A Phase II Trial of Docetaxel/Prednisone in Combination With Sargramostim as Treatment for Hormone-refractory Prostate Cancer
1. Patients must have signed an IRB-approved informed consent.
2. Patients must be male with histologically confirmed metastatic adenocarcinoma of the
prostate with progressive disease, despite androgen deprivation.
3. Patients must have a history of prior hormone therapy (must fulfill one of the
- Castration and/or luteinizing-hormone releasing hormone (LHRH) agonist
- Antiandrogen therapy (flutamide, nilutamide, bicalutamide, or cyproterone
- Antiandrogen therapy withdrawal
- Estramustine monotherapy
- Other hormonal therapy (eg, ketoconazole). Note: Patients must be off
ketoconazole at least 1 month. If PSA is decreasing, the patient must
demonstrate a rising PSA on at least 2 sequential reading at least 2 weeks
4. Patients must have a serum testosterone <50 ng/dL (if the patient has not undergone
orchiectomy, he must continue primary androgen deprivation with LHRH analogue).
5. Patient must fulfill one of the following criteria:
- Patients with measurable disease:
Patients must have disease progression defined by the RECIST criteria.
- Patients with no measurable disease:
Patients with PSA only disease must have an elevated PSA by Consensus Criteria. -OR-
- Patients with a positive bone scan must also have elevated PSA defined by
6. Progressive disease (as defined above) must be documented after discontinuation of
7. Patients who are receiving an antiandrogen as part of primary androgen ablation must
also demonstrate disease progression following discontinuation of the antiandrogen.
8. Patients on antiandrogen therapy must discontinue therapy and subsequently
demonstrate disease progression (at least 4 weeks since prior flutamide or
nilutamide, 8 weeks since prior bicalutamide).
9. Patients must have discontinued all agents or herbal products known to decrease PSA
levels (eg, Megace [megestrol acetate], Saw Palmetto, and PC-SPEC) or any systemic
corticosteroid at least 4 weeks prior to enrollment.
10. Patients must have Karnofsky Performance Status (PS) >60.
11. Patients must have a life expectancy >3 months.
12. Patients must be >18 years of age.
13. Patients may have received prior radiation (except for radiation to the entire
pelvis), provided that less than 25% of the bone marrow has been treated, and the
patient has recovered from the acute toxic effects of treatment prior to trial
enrollment. Irradiation of a symptomatic lesion, or one that may produce disability
(eg, unstable femur) prior to study initiation is permitted, provided other
measurable disease is present. Prior radiation treatment must have been completed at
least 4 weeks prior to enrollment. Lesions that have been irradiated in the advanced
disease setting may not be included as sites of measurable disease.
14. Patients must agree to use effective contraceptive measures during study treatment
and for a reasonable time thereafter.
15. Patients must have absolute neutrophil count (ANC) >1500/μL, platelet count
>100,000/μL, and hemoglobin >8 mg/dL.
16. Patients must have alanine transaminase (ALT), aspartate transaminase (AST), and
total bilirubin within normal limits (WNL), serum creatinine <1.5 x upper limit of
17. Patients must be willing and able to self-administer or have a caregiver who can
administer in compliance with the protocol (sargramostim).
1. Prior systemic chemotherapy for the treatment of HRPC, with the exception of
2. Prior treatment with ketoconazole, aminoglutethimide, or corticosteroids for the
treatment of progressive prostate cancer.
3. No prior immunotherapy with the exception of routine immunizations.
4. Myocardial infarction or significant change in anginal pattern within the last 6
months, symptomatic congestive heart failure (New York Heart Association Class III or
higher, see Appendix II) or uncontrolled cardiac arrhythmia.
5. Patients with known HIV-positive status.
6. Major surgery or radiation therapy <4 weeks prior to enrollment.
7. Prior radiopharmaceuticals (strontium, samarium) within 8 weeks prior to enrollment.
8. Patients with a history of severe hypersensitivity reaction to docetaxel, prednisone,
sargramostim, yeast-derived products, other drugs formulated with polysorbate 80, or
any of the components in these drugs.
9. Patients with poorly controlled diabetes (fasting blood glucose >250 mg/dL) despite
optimization of medical therapy.
10. Patients with serious uncontrolled intercurrent infections, nonmalignant medical
illnesses, or active uncontrolled autoimmune disease. Note: suppressive antibiotic
therapy for chronic urinary tract infections is allowed.
11. Patients with a systemic fungal infection.
12. Patients with psychiatric illness/social situations that would limit compliance with
treatment or adequate informed consent.
13. Any patient who is unable to comply with requirements of study.
14. Patients with symptomatic peripheral neuropathy Grade >2 (NCI Common Toxicity
Criteria Version 3.0.
15. Patients with known brain or leptomeningeal involvement.
16. Patients with second primary malignancy, except adequately treated nonmelanomatous
carcinoma of the skin or other malignancy treated >5 years previously and with no
other evidence of recurrence.