CANOPY: Study of Cabozantinib and Nivolumab in Metastatic Castration Resistant Prostate Cancer

Sponsor

Rana McKay, MD (Other)

Overall Status

Not yet recruiting

CT.gov ID

NCT05502315

Collaborator

Exelixis (Industry), Bristol-Myers Squibb (Industry)

Enrollment

Arm

18.4

Anticipated Duration (Months)

Study Details

Study Description

Brief Summary

This is a multicenter, single-arm, two-stage open-label phase 2 study of the combination of cabozantinib + nivolumab in subjects with advanced castration-resistant prostate cancer (CRPC).

Condition or Disease	Intervention/Treatment	Phase
Castration-resistant Prostate Cancer Metastatic Cancer	Drug: Cabozantinib Drug: Nivolumab	Phase 2

Detailed Description

Eligible subjects will undergo a baseline biopsy prior to treatment initiation. They will then initiate treatment with cabozantinib (40 mg orally daily) and nivolumab (480 mg intravenously every four weeks). An on-treatment biopsy will be performed during Cycle 2. Subjects will continue treatment until radiographic progression, toxicity or withdrawal. Prostate-specific antigen (PSA) levels will be evaluated once every cycle. Radiographic assessments will occur every two cycles for one year and then every three cycles thereafter. Cycle length is 28 days.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

50 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase 2 Study of Cabozantinib and Nivolumab in Metastatic Castration Resistant Prostate Cancer

Anticipated Study Start Date :

Oct 1, 2022

Anticipated Primary Completion Date :

Apr 12, 2023

Anticipated Study Completion Date :

Apr 12, 2024

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Experimental Group 40 mg of cabozantinib taken orally every day (days 1-28) of a 28 day cycle 480 mg of nivolumab given intravenously on the first day (day 1) of each 28 day cycle	Drug: Cabozantinib 40 mg taken orally Other Names: Cabometyx Drug: Nivolumab 480 mg by infusion Other Names: Opdivo

Arm

Intervention/Treatment

Experimental: Experimental Group

40 mg of cabozantinib taken orally every day (days 1-28) of a 28 day cycle 480 mg of nivolumab given intravenously on the first day (day 1) of each 28 day cycle

Drug: Cabozantinib

40 mg taken orally

Other Names:

Cabometyx

Drug: Nivolumab

480 mg by infusion

Other Names:

Opdivo

Outcome Measures

Primary Outcome Measures

Radiographic Progression Free Survival (rPFS) [6 months]
The primary endpoint is the efficacy of treatment via assessment of 6 month rPFS defined by RECIST version 1.1 for soft tissue and Prostate Cancer Working Group 3 (PCWG3) criteria for bone metastases. rPFS is defined as the duration of time from the first day of the start of study treatment to time of radiographic progression or death due to any cause, whichever occurs first.

Secondary Outcome Measures

PSA Response [3 years]
PSA response per PCWG3. PSA response defined as a ≥50% decline in PSA from baseline (measured twice at least 3 weeks apart).
Overall Response Rate (ORR) [3 years]
ORR by RECIST version 1.1 in subjects with measurable disease. ORR will be defined using RECIST version 1.1 criteria for subjects with measurable disease.
6-month rPFS in predefined subgroups [6 months]
Defined as 1) subjects with and without visceral metastases and 2) subjects with and without bone metastases. 6 month rPFS defined by RECIST version 1.1 for soft tissue and Prostate Cancer Working Group 3 (PCWG3) criteria for bone metastases. rPFS is defined as the duration of time from the first day of the start of study treatment to time of radiographic progression or death due to any cause, whichever occurs first.
6-month PSA response in predefined subgroups [6 months]
Defined as 1) subjects with and without visceral metastases and 2) subjects with and without bone metastases. PSA response per PCWG3. PSA response defined as a ≥50% decline in PSA from baseline (measured twice at least 3 weeks apart).
6-month ORR in predefined subgroups [6 months]
Defined as 1) subjects with and without visceral metastases and 2) subjects with and without bone metastases. ORR by RECIST version 1.1 in subjects with measurable disease.
rPFS [3 years]
Defined by radiographic progression by RECIST 1.1 for soft tissue and PCWG3 version 1.1 for bone metastases.
Overall Survival (OS) [3 years]
Overall survival (OS) is defined as time from start of study treatment to the date of death from any cause. Subjects who are alive will be censored at last follow up date.
Assess conversion of circulating tumor cell (CTC) count [3 years]
Conversion of CTC count from ≥ 5 cells/7.5 mL blood at baseline to < 5 cells/7.5 mL blood confirmed by at least two readings 4 weeks apart.
Assess adverse events [3 months]
Safety and tolerability as determined by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Time to PSA Progression [3 years]
Time to PSA progression as defined by PCWG3 criteria.
Time to occurrence of first symptomatic skeletal event. [3 years]
A skeletal related event is the use of external beam radiotherapy to relieve skeletal symptoms or the occurrence of new symptomatic pathological bone fractures (vertebral or non-vertebral) or the occurrence of spinal cord compression or a tumor related orthopedic surgical intervention.
Time from treatment discontinuation to first subsequent anti-cancer therapy [3 years]
Evaluate time from treatment discontinuation to first subsequent anti-cancer therapy (including androgen receptor signaling agents, cytotoxic chemotherapy, immunotherapy, or investigational agents) or death.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

Male

Accepts Healthy Volunteers:

Inclusion Criteria:

Subjects must meet all of the following applicable inclusion criteria to participate in this study:

Willing and able to provide, or have a legally authorized representative provide, written informed consent and HIPAA authorization for the release of personal health information. A signed informed consent must be obtained before screening procedures are performed. NOTE: HIPAA authorization may be either included in the informed consent or obtained separately.
Males 18 years of age and above.
Histological or cytological proof of prostate adenocarcinoma.
ECOG status of ≤ 2
Progressive mCRPC as defined: 1) castrate levels of serum testosterone < 50 ng/dL AND

progressive disease as defined by PSA or radiographic progression. Subjects with measurable and non-measurable disease (i.e., bone only metastases) are allowed. NOTE: ENROLLMENT of subjects with non-measurable disease (i.e., bone only metastases) will be capped at 50% of enrollment target (n=25).

Must have exposure to one prior taxane (or be taxane ineligible or refuse taxane) AND one prior AR-targeting agent (for example, abiraterone, enzalutamide, apalutamide, darolutamide). Receipt of taxane or AR-targeting agent may be in the hormone sensitive or castration resistant setting.
Normal organ function with acceptable initial laboratory values within 14 days of treatment start:
WBC: ≥ 2,500/mcL
ANC: ≥ 1,500/mcL
Hemoglobin: ≥ 9 g/dL (transfusions within 7 days of study treatment are permitted)
Platelet count: ≥ 100,000/mcL
Serum creatinine or calculated Creatinine Clearance: Serum creatinine ≤ 1.5 x ULN or calculated CrCl ≥ 40 mL/min as defined by Cockcroft-Gault equation
Total Bilirubin: ≤ 1.5 x ULN (≤ 3 x ULN for subjects with documented Gilbert's disease)
SGOT (AST): ≤ 3 x ULN
SGPT (ALT): ≤ 3 x ULN
Alkaline Phosphatase (ALP) : ≤ 5 x ULN with documented bone metastases
Serum Albumin: ≥ 2.8 g/dL
Urine protein/creatinine ratio (UPCR): ≤ 1 mg/mg (≤ 113.2 mg/mmol), or 24-h urine protein ≤ 1 g
Subjects must agree to use a medically acceptable method of birth as outlined in the protocol
HIV-positive with negative viral loads on stable antiretroviral regimen will be considered eligible. Subjects must have CD4 count > 350.

Exclusion Criteria:

Subjects meeting any of the criteria below may not participate in the study:

Small cell or neuroendocrine component or histology.
Prior cabozantinib or checkpoint inhibitor.
Receipt of any type of small molecule kinase inhibitor (including investigational kinase inhibitor) within 2 weeks before first dose of study treatment.
Receipt of any type of cytotoxic, biologic or investigational systemic anti-cancer agent within 4 weeks before first dose of study treatment.
Treatment with abiraterone, apalutamide, or darolutamide within 2 weeks of treatment initiation. Treatment with investigational prostate cancer directed therapy within 4 weeks of treatment initiation. Treatment with enzalutamide within 4 weeks of treatment initiation.
Prior treatment with radium-223.
Receipt of more than 2 lines of therapy for CRPC. Receipt of more than 1 line of chemotherapy (including both hormone sensitive and CRPC). First-generation anti-androgen use (such as bicalutamide) will not be tabulated as a line of therapy.
Administration of a live, attenuated vaccine within 30 days prior to first dose of study treatment.
Active autoimmune disease or condition requiring prednisone >10 mg daily (or equivalent). Physiologic replacement is permitted. Topical, ocular, intra-articular steroids or inhaled corticosteroids are permitted.
Imminent or established spinal cord compression based on clinical and/or imaging findings.
Radiation therapy within 1 week of study treatment start.
Known brain metastases or cranial epidural disease unless adequately treated with radiotherapy and/or surgery (including radiosurgery) and stable for at least 4 weeks prior to first dose of study treatment.
History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest CT scan.
Malabsorption syndrome.
Requirement for hemodialysis or peritoneal dialysis.
History of solid organ or allogenic stem cell transplant.
Active hepatitis B/C or positive TB test with active mycobacterial infection requiring systemic treatment.
Active treatment (within 5 days of registration) with coumarin agents (e.g., warfarin), direct thrombin inhibitors (e.g., dabigatran), direct factor Xa inhibitor betrixaban, or platelet inhibitors (e.g., clopidogrel).
The subject has uncontrolled, significant intercurrent or recent illness including, but not limited to, the following conditions:
Cardiovascular disorders.
Gastrointestinal (GI) disorders including those associated with a high risk of perforation or fistula formation.
Major surgery (e.g., laparoscopic nephrectomy, GI surgery, removal or biopsy of brain metastasis) within 2 weeks before first dose of study treatment. Minor surgeries within 10 days before first dose of study treatment. Subjects must have complete wound healing from major surgery or minor surgery before first dose of study treatment. Subjects with clinically relevant ongoing complications from prior surgery are not eligible.
Any other active malignancy at time of first dose of study treatment or diagnosis of another malignancy within 3 years prior to first dose of study treatment that requires active treatment.
Known allergy to any of the compounds under investigation.
Inability to swallow tablets.