic prostate cancer.
• Candidate for treatment with enzalutamide, abiraterone acetate, darolutamide or apalutamide with documented current evidence of metastatic prostate cancer.
• Surgically or medically castrated.
• Adequate organ and marrow function.
• Eastern Cooperative Oncology Group Performance Status (ECOG PS): 0-1 with no deterioration over the previous 2 weeks.
• Life expectancy ≥ 16 weeks.
• Non-sterilized male patients who are sexually active with a female partner of childbearing potential must use a condom with spermicide from screening to approximately 6 months after the last dose of study treatment .

For Patients Recruited Specifically to tumour Pharmacodynamic Cohorts:

• Patients must have at least 1 tumour suitable for paired biopsies

For Part A:

• Patients with Metastatic Castrate ion-Resistant Prostate Cancer (mCRPC) or Metastatic Castration Sensitive Prostate Cancer (mCSPC).

For Part B:

• Patients must have mCSPC (de novo or recurrent) with a baseline PSA value of ≥ 0.2 ng/mL

Exclusion Criteria:

For Part A mCRPC patients only:

• Any previous treatment with a new hormonal agent (NHA), poly (adenosine diphosphateribose) polymerase inhibitor (PARPi), Lutetium prostate-specific membrane antigen (Lu-PSMA), platinum chemotherapy
• Patients recruited to the PDc cohorts should not have received a prior use of new hormonal agents (NHA).

For Part A and Part B mCSPC Patients:

• Any previous treatment with a PARPi, platinum, NHA, Immuno-oncology (IO), radiopharmaceutical therapy, or prior treatment with docetaxel in mCSPC setting.

• Concomitant use of medications or herbal supplements known to be:

  1. Strong and moderate CYP3A4 inducers/inhibitors (applies for all arms)
  2. For Arm 1 (enzalutamide) patients: Strong CYP2C8 inhibitors
  3. For Arm 3 (darolutamide) patients: Strong P-glycoprotein inducers
• Concomitant use of drugs that are known to prolong or shorten QT and have a known risk of Torsades de Pointes.

• Treatment with any of the following:

  1. Any investigational agents or study interventions from a previous clinical study within 5 half lives or 3 weeks (whichever is longer) of the first dose of study treatment.
  2. Any other anticancer treatment within the following time periods prior to the first dose of study treatment: (i) Cytotoxic and non-cytotoxic treatment: 3 weeks or 5 half-lives (whichever is shorter). (ii) Biological products including immuno-oncology agents: 4 weeks before enrolment.
  3. Any live virus or bacterial vaccine within 28 days of the first dose of study treatment.
• Any concurrent anticancer therapy or concurrent use of prohibited medications.
• Major surgery within 4 weeks prior to the first dose of study treatment.
• Radiotherapy with a wide field of radiation within 4 weeks or radiotherapy with a limited field of radiation for palliation within 2 weeks of the first dose of study treatment.
• With the exception of alopecia, and peripheral neuropathy; any unresolved toxicities from prior therapy greater than Common Terminology Criteria for Adverse Events (CTCAE) Grade 1 at the time of study enrolment.
• Any history of persisting (> 2 weeks) severe pancytopenia.
• Spinal cord compression, or brain metastases unless asymptomatic and treated and stable.
• Any evidence of severe or uncontrolled systemic diseases, including, active bleeding diatheses, or active infection including hepatitis B, hepatitis C and human immunodeficiency virus (HIV).
• Patients with any known predisposition to bleeding (eg, active peptic ulceration, recent [within 6 months] haemorrhagic stroke, proliferative diabetic retinopathy.
• Any clinically significant cardiac disorders including QT prolongation, abnormal electrocardiogram (ECG).
• Any clinically significant cardiovascular diseases including symptomatic heart failure, uncontrolled hypertension, acute coronary syndrome, cardiomyopathy, valvular heart disease, atrial fibrillation, stroke.
• Patients with history of myelodysplastic syndrome (MDS)/ acute myeloid leukaemia (AML).
• Refractory nausea and vomiting, chronic gastrointestinal diseases, inability to swallow the formulated product or previous significant bowel resection.
• Known allergy or hypersensitivity to investigational product(s) or any of the excipients of the investigational product(s).
• Any condition that would interfere with evaluation of the study treatment or interpretation of patient safety or study results.
• Uncontrolled intercurrent illness within the last 12 months, including but not limited to, active interstitial lung disease, serious chronic gastrointestinal (GI) conditions associated with diarrhoea, or psychiatric illness/social situations
• History of another primary malignancy except for malignancy treated with curative intent with no known active disease within 3 years before the first dose of study treatment and of low potential risk for recurrence.
• Concurrent enrolment in another clinical study, unless it is an observational (non-interventional) clinical study or during the follow-up period of an interventional study.
• Arm 1 (Enzalutamide) and Arm 4 (Apalutamide): History of seizure or any condition that may predispose to seizure (eg, prior cortical stroke, significant brain trauma).
• Arm 2 (Abiraterone acetate) only: (i) Active infection or other medical condition that would contraindicate the use of systemic steroids (prednisone/prednisolone). (ii) Low serum potassium (< 3.5 mmol/L). (iii) History of uncontrolled pituitary or adrenal dysfunction.
• Arm 4 (Apalutamide): (i) Moderate or severe skin conditions or diseases that could affect the skin (eg. scleroderma, lupus). (ii) Any skin or medical condition that in the Investigator's opinion could increase the risk of skin toxicity.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm 1 (AZD5305 in combination with enzalutamide); Patients will receive an oral dose of AZD5305 and Enzalutamide once daily until disease progression, initiation of alternative anticancer therapy, unacceptable toxicity, withdrawal of consent, or other reasons to discontinue study treatment occur.	Drug: AZD5305; Patients will receive an oral dose of AZD5305 once daily; Drug: Enzalutamide; Patients will receive an oral dose of Enzalutamide once daily; Other Names: Xtandi
Experimental: Arm 2 (AZD5305 in combination with abiraterone acetate); Patients will receive an oral dose of AZD5305 and Abiraterone Acetate once daily until disease progression, initiation of alternative anticancer therapy, unacceptable toxicity, withdrawal of consent, or other reasons to discontinue study treatment occur.	Drug: AZD5305; Patients will receive an oral dose of AZD5305 once daily; Drug: Abiraterone Acetate; Patients will receive an oral dose of Abiraterone Acetate once daily; Other Names: Zytiga
Experimental: Arm 3 (AZD5305 in combination with darolutamide); Patients will receive an oral dose of AZD5305 once daily and Darolutamide twice daily until disease progression, initiation of alternative anticancer therapy, unacceptable toxicity, withdrawal of consent, or other reasons to discontinue study treatment occur.	Drug: AZD5305; Patients will receive an oral dose of AZD5305 once daily; Drug: Darolutamide; Patients will receive an oral dose of Darolutamide twice daily; Other Names: Nubeqa
Experimental: Arm 4 (AZD5305 in combination with apalutamide); Patients will receive an oral dose of AZD5305 and Apalutamide once daily until disease progression, initiation of alternative anticancer therapy, unacceptable toxicity, withdrawal of consent, or other reasons to discontinue study treatment occur.	Drug: Apalutamide; Patients will receive an oral dose of Apalutamide once daily; Other Names: Erleada

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of patients with Adverse Events and Serious Adverse Events	Number of patients with adverse events and with serious adverse events including abnormal clinical observations, abnormal ECG parameters, abnormal laboratory assessments and abnormal vital signs that changed from baseline will be assessed.	Up to post treatment follow-up (28 days after last dose) [assessed up to 2.3 years]
Part A: Number of patients with Dose Limiting Toxicities (DLTs)	To assess the safety and tolerability of AZD5305 when given in combination with NHA.	For Arm 1: 35 days, For Arm 2 and 3: 28 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Area Under the concentration Curve (AUC) of AZD5305	To characterise the PK (AUC) of AZD5305 at steady state after multiple dosing of AZD5305 monotherapy.	At the end of Cycle 0 (Cycle 0 is of 7 days)
Maximum plasma concentration (Cmax) of AZD5305	To characterise the PK (Cmax) of AZD5305 at steady state after multiple dosing of AZD5305 monotherapy.	At the end of Cycle 0 (Cycle 0 is of 7 days)
Time to maximum concentration (tmax) of AZD5305	To characterise the PK (tmax) of AZD5305 at steady state after multiple dosing of AZD5305 monotherapy.	At the end of Cycle 0 (Cycle 0 is of 7 days)
AUC of AZD5305	To characterise the PK (AUC) of AZD5305 following oral dose administration of AZD5305 in combination with NHA.	Arm 1: At Cycle 1 Day 1, Cycle 1 Day 22, Cycle 2 Day 1, Cycle 2 Day 2, Cycle 2 Day 8, and Cycle 3 Day 1; Arm 2 and 3: At Cycle 1 Day 1, Cycle 1 Day 15 and Cycle 2 Day 1 (Each Cycle is of 28 days)
Cmax of AZD5305	To characterise the PK (Cmax) of AZD5305 following oral dose administration of AZD5305 in combination with NHA.	Arm 1: At Cycle 1 Day 1, Cycle 1 Day 22, Cycle 2 Day 1, Cycle 2 Day 2, Cycle 2 Day 8, and Cycle 3 Day 1; Arm 2 and 3: At Cycle 1 Day 1, Cycle 1 Day 15 and Cycle 2 Day 1 (Each Cycle is of 28 days)
tmax of AZD5305	To characterise the PK (tmax) of AZD5305 following oral dose administration of AZD5305 in combination with NHA.	Arm 1: At Cycle 1 Day 1, Cycle 1 Day 22, Cycle 2 Day 1, Cycle 2 Day 2, Cycle 2 Day 8, and Cycle 3 Day 1; Arm 2 and 3: At Cycle 1 Day 1, Cycle 1 Day 15 and Cycle 2 Day 1 (Each Cycle is of 28 days)
Objective response rate (ORR)	To assess the preliminary antitumour activity of AZD5305 in combination with NHA. ORR will be assessed as per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 (soft tissue) and Prostate Cancer Clinical Trials Working Group 3 (PCWG3) and is defined as the percentage of patients who have a confirmed visit response of complete response (CR) or partial response (PR) in their soft tissue disease and no disease progression in their bone scan.	From Screening (Day -28) to confirmed disease progression [assessed up to 2.3 years]
Duration of response (DoR)	To assess the preliminary antitumour activity of AZD5305 in combination with NHA. DoR is defined as the time from the date of first documented response (which is subsequently confirmed) until date of documented progression or death in the absence of progressive disease (PD).	From Screening (Day -28) to confirmed disease progression [assessed up to 2.3 years]
Time to response (TTR)	To assess the preliminary antitumour activity of AZD5305 in combination with NHA. TTR is defined as the time from first dose until the first documentation of a subsequently confirmed objective response.	From Screening (Day -28) to confirmed disease progression [assessed up to 2.3 years]
Percentage change in tumour size	To assess the preliminary antitumour activity of AZD5305 in combination with NHA. Percentage change in tumour size will be determined for patients with measurable disease at baseline.	From Screening (Day -28) to confirmed disease progression [assessed up to 2.3 years]
AUC of Enzalutamide	To characterize the PK (AUC) of Enzalutamide in plasma at steady state when given orally in combination with AZD5305	At Cycle 1 Day 22, Cycle 2 Day 1, Cycle 2 Day 2, Cycle 2 Day 8 and Cycle 3 Day 1 (Each Cycle is of 28 days)
Cmax of Enzalutamide	To characterize the PK (Cmax) of Enzalutamide in plasma at steady state when given orally in combination with AZD5305	At Cycle 1 Day 22, Cycle 2 Day 1, Cycle 2 Day 2, Cycle 2 Day 8 and Cycle 3 Day 1 (Each Cycle is of 28 days)
tmax of Enzalutamide	To characterize the PK (tmax) of Enzalutamide in plasma at steady state when given orally in combination with AZD5305	At Cycle 1 Day 22, Cycle 2 Day 1, Cycle 2 Day 2, Cycle 2 Day 8 and Cycle 3 Day 1 (Each Cycle is of 28 days)
Radiographic progression-free survival (rPFS)	To assess the preliminary antitumour activity of AZD5305 in combination with NHA. rPFS is defined as the time from start of first treatment until progression as per RECIST v1.1 (soft tissue) and PCWG3 criteria (bone) or death from any cause.	From Screening (Day -28), 12 months, 24 months and up to confirmed disease progression [assessed up to 2.3 years]
Number of patients with ≥ 50% prostate-specific antigen (PSA) decrease from baseline	To assess the preliminary antitumour activity of AZD5305 in combination with NHA.	From Screening (Day -28) to confirmed disease progression [assessed up to 2.3 years]
Number of patients with ≥ 90% prostate-specific antigen (PSA) decrease from baseline	To assess the preliminary antitumour activity of AZD5305 in combination with NHA.	From Screening (Day -28) to confirmed disease progression [assessed up to 2.3 years]
Part B: Number of patients with undetectable PSA (< 0.2 ng/mL)	To assess the preliminary antitumour activity of AZD5305 in combination with NHA.	3, 6, 9 and 12 months
PSA Progression-free survival	To assess the preliminary antitumour activity of AZD5305 in combination with NHA.	6, 12, 18, 24 and 30 months
AUC of Apalutamide	To characterize the PK (AUC) of Apalutamide in plasma at steady state when given orally in combination with AZD5305	At Cycle 1 Day 22, Cycle 2 Day 1, Cycle 2 Day 2, Cycle 2 Day 8 and Cycle 3 Day 1 (Each Cycle is of 28 days)
Cmax of Apalutamide	To characterize the PK (Cmax) of Apalutamide in plasma at steady state when given orally in combination with AZD5305	At Cycle 1 Day 22, Cycle 2 Day 1, Cycle 2 Day 2, Cycle 2 Day 8 and Cycle 3 Day 1 (Each Cycle is of 28 days)
tmax of Apalutamide	To characterize the PK (tmax) of Apalutamide in plasma at steady state when given orally in combination with AZD5305	At Cycle 1 Day 22, Cycle 2 Day 1, Cycle 2 Day 2, Cycle 2 Day 8 and Cycle 3 Day 1 (Each Cycle is of 28 days)
Part B: Homologous recombination repair gene mutation (HRRRm)	To investigate HRRm (including BRCA1/2) and their relationship with clinical response	From Screening (Day -28) to confirmed disease progression [assessed up to 2.3 years]

Collaborators and Investigators

• Sponsor: AstraZeneca
• Collaborators: Bayer

Study record dates

Study Major Dates

• Study Start (Actual): June 2, 2022
• Primary Completion (Estimated): August 15, 2030
• Study Completion (Estimated): August 15, 2030

Study Registration Dates

• First Submitted: April 19, 2022
• First Submitted That Met QC Criteria: May 5, 2022
• First Posted (Actual): May 10, 2022

Study Record Updates

• Last Update Posted (Actual): April 25, 2024
• Last Update Submitted That Met QC Criteria: April 24, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: PETRANHA; AZD5305; New Hormonal Agents
• 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; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Hormones, Hormone Substitutes, and Hormone Antagonists; Cytochrome P-450 Enzyme Inhibitors; Hormone Antagonists; Steroid Synthesis Inhibitors; Abiraterone Acetate
• Other Study ID Numbers: D9720C00003; 2021-006289-19 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal. All requests will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.

Yes, indicates that AZ are accepting requests for IPD, but this does not mean all requests will be shared.

• IPD Sharing Time Frame: AstraZeneca will meet or exceed data availability as per the commitments made to the EFPIA Pharma Data Sharing Principles. For details of our timelines, please rerefer to our disclosure commitment at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
• IPD Sharing Access Criteria: When a request has been approved AstraZeneca will provide access to the de-identified individual patient-level data in an approved sponsored tool. Signed Data Sharing Agreement (non-negotiable contract for data accessors) must be in place before accessing requested information. Additionally, all users will need to accept the terms and conditions of the SAS MSE to gain access. For additional details, please review the Disclosure Statements at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.

Drug and device information, study documents

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