DEXTER: Dexamethasone Prior to Re-treatment With Enzalutamide in Treating Patients With Metastatic Hormone-Resistant Prostate Cancer Previously Treated With Enzalutamide and Docetaxel
Study Details
Study Description
Brief Summary
This pilot trial studies how well dexamethasone and re-treatment with enzalutamide work in treating patients with prostate cancer that has spread to other places in the body (metastatic), does not respond to hormone therapy (hormone-resistant), and was previously treated with enzalutamide and docetaxel. Dexamethasone treatment may be able to reverse one resistance mechanism to enzalutamide therapy (overabundance of receptors for dexamethasone and other glucocorticoids inside cancer cells) and allow for renewed therapeutic sensitivity to enzalutamide. Androgens (a type of male hormone) can bind to androgen receptors found inside prostate cancer cells, which may cause the cancer cells to grow. Enzalutamide may stop the growth of prostate cancer cells by blocking the activity of the cancer cell androgen receptors. Giving dexamethasone prior to re-treatment with enzalutamide may be a treatment for prostate cancer.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Detailed Description
PRIMARY OBJECTIVES:
- To determine the prostate-specific antigen (PSA) response rate to enzalutamide (Enza) after treatment with dexamethasone (Dex) therapy.
SECONDARY OBJECTIVES:
-
Objective response rate to Enza in patients with measurable disease on computed tomography (CT) scan using Response Evaluation Criteria in Solid Tumors (RECIST) criteria.
-
Time to PSA progression (based upon Prostate Cancer Working Group 2 [PCWG2] criteria) for treatment with Dex.
-
Effect of each treatment on quality of life as assessed by patient completion of validated instruments (Functional Assessment of Chronic Illness Therapy [FACIT]-Fatigue Scale, RAND Short Form-36 [RANDSF-36]).
-
PSA response rates to Dex for patients who are androgen receptor splice variant 7 (AR-V7) positive and AR-V7 negative, respectively, at study entry.
-
Response rates to Enza for patients who are AR-V7 positive and AR-V7 negative, respectively, at study entry.
-
Percentage of patients who are AR-V7 positive at study entry who are AR-V7 negative at time of initiation of Enza, or vice-versa.
OUTLINE:
Patients receive dexamethasone orally (PO) once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for 4 weeks.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Treatment (dexamethasone and enzalutamide) Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. |
Drug: Dexamethasone
Given PO
Other Names:
Drug: Enzalutamide
Given PO
Other Names:
Other: Laboratory Biomarker Analysis
Correlative studies
Other: Quality-of-Life Assessment
Ancillary studies
Other Names:
|
Outcome Measures
Primary Outcome Measures
- PSA Response Rate [Up to 4 weeks post-treatment]
PSA response rate is defined as the proportion of subjects with a >= 50% PSA decline from baseline level when starting enzalutamide and maintained for >= 4 weeks at any time-point after receiving enzalutamide. Will determine its corresponding 95% confidence interval.
Secondary Outcome Measures
- Changes in Quality of Life Assessment Scores, Assessed Using FACIT-Fatigue Scale and RANDSF-36 Surveys [Baseline to up to 4 weeks post-treatment]
Summary statistics of the scores will be reported at baseline before starting dexamethasone and each follow-up time during the treatment of dexamethasone and enzalutamide. Changes in quality of life scores over the course of the study will be computed and their significance will be evaluated by paired-sample t-tests.
- Objective Response Rate to Enzalutamide in Patients With Measurable Disease on CT Scan [Up to 4 weeks post-treatment]
Will estimate 95% confidence interval.
- Response Rate With Dexamethasone by AR-V7 Status at Study Entry [Baseline]
- Response Rate With Enzalutamide by AR-V7 Status at Study Entry [Baseline]
- Time to PSA Progression, Based Upon PCWG2 Criteria, for Treatment With Dexamethasone [Up to 4 weeks post-treatment]
Will be summarized using Kaplan-Meier approach.
- Time to Radiographic Progression for Treatment With Dexamethasone [Up to 4 weeks post-treatment]
Will be summarized using Kaplan-Meier approach.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patients must have histologically or cytologically confirmed adenocarcinoma of the prostate
-
Patients must have metastatic disease radiographically documented by CT/magnetic resonance imaging (MRI) or bone scan; measurable disease is not necessary for inclusion
-
Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
-
Life expectancy of greater than 3 months in the opinion of the investigator
-
Absolute neutrophil count >= 1,500/mcL
-
Platelets >= 100,000/mcL
-
Hemoglobin >= 8; transfusion is allowed
-
Total bilirubin =< 1.5 x institutional upper limit of normal
-
Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional upper limit of normal
-
Creatinine clearance >= 30 by Cockcroft-Gault formula
-
Patients must have progression after prior treatment with Enza at any point in the disease course (pre- or post-chemotherapy)
-
Patients must have progressed after prior treatment with docetaxel; docetaxel must have specifically been given for castration-resistant metastatic disease
-
Prior treatment with other second line hormone therapy is allowed (e.g. flutamide, bicalutamide, nilutamide, ketoconazole, abiraterone, ARN-509); patients must be off these therapies for at least 4 weeks prior to starting treatment
-
Prior treatment with Xofigo (223Radium), Provenge, mitoxantrone and cabazitaxel is allowed
-
Patients must have rising PSA on two successive measurements, at least 2 weeks apart
-
Patient must be treated with continuous androgen ablative therapy (e.g. goserelin, leuprolide, triptorelin, or degarelix, if he has not had prior surgical castration) and have castrate levels of testosterone (< 50 ng/dL or 1.7 nmol/L)
-
Ability to understand and the willingness to sign a written informed consent document
Exclusion Criteria:
-
Patients who have had chemotherapy or radiotherapy within 4 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier (persistent toxicity >= grade 1)
-
Patients who have received any other investigational agents within the last 4 weeks
-
History of allergic reactions attributed to compounds of similar chemical or biologic composition to Dex or Enza
-
Any use of systemic corticosteroids in the prior 4 weeks
-
Uncontrolled diabetes mellitus
-
History of seizure, underlying brain injury with loss of consciousness, transient ischemic attack within the past 12 months, cerebral vascular accident, brain metastases, and brain arteriovenous malformations
-
Patients receiving any medications or substances that are inhibitors or inducers of cytochrome P450 family 2, subfamily C, polypeptide 8 (CYP2C8) are ineligible (e.g. gemfibrozil, rifampin, trimethoprim, pioglitazone)
-
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations or geographical condition that would limit compliance with study requirements
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Johns Hopkins University/Sidney Kimmel Cancer Center | Baltimore | Maryland | United States | 21287 |
Sponsors and Collaborators
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Samuel Denmeade, Johns Hopkins University/Sidney Kimmel Cancer Center
Study Documents (Full-Text)
More Information
Publications
None provided.- J1548
- NCI-2015-00918
- IRB00064598
- J1548
- P30CA006973
Study Results
Participant Flow
Recruitment Details | |
---|---|
Pre-assignment Detail | One of the five patients enrolled, failed screen due to declining Eastern Cooperative Oncology Group (ECOG) Score of 3, and therefore could not start study. |
Arm/Group Title | Treatment (Dexamethasone and Enzalutamide) |
---|---|
Arm/Group Description | Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of prostate specific antigen (PSA) progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. Dexamethasone: Given PO Enzalutamide: Given PO Laboratory Biomarker Analysis: Correlative studies Quality-of-Life Assessment: Ancillary studies |
Period Title: Overall Study | |
STARTED | 4 |
COMPLETED | 0 |
NOT COMPLETED | 4 |
Baseline Characteristics
Arm/Group Title | Treatment (Dexamethasone and Enzalutamide) |
---|---|
Arm/Group Description | Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. Dexamethasone: Given PO Enzalutamide: Given PO Laboratory Biomarker Analysis: Correlative studies Quality-of-Life Assessment: Ancillary studies |
Overall Participants | 4 |
Age (Count of Participants) | |
<=18 years |
0
0%
|
Between 18 and 65 years |
0
0%
|
>=65 years |
4
100%
|
Sex: Female, Male (Count of Participants) | |
Female |
0
0%
|
Male |
4
100%
|
Ethnicity (NIH/OMB) (Count of Participants) | |
Hispanic or Latino |
0
0%
|
Not Hispanic or Latino |
0
0%
|
Unknown or Not Reported |
4
100%
|
Race (NIH/OMB) (Count of Participants) | |
American Indian or Alaska Native |
0
0%
|
Asian |
0
0%
|
Native Hawaiian or Other Pacific Islander |
0
0%
|
Black or African American |
1
25%
|
White |
3
75%
|
More than one race |
0
0%
|
Unknown or Not Reported |
0
0%
|
Region of Enrollment (Count of Participants) | |
United States |
4
100%
|
Outcome Measures
Title | PSA Response Rate |
---|---|
Description | PSA response rate is defined as the proportion of subjects with a >= 50% PSA decline from baseline level when starting enzalutamide and maintained for >= 4 weeks at any time-point after receiving enzalutamide. Will determine its corresponding 95% confidence interval. |
Time Frame | Up to 4 weeks post-treatment |
Outcome Measure Data
Analysis Population Description |
---|
Data was not collected, the study was terminated early due to lower enrollment. |
Arm/Group Title | Treatment (Dexamethasone and Enzalutamide) |
---|---|
Arm/Group Description | Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. Dexamethasone: Given PO Enzalutamide: Given PO Laboratory Biomarker Analysis: Correlative studies Quality-of-Life Assessment: Ancillary studies |
Measure Participants | 0 |
Title | Changes in Quality of Life Assessment Scores, Assessed Using FACIT-Fatigue Scale and RANDSF-36 Surveys |
---|---|
Description | Summary statistics of the scores will be reported at baseline before starting dexamethasone and each follow-up time during the treatment of dexamethasone and enzalutamide. Changes in quality of life scores over the course of the study will be computed and their significance will be evaluated by paired-sample t-tests. |
Time Frame | Baseline to up to 4 weeks post-treatment |
Outcome Measure Data
Analysis Population Description |
---|
Data was not collected, the study was terminated early due to lower enrollment. |
Arm/Group Title | Treatment (Dexamethasone and Enzalutamide) |
---|---|
Arm/Group Description | Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. Dexamethasone: Given PO Enzalutamide: Given PO Laboratory Biomarker Analysis: Correlative studies Quality-of-Life Assessment: Ancillary studies |
Measure Participants | 0 |
Title | Objective Response Rate to Enzalutamide in Patients With Measurable Disease on CT Scan |
---|---|
Description | Will estimate 95% confidence interval. |
Time Frame | Up to 4 weeks post-treatment |
Outcome Measure Data
Analysis Population Description |
---|
Data was not collected, the study was terminated early due to lower enrollment. |
Arm/Group Title | Treatment (Dexamethasone and Enzalutamide) |
---|---|
Arm/Group Description | Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. Dexamethasone: Given PO Enzalutamide: Given PO Laboratory Biomarker Analysis: Correlative studies Quality-of-Life Assessment: Ancillary studies |
Measure Participants | 0 |
Title | Response Rate With Dexamethasone by AR-V7 Status at Study Entry |
---|---|
Description | |
Time Frame | Baseline |
Outcome Measure Data
Analysis Population Description |
---|
Data was not collected, the study was terminated early due to lower enrollment. |
Arm/Group Title | Treatment (Dexamethasone and Enzalutamide) |
---|---|
Arm/Group Description | Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. Dexamethasone: Given PO Enzalutamide: Given PO Laboratory Biomarker Analysis: Correlative studies Quality-of-Life Assessment: Ancillary studies |
Measure Participants | 0 |
Title | Response Rate With Enzalutamide by AR-V7 Status at Study Entry |
---|---|
Description | |
Time Frame | Baseline |
Outcome Measure Data
Analysis Population Description |
---|
Data was not collected, the study was terminated early due to lower enrollment. |
Arm/Group Title | Treatment (Dexamethasone and Enzalutamide) |
---|---|
Arm/Group Description | Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. Dexamethasone: Given PO Enzalutamide: Given PO Laboratory Biomarker Analysis: Correlative studies Quality-of-Life Assessment: Ancillary studies |
Measure Participants | 0 |
Title | Time to PSA Progression, Based Upon PCWG2 Criteria, for Treatment With Dexamethasone |
---|---|
Description | Will be summarized using Kaplan-Meier approach. |
Time Frame | Up to 4 weeks post-treatment |
Outcome Measure Data
Analysis Population Description |
---|
Data was not collected, the study was terminated early due to lower enrollment. |
Arm/Group Title | Treatment (Dexamethasone and Enzalutamide) |
---|---|
Arm/Group Description | Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. Dexamethasone: Given PO Enzalutamide: Given PO Laboratory Biomarker Analysis: Correlative studies Quality-of-Life Assessment: Ancillary studies |
Measure Participants | 0 |
Title | Time to Radiographic Progression for Treatment With Dexamethasone |
---|---|
Description | Will be summarized using Kaplan-Meier approach. |
Time Frame | Up to 4 weeks post-treatment |
Outcome Measure Data
Analysis Population Description |
---|
Data was not collected, the study was terminated early due to lower enrollment. |
Arm/Group Title | Treatment (Dexamethasone and Enzalutamide) |
---|---|
Arm/Group Description | Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. Dexamethasone: Given PO Enzalutamide: Given PO Laboratory Biomarker Analysis: Correlative studies Quality-of-Life Assessment: Ancillary studies |
Measure Participants | 0 |
Adverse Events
Time Frame | 4 weeks post treatment for each treatment cycle, up to 1 year | |
---|---|---|
Adverse Event Reporting Description | Every visit | |
Arm/Group Title | Treatment (Dexamethasone and Enzalutamide) | |
Arm/Group Description | Patients receive dexamethasone PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity until there is evidence of PSA progression, clinical disease progression, or radiographic disease progression. At time of progression, dexamethasone will be stopped via a rapid taper over one week if patients were treated for over 30 days. Patients then receive enzalutamide PO once daily on days 1-28. Treatment repeats every 28 days for up to 3 courses in the absence of clinical disease progression or unacceptable toxicity. Dexamethasone: Given PO Enzalutamide: Given PO Laboratory Biomarker Analysis: Correlative studies Quality-of-Life Assessment: Ancillary studies | |
All Cause Mortality |
||
Treatment (Dexamethasone and Enzalutamide) | ||
Affected / at Risk (%) | # Events | |
Total | 0/4 (0%) | |
Serious Adverse Events |
||
Treatment (Dexamethasone and Enzalutamide) | ||
Affected / at Risk (%) | # Events | |
Total | 0/4 (0%) | |
Other (Not Including Serious) Adverse Events |
||
Treatment (Dexamethasone and Enzalutamide) | ||
Affected / at Risk (%) | # Events | |
Total | 3/4 (75%) | |
Endocrine disorders | ||
cushingoid (increased appetite and weight ) | 2/4 (50%) | 2 |
Eye disorders | ||
Eye disorders (reddened eyes) | 1/4 (25%) | 1 |
General disorders | ||
fatigue | 2/4 (50%) | 2 |
abdominal pain | 1/4 (25%) | 1 |
Investigations | ||
Paresthesia | 1/4 (25%) | 1 |
Musculoskeletal and connective tissue disorders | ||
left hand cramps | 1/4 (25%) | 1 |
Right rib pain | 1/4 (25%) | 1 |
Nervous system disorders | ||
insomnia | 2/4 (50%) | 2 |
irritability | 1/4 (25%) | 1 |
Respiratory, thoracic and mediastinal disorders | ||
dyspnea | 1/4 (25%) | 1 |
SORE THROAT | 1/4 (25%) | 1 |
Skin and subcutaneous tissue disorders | ||
BILATERAL LOWER EXTREMITIES EDEMA | 1/4 (25%) | 1 |
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
Name/Title | Samuel Denmeade |
---|---|
Organization | SKCCC at JHU |
Phone | 410-955-8875 |
denmesa@jhmi.edu |
- J1548
- NCI-2015-00918
- IRB00064598
- J1548
- P30CA006973