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Enzalutamide With or Without Abiraterone and Prednisone in Treating Patients With Castration-Resistant Metastatic Prostate Cancer

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ClinicalTrials.gov Identifier: NCT01949337
Recruitment Status : Active, not recruiting
First Posted : September 24, 2013
Results First Posted : June 1, 2020
Last Update Posted : September 28, 2023
Sponsor:
Collaborators:
National Cancer Institute (NCI)
Astellas Pharma US, Inc.
Medivation, Inc.
Biologics, Inc.
Information provided by (Responsible Party):
Alliance for Clinical Trials in Oncology

Study Description
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Brief Summary:
This randomized phase III trial studies enzalutamide to see how well it works compared to enzalutamide, abiraterone, and prednisone in treating patients with castration-resistant metastatic prostate cancer. Androgens can cause the growth of prostate cancer cells. Drugs, such as enzalutamide, abiraterone acetate, and prednisone, may lessen the amount of androgens made by the body.

Condition or disease Intervention/treatment Phase
Adenocarcinoma of the Prostate Hormone-resistant Prostate Cancer Recurrent Prostate Cancer Stage IV Prostate Cancer Drug: enzalutamide Drug: abiraterone Drug: prednisone Phase 3

Detailed Description:

Patients are randomized to one of two treatment groups: enzalutamide or enzalutamide, abiraterone and prednisone. Treatment will continue until disease progression or unacceptable toxicity. Patients are followed for clinical outcomes for a maximum of 5 years post study treatment. The primary and secondary objectives are described below.

  1. Primary Objective:

    To compare the overall survival of patients with progressive metastatic castration-resistant prostate cancer (CRPC) treated with either enzalutamide only or enzalutamide with abiraterone and prednisone

  2. Secondary Objectives:

    • To assess the grade 3 or higher toxicity profile and compare safety by treatment arm.
    • To assess and compare post-treatment prostate-specific antigen (PSA) declines by treatment arm.
    • To compare radiographic progression free survival defined by Prostate Cancer Working Group 2 (PCWG2), and objective response rate, by treatment arm.
    • To test for radiographic progression free survival (rPFS) treatment interaction in predicting overall survival.
    • To assess pre- and post-treatment measures of tumor burden and bone activity using sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) and technetium (Tc) methylene diphosphonate (MDP) bone scintigraphy and correlate these measures with overall survival.
    • To develop and validate prognostic and predictive models of overall survival that include baseline clinical and molecular markers.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1311 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase III Trial of Enzalutamide (NSC# 766085) Versus Enzalutamide, Abiraterone and Prednisone for Castration Resistant Metastatic Prostate Cancer
Actual Study Start Date : January 22, 2014
Actual Primary Completion Date : November 2, 2018
Estimated Study Completion Date : August 31, 2024

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Arm A: (enzalutamide)
Patients receive enzalutamide 160 mg PO QD. Treatment will continue until confirmed disease progression or unacceptable toxicity.
 Drug: enzalutamide
Enzalutamide 160 mg daily, orally
Experimental: Arm B: (enzalutamide, abiraterone, prednisone)
Patients receive enzalutamide 160 mg PO QD, abiraterone 1000 mg PO QD, and prednisone 5 mg PO BID. Treatment will continue until confirmed disease progression or unacceptable toxicity.
 Drug: enzalutamide
Enzalutamide 160 mg daily, orally

Drug: abiraterone
abiraterone 1000 mg daily, orally

Drug: prednisone
prednisone 5 mg twice daily, orally


Outcome Measures
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Primary Outcome Measures :
  1. Overall Survival (OS) [ Time Frame: Up to 5 years post treatment ]
    Overall survival is defined as the time from study registration to death due to any cause.


Secondary Outcome Measures :
  1. Number of Participants Who Has Experienced at Least One Toxicity (Defined as a Grade 3 or Higher Adverse Event Deemed at Least Possibly Related to Treatment) [ Time Frame: Up to 5 years post treatment ]
    The number of participants who has experienced at least one toxicity (defined as a grade 3 or higher adverse event deemed at least possibly related to treatment)

  2. Decline in Prostate Specific Antigen (PSA) [ Time Frame: Up to 5 years post treatment ]
  3. Progression Free Survival (PFS) [ Time Frame: Up to 5 years post treatment ]
  4. Objective Response Rate [ Time Frame: Up to 5 years post treatment ]
  5. Radiographic Progression Free Survival (rPFS) [ Time Frame: Up to 5 years post treatment ]
  6. Tumor Burden and Bone Activity [ Time Frame: Up to 5 years post treatment ]

Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Eligibility Criteria:

  1. Documentation of Disease - Progressive castration-resistant metastatic prostate cancer with histologically or cytologically confirmed adenocarcinoma of the prostate without neuroendocrine differentiation or small cell features

  2. Patients must have measurable or non-measurable disease:

    1. Measurable Disease - For visceral or extra nodal lesions to be considered measurable, they must be ≥ 10 mm in one dimension, using spiral CT. For lymph nodes to be considered measurable (ie, target or evaluable lesions), they must be ≥ 20 mm in at least one dimension, using spiral CT.
    2. Non-Measurable Disease - All other lesions, including small lesions (longest diameter < 20 mm with conventional techniques or < 10 mm with spiral CT scan) and truly non-measurable lesions. Lesions that are considered non-measurable include bone lesions (only).
    3. Patients with node only disease (ie, no presence of visceral, extra nodal lesions or bone lesions) must have node(s) that measure ≥ 15 mm in short axis.

  3. Progressive Disease - Patients must have progressive disease at study entry defined as one or more of the following three criteria that occurred while the patient was on androgen deprivation therapy. For patients enrolling on the basis of soft tissue or bone progression, the baseline scan must show progression relative to a comparison scan. If the comparison scan is not available, the baseline scan report must reference the previous scan to document progression.

    1. PSA progression defined by a minimum of two rising PSA levels with an interval of ≥ 1 week between each determination. Patients who received an anti-androgen must have progression documented by a minimum of two rising PSA levels with an interval of ≥ 1 week between each determination such that at least the second of these rises is ≥ 4 weeks since last flutamide, bicalutamide or nilutamide.

      The PSA value at the screening should be ≥ 2 µg/L (2 ng/mL) .

    2. Soft tissue disease progression defined by the protocol
    3. Bone disease progression defined by the Prostate Cancer Working Group 2 (PCWG2) with two or more new lesions on bone scan

  4. Prior Treatment

    1. No treatment with prior taxane-based chemotherapy for metastatic disease

      • Patients who received prior taxane-based chemotherapy as neoadjuvant or adjuvant therapy for local disease, or who received taxane-based therapy in the PSA clinical (non-metastatic) state is allowable provided that the total duration of exposure was six cycles or less and chemotherapy was completed more than 6 months prior to registration
      • Taxane-based chemotherapy that was aborted due to allergic reactions or intolerance to chemotherapy and therefore received one cycle of prior therapy is allowable
    2. No prior enzalutamide, abiraterone or other novel antiandrogen or androgen synthesis inhibitor

    3. No treatment with any of the following for prostate cancer within 4 weeks prior to enrollment:

      • Hormonal therapy (e.g., androgen receptor [AR] antagonists, 5 alpha reductase inhibitors, estrogens) Note: Treatment with bicalutamide and nilutamide within 4 weeks prior to enrollment is not allowed. Treatment with flutamide within 4 weeks prior to enrollment is not allowed. Treatment with all other gonadotropin- releasing hormone (GnRH) analogues or antagonists is allowed.
      • Chemotherapy
      • Biologic therapy
      • Investigational therapy
      • Immunotherapy
    4. No use of herbal products that may decrease PSA levels within 4 weeks prior to enrollment
    5. No use of systemic steroids greater than the equivalent of 10 mg of prednisone/prednisolone per day within 4 weeks prior to enrollment
    6. No prior use of ketoconazole for greater than 7 days
    7. No prior radiation therapy or radionuclide therapy for the treatment of metastasis within four weeks prior to enrollment
    8. Patients receiving bisphosphonate therapy or denosumab must have been on a stable dose for at least 4 weeks prior to enrollment
    9. Patients must maintain ongoing androgen deprivation therapy with a GnRH analogue, antagonist, or bilateral orchiectomy (i.e., surgical or medical castration)

  5. Patient History

    1. No known or suspected brain metastases (NOTE: patients with treated epidural disease are allowed)
    2. No planned palliative procedures for alleviation of bone pain such as radiation therapy or surgery
    3. No structurally unstable bone lesions suggesting impending fracture
    4. No history of seizure or any condition that may increase the patient's seizure risk (e.g., prior cortical stroke, significant brain trauma). No history of transient ischemic attack (TIA) within 12 months of enrollment

    5. No clinically significant cardiovascular disease including:

      • Myocardial infarction (MI) within 6 months
      • Uncontrolled angina within 3 months
      • Congestive heart failure (CHF) with New York Heart Association (NYHA) class 3 or 4, or patients with NYHA class 3 or 4 in the past, unless a screening echocardiogram (echo) or multigated acquisition scan (MUGA) performed within three months demonstrates an ejection fraction (EF) > 45%
      • History of clinically significant ventricular arrhythmias (e.g., ventricular tachycardia, ventricular fibrillation, torsades de pointes)
      • History of Mobitz II second degree or third degree heart block without a permanent pacemaker in place
      • Hypotension (systolic blood pressure [BP] < 86 mmHg) or bradycardia (< 50 bpm) at screening
      • Uncontrolled hypertension (systolic BP > 170 mmHg or diastolic BP > 105 mmHg at screening)
    6. No gastrointestinal (GI) disorder that negatively affects absorption
    7. No major surgery within 4 weeks prior to enrollment

  6. Age and performance status

    1. Age ≥ 18 years of age
    2. Eastern Cooperative Oncology Group (ECOG) performance status 0-1
    3. Asymptomatic or mildly symptomatic from prostate cancer

  7. Required Initial Laboratory Values

    1. Granulocytes ≥ 1,500/µL
    2. Platelet count ≥ 100,000/µL
    3. Hemoglobin ≥ 9 g/dL
    4. Creatinine ≤ 2 x upper limits of normal (ULN)
    5. Bilirubin ≤ 1.5 x ULN
    6. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≤ 2 x ULN
    7. Albumin ≥ 3 g/dl
    8. Total testosterone ≤ 50 ng/dL (1.7 nmol/L)
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01949337


Locations
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Sponsors and Collaborators
Alliance for Clinical Trials in Oncology
National Cancer Institute (NCI)
Astellas Pharma US, Inc.
Medivation, Inc.
Biologics, Inc.
Investigators
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Study Chair: Michael Morris, M.D. Memorial Sloan Kettering Cancer Center
  Study Documents (Full-Text)

Documents provided by Alliance for Clinical Trials in Oncology:
Study Protocol and Statistical Analysis Plan  [PDF] February 14, 2018

More Information
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Responsible Party: Alliance for Clinical Trials in Oncology
ClinicalTrials.gov Identifier: NCT01949337    
Other Study ID Numbers: A031201
U10CA031946 ( U.S. NIH Grant/Contract )
NCI-2013-01737 ( Registry Identifier: Clinical Trial Reporting Program )
First Posted: September 24, 2013    Key Record Dates
Results First Posted: June 1, 2020
Last Update Posted: September 28, 2023
Last Verified: September 2023
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Genital Diseases
Urogenital Diseases
Prostatic Diseases
 Male Urogenital Diseases
Prednisone
Anti-Inflammatory Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal
Antineoplastic Agents