Everolimus in Treating Patients With Newly Diagnosed Localized Prostate Cancer
Randomized Phase II Study of Two Different Doses of RAD-001 (Everolimus) as Neo-Adjuvant Therapy in Patients With Localized Prostate Cancer
RATIONALE: Everolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving everolimus before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.
PURPOSE: This randomized phase II trial is studying the side effects and how well everolimus works in treating patients with newly diagnosed localized prostate cancer.
研究概览
详细说明
OBJECTIVES:
Primary
- To determine the clinical effects of everolimus, in terms of pathologic response (i.e., histologic P0, margin status, or capsular penetration) and surgical outcome, in patients with newly diagnosed localized prostate cancer treated with two different doses of everolimus prior to radical prostatectomy.
- To evaluate the safety and tolerability of this drug in these patients.
Secondary
- To determine the effect of this drug on prostate-specific antigen (PSA) levels in these patients.
- To determine the effect of this drug on levels of expression of PTEN, Akt, phospho-mTOR (i.e., Se2448), phospho-p70 S6 kinase (i.e., Thre389), phospho-Smad3 (i.e., Ser433/435), phospho-Smads 1/5 (i.e., Ser463/465), AR, and TUNEL in these patients.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
- Arm I: Patients receive low-dose oral everolimus once daily for up to 8 weeks in the absence of unacceptable toxicity.
- Arm II: Patients receive high-dose oral everolimus once daily for up to 8 weeks in the absence of unacceptable toxicity.
Within 7 days after the last dose of everolimus, all patients undergo radical prostatectomy with bilateral pelvic lymphadenectomy.
Tumor biopsy specimens acquired prior to treatment and prostate tumor tissue acquired at the time of radical prostatectomy are evaluated for biomarker correlative studies. Tissue samples are assessed by immunohistochemistry (IHC) and tissue microarray analysis for expression of cellular and molecular biomarkers (i.e., p-S6, p-4E-BP1, and p-Akt) that correlate with response. Prostatectomy specimens are also assessed by pathologic analysis for histopathologic response (i.e., pathologic stage, Gleason score, margin status, and tumor size).
After completion of study therapy, patients are followed at 6 weeks.
研究类型
注册 (实际的)
阶段
- 阶段2
联系人和位置
学习地点
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Ohio
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Cleveland、Ohio、美国、44195
- Cleveland Clinic Taussig Cancer institute, Case Comprehensive Cancer Center
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
DISEASE CHARACTERISTICS:
Histologically or cytologically confirmed newly diagnosed, localized adenocarcinoma of the prostate, meeting any of the following criteria:
- Clinical stage T2a, T2b, T2c, or T3 disease (any grade or PSA)
- Gleason score 7 (4+3 only) or ≥ 8 (any stage or PSA)
- Serum PSA ≥ 10 ng/dL (any grade or stage)
- Any stage, PSA, or Gleason score AND ≥ 35% chance of biochemical failure at 5 years based on Kattan's nomogram
- Recommended for radical prostatectomy
- Normal testosterone level
- No pure neuroendocrine or small cell prostate cancer
- No metastatic disease by CT scan, MRI, bone scan, or X-ray
- No clinical evidence of CNS metastases
PATIENT CHARACTERISTICS:
Inclusion criteria:
- ECOG performance status (PS) 0-1 or Karnofsky PS 70-100%
- ANC ≥ 1,500/μL
- Platelet count ≥ 100,000/μL
- Hemoglobin ≥ 8 g/dL
- AST and ALT ≤ 1.5 times upper limit of normal (ULN)
- Bilirubin ≤ 1.5 times ULN
- Creatinine ≤ 1.5 times ULN
- PT/PTT normal (no anticoagulants)
- No active unresolved infection
- No known HIV positivity
- Fertile patients must use effective contraception during and for 6 months after completion of study therapy
Exclusion criteria:
- Known hypersensitivity to everolimus or other rapamycins (e.g., sirolimus or temsirolimus) or to its excipients
Gastrointestinal (GI) disease, condition, or symptoms that may significantly impair GI function and alter the absorption of everolimus, including any of the following:
- Ulcerative disease
- Uncontrolled nausea
- Vomiting
- Diarrhea
- Malabsorption syndrome
- Other active malignancy or malignancy at ≥ 30% risk for relapse after completion of therapy, except nonmelanoma skin cancer
Uncontrolled concurrent illness including, but not limited to, any of the following:
- Ongoing or active infection (e.g., bacterial, viral or fungal)
- Severely impaired lung function
- Uncontrolled diabetes (fasting serum glucose > 1.5 times ULN)
- Liver disease (e.g., cirrhosis, chronic active hepatitis, or chronic persistent hepatitis)
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Cardiac arrhythmia
- Psychiatric illness or social situation that would limit study compliance
- Any underlying medical condition which, in the principal investigator's opinion, will make the administration of everolimus hazardous OR obscure the interpretation of adverse events
PRIOR CONCURRENT THERAPY:
- More than 4 weeks since major surgery
- More than 3 months since finasteride
- No prior or concurrent radiotherapy to the prostate gland or pelvis
- No prior hormones (e.g., luteinizing hormone-releasing hormone [LHRH] agonists, LHRH antagonists, or antiandrogens [e.g., bicalutamide, flutamide, or nilutamide]) and/or PC-SPES (or PC-x product) or estrogen-containing nutraceuticals
- No prior rapamycin mTOR inhibitor
- No prior small bowel resection that may significantly impair GI function and alter the absorption of everolimus
- No prior or concurrent immunotherapy, chemotherapy, or other investigational therapy for prostate cancer
- No other concurrent investigational or commercial agents
- No other concurrent anticancer agents
- No concurrent, chronic treatment with systemic steroids (except inhaled or topical steroids) or another immunosuppressive agent
- No concurrent live vaccines
- No concurrent strong inhibitors or inducers of the isoenzyme CYP3A administered as systemic therapy
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
实验性的:Low-dose Everolimus Cohort
5mg Everolimus daily continuously for 8 weeks and conventional surgery
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Patients will receive arm-specific dosage of Everolimus daily continuously for 8 week
其他名称:
Radical prostatectomy with bilateral pelvic lymphadenectomy will be performed within 10 days of the completion of week 8 on RAD-001 (Everolimus).
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有源比较器:High-dose Everolimus Cohort
10mg Everolimus daily continuously for 8 weeks and conventional surgery
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Patients will receive arm-specific dosage of Everolimus daily continuously for 8 week
其他名称:
Radical prostatectomy with bilateral pelvic lymphadenectomy will be performed within 10 days of the completion of week 8 on RAD-001 (Everolimus).
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Proportion of Patients Who Are P0 (i.e., no Clinically Detectable Tumor in the Pathologic Specimen) at Surgery
大体时间:After 8 weeks of therapy at the time of prostatectomy
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Specimens are fixed in formalin for 24 hours.Specimens are the cut at 3 mm intervals perpendicular to the rectal surface and the sections are examined grossly and microscopically on routine Hematoxylin and Eosin stain (H&E) (pathologic complete response or P0) will be defined as responders.
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After 8 weeks of therapy at the time of prostatectomy
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Toxicity Profile of Each Dose (Number of Patients With Worst Grade Toxicity)
大体时间:at daily dose for 8 weeks
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Toxicity will be assessed using the NIH-NCI Common Terminology Criteria for Adverse Events, version 3.0 (CTCAEv3.0)
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at daily dose for 8 weeks
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Change in PSA
大体时间:Up to 16 weeks after start of study
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Time-to-event data, such as change in PSA will be summarized using the method of Kaplan and Meier.
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Up to 16 weeks after start of study
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其他结果措施
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Effect of Treatment on Biological and Molecular Markers
大体时间:After 8 weeks of therapy
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Immunohistochemical Staining of Cellular and Molecular Markers in Prostate Tumor Tissue
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After 8 weeks of therapy
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合作者和调查者
调查人员
- 首席研究员:Jorge A. Garcia, MD、Case Comprehensive Cancer Center
出版物和有用的链接
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
其他研究编号
- CASE21806
- P30CA043703 (美国 NIH 拨款/合同)
- CASE-21806 (其他标识符:Case Comprehensive Cancer Center)
- CASE-21806-CC256 (其他标识符:Cancer Center IRB)
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Everolimus的临床试验
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Universitaire Ziekenhuizen KU Leuven完全的