A Randomized Phase II Trial Combining Vaccine Therapy With PROSTVAC /TRICOM and Enzalutamide vs. Enzalutamide Alone in Men With Metastatic Castration Resistant Prostate Cancer
Background:
- Enzalutamide is a well-tolerated, modern androgen receptor antagonist (ARA) with more
enhanced anti-tumor activity compared to previous ARAs. Phase III trial has
demonstrated a 4.8 month improvement in survival and a 37% risk reduction in death in
metastatic castration resistant prostate cancer (mCRPC) patients who have had previous
docetaxel.
- PROSTVAC(Trademark) is a therapeutic cancer vaccine which is designed to induce an
anti-tumor immune response. In a randomized controlled Phase 2 trial, PROSTVAC therapy
was associated with a prolongation of survival by 8.5 months in men with metastatic
castrateresistant prostate cancer. An international Phase 3 trial is on-going.
- Preclinical data has demonstrated that hormonal therapies such as ARAs can enhance the
immune response through multiple mechanisms. Specifically, our group has shown that
enzalutamide can increase thymic production of na ve T-cells, which could be activated
by a cancer vaccine. Together, these data provide an important rationale to combine
enzalutamide with PSA-TRICOM in mCRPC.
- Data from the clinical trials with these therapies suggest that they are very well
tolerated and without overlapping toxicity.
Objective:
-Determine if PSA-TRICOM combined with enzalutamide will increase time to progression (as
defined by Prostate Cancer Clinical Trials Working Group 2 criteria, incorporated in section
5.2) in chemotherapy-naive metastatic castration resistant prostate cancer patients compared
to enzalutamide alone.
Design:
- The study will randomize chemotherapy-naive, mCRPC patients to either enzalutamide
alone or enzalutamide with PSA-TRICOM. Enzalutamide will be given at the standard dose
of 160 mg daily.
- PSA-TRICOM will be administered identical to the Phase III dosing with vaccine given
week 1 (vaccinia-PSA-TRICOM, 2x108 units subcutaneously) and then week 3, 5 and then
monthly fowlpox-vaccine (2x109 units subcutaneously).
- After completing 6 months of vaccine, fowlpox-vaccine (2x109 units subcutaneously will
be administered every 3 months. Patients will be treated until radiographic progression
on scans using Prostate Cancer Working Group Criteria.
Eligibility:
- mCRPC patients with rising PSA or progressive disease despite castration levels of
testosterone.
- Chemotherapy-na ve with minimal or no symptoms related to prostate cancer.
- Patients with history of autoimmune disease, brain/leptomeningeal metastasis, a second
malignancy within 3 years of enrollment, or a severe co-morbid condition will be
excluded.
- Patients who have received abiraterone will be excluded
- Patients will be stratified based on previous sipuleucel-T.
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Increase in time to progression
4-5 years
No
Ravi A Madan, M.D.
Principal Investigator
National Cancer Institute (NCI)
United States: Federal Government
130146
NCT01867333
May 2013
June 2016
Name | Location |
---|---|
National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda, Maryland 20892 |