A Randomized Phase 2.5 Study of (153)Sm-EDTMP (Quadramet) With or Without a PSA/TRICOM Vaccine in Men With Androgen-Insensitive Metastatic Prostate Cancer
- INCLUSION CRITERIA:
A. Histopathological documentation of prostate cancer confirmed in the Laboratory of
Pathology at the NIH Clinical Center, National Institutes of Health (NIH), the National
Naval Medical Center, or Walter Reed Army Medical Center; or participating Institute's
Department of Pathology prior to starting this study. If no pathologic specimen is
available, patients may enroll with a pathologist's report showing a histologic diagnosis
of prostate cancer and a clinical course consistent with the disease.
B. Must have metastatic AIPC with at least 2 bone lesions consistent with prostate cancer
metastasis and progressive disease (2 rising PSA values separated by at least one week,
new or enlarging lesions consistent with prostate cancer, or clinical progression) on
docetaxel for metastatic prostate cancer or inability to tolerate docetaxel.
C. Life expectancy greater than or equal to 6 months.
D. ECOG performance status of 0 to 2.
E. No systemic steroid or steroid eye drop use within 2 weeks prior to initiation of
F. Hematological eligibility parameters (within 16 days of starting therapy).
- Granulocyte count greater than or equal to 1,500/mm(3)
- PLT count greater than or equal to 100,000/mm(3)
- Hgb greater than or equal to 10 Gm/dL (Transfusion may be given to accomplish this)
G. Biochemical eligibility parameters (within 16 days of starting therapy)
-Hepatic function: AST and ALT less than 2.5 times upper limit of normal; bilirubin less
than 1.5 mg/dL OR in patients with Gilbert's syndrome, a total bilirubin less than or
equal to 3.0 mg/dL.
H. No other active malignancies within the past 12 months (with the exception of
nonmelanoma skin cancers or carcinoma in situ of the bladder and treated with curative
intent) or life-threatening illnesses.
I. Willing to travel to the NIH or participating Institute for follow-up visits.
J. 18 years of age or greater.
K. Able to understand and sign informed consent.
L. Agree to use adequate contraception prior to study entry and for at least 4 months
following the last vaccine injection.
M. Patients must remain on medical castration therapy with testosterone-suppressing
therapy (e.g., GnRH agonist), unless they have had surgical castration.
N. Patients must have recovered from acute toxicities related to prior therapy or surgery.
For chemotherapy, typically this is 3 to 4 weeks.
O. Patients who are incontinent of urine should be willing to undergo bladder
catheterization to minimize the risk of radioactive contamination of clothing, bed linen,
and the patient's environment.
P. Concurrent treatment with bisphosphonates is allowed. If bisphosphonates have been
given within 2 weeks prior to planned (153)Sm-EDTMP, then a 99Tc whole-body scintigraphy
(bone scan) will be performed to confirm uptake into lesions. Bisphosphonates will not be
given within 48 hours after (153)Sm-EDTMP administration.
Q. Serum creatinine less than or equal to 1.5 times upper limit of normal OR creatinine
clearance on a 24-h urine collection of greater than or equal to 60 mL/min.
A. Patients should have no evidence, as listed below, of being immunocompromised:
- HIV positivity due to the potential for decreased tolerance and risk for severe side
- Hepatitis B or C positivity.
- Concurrent use of topical steroids (including steroid eye drops) or systemic
steroids. This is to avoid immunosuppression which may lead to potential
complications with vaccinia (priming vaccination). Nasal or inhaled steroid use is
B. Patients should have no autoimmune diseases that have required treatment, such as
Addison's disease, Hashimoto's thyroiditis, systemic lupus erythematosus, Sjogren's
syndrome, scleroderma, myasthenia gravis, Goodpasture's syndrome, or active Grave's
disease. Patients with a history of autoimmunity that has not required systemic
immunosuppressive therapy or does not threaten vital organ function, including CNS, heart,
lungs, kidneys, skin, and GI tract, will be allowed.
C. History of allergy or untoward reaction to prior vaccination with vaccinia virus or to
any component of the vaccinia vaccine regimen. Note: prior vaccination with vaccinia is
D. Do not administer the recombinant vaccinia vaccine if the recipient or, for at least 3
weeks after vaccination, their close household contacts (close household contacts are
those who share housing or have close physical contact), are persons with active or a
history of eczema or other eczematoid skin disorders; those with other acute, chronic or
exfoliative skin conditions (e.g., atopic dermatitis, burns, impetigo, varicella zoster,
severe acne, or other open rashes or wounds) until condition resolves; pregnant or nursing
women; children 3 years of age and under; and immunodeficient or immunosuppressed persons
(by disease or therapy), including HIV infection.
E. Serious intercurrent medical illness (e.g., one that requires treatment) which would
interfere with the ability of the patient to carry out the treatment program, including,
but not limited to, inflammatory bowel disease, Crohn's disease, ulcerative colitis, or
F. Patients with a history of cardiomyopathy or symptomatic congestive heart failure
(unless stable on treatment), symptomatic arrhythmia not controlled by medication.
Unstable atherosclerotic heart disease (e.g. unstable angina) who require active
intervention and history of myocardial infarction or embolic stroke within the past 6
G. Patients with cardiac disease who have fatigue, palpitation, dyspnea or angina with
ordinary physical activity (New York Heart Association class 2 or greater) are not
H. Patients with a history of congestive heart failure or who have objective evidence of
congestive heart failure by physical exam or imaging are not eligible, unless the
underlying cause has been treated and patient has documented normal ejection fraction.
I. Patients with pulmonary disease who have fatigue or dyspnea with ordinary physical
activity are not eligible.
J. Concurrent chemotherapy.
K. No brain metastasis or history of seizures, encephalitis, or multiple sclerosis.
L. Serious hypersensitivity reaction to egg products.
M. Prior splenectomy.
N. Contraindicated in patients who have known hypersensitivity to EDTMP or similar
O. Patients with symptomatic soft tissue disease or parenchymal disease will be excluded.
P. Radiation therapy to bone within 4 weeks of study entry.
Q. Patients previously treated with (153)Sm-EDTMP will be excluded.
R. Patients requiring urgent local radiotherapy or orthopedic stabilization.