Pertuzumab, Trastuzumab, Hyaluronidase-zzxf and Enzalutamide for Treatment of Metastatic Castration-Resistant Prostate Cancer

Phase II Trial of Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (HP) Plus Enzalutamide for the Treatment of Selected Patients With Metastatic Castration-Resistant Prostate Cancer (TraPPer)

This phase II trial tests how well pertuzumab, trastuzumab, hyaluronidase-zzxf and enzalutamide works in treating patients with castration-resistant prostate cancer that has spread from where it first started to other places in the body (metastatic). Pertuzumab and trastuzumab are monoclonal antibodies and forms of targeted therapy that attach to a receptor protein called human epidermal growth factor receptor-2 (HER2). HER2 is found on some cancer cells. When pertuzumab or trastuzumab attach to HER2, the signals that tell the cells to grow are blocked and the tumor cell may be marked for destruction by the body's immune system. Hyaluronidase is an endoglycosidase. It helps to keep pertuzumab and trastuzumab in the body longer, so that these medications will have a greater effect. Hyaluronidase also allows pertuzumab and trastuzumab to be given by injection under the skin and shortens their administration time compared to pertuzumab or trastuzumab alone. Chemotherapy drugs, such as enzalutamide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving pertuzumab, trastuzumab, hyaluronidase-zzxf and enzalutamide may kill more cancer cells.

Study Overview

• Status: Completed
• Conditions: Castration-Resistant Prostate Carcinoma; Stage IVB Prostate Cancer AJCC v8
• Intervention / Treatment: Other: Questionnaire Administration; Procedure: Magnetic Resonance Imaging; Procedure: Computed Tomography; Procedure: Biopsy; Procedure: Echocardiography; Drug: Hyaluronidase-zzxf/Pertuzumab/Trastuzumab; Drug: Enzalutamide; Procedure: Biospecimen Collection

Detailed Description

PRIMARY OBJECTIVE:

I. Evaluate the preliminary efficacy of the combination of pertuzumab, trastuzumab, and hyaluronidase-zzxf plus enzalutamide with regard to objective response rate (Prostate Cancer Clinical Trials Working Group 3 [PCWG 3.0]) in enzalutamide-refractory metastatic castration-resistant prostate cancer.

SECONDARY OBJECTIVES:

I. Estimate the radiographic progression-free survival for this combination. II. Estimate the overall survival for this combination.

EXPLORATORY OBJECTIVES:

I. Assessment of this combination for adverse events according to clinical judgment and patient-reported outcomes (Patient Reported Outcomes-Common Terminology Criteria for Adverse Events [PRO-CTCAE] - Prostate Cancer).

II. Assessment of patient quality of life using Functional Assessment of Cancer Therapy- Prostate (FACT-P) questionnaire.

CORRELATIVE OBJECTIVES:

I. Determine the correlation between outcomes as above and systemic NRG-1 levels at baseline and over time.

II. Determine the correlation between outcomes as above and change in HER2/HER3/androgen receptor (AR) gene signatures.

OUTLINE:

Patients receive pertuzumab, trastuzumab, and hyaluronidase-zzxf subcutaneously (SC) on day 1 of each cycle and enzalutamide orally (PO) once daily (QD) on days 1-21 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography (ECHO), biopsy, computed tomography (CT), and magnetic resonance imaging (MRI) scans and collection of blood samples throughout the study.

After completion of study treatment, patients are followed up every 3 months until progressive disease then every 6 months thereafter.

• Study Type: Interventional
• Enrollment (Actual): 7
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Scottsdale, Arizona, United States, 85259
      • Mayo Clinic in Arizona
  • Florida
    • Jacksonville, Florida, United States, 32224-9980
      • Mayo Clinic in Florida
  • Minnesota
    • Rochester, Minnesota, United States, 55905
      • Mayo Clinic in Rochester

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• PRE-REGISTRATION: Age >= 18 years.
• PRE-REGISTRATION: Clinically or histologically confirmed diagnosis of second-generation antiandrogen-refractory metastatic castration-resistant prostate cancer.
• PRE-REGISTRATION: Measurable disease as defined by the Prostate Cancer Working Group (PCWG3) criteria.

• PRE-REGISTRATION: Prior treatment required:

  • Second generation anti-androgen (2GAA) therapy (e.g., enzalutamide, abiraterone) at any time prior registration.
• PRE-REGISTRATION: Provide written informed consent.
• PRE-REGISTRATION: Willing to return to enrolling institution for follow-up (during the Active Monitoring Phase of the study).
• PRE-REGISTRATION: Ability to complete questionnaire(s) by themselves or with assistance.
• PRE-REGISTRATION: Willingness to provide mandatory blood specimens for correlative research.
• PRE-REGISTRATION: Willingness to provide mandatory tissue specimens for correlative research.
• REGISTRATION: Plasma NRG-1 level >= 4 ng/ml
• REGISTRATION: Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0, 1 or 2.
• REGISTRATION: Hemoglobin >= 9.0 g/dL
• REGISTRATION: Absolute neutrophil count (ANC) >= 1500/mm^3
• REGISTRATION: Platelet count >= 100,000/mm^3
• REGISTRATION: Total bilirubin =< 1.5 x upper limit of normal (ULN)
• REGISTRATION: Alanine aminotransferase (ALT) and aspartate transaminase (AST) =< 3 x ULN (=< 5 x ULN for patients with liver involvement).
• REGISTRATION: PT/INR/aPTT =<1.5 x ULN OR if patient is receiving anticoagulant therapy and INR or aPTT is within target range of therapy.
• REGISTRATION: Calculated creatinine clearance >= 45 ml/min using the Cockcroft-Gault formula.
• REGISTRATION: Left ventricular ejection fraction (LVEF) >= 50% =< 15 days prior to registration.
• REGISTRATION: Provide written informed consent.
• REGISTRATION: Ability to complete questionnaire(s) by themselves or with assistance.
• REGISTRATION: Willingness to provide mandatory blood specimens for correlative research.
• REGISTRATION: Willingness to provide mandatory tissue specimens for correlative research.
• REGISTRATION: Willing to return to enrolling institution for follow-up (during the Active Monitoring Phase of the study).

Exclusion Criteria:

• PRE-REGISTRATION: History of myocardial infarction =< 6 months prior to pre-registration, or congestive heart failure requiring use of ongoing maintenance therapy for life threatening ventricular arrhythmias.

• PRE-REGISTRATION: Failure to recover from acute, reversible effects of prior therapy regardless of interval since last treatment.

  • EXCEPTION: Grade 1 peripheral (sensory) neuropathy that has been stable for at least 3 months since completion of prior treatment.

• PRE-REGISTRATION: Uncontrolled intercurrent non-cardiac illness including, but not limited to:

  • Ongoing or active infection
  • Psychiatric illness/social situations
  • Dyspnea at rest due to complications of advanced malignancy or other disease that requires continuous oxygen therapy
  • Any other conditions that would limit compliance with study requirements

• PRE-REGISTRATION: Immunocompromised patients and patients known to be human immunodeficiency virus (HIV) positive and currently receiving antiretroviral therapy.

  • NOTE: Patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial.
• PRE-REGISTRATION: Receiving any other investigational agent which would be considered as a treatment for the prostate cancer.
• PRE-REGISTRATION: Thromboembolic event =< 60 days prior to pre-registration.

• PRE-REGISTRATION: Serious cardiac illness or medical conditions including, but not confined to, the following:

  • History of NCI CTCAE v5.0 Grade >= 3 symptomatic congestive heart failure (CHF) or New York Heart Association (NYHA) Class >= II
  • High-risk uncontrolled arrhythmias (i.e., atrial tachycardia with a heart rate >= 100/min at rest, significant ventricular arrhythmia [ventricular tachycardia], or higher-grade atrioventricular [AV]-block, such as second-degree AVblock Type 2 [Mobitz II] or third-degree AV-block)
  • Serious cardiac arrhythmia or severe conduction abnormality not controlled by adequate medication
  • Angina pectoris requiring anti-angina medication
  • Clinically significant valvular heart disease
  • Evidence of transmural infarction on electrocardiogram (ECG)
  • Poorly controlled hypertension (e.g., systolic > 180 mm Hg or diastolic > 100mmHg)
• PRE-REGISTRATION: Serious cardiac arrhythmia or severe conduction abnormality not controlled by adequate medication.
• PRE-REGISTRATION: Angina pectoris requiring anti-angina medication.
• PRE-REGISTRATION: Clinically significant valvular heart disease.
• PRE-REGISTRATION: Evidence of transmural infarction on electrocardiogram (ECG).
• PRE-REGISTRATION: Poorly controlled hypertension (e.g., systolic > 180 mm Hg or diastolic > 100mmHg).
• PRE-REGISTRATION: History of ventricular dysrhythmias or risk factors for ventricular dysrhythmias, such as structural heart disease (e.g., severe left ventricular systolic dysfunction [LVSD], left ventricular hypertrophy), coronary heart disease (symptomatic or with ischemia demonstrated by diagnostic testing), clinically significant electrolyte abnormalities (e.g., hypokalemia, hypomagnesemia, hypocalcemia), or family history of sudden unexplained death or long QT syndrome.

• REGISTRATION: Any of the following because this study involves an agent that has known genotoxic, mutagenic, and teratogenic effects:

  • Pregnant persons
  • Nursing persons
  • Persons of childbearing potential or able to father a child who are unwilling to employ adequate contraception

• REGISTRATION: Failure to recover from any of the following therapies prior to registration:

  • Major surgery
  • Chemotherapy
  • Infection requiring systemic treatment
• REGISTRATION: Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens.
• REGISTRATION: Immunocompromised patients and patients known to be HIV positive and currently receiving antiretroviral therapy.

NOTE: Patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial.

• REGISTRATION: Uncontrolled intercurrent illness including, but not limited to:

  • Ongoing or active infection
  • Symptomatic congestive heart failure
  • Unstable angina pectoris
  • Cardiac arrhythmia
  • Or psychiatric illness/social situations that would limit compliance with study requirements.
• REGISTRATION: Currently receiving any other investigational agent which would be considered as a treatment for the primary neoplasm.
• REGISTRATION: Other active malignancy =< 3 years prior to registration. EXCEPTIONS: Non-melanotic skin cancer or carcinoma-in-situ of the cervix. NOTE: If there is a history of prior malignancy, they must not be receiving other specific treatment (e.g., other hormonal therapy, chemotherapy) for their cancer.
• REGISTRATION: History of myocardial infarction =< 6 months, or congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias.
• REGISTRATION: Known hypersensitivity to pertuzumab, or trastuzumab, or hyaluronidase, or to any of its excipients.
• REGISTRATION: Requirement for drugs or substances which can interfere with the actions of the study drugs (enzalutamide or pertuzumab/trastuzumab/hyaluronidase-zzxf). Consult pharmacist for review.

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: Treatment (HP, enzalutamide); Patients receive pertuzumab, trastuzumab, and hyaluronidase-zzxf SC on day 1 of each cycle and enzalutamide PO QD on days 1-21 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO, biopsy, CT, and MRI scans and collection of blood samples throughout the study.

Other: Questionnaire Administration; Ancillary studies; Procedure: Magnetic Resonance Imaging; Undergo MRI; Other Names: MRI; Magnetic Resonance; Magnetic Resonance Imaging Scan; Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance; MR; MR Imaging; MRI Scan; NMR Imaging; NMRI; Nuclear Magnetic Resonance Imaging; Procedure: Computed Tomography; Undergo CT; Other Names: CT; CAT; CAT Scan; Computed Axial Tomography; Computerized Axial Tomography; Computerized Tomography; CT Scan; tomography; Procedure: Biopsy; Undergo biopsy; Other Names: Bx; BIOPSY_TYPE; Procedure: Echocardiography; Undergo ECHO; Other Names: EC; Drug: Hyaluronidase-zzxf/Pertuzumab/Trastuzumab; Given SC; Other Names: Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf; Pertuzumab/Trastuzumab/Hyaluronidase-zzxf; Phesgo; Drug: Enzalutamide; Given PO; Other Names: Xtandi; MDV3100; ASP9785; Procedure: Biospecimen Collection; Undergo collection of blood and tissue samples; Other Names: Biological Sample Collection; Biospecimen Collected; Specimen Collection

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Response Rate (ORR)	ORR is defined as the proportion of patients who experience either a partial response or complete response as defined by Prostate Cancer Working Group 3 (PCWG3). Overall Response per Prostate Cancer Working Group 3 (PCWG3) is a composite assessment integrating soft-tissue disease evaluated by RECIST v1.1 and bone disease evaluated separately using PCWG3 bone scan criteria. Complete Response (CR) is disappearance of all soft-tissue target lesions (with lymph nodes <10 mm short axis) and no bone progression; Partial Response (PR) is a ≥30% decrease in the sum of diameters of soft-tissue target lesions with no bone progression; Stable Disease (SD) is neither CR/PR nor Progressive Disease. Progressive Disease (PD) is declared by radiographic progression in either domain, defined as RECIST v1.1 progression or confirmed bone progression using the PCWG3 2+2 rule for new bone lesions, regardless of PSA changes.	Up to 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression-free Survival (PFS)	PFS is defined as the time from study entry to the first of either confirmed radiographic disease progression or death from any cause, determined based on Prostate Cancer Clinical Trials Working Group 3 (PCWG3) criteria.	Up to 1 year
Overall Survival (OS)	OS is defined as the time from study entry to death from any cause.	Up to 1 year
Number of Participants With Treatment-related Grade 3 or Higher Adverse Event	The rate of patients experiencing any Grade 3 or higher adverse event > deemed at least possibly related to treatment will be reported. The maximum grade for each type of adverse event by patient will also be > summarized by frequencies and percentages using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.	Up to 1 year
Change in Quality of Life (QoL) From Baseline	Assessed using the Functional Assessment of Cancer Therapy - Prostate (FACT-P), a 39-item questionnaire that measures quality of life (QOL) in men with prostate cancer. Questions are answered on a scale of 0-4 where 0=not at all; 1=a little bit; 2=somewhat; 3=quite a bit; and 4=very much. FACT-P is composed of five subscales: Physical Well-Being (7 items; score range 0-28), Social/Family Well-Being (7 items; 0-28), Emotional Well-Being (6 items; 0-24), Functional Well-Being (7 items; 0-28), and the Prostate Cancer Subscale (12 items; 0-48). Subscale scores are summed to compute a total FACT-P score ranging from 0 to 156, with higher scores indicating better quality of life and lower scores indicating worse quality of life. Patient responses to the FACT-P will be summarized descriptively by the change in FACT-P score from baseline at last assessment. .	Up to 1 year

Collaborators and Investigators

• Sponsor: Mayo Clinic
• Investigators: Principal Investigator: Jacob Orme, M.D., Ph.D., Mayo Clinic in Rochester

Publications and helpful links

Helpful Links

• Mayo Clinic Clinical Trials

Study record dates

Study Major Dates

• Study Start (Actual): March 8, 2024
• Primary Completion (Actual): April 10, 2025
• Study Completion (Actual): April 10, 2025

Study Registration Dates

• First Submitted: February 7, 2023
• First Submitted That Met QC Criteria: February 7, 2023
• First Posted (Actual): February 16, 2023

Study Record Updates

• Last Update Posted (Actual): May 15, 2026
• Last Update Submitted That Met QC Criteria: April 23, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Genital Neoplasms, Male; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Genital Diseases, Male; Prostatic Diseases; Male Urogenital Diseases; Prostatic Neoplasms; Amino Acids, Peptides, and Proteins; Proteins; Investigative Techniques; Clinical Laboratory Techniques; Diagnostic Techniques and Procedures; Diagnosis; Surgical Procedures, Operative; Cytological Techniques; Cytodiagnosis; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Serum Globulins; Globulins; Diagnostic Techniques, Surgical; Chemistry Techniques, Analytical; Spectrum Analysis; Trastuzumab; Biopsy; Specimen Handling; pertuzumab; Magnetic Resonance Spectroscopy; enzalutamide
• Other Study ID Numbers: MC210504 (Other Identifier: Mayo Clinic in Rochester); NCI-2022-10773 (Registry Identifier: CTRP (Clinical Trial Reporting Program)); 21-013057 (Other Identifier: Mayo Clinic Institutional Review Board)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No