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History of Changes for Study: NCT04179864
A Phase 1b/2 Open-Label Study in Chemotherapy Naive Subjects With Metastatic Castration-Resistant Prostate Cancer
Latest version (submitted April 26, 2024) on ClinicalTrials.gov
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Study Record Versions
Version A B Submitted Date Changes
1 November 25, 2019 None (earliest Version on record)
2 December 10, 2019 Outcome Measures, Conditions, Study Description, Study Status, Contacts/Locations and Eligibility
3 December 16, 2019 Study Status
4 February 3, 2020 Contacts/Locations, Outcome Measures, Study Status, Eligibility and Study Description
5 February 27, 2020 Contacts/Locations and Study Status
6 May 6, 2020 Contacts/Locations and Study Status
7 May 26, 2020 Contacts/Locations, Study Status and Study Identification
8 August 3, 2020 Contacts/Locations and Study Status
9 March 8, 2021 Outcome Measures, Arms and Interventions, Study Design, Study Status, Study Description, Contacts/Locations, Eligibility and Study Identification
10 May 12, 2021 Contacts/Locations and Study Status
11 May 20, 2021 Contacts/Locations and Study Status
12 May 24, 2021 Outcome Measures, Eligibility, Study Description and Study Status
13 June 29, 2021 Contacts/Locations and Study Status
14 December 8, 2021 Contacts/Locations, Study Status, Study Description and Study Identification
15 April 28, 2022 Study Status, Contacts/Locations, Eligibility, Outcome Measures, Study Description and Study Identification
16 May 9, 2023 Recruitment Status, Study Status, Contacts/Locations, Outcome Measures, Study Identification, Arms and Interventions, Study Description and Conditions
17 May 17, 2023 Study Status and Study Identification
18 July 13, 2023 Study Status
19 August 11, 2023 Study Status
20 September 21, 2023 Study Status
21 October 25, 2023 Study Status
22 November 30, 2023 Study Status
23 December 29, 2023 Study Status
24 January 30, 2024 Study Status
25 February 29, 2024 Study Status
26 March 4, 2024 Study Status and Study Design
27 April 26, 2024 Study Status and IPDSharing
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Study NCT04179864
Submitted Date:  November 25, 2019 (v1)

Open or close this module Study Identification
Unique Protocol ID: EZH-1101
Brief Title: A Phase 1b/2 Open-Label Study in Chemotherapy Naive Subjects With Metastatic Castration-Resistant Prostate Cancer
Official Title: A Phase 1b/2 Open-Label Study Evaluating Tazemetostat in Combination With Enzalutamide or Abiraterone/Prednisone in Chemotherapy Naive Subjects With Metastatic Castration-Resistant Prostate Cancer
Secondary IDs:
Open or close this module Study Status
Record Verification: November 2019
Overall Status: Recruiting
Study Start: September 26, 2019
Primary Completion: September 1, 2020 [Anticipated]
Study Completion: November 1, 2020 [Anticipated]
First Submitted: November 14, 2019
First Submitted that
Met QC Criteria:
November 25, 2019
First Posted: November 27, 2019 [Actual]
Last Update Submitted that
Met QC Criteria:
November 25, 2019
Last Update Posted: November 27, 2019 [Actual]
Open or close this module Sponsor/Collaborators
Sponsor: Epizyme, Inc.
Responsible Party: Sponsor
Collaborators:
Open or close this module Oversight
U.S. FDA-regulated Drug: Yes
U.S. FDA-regulated Device: No
Data Monitoring: No
Open or close this module Study Description
Brief Summary: This is global, multi-center, open-label, randomized phase 1b, active-controlled safety and efficacy study of oral administration of tazemetostat in combination with enzalutamide or abiraterone/prednisone versus enzalutamide or abiraterone/prednisone alone in asymptomatic or mildly symptomatic subjects with progressive, metastatic castration-resistant prostate cancer (mCRPC) who have progressed on either abiraterone acetate, enzalutamide, or apalutamide or who are second generation anti-androgen treatment naive, and who have not received chemotherapy for mCRPC. This study is designed to determine the RP2D of tazemetostat in combination with either enzalutamide or abiraterone/prednisone, based on safety, tolerability, pharmacokinetic, pharmacodynamic, and efficacy profiles.
Detailed Description: In the study, a maximum of 48 subjects (18 for the combination with abiraterone/prednisone and 30 for the combination with enzalutamide) will be enrolled initially at a dose of 400 mg tazemetostat twice daily, followed by 600 mg tazemetostat twice daily, followed by 800 mg tazemetostat twice daily, if there are no dose-limiting toxicities (DLTs; as defined in the protocol. For the enzalutamide combination only, dose escalation may further proceed to 1200 mg twice daily followed by 1600 mg twice daily, as tolerated. For both enzalutamide and abiraterone/prednisone, prescribed doses as recommended by the respective package inserts will be used throughout the study. Subjects enrolled who do not experience a DLT may continue in the study after cycle 1 on the combination regimen at the assigned dose until progression or occurrence of unacceptable toxicity.
Open or close this module Conditions
Conditions: Prostate Cancer
Keywords: metastatic castration resistant prostate cancer
Open or close this module Study Design
Study Type: Interventional
Primary Purpose: Treatment
Study Phase: Phase 1
Interventional Study Model: Parallel Assignment
Number of Arms: 2
Masking: None (Open Label)
Allocation: Non-Randomized
Enrollment: 48 [Anticipated]
Open or close this module Arms and Interventions
Arms Assigned Interventions
Experimental: Tazemetostat in Combination with Abiraterone/Prednisone
Abiraterone/prednisone will be administered on cycle 1 day 1 and Tazemetostat on day 2
Drug: Tazemetostat
Tazemetostat (EPZ-6438) is a selective small-molecule inhibitor of the histone-lysine methyltransferase EZH2 gene
Other Names:
  • EPZ-6438
  • E7438
Drug: Abiraterone/prednisone
1,000 mg (two 500 mg tablets or four 250 mg tablets) orally once daily in combination with prednisone 5 mg administered orally twice daily.
Other Names:
  • Zytiga
Experimental: Tazemetostat in Combination with Enzalutamide
Enzalutamide will be administered on cycle 1 day 1 and Tazemetostat on day 2
Drug: Tazemetostat
Tazemetostat (EPZ-6438) is a selective small-molecule inhibitor of the histone-lysine methyltransferase EZH2 gene
Other Names:
  • EPZ-6438
  • E7438
Drug: Enzalutamide
enzalutamide 160 mg (four 40 mg capsules) orally once daily
Other Names:
  • Xtandi
Open or close this module Outcome Measures
Primary Outcome Measures:
1. Ph 1b: Determine the safety and tolerability of each of the combinations by reviewing dose limiting toxicities.
[ Time Frame: The incidence and severity of treatment-emergent adverse events (AEs) qualifying as protocol-defined DLTs in Cycle 1 (28 days) ]

Safety and tolerability of Tazemetostat in combination with enzalutamide or with abiraterone/prednisone
2. Ph 1b: Select the recommended phase 2 doses (RP2D) for each combination
[ Time Frame: 1 cycle/28 days ]

Based on pharmacokinetic (PK) and pharmacodynamic parameters as well as efficacy and the overall tolerability of each of the combinations
Secondary Outcome Measures:
1. PSA ≥50% Response Rate
[ Time Frame: Assessed every cycle for an average of one year. ]

Confirmed PSA responses will be defined as ≥50% reductions in PSA from baseline to lowest post baseline PSA result, with a consecutive assessment
2. Time to PSA Progression
[ Time Frame: Assessed every cycle for an average of one year. ]

PSA progression is defined as a ≥25% increase and an absolute increase of ≥ 2 μg/L (2 ng/mL) above the nadir (or baseline value for subjects who did not have a decline in PSA value at week 17)
3. Time to First Skeletal-Related Event (SRE)
[ Time Frame: During screening and every 9 weeks if clinically indicated at baseline, average of one year. ]

Time from randomization to first SRE will be assessed. An SRE is defined as radiation therapy or surgery to bone, pathologic bone fracture, spinal cord compression, or change of antineoplastic therapy to treat bone pain
4. ORR and Best Overall Soft Tissue Response
[ Time Frame: Assessed at screening and every 9 weeks for the first 6 months then every 12 weeks thereafter, average of one year. ]

ORR is defined per PCWG3 criteria and mRECIST 1.1 guidelines
5. Disease Control Rate
[ Time Frame: At screening to 6 months on study therapy ]

No radiographic progression per PCWG3, unequivocal clinical progression, or death
6. Time to Initiation of Subsequent Antineoplastic Cytotoxic Chemotherapy
[ Time Frame: Duration of the study, an average of one year. ]

A log-rank test will be used to compare time to initiation of subsequent antineoplastic cytotoxic chemotherapy between tazemetostat in combination with enzalutamide or abiraterone/prednisone, and enzalutamide or abiraterone/prednisone treatment alone, respectively
7. Further evaluate the incidence of treatment-emergent adverse events for safety and tolerability of each of the combinations
[ Time Frame: From randomization until radiographic progression, for up to one year. ]

Combinations tazemetostat with enzalutamide or tazemetostat with abiraterone/prednisone
8. Assess pharmacokinetic of tazemetostat, enzalutamide and abiraterone by area under the plasma concentration-time curve from time 0 to the time of the last quantifiable concentration (AUC0-last).
[ Time Frame: Assessed on cycle 1 on days 1, 2 and 21; and cycle 2, day 1 (each cycle is 28 days). ]

Assess the PK of tazemetostat when administered in combination with enzalutamide and abiraterone/prednisone and the PK of enzalutamide and abiraterone when administered in combination with tazemetostat.
9. Assess pharmacokinetic of tazemetostat, enzalutamide and abiraterone by maximum plasma concentration (Cmax).
[ Time Frame: Assessed on cycle 1 on days 1, 2 and 21; and cycle 2, day 1 (each cycle is 28 days). ]

Assess the PK of tazemetostat when administered in combination with enzalutamide and abiraterone/prednisone and the PK of enzalutamide and abiraterone when administered in combination with tazemetostat
10. Assess pharmacokinetic of tazemetostat, enzalutamide and abiraterone by under Cmax: maximum plasma concentration.
[ Time Frame: Assessed on cycle 1 on days 1, 2 and 21; and cycle 2, day 1 (each cycle is 28 days). ]

Assess the PK of tazemetostat when administered in combination with enzalutamide and abiraterone/prednisone and the PK of enzalutamide and abiraterone when administered in combination with tazemetostat
11. Assess circulating tumor cells conversion rate
[ Time Frame: Assessed every cycle for duration of the study, an average of one year. ]

In subjects who enter the study with unfavorable CTCs (5 or more cells per 7.5 mL of blood), conversion to favorable status is defined as 4 or fewer cells per 7.5 mL of blood. The CTC conversion rate is the proportion of subjects who convert to a favorable status (per PCWG3 criteria).
12. Assess CTC 30% response rate
[ Time Frame: Assessed every cycle for duration of the study, an average of one year. ]

CTC 30% response is defined as a ≥30% reduction in number of CTCs per 7.5 mL of blood from baseline in subjects who enter the study with unfavorable CTCs.
Open or close this module Eligibility
Minimum Age: 18 Years
Maximum Age:
Sex: Male
Gender Based:
Accepts Healthy Volunteers: No
Criteria:

Inclusion Criteria:

  1. Age at the time of consent ≥ 18 years.
  2. Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1 (Appendix
  3. Life expectancy of > 3 months.
  4. Histologically or cytologically confirmed adenocarcinoma of the prostate. Small cell or neuroendocrine tumors of the prostate are also permitted.
  5. Progressive disease in the setting of medical or surgical castration (ie, castration- resistant prostate cancer [CRPC]) by PCWG3 criteria for study entry.
    • Evidence of disease progression by rising PSA or
    • Soft tissue progression per mRECIST 1.1 or
    • Evidence of disease progression by observation of 2 new bone lesions since the initiation of last systemic therapy.
  6. Metastatic prostate cancer disease, documented by imaging.
  7. Must have undergone bilateral orchiectomy (surgical castration) or be willing to continue GnRH analog or antagonist (medical castration).
  8. Surgically or medically castrated, with serum testosterone ≤ 50 ng/dL (≤ 1.73 nmol/L) at screening.
  9. Previously untreated with or progressed on a second generation androgen inhibitor (abiraterone, enzalutamide, or apalutamide).
  10. No prior treatment with cytotoxic chemotherapy for mCRPC is permitted. Up to six prior cycles of docetaxel received for castration-sensitive disease is permitted for those subjects prior to receiving enzalutamide or abiraterone/prednisone.
  11. Demonstrate adequate organ function as defined below:
    • Absolute neutrophil count ≥ 1,000 /μL.
    • Platelet Count ≥ 100,000 /μL.
    • Hemoglobin ≥ 9 g/dL without a transfusion within 2 weeks of screening.
    • Serum creatinine ≤ 2 × upper limit of normal (ULN) or
      • Creatinine clearance ≥ 40 mL/min as estimated by the Cockcroft and Gault formula in subjects with creatinine > 2 × ULN.
    • Bilirubin ≤ 1.5 × ULN unless evidence of Gilbert's disease in which case < 3 × ULN.
    • Aspartate aminotransferase ≤ 2.5 × ULN without liver metastases; must be ≤ 5 × ULN with liver metastases.
    • Alanine aminotransferase ≤ 2.5 × ULN without liver metastases; must be ≤ 5 × ULN with liver metastases.
    • Albumin > 3.0 g/dL (30 g/L) at screening.

Exclusion Criteria:

  1. Known symptomatic brain metastases.
  2. Untreated or impending spinal cord compression.
  3. Treatment with any of the following for prostate cancer within the indicated timeframe prior to day 1 of starting study treatment:
    • First generation: AR antagonists (eg, bicalutamide, nilutamide, flutamide) within 4 weeks.
    • 5 alpha reductase inhibitors, ketoconazole, estrogens (including diethylstilbesterol), or progesterones within 2 weeks.
    • Chemotherapy within 3 weeks.
    • Prior radionuclide therapy within 4 weeks.
  4. Severe concurrent disease, infection, or co-morbidity that, in the judgment of the Investigator, would make the subject inappropriate for enrollment.
  5. History of another invasive cancer within 3 years of randomization, with the exception of treated non-melanoma skin cancer, treated superficial bladder cancer, or fully treated cancers with a remote probability of recurrence in the opinion of both the Medical Monitor and Investigator.
  6. History of seizure or any condition that may predispose to seizure (eg, prior cortical stroke or significant brain trauma). History of sub clinical seizures manifested by loss of consciousness or transient ischemic attack within 12 months of randomization. However, subjects on medications with seizure lowering threshold will be admitted.
  7. Clinically significant cardiovascular disease including the following:
    • Myocardial infarction within 6 months before screening.
    • Uncontrolled angina within 3 months before screening.
    • Congestive heart failure (New York Heart Association class 3 or 4), or a history of congestive heart failure (New York Heart Association class 3 or 4), unless a screening echocardiogram or multigated acquisition scan performed within 3 months before randomization demonstrates a left ventricular ejection fraction
      • 50% (Appendix 2).
    • History of clinically significant ventricular arrhythmias (eg, sustained ventricular tachycardia, ventricular fibrillation, torsades de pointes).
    • History of Mobitz 2 second-degree or third-degree heart block without a permanent pacemaker in place.
    • Hypotension as indicated by systolic blood pressure <86 millimeters of mercury (mmHg) at screening.
    • Bradycardia as indicated by a heart rate of <45 beats per minute on the screening ECG, and upon physical examination.
    • Uncontrolled hypertension as indicated by systolic blood pressure >170 mmHg or diastolic blood pressure >105 mmHg at screening.
  8. Gastrointestinal disorder affecting absorption (eg, gastrectomy, active peptic ulcer disease within 3 months before randomization).
  9. Major surgery within 4 weeks of randomization.
  10. For subjects taking abiraterone and prednisone, no evidence of hepatic impairment.
  11. Hypersensitivity reaction to the active pharmaceutical ingredient of tazemetostat, abiraterone, prednisone, or enzalutamide, or any of the other components of each individual agent under study.
  12. Is unwilling to exclude grapefruit juice, Seville oranges, and grapefruit from the diet and all foods that contain those fruits from time of enrollment to while on study.
  13. Is currently taking any prohibited medication(s) as described in Section 9.3.3.
  14. Has had prior exposure to tazemetostat or other inhibitor(s) of enhancer of zeste homologue-2.
  15. Is immunocompromised (ie, has a congenital immunodeficiency). Subjects diagnosed with human immunodeficiency virus (HIV) are eligible to participate in the study if they meet the following criteria:
    • No history of AIDS-defining opportunistic infections, or have not had an opportunistic infection within the 12 months prior to enrollment.
    • No history of AIDS-defining cancers (eg, Kaposi's sarcoma, aggressive B-cell lymphoma, and invasive cervical cancer).
    • Subjects may take prophylactic antimicrobials; however, subjects taking specific antimicrobial drugs where there may be drug-drug interaction or overlapping toxicities with study drugs must be excluded from study participation.
    • Subjects should be on established anti-retroviral therapy for ≥4 weeks with an HIV viral load of < 400 copies/mL and/or CD4+ T-cell (CD4+) count ≥ 350 cells/uL prior to enrollment.
  16. Has thrombocytopenia, neutropenia, or anemia of Grade ≥3 (per National Cancer Institute's Common Terminology Criteria for Adverse Events [CTCAE] 5.0 criteria) or any prior history of myeloid malignancies, including myelodysplastic syndrome (MDS).

    Has abnormalities known to be associated with MDS (eg del 5q, chr 7 abn) and myeloproliferative neoplasms (eg JAK2 V617F) observed in cytogenetic testing and DNA sequencing. NOTE: Bone marrow aspirate/biopsy will be conducted following abnormal peripheral blood smear morphology assessment conducted by central laboratory. Cytogenetic testing and DNA sequencing will be conducted following an abnormal result of bone marrow aspirate/biopsy.

  17. Has a prior history of T-cell lymphoblastic lymphoma/ T-cell acute lymphoblastic leukemia.
  18. Is unable to take oral medications or has malabsorption syndrome or any other uncontrolled gastrointestinal condition (eg, nausea, diarrhea or vomiting) that might impair the bioavailability of study treatments.
  19. Subjects with hepatitis B or hepatitis C are ineligible to participate in the study unless they meet the following criteria:
    • Do not have uncontrolled hepatitis B or C infection, are not on active immunosuppressive therapy, and do not have a history of autoimmune disease requiring ongoing systemic therapy.
    • Subjects taking therapy for hepatitis where there may be a drug-drug interaction or overlapping toxicities with study drugs must be excluded from study participation.
Open or close this module Contacts/Locations
Central Contact Person: Shefali Agarwal, MD
Telephone: 855001101
Email: clinicaltrials@epizyme.com
Locations: United States, Colorado
The Urology Center Of Colorado
[Not yet recruiting]
Denver, Colorado, United States, 80211
Contact:Contact: Lawrence Karsh
United States, Kentucky
Norton Cancer Institute - Broadway
[Not yet recruiting]
Louisville, Kentucky, United States, 40202
Contact:Contact: Arash R Kalebasty
Contact:Principal Investigator: Arash R Kalebasty
United States, New York
Memorial Sloan Kettering Cancer Center
[Not yet recruiting]
New York, New York, United States, 10065
Contact:Contact: Wassim Abida
Monter Cancer Center
[Not yet recruiting]
New York, New York, United States, 11042
Contact:Contact: Thomas Bradley
United States, Texas
Mary Crowley Cancer Research
[Recruiting]
Dallas, Texas, United States, 75230
Contact:Contact: Ashley Ross 972-566-3000
Urology San Antonio
[Recruiting]
San Antonio, Texas, United States, 78229
Contact:Contact: Daniel Saltztein, MD
Contact:Principal Investigator: Daniel Saltztein, MD
Open or close this module IPDSharing
Plan to Share IPD:
Open or close this module References
Citations:
Links:
Available IPD/Information:

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