A Phase II Study Of Estramustine, Docetaxel, And Bevacizumab (IND # 7921, NSC # 704865) In Men With Hormone Refractory Prostate Cancer
Inclusion Criteria:
- Patients must have histologically documented adenocarcinoma of the prostate with
progressive systemic (metastatic) disease despite castrate levels of testosterone due
to orchiectomy or LHRH agonist (which must be continued); castrate levels of
testosterone must be maintained
- At the time of enrollment, patients must have evidence of metastatic disease, either:
- Measurable disease (with any PSA) OR
- Non-measurable disease with PSA >= 5 ng/ml; patients with PSA >= 5 ng/ml only
are not eligible DEFINITION OF MEASURABLE DISEASE/TARGET LESIONS
- Any lesion that can be accurately measured in at least one dimension (longest
diameter to be recorded) as >= 20 mm with conventional techniques: 1) physical
exam for clinically palpable lymph nodes and superficial skin lesions, 2) chest
X-ray for clearly defined lung lesions surrounded by aerated lung OR those
lesions measured as >= 10 mm with a spiral CT scan or MRI
- Measurable lesions (up to a maximum of 10 in number) representative of all
organs involved to be identified as target lesions; the sum of the longest
diameters (LD) for all target lesions will be calculated and reported as
baseline sum LD
- If measurable disease is confined to a solitary lesion then its neoplastic
nature will need to be confirmed by histology
- Ultrasound may not be used to measure tumor lesions that are not easily
accessible clinically DEFINITION OF NON-MEASURABLE DISEASE/NON-TARGET
LESIONS
- Non-target lesions include all other lesions, including small lesions with
longest diameter < 20 mm with conventional techniques or < 10 mm with spiral CT
scan and truly non-measurable lesions, which include:
- Bone lesions
- Pleural or pericardial effusions, ascites
- CNS lesions, leptomeningeal disease
- Irradiated lesions, unless progression documented after RT
- Patients must have demonstrated evidence of progressive disease since the most recent
change in therapy; progressive disease is defined as any one of the following
(measurable disease, bone scan, or PSA progression):
- MEASURABLE DISEASE PROGRESSION: Objective evidence of increase > 20% in the sum
of the longest diameters (LD) of target lesions from the time of maximal
regression or the appearance of one or more new lesions
- BONE SCAN PROGRESSION: Appearance of one or more new lesions on bone scan
attributable to prostate cancer along with a PSA >= 5 ng/ml will constitute
progression
- PSA PROGRESSION: An elevated PSA (at least >= 5 ng/ml) which has risen serially
from baseline on two occasions each at least one week apart. If the confirmatory
PSA (#3) value is less (i.e., #3b) than screening PSA (#2) value, then an
additional test for rising PSA (#4) will be required to document progression
- Failure despite standard androgen deprivation therapy
- Flutamide and megestrol acetate (any dose) must be discontinued at least 4 weeks
prior to registration; bicalutamide and nilutamide must be discontinued at least 6
weeks prior to registration. If improvement following antiandrogen withdrawal is
noted, progression must be established using the criteria above; primary testicular
androgen suppression (e.g., with an LHRH analogue) should not be discontinued
- At least 4 weeks since any hormonal therapy, including ketoconazole,
aminoglutethimide, systemic steroids (any dose), megestrol acetate (any dose)
- No prior cytotoxic chemotherapy, including estramustine or suramin
- No prior anti-angiogenesis agents, including thalidomide and bevacizumab
- >= 4 weeks since major surgery and fully recovered
- >= 4 weeks since any prior radiation and fully recovered
- >= 8 weeks since the last dose of strontium-89 or Samarium
- Patients receiving bisphosphonate therapy prior to initiating protocol treatment must
have received bisphosphonates for at least 1 month and have progressive disease
despite this therapy
- CTC (ECOG) performance status: 0-2
- No myocardial infarction or significant change in anginal pattern within one year or
current congestive heart failure (NYHA Class 2 or higher)
- No deep venous thrombosis or pulmonary embolus within one year. No need for full-dose
oral or parenteral anticoagulation; daily prophylactic aspirin is allowed
- No clinically significant peripheral neuropathy
- Granulocytes >= 1500/ul
- Platelet count >= 100,000/ul
- Creatinine =< 1.5 x upper limit of normal
- Bilirubin =< 1.0 x upper limit of normal
- AST =< 1.5 x upper limits of normal
- Urinalysis =< 1 + protein on dipstick
- PSA >= 5 ng/ml (if non-measurable disease)
- Serum Testosterone =< 50 ng/ml for patients who have not had bilateral orchiectomy