A Phase I/II Study of Docetaxel/Prednisone and PTK 787/ZK 222584 in Previously Untreated Metastatic Hormone Refractory Prostate Cancer
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically documented adenocarcinoma of the prostate
- Progressive, systemic (metastatic) disease despite castrate levels of testosterone
due to orchiectomy or luteinizing-hormone releasing hormone (LHRH) agonist, meeting 1
of the following criteria:
- Measurable disease, defined as any lesion that can be accurately measured in at
least 1 dimension ≥ 2 cm by conventional techniques or ≥ 1 cm by spiral CT scan
or MRI
- Nonmeasurable disease with PSA ≥ 5 ng/mL
- Bone lesions
- Pleural or pericardial effusions, ascites
- CNS lesions, leptomeningeal disease
- Irradiated lesions, unless progression documented after radiotherapy
- No PSA ≥ 5 ng/mL as only evidence of disease
- PSA evidence for progressive prostate cancer consists of a PSA level ≥ 5 ng/mL
that has risen on ≥ 2 successive occasions, ≥ 2 weeks apart
- Castrate levels of testosterone (< 50 ng/dL) must be maintained
- If no prior orchiectomy, patients must remain on testicular androgen suppression
(e.g., with an LHRH analogue)
- Patients receiving an antiandrogen as part of primary androgen ablation must
demonstrate disease progression after discontinuation of antiandrogen
- Disease progression after antiandrogen withdrawal is defined as 2 consecutive
rising PSA values, obtained at least 2 weeks apart, or documented osseous or
soft tissue progression
- For patients receiving flutamide or megestrol acetate, at least 1 of the
PSA values must be obtained 4 weeks or more after flutamide/megestrol
acetate discontinuation
- For patients receiving bicalutamide or nilutamide, at least 1 of the PSA
values must be obtained 6 weeks or more after antiandrogen discontinuation
- If improvement after antiandrogen withdrawal is noted, disease progression must
be established
- No pleural effusion or ascites that causes respiratory compromise ( ≥ grade 2
dyspnea)
- No history of CNS disease, including primary brain tumor, seizures, or carcinomatous
meningitis
PATIENT CHARACTERISTICS:
- Fertile patients must use effective barrier contraception during and for 3 months
after completion of study treatment
- Karnofsky performance status ≥ 60%
- Life expectancy > 12 weeks
- Granulocyte count > 1,500/mm^3
- Platelet count > 75,000/mm^3
- Hemoglobin > 8.0 g/dL
- Creatinine < 1.5 times upper limit of normal (ULN)
- Bilirubin < 1.5 times ULN
- SGOT/SGPT < 1.5 times ULN
- Urinalysis ≤ 1+ proteinuria based on dipstick reading OR 2+ proteinuria on dipstick
reading AND total urinary protein ≤ 3,500 mg on 24 hour urine collection and
creatinine clearance ≥ 50 mL/min on a 24-hour urine collection
- No impairment of gastrointestinal (GI) function or GI disease that may affect or
alter absorption of vatalanib (i.e., malabsorption syndromes)
- No myocardial infarction or significant change in anginal pattern within the last 6
months, symptomatic congestive heart failure (New York Heart Association class III or
IV), or uncontrolled cardiac arrhythmia
- No pre-existing grade 3 or 4 clinical peripheral neuropathy
- No history of severe hypersensitivity reaction to docetaxel or other drugs formulated
with polysorbate 80
- No deep vein thrombosis or pulmonary embolus within the past year
- No poorly controlled diabetes (fasting blood glucose > 250) despite optimization of
medical therapy
- No labile or poorly controlled hypertension (systolic blood pressure > 160 mm Hg,
diastolic blood pressure > 90 mm Hg) despite maximal management with
anti-hypertensives
- No serious uncontrolled, concurrent medical illness, including ongoing or active
infection
- Patients on Suppressive antibiotic therapy for chronic urinary tract infection
are eligible
- No psychiatric illness or social situation that would limit compliance with treatment
- No "currently active" second malignancy other than nonmelanoma skin cancers
- Not considered "currently active" if competed therapy and at < 30% risk of
relapse
- No interstitial pneumonia or extensive and symptomatic interstitial fibrosis of the
lung
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No grapefruit or grapefruit juice during study treatment
- No history of gastrectomy/small bowel resection
- At least 4 weeks since prior hormonal therapy, including ketoconazole,
aminoglutethimide, systemic steroids (any dose), and megestrol acetate (any dose)
- At least 4 weeks since prior drug or herbal product known to decrease PSA levels
(e.g., finasteride, saw palmetto, or PC-SPES)
- At least 4 weeks since prior major surgery and fully recovered
- At least 4 weeks since prior radiation therapy and fully recovered
- At least 8 weeks since the last dose of prior strontium chloride Sr 89 or samarium Sm
153 lexidronam pentasodium
- Patients receiving bisphosphonate therapy prior to initiating protocol treatment must
have received bisphosphonates for at least the past month
- No bisphosphonate initiation for 1 month prior to and during study treatment
- No prior systemic chemotherapy for prostate cancer
- No prior antiangiogenic agents (thalidomide, bevacizumab)
- No other concurrent chemotherapy, investigational agents, radiotherapy (including
palliative), or biologic therapy
- No biologic therapy or immunotherapy ≤ 4 weeks prior to study treatment
- No more than 1 prior therapy with an investigational agent, completed ≥ 4 weeks prior
to study treatment
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No concurrent therapeutic warfarin or similar oral anticoagulant that is metabolized
by the cytochrome p450 system
- Heparin is allowed
- No other concurrent hormonal therapy except for the following:
- Steroids for adrenal failure
- Hormones for nondisease-related conditions (e.g., insulin for diabetes)
- Intermittent dexamethasone