Bipolar Androgen Therapy Plus Olaparib in Patient With Castration-Resistant Prostate Cancer


Condition: Castration Levels of Testosterone, Castration-Resistant Prostate Carcinoma, Prostate Adenocarcinoma, PSA Level Greater Than or Equal to One, PSA Progression

Intervention:

  • Other: Laboratory Biomarker Analysis
  • Drug: Olaparib
  • Other: Quality-of-Life Assessment
  • Other: Survey Administration
  • Drug: Testosterone Enanthate
  • Drug: Testosterone Cypionate

Purpose: This phase II trial studies how well testosterone (enanthate or cypionate) and olaparib work in treating participants with prostate cancer that has progressed despite hormonal therapy. Hormonal therapy, such as leuprolide, may lessen the amount of male sex hormones made by the body. In patients that have developed progressive cancer in spite of standard hormonal treatment (i.e. castration-resistant prostate cancer), administering testosterone may result in regression of tumors by causing DNA damage in cancer cells that have adapted to low testosterone conditions. Olaparib may stop the growth of tumor cells by blocking some of the enzymes involved in repairing DNA damage. Therefore, giving testosterone and olaparib together may work better in treating castration-resistant prostate cancer by generating DNA damage that the cancer cell is unable to repair.

Study Type: Interventional

Clinical Trials Identifier NCT 8-digits: NCT03516812

Sponsor: University of Washington

Primary Outcome Measures:

  • Measure: Percent of patients with a prostate-specific antigen (PSA) decline of at least 50% below baseline PSA50 response rate
  • Time Frame: Up to 12 weeks after initiating therapy
  • Safety Issue:
  • Measure: Incidence of adverse events (AEs) according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03
  • Time Frame: Up to 30 days after last dose
  • Safety Issue:

Secondary Outcome Measures:

  • Measure: Radiographic response rate
  • Time Frame: Up to 2 years
  • Safety Issue:
  • Measure: PSA progression free survival (PFS)
  • Time Frame: From the start of treatment until PSA progression, assessed up to 2 years
  • Safety Issue:
  • Measure: Overall survival (OS)
  • Time Frame: Up to 2 years
  • Safety Issue:
  • Measure: Radiographic PFS
  • Time Frame: Up to 2 years
  • Safety Issue:
  • Measure: PSA50 response rate (i.e. decline in PSA ≥ 50% from baseline)
  • Time Frame: Up to 2 years
  • Safety Issue:
  • Measure: Average change in quality of life (QOL) assessed by the Functional Assessment of Cancer Therapy-Prostate (FACT-P) survey
  • Time Frame: Up to 12 weeks after initiating therapy
  • Safety Issue:
  • Measure: Average change in quality of life (QOL) assessed by the International Index of Erectile Function (IIEF) survey
  • Time Frame: Up to 12 weeks after initiating therapy
  • Safety Issue:

Estimated Enrollment: 30

Study Start Date: August 29, 2018

Phase: Phase 2

Eligibility:

  • Age: minimum 18 Years maximum N/A
  • Gender: Male

Inclusion Criteria:

  • Must be willing to provide informed consent prior to any study specific procedures
  • Documented histologically confirmed adenocarcinoma of the prostate
  • Patient must have evidence of castration resistant prostate cancer as evidenced by PSA progression (per Prostate Cancer Working Group 3 [PCWG3] criteria) and a castrate serum testosterone level (i.e., ≤ 50 mg/dL)
  • PSA must be at least 1 ng/ml and rising on two successive measurements at least two weeks apart
  • Patients must have progressed on abiraterone and/or enzalutamide; there must be at least a 3-week washout period after stopping the most recent approved therapy for mCRPC (i.e., abiraterone, enzalutamide, Ra-223, sipuleucel-t); if applicable, patients should be weaned off steroids at least 1 week prior to starting treatment
  • No prior chemotherapy for the treatment of mCRPC; patients may have received docetaxel for the treatment of hormone-sensitive prostate cancer
  • Prior treatment with non-chemotherapy investigational agents is permitted; there must be at least a 3-week washout period after stopping any investigational cancer agent
  • Hemoglobin ≥ 10.0 g/dL with no blood transfusion in the past 28 days (within 28 days prior to administration of study treatment)
  • Absolute neutrophil count (ANC) ≥ 1.5 x 10^9/L (within 28 days prior to administration of study treatment)
  • Platelet count ≥ 100 x 10^9/L (within 28 days prior to administration of study treatment)
  • Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN) (within 28 days prior to administration of study treatment)
  • Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvate transaminase [SGPT]) ≤ 2.5 x institutional upper limit of normal unless liver metastases are present in which case they must be ≤ 5 x ULN (within 28 days prior to administration of study treatment)
  • Patients must have creatinine clearance estimated using the Cockcroft-Gault equation of ≥ 51 mL/min (within 28 days prior to administration of study treatment)
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-1
  • Patients must have a life expectancy ≥ 16 weeks
  • Male patients and their partners, who are sexually active and of childbearing potential, must agree to the use of two highly effective forms of contraception in combination throughout the period of taking study treatment and for 3 months after last dose of study drug(s) to prevent pregnancy in a partner
  • Patient is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations
  • At least one lesion (measurable and/or non-measurable) that can be accurately assessed at baseline by computed tomography (CT), positron-emission tomography (PET), magnetic resonance imaging (MRI) and/or bone scan and is suitable for repeated assessment
  • Must have archival tissue available, be willing to undergo metastatic biopsy or have a sufficient plasma circulating tumor DNA (ctDNA) concentration in order to perform next-generation DNA sequencing
  • The study will require that 50% of enrolled subjects have homozygous deletions, deleterious mutations, or both in one or more of the DNA damage response (DDR) genes; the other 50% of patients must have an intact DDR pathway

Exclusion Criteria:

  • Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site)
  • Previous enrollment in this study
  • Participation in another clinical study with an investigational product during the last 3 weeks
  • Any previous treatment with poly-adenosine diphosphate ribose polymerase (PARP) inhibitor, including olaparib
  • Other malignancy within the last 5 years except: adequately treated non-melanoma skin cancer or other solid tumors including lymphomas (without bone marrow involvement) curatively treated with no evidence of disease for ≥ 5 years
  • Resting electrocardiogram (ECG) with corrected QT interval (QTc) > 470 msec on 2 or more time points within a 24 hour period or family history of long QT syndrome
  • Patients receiving any systemic chemotherapy or radiotherapy (except for palliative reasons) within 3 weeks prior to study treatment
  • Concomitant use of known strong CYP3A inhibitors (e.g., itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or moderate CYP3A inhibitors (e.g., ciprofloxacin, erythromycin, diltiazem, fluconazole, verapamil); the required washout period prior to starting olaparib is 2 weeks
  • Concomitant use of known strong (e.g., phenobarbital, enzalutamide, phenytoin, rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John's wort) or moderate CYP3A inducers (e.g., bosentan, efavirenz, modafinil); the required washout period prior to starting olaparib is 3 weeks for enzalutamide, 5 weeks for phenobarbital and 3 weeks for other agents
  • Persistent toxicities (> Common Terminology Criteria for Adverse Event [CTCAE] grade 2) caused by previous cancer therapy, excluding alopecia
  • Patients with myelodysplastic syndrome/acute myeloid leukemia or with features suggestive of myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML)
  • Patients with symptomatic uncontrolled brain metastases; a scan to confirm the absence of brain metastases is not required; the patient can receive a stable dose of corticosteroids before and during the study as long as these were started at least 4 weeks prior to treatment; patients with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days
  • Major surgery within 2 weeks of starting study treatment and patients must have recovered from any effects of any major surgery
  • Patients considered a poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease or active, uncontrolled infection; examples include, but are not limited to, uncontrolled ventricular arrhythmia, recent (within 5 years) myocardial infarction, uncontrolled major seizure disorder, uncontrolled hypertension (blood pressure [BP] ≥ 160/100), stroke within the past 5 years, uncontrolled diabetes (hemoglobin [hgb] A1C > 7), unstable spinal cord compression, superior vena cava syndrome, extensive interstitial bilateral lung disease on high resolution computed tomography (HRCT) scan or any psychiatric disorder that prohibits obtaining informed consent
  • Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the study medication
  • Immunocompromised patients, e.g., patients who are known to be serologically positive for human immunodeficiency virus (HIV)
  • Patients with a known hypersensitivity to olaparib or any of the excipients of the product
  • Patients with a known hypersensitivity to the testosterone cypionate or any of the excipients of the product
  • Patients with known active hepatitis (i.e., hepatitis B or C) due to risk of transmitting the infection through blood or other body fluids
  • Previous allogenic bone marrow transplant or double umbilical cord blood transplantation (dUCBT)
  • Whole blood transfusions in the last 120 days prior to entry to the study (packed red blood cells and platelet transfusions are acceptable)
  • Evidence of serious and/or unstable pre-existing medical, psychiatric or other condition (including laboratory abnormalities) that could interfere with patient safety or provision of informed consent to participate in this study
  • Any psychological, familial, sociological, or geographical condition that could potentially interfere with compliance with the study protocol and follow-up schedule
  • Evidence of disease that, in the opinion of the investigator, would put the patient at risk from testosterone therapy (e.g. femoral metastases with concern over fracture risk, spinal metastases with concern over spinal cord compression, lymph node disease with concern for ureteral obstruction)
  • Patients with pain attributable to their prostate cancer
  • Tumor causing urinary outlet obstruction that requires catheterization for voiding; patients that require catheterization to void secondary to benign strictures or other non-cancer causes will be permitted to enroll
  • Prior history of deep venous thrombosis or pulmonary embolism within 5 years prior to enrollment in the study and not currently on systemic anticoagulation
  • Patients with NYHA (New York Heart Association) class III or IV heart failure or history of a prior myocardial infarction (MI) within the last five years prior to enrollment in the study

Contact:

  • Michael T. Schweizer
  • (206) 288-6252

Location:

  • Fred Hutch/University of Washington Cancer Consortium
  • Seattle Washington 98109 United States

View trial on ClinicalTrials.gov


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