Sequencing Abiraterone and Enzalutamide in mCRPC
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ClinicalTrials.gov Identifier: NCT02125357 |
Recruitment Status :
Completed
First Posted : April 29, 2014
Last Update Posted : August 7, 2020
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Tracking Information | ||||
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First Submitted Date ICMJE | April 22, 2014 | |||
First Posted Date ICMJE | April 29, 2014 | |||
Last Update Posted Date | August 7, 2020 | |||
Actual Study Start Date ICMJE | September 2014 | |||
Actual Primary Completion Date | February 4, 2020 (Final data collection date for primary outcome measure) | |||
Current Primary Outcome Measures ICMJE |
PSA response rate in mCRPC patients with PSA progression on first-line therapy when crossed over to second-line therapy with the opposite agent [ Time Frame: 1 year ] | |||
Original Primary Outcome Measures ICMJE |
To evaluate the PSA response rate in mCRPC patients with PSA progression on first-line therapy with abiraterone acetate or enzalutamide when crossed over to second-line therapy with the opposite agent. [ Time Frame: 1 year ] PSA response rate as defined as a >/= 30% decline in PSA from baseline confirmed on repeat measurement >/= 28 days later
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Change History | ||||
Current Secondary Outcome Measures ICMJE |
Potential biomarkers that are associated with treatment efficacy and/ or resistance [ Time Frame: 1 year ] Among mCRPC patients receiving abiraterone acetate and enzalutamide
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Original Secondary Outcome Measures ICMJE |
To collect serum and plasma to identify potential biomarkers that are associated with treatment efficacy and/ or resistance in mCRPC patients receiving abiraterone acetate and enzalutamide [ Time Frame: 1 year ] | |||
Current Other Pre-specified Outcome Measures |
PSA response rate in mCRPC patients treated with first-line abiraterone acetate or enzalutamide [ Time Frame: 1 year ] | |||
Original Other Pre-specified Outcome Measures |
To evaluate the PSA response rate in mCRPC patients treated with first-line abiraterone acetate or enzalutamide [ Time Frame: 1 year ] | |||
Descriptive Information | ||||
Brief Title ICMJE | Sequencing Abiraterone and Enzalutamide in mCRPC | |||
Official Title ICMJE | A Randomized Phase II Study of Sequencing Abiraterone Acetate and Enzalutamide in Metastatic Castration-Resistant Prostate Cancer | |||
Brief Summary | This study is being offered to patients who have castrate-resistant (also known as hormone-refractory) prostate cancer. The cancer has metastasized or spread outside the prostate area to other parts of the body. The purpose of this study is to evaluate the effects of sequencing hormonal therapies (abiraterone acetate and enzalutamide) and to assess treatment efficacy of these two agents. |
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Detailed Description | Abiraterone acetate and enzalutamide have emerged as standard therapies in metastatic castration-resistant prostate cancer (mCRPC). Both agents improve outcomes in patients previously treated with docetaxel and in those that are chemotherapy-naive. Although their mechanisms of action differ, both abiraterone and enzalutamide target persistent androgen receptor (AR) signaling. Abiraterone inhibits CYP17 and testicular and extragonadal androgen production whereas enzalutamide directly antagonises the AR. Whether cross resistance occurs between these agents if used in sequence is unknown, but theoretically disparate mechanisms of resistance may allow for successful sequencing of these agents. Prior studies have reported Prostate-Specific Antigen (PSA) response rates of under 10% in patients treated with abiraterone after enzalutamide and 13%-29% in patients treated with enzalutamide after abiraterone. Since these data were generated in small, retrospective series, a prospective clinical trial is warranted to evaluate effects of sequencing abiraterone and enzalutamide. A randomised phase II study is proposed in which patients with PSA progression on abiraterone or enzalutamide will be crossed over to the opposite agent. Although not a surrogate for clinical outcomes, PSA changes will be used to assess treatment efficacy since PSA expression is driven by AR activation. Apart from determining optimal sequencing of abiraterone and enzalutamide in mCRPC patients, a key issue associated with the use of these agents is identifying circulating biomarkers associated with treatment response and resistance. Our group has preliminary data showing that a high proportion of enzalutamide-resistant mCRPC patients and some abiraterone-resistant mCRPC patients possess focal AR amplification in cell-free tumour DNA extracted from plasma. In pre-clinical studies, other potential mechanisms of resistance to these agents include increased expression of AR splice variants (abiraterone and enzalutamide) increased expression of CYP17 (abiraterone), upregulation of the stress-activated chaperone protein clusterin (enzalutamide only) and a point mutation (F876L) in the ligand-binding domain of the AR (enzalutamide only). Non-coding RNAs (ncRNAs) are additional biomarkers of interest since they are implicated in tumorigenesis and are readily detectable in plasma of mCRPC patients. Examination of these biomarkers in serum and plasma is planned, with the aim of identifying potentially novel factors associated with treatment efficacy and resistance in mCRPC patients receiving abiraterone and enzalutamide. The cognitive effects of abiraterone and enzalutamide are not well described. Enzalutamide is known to cross the blood-brain barrier and infrequently causes seizures, possibly related to effects on the γ-aminobutyric acid-gated chloride channel. In the enzalutamide registration study, a small subset (< 5%) of patients also developed mental impairment disorders including amnesia, memory impairment, cognitive disorder and disturbance in attention. Conversely, no central nervous system effects of abiraterone have been reported. Cognitive testing will therefore be undertaken in this study to evaluate potential differences between these agents. |
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Study Type ICMJE | Interventional | |||
Study Phase ICMJE | Phase 2 | |||
Study Design ICMJE | Allocation: Randomized Intervention Model: Crossover Assignment Masking: None (Open Label) Primary Purpose: Other |
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Condition ICMJE | Metastatic Castration-Resistant Prostate Cancer | |||
Intervention ICMJE |
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Study Arms ICMJE |
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Publications * |
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* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
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Recruitment Information | ||||
Recruitment Status ICMJE | Completed | |||
Actual Enrollment ICMJE |
202 | |||
Original Estimated Enrollment ICMJE |
118 | |||
Actual Study Completion Date ICMJE | February 4, 2020 | |||
Actual Primary Completion Date | February 4, 2020 (Final data collection date for primary outcome measure) | |||
Eligibility Criteria ICMJE | Inclusion Criteria:
Exclusion Criteria:
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Sex/Gender ICMJE |
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Ages ICMJE | 18 Years and older (Adult, Older Adult) | |||
Accepts Healthy Volunteers ICMJE | No | |||
Contacts ICMJE | Contact information is only displayed when the study is recruiting subjects | |||
Listed Location Countries ICMJE | Canada | |||
Removed Location Countries | ||||
Administrative Information | ||||
NCT Number ICMJE | NCT02125357 | |||
Other Study ID Numbers ICMJE | GUTG-001 | |||
Has Data Monitoring Committee | No | |||
U.S. FDA-regulated Product | Not Provided | |||
IPD Sharing Statement ICMJE | Not Provided | |||
Current Responsible Party | British Columbia Cancer Agency | |||
Original Responsible Party | Same as current | |||
Current Study Sponsor ICMJE | British Columbia Cancer Agency | |||
Original Study Sponsor ICMJE | Same as current | |||
Collaborators ICMJE | Not Provided | |||
Investigators ICMJE |
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PRS Account | British Columbia Cancer Agency | |||
Verification Date | August 2020 | |||
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP |