A Randomized Phase II Trial of Dasatinib Plus Abiraterone Compared to Abiraterone Alone for Metastatic, Castration-Resistant Prostate Cancer Prior to Chemotherapy
Inclusion Criteria:
- Metastatic, castration-resistant prostate cancer
- Defined as evaluable radiographic disease with rising PSA x 2 (at least 1 week
apart) or radiographic progression (new soft tissue/bone lesions or enlarging
soft tissue lesions) despite medical or surgical castration
- No limit on prior hormonal therapies (i.e. anti-androgens, ketoconazole) except
that subject must not have received abiraterone previously
- No limit on prior biologic therapies (i.e. immune therapy, antiangiogenic,
targeted) except that patient should not have received dasatinib or other v-src
sarcoma (Schmidt-Ruppin A-2) viral oncogene homolog (avian) (src)-targeted
therapy
- No prior chemotherapy for metastatic disease
* Subjects who have received chemotherapy in the neoadjuvant or adjuvant setting will
be eligible provided chemotherapy was completed > 6 months prior to enrollment
- Eastern Cooperative Oncology Group (ECOG) 0-2
- Total bilirubin =< 1.5 times the institutional upper limit of normal (ULN) except for
Gilbert's syndrome
- Hepatic enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT] )
=< 2.5 times the institutional ULN
- Serum sodium (Na), potassium (K+), magnesium (Mg+), phosphate and calcium (Ca+) >
lower limit of normal (LLN)
- Serum creatinine =< 1.5 time the institutional ULN
- Hemoglobin (Hb) >= 9
- Platelets >= 100,000
- Absolute neutrophil count (ANC) >= 1000
- Ability to take oral medication (study medications must be swallowed whole)
- Men with fathering potential must agree to use contraception throughout study
treatment; acceptable methods include: condoms, sponge, intrauterine device (IUD),
oral contraceptives
- Concomitant medications * Patient agrees to discontinue St. Johns wort while
receiving dasatinib therapy (discontinue St. Johns wort at least 5 days before
starting dasatinib)
Exclusion Criteria:
- Known hepatitis B or C or human immunodeficiency virus (HIV), regardless of viral
load
* Testing for the purposes of enrollment is not mandatory, however a documented
history of these infections will be exclusionary due to concerns for drug-drug
interactions with antivirals and potential for increased risk of liver toxicity
- Radiation for palliation of bony metastases within the preceding 2 weeks
- Prior chemotherapy for metastatic castration-resistant prostate cancer (CRPC)
* Immune therapy with sipuleucel-T is allowed, provided the last infusion was >= 28
days prior to study therapy and there has been at least one documented PSA value
rising after completion of sipuleucel-T therapy or progression of disease on imaging
after sipuleucel-T
- Malignancy (aside from prostate cancer) which required radiotherapy or systemic
treatment within the past 5 years
- Superficial bladder cancer treated with intravesical therapy and currently in
remission will not be an exclusion
- Skin cancers will not be an exclusion, except for melanoma with a thickness > 1
mm
- Concurrent medical condition which may increase the risk of toxicity, including:
- Pleural or pericardial effusion of any grade at the time of study entry
- Cardiac symptoms; any of the following should be considered for exclusion: **
Uncontrolled angina, congestive heart failure or myocardial infarction (MI)
within (6 months)
- Diagnosed congenital long QT syndrome
- Any history of clinically significant ventricular arrhythmias (such as
ventricular tachycardia, ventricular fibrillation, or Torsades de pointes)
** Prolonged QTc/f interval on pre-entry electrocardiogram (> 450 msec)
- Subjects with hypokalemia or hypomagnesemia if it cannot be corrected prior
to abiraterone administration
- History of significant bleeding disorder unrelated to cancer, including:
- Diagnosed congenital bleeding disorders (e.g., von Willebrand's disease)
- Diagnosed acquired bleeding disorder within one year (e.g., acquired anti-factor
VIII antibodies)
- Ongoing or recent (=< 3 months) significant gastrointestinal bleeding
- Prohibited treatments and/or therapies
- Subjects should not be on any additional anti-cancer therapy except for
luteinizing hormone-releasing hormone (LHRH) agonist/antagonist; specifically
excluded medications include ketoconazole, estrogens, and anti-androgens
- Category I drugs that are generally accepted to have a risk of causing Torsades
de pointes including: (Patients must discontinue drug 7 days prior to starting
dasatinib)
- Quinidine, procainamide, disopyramide
- Amiodarone, sotalol, ibutilide, dofetilide
- Erythromycin, clarithromycin
- Chlorpromazine, haloperidol, mesoridazine, thioridazine, pimozide
- Cisapride, bepridil, droperidol, methadone, arsenic, chloroquine,
domperidone, halofantrine, levomethadyl, pentamidine, sparfloxacin,
lidoflazine
- Prisoners or subjects who are involuntarily incarcerated
- Subjects who are compulsorily detained for treatment of either a psychiatric or
physical (eg, infectious disease) illness