safety and tolerability study using wst11 in patients with localized prostate cancer

Conditions: Prostate Cancer

Summary: the aim of this study is to determine the optimal treatment conditions (wst11 dose and light energy dose) to achieve ablation in one lobe of the prostate and to evaluate the safety and quality of life of wst11 medicated vascular-targeted photodynamic therapy (vtp) in men with localized prostate cancer.

this study is designed as a multicenter, phase i/ii, prospective, open-labeled, single intravenous (iv) dose, clinical trial in patients with localized prostate cancer. the study population will be men who have been offered curative therapy (radical prostatectomy; cryotherapy; brachytherapy; external beam radiotherapy (ebrt), and refused. patients must have already had a previous biopsy showing a histologically proven carcinoma of the prostate. the identification and the location of the tumor will be done using both dynamic contrast magnetic resonance imaging (mri) and biopsy. only unilateral treatment with wst11-medicated vtp will be performed during the study. treatment will consist of a single, 10 minute, iv administration of wst11 at doses of 2mg/kg, 4 mg/kg or 6 mg/kg, followed by either light activation delivered through transperineal interstitial optical fibers for 20 minutes using 753 nm laser light at escalating fixed energy doses of 200 j/cm or 300 j/cm by escalating power at each energy to 167 mw/cm or 250 mw/cm respectively. a brachytherapy-like template is used for the placement of the transparent implant catheters which are positioned in the prostate under transrectal ultrasound image guidance. the illumination fiber(s) are then inserted into the implant catheters. if the safety profile for a given wst11 and light dose is acceptable, additional patients may be treated with multiple fibers at that wst11 treatment dose. for cases where the month 6 biopsy is positive, the patient will be offered the opportunity to be retreated with wst11

Eligibility criteria:
inclusion criteria: * at least 18 years of age * diagnosed with localized, prostate cancer and who have been offered curative therapy (radical prostatectomy; cryotherapy; brachytherapy; external beam radiotherapy (ebrt), and refused * localized prostate cancer stage t1c up to t2a based on biopsy performed at least 6 weeks prior to enrollment * gleason score ≤ 3+3 with ≤50% of sampled cores positive, and each positive core having a tumour length of ≤5 mm * prostate specific antigen (psa) \< 10 ng/ml * no prior treatment for prostate cancer * signed informed consent form exclusion criteria: * any condition or history of illness or surgery that, in the opinion of the investigator and/or the sponsor, might confound the results of the study or pose additional risks to the patient. * all patients whose current pre-operative cardiac evaluation does not show their fitness for a procedure requiring general anesthesia; * patients with a prior history of viral or alcoholic hepatitis, and other patients felt to be at risk for hepatotoxicity including concomitant use of potentially hepatotoxic medications or dietary supplements; * patients with a history of inflammatory bowel disease or other factors which may increase the risk of fistula formation; * patients who have received any hormonal manipulation (excluding 5-alpha reductase inhibitors) or androgen supplements within the previous 6 months; * patients previously treated by radiation therapy (external therapy or brachytherapy) or chemotherapy or any therapy for prostate cancer; * patients who have received or are receiving chemotherapy for prostate carcinoma or other significant cancer; * patients who have undergone previous turp (trans-urethral resection of the prostate); * patients with a history of urethral stricture disease * patients with a history of acute urinary retention * patients who are currently (within 10 days before the treatment procedure) receiving any medications having potential photosensitizing effects (e.g. tetracyclines, sulfonamides, phenothiazines, sulfonylurea hypoglycemic agents, thiazide diuretics and griseofulvin) * patients who are currently receiving anticoagulant drugs (within 10 days before the treatment procedure) (e.g.: coumadin, warfarin) * patient who stopped long term treatment of acetylsalicylic acid (aspirin) or other anti platelets agents within 10 days prior to the treatment procedure; * patient suspected of disseminated intravascular coagulation (dic) as defined by the presence of three out of the five following criteria: platelets decrease, increase of pt, increase of aptt, fibrinogen decrease, d-dimer increase; from the normal laboratory ranges; * patient with a history of vasculitis or collagen vascular disease; * history of non compliance with medical therapy and medical recommendations or an unwillingness or inability to complete patient self-administered questionnaires; * participation in a clinical study or receipt of an investigational treatment within the past 3 months; * a history of porphyria; * a history of sun hypersensitivity or photosensitive dermatitis; * renal disorders (blood creatinine \> 1.5 x uln) or known post mictional residue \> 150cc * hepatic disorders (transaminases \> uln, bilirubin \> uln, ggt \> uln). in case of slight abnormalities, another exam could be performed. if the results are within normal ranges, then the patient can be included; * hematological disorders (white cells \< 2500/mm3, neutrophils \< 1500/mm3, platelets, \< 140.000/mm3, hb ≤ 10 g/dl); * patients with contra-indication to mri (such as pace maker, metal prosthesis, etc.).

Keywords: prostatic disease genital neoplasm, male urogenital neoplasm genital disease male male urogenital disease neoplasms neoplasm by site prostatic neoplasm carcinoma