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Phase II, Randomized Study of Patients With Rising PSA at High-Risk of Progression After Primary Therapy to Assess the Clinical and Molecular Efficacy of the Enzastaurin - Bicalutamide Combination to Suppress the Androgen Receptor Without Testosterone Ablation


Phase 2
18 Years
N/A
Not Enrolling
Male
Prostate Cancer

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Trial Information

Phase II, Randomized Study of Patients With Rising PSA at High-Risk of Progression After Primary Therapy to Assess the Clinical and Molecular Efficacy of the Enzastaurin - Bicalutamide Combination to Suppress the Androgen Receptor Without Testosterone Ablation


OBJECTIVES:

Primary

- To compare the two regimens on the proportion of patients with undetectable
prostate-specific antigen (PSA) level (< 0.2 ng/mL) at 44 weeks.

Secondary

- To assess the proportion of patients with PSA decline > 85% at 44 weeks on the
combination therapy arm compared to that of bicalutamide monotherapy arm.

- To assess the distribution of best PSA response in each study arm.

- To assess the time to PSA progression and the time to PSA nadir in each arm of the
study.

- To assess the duration of PSA response in each arm of the study.

- To characterize the PSA slope before, during, and after treatment.

- To evaluate the safety and tolerability of enzastaurin hydrochloride in this patient
population.

- To determine whether Gleason score or prior hormonal therapy has any effect on PSA
response to treatment.

OUTLINE: This is a multicenter study. Patients are stratified according to Gleason score (≤
6 vs 7 vs 8-10) and prior hormonal therapy (yes vs no). Patients are randomized to 1 of 2
treatment arms.

- Arm A:

- Weeks 1-12: Patients are observed without treatment. Patients with a
prostate-specific antigen (PSA) rise of > 50% above baseline or nadir (whichever
is lowest) and a rise of at least 5 ng/mL, confirmed by a repeat PSA at least 2
weeks later, may be started on bicalutamide before the end of week 12 at the
discretion of the treating physician.

- Weeks 13-44: Patients with a rise PSA ≥ 50% above baseline or nadir, and a PSA
rise of at least 5 ng/mL confirmed by a repeat PSA at least 2 weeks later, are
removed from study. Patients receive oral bicalutamide once daily. Patients
achieving a PSA decline ≥ 50% in the absence of toxicity may continue to receive
bicalutamide up to 72 weeks.

- Arm B:

- Weeks 1-12: Patients receive oral enzastaurin hydrochloride twice daily. Patients
with a PSA rise of > 50% above baseline or nadir, and a rise of at least 5 ng/mL,
confirmed by a repeat PSA at least 2 weeks later, may be started on bicalutamide
before the end of week 12 at the discretion of the treating physician.

- Weeks 13-44: Patients with a PSA rise of ≥ 50% above baseline or nadir, and a rise
of at least 5 ng/mL, confirmed by a repeat PSA at least 2 weeks later, are removed
from study. Patients receive oral enzastaurin twice daily and oral bicalutamide
once daily. Patients achieving a PSA decline ≥ 50% in the absence of toxicity may
continue on this combination therapy up to 72 weeks.

After completion of study treatment, patients are followed every 3 months for 5 years, and
then every 6 months for up to 10 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed prostate cancer

- Hormone-sensitive disease, as evidenced by a serum total testosterone level >
150 ng/dL

- No evidence of metastatic disease on physical exam, CT abdomen/pelvis (or MRI),
chest x-ray or CT scan and bone scan within 6 weeks prior to randomization

- Underwent prior definitive surgery or radiotherapy

- Must have evidence of biochemical failure after primary therapy and subsequent
progression as determined by 1 of the following:

- Prostate-specific antigen (PSA) ≥ 0.4 ng/mL (in case of radical prostatectomy)

- PSA rise ≥ 2 ng/mL above the nadir PSA (in case of radiotherapy)

- Baseline PSA must be at least 2 ng/mL and no greater than 50 ng/mL

- PSA doubling time (PSADT) < 12 months

PATIENT CHARACTERISTICS:

- ECOG performance status 0 - 1

- Granulocytes ≥ 1,500/mm^3

- Platelet count ≥ 75,000/mm^3

- Serum creatinine normal or creatinine clearance ≥ 60 mL/min

- Serum total bilirubin ≤ 1.5 times upper limit of normal (ULN)

- Alkaline phosphatase ≤ 2.5 times ULN

- SGOT and SGPT < 2.5 times ULN

- PT/INR normal

- Fertile patients must use effective barrier contraception during and for at least 3
months after completion of study treatment

- No gastrointestinal (GI) tract disease resulting in: inability to take oral
medication, malabsorption syndrome, a requirement for IV alimentation, prior surgical
procedures affecting absorption, or uncontrolled inflammatory GI disease (e.g.,
Crohn's, ulcerative colitis)

- No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to enzastaurin hydrochloride or bicalutamide

- No uncontrolled intercurrent illness including, but not limited to, any of the
following:

- Ongoing or active infection

- Symptomatic congestive heart failure

- Unstable angina pectoris

- Cardiac arrhythmia

- Psychiatric illness/social situations that would limit compliance with study
requirements

- A history of other malignancy is permitted if the patient is predicted to be
disease-free for 2 years

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- More than 4 weeks since prior salvage therapy with intent to cure (i.e., surgery,
radiotherapy, or other local ablative procedures)

- More than 4 weeks since prior prophylactic radiotherapy to prevent gynecomastia

- More than 1 year since prior therapy modulating testosterone levels (such as
luteinizing-hormone releasing-hormone agonists/antagonists and antiandrogens) unless
in the neoadjuvant or adjuvant setting

- No 5 alpha reductase inhibitors, ketoconazole, megestrol acetate, systemic steroids,
or herbal supplements during PSA value collection

- At least 14 days since prior enzyme-inducing anti-epileptic drugs (EIAEDs)

- Patients who must begin EIAED therapy while on study are allowed to remain

- No concurrent combination antiretroviral therapy for HIV-positive patients

- No concurrent anticoagulant therapy

- Low dosage acetyl salicylic acid ≤ 325 mg/day allowed

- No other concurrent investigational agents or anticancer therapy (i.e., chemotherapy,
immunotherapy, radiotherapy, surgery for cancer, or experimental medications)

- No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to enzastaurin or bicalutamide

- Prior neoadjuvant and/or adjuvant therapy ≤ 4 weeks prior to randomization (i.e.,
hormones, chemotherapy, vaccines, or experimental agents) allowed if PSA rise and
PSADT were documented after testosterone level was > 150 ng/dL

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Primary Purpose: Treatment

Outcome Measure:

Comparison of proportion of patients with undetectable prostate-specific antigen PSA level (< 0.2 ng/mL) at 44 weeks

Safety Issue:

No

Principal Investigator

Anna C. Ferrari, MD

Investigator Role:

Study Chair

Investigator Affiliation:

New York University School of Medicine

Authority:

Unspecified

Study ID:

CDR0000596077

NCT ID:

NCT00685633

Start Date:

December 2008

Completion Date:

Related Keywords:

  • Prostate Cancer
  • stage I prostate cancer
  • stage II prostate cancer
  • stage III prostate cancer
  • recurrent prostate cancer
  • Prostatic Neoplasms

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