A Phase I Open-label, Dosimetry, Biodistribution and Pharmacokinetic Study of Alpharadin™ in Patients With Hormone Refractory Prostate Cancer and Skeletal Metastases
Inclusion Criteria:
1. Histologically or cytologically confirmed adenocarcinoma of the prostate.
2. Hormone refractory with evidence of rising PSA:
- Patient must be maintained on androgen ablation therapy with LHRH agonist
(stable dose for at least 8 weeks prior to study entry), or have undergone
bilateral orchiectomy
- Serum testosterone level is required to be =50 ng/dl
- Patients who have received prior antiandrogen drug therapy:
- Flutamide, nilutamide or cyproterone acetate must have stopped at least
four weeks prior to study drug administration and progression, as defined
by rising PSA as defined below, must have been demonstrated since
cessation;
- Bicalutamide must have stopped at least six weeks prior to study drug
administration and progression, as defined by rising PSA as defined below,
must have been demonstrated since cessation
- PSA progression
- Progressive rise in PSA, defined as two consecutive increases in PSA
documented over a previous reference value (measure 1). The first increase
in PSA (measure 2) should occur at a minimum of 1 week from the reference
value (measure 1). This increase in PSA should be confirmed (measure 3)
after a minimum of 1 week. If the confirmatory PSA value (measure 3) is
less than the previous value, the patient will still be eligible provided
the next PSA measure (measure 4) is found to be greater than the second PSA
value (measure 2).
3. Skeletal metastases confirmed by bone scintigraphy within the last 6 weeks
4. Performance status: ECOG 0-2
5. Life expectancy: >/= 6 months
6. Laboratory requirements:
- Neutrophil count >/= 1.5 x 109/L
- Platelet count >/= 100 x109/L
- Haemoglobin >/= 95 g/L
- Total bilirubin level within normal institutional limits
- ASAT and ALAT = 2,5 times upper institutional limit of the normal range
- S-Creatinine = 1,5 times upper institutional limit of the normal range
7. The patient is willing and able to comply with the protocol, and agrees to return to
the hospital for follow-up visits and examination
8. Able and willing to give written informed consent.
Exclusion Criteria:
1. Has received an investigational drug within 4 weeks prior to the administration of
radium-223, or is scheduled to receive one during the treatment and post-treatment
period
2. Has received chemo-, immunotherapy, or external radiotherapy within the last 4 weeks
prior to administration of study drug, or has not recovered from adverse events due
to agents administered more than 4 weeks earlier
3. More than one regimen of previous cytotoxic chemotherapy
4. Has received prior hemibody external radiotherapy
5. Has a need for immediate external radiotherapy
6. Has received systemic radiotherapy with radium-223, strontium-89, samarium-153,
rhenium-186 or rhenium-188 for the treatment of bony metastases within the last year
prior to administration of study drug.
7. Has started treatment with bisphosphonates less than 3 months prior to administration
of study drug. Patients are allowed to be on bisphosphonates provided patient is on a
stable dose for >/= 12 weeks before administration of study drug.
8. Patients who are = 4 weeks (6 weeks for bicalutamide) post withdrawal of
antiandrogen therapy
9. Patients who have started or stopped systemic steroids, within a week prior to study
drug administration, or are expected to be subject to changes in the systemic steroid
medication
10. Other currently active (relapse within the last 3 years) malignancy (except
non-melanoma skin cancer) that are not prostate cancer metastases
11. Visceral (e.g. liver, lung) metastases from prostate cancer as assessed by abdominal/
pelvic CT or chest radiograph within six weeks before administration of study drug;
12. Lymph node metastases with short-axis diameter greater than 2 cm.
13. Bulky loco-regional disease
14. Any other serious illness or medical condition, for example:
- any uncontrolled infection
- any patient who has clinical heart failure severe enough to cause marked
limitation of activity, and who is only comfortable at rest; or any patient who
has heart failure more severe than this (NYHA Heart Failure Class III or IV).
- Crohns disease or ulcerative colitis