Durvalumab With or Without Tremelimumab in Metastatic Castration Resistant Prostate Cancer
Condition: Prostate Cancer
MeSH terms: Prostatic Neoplasms
Intervention: Durvalumab; Tremelimumab
Intervention MeSH terms: Durvalumab; Tremelimumab
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 52.0
Sex: Male
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      The purpose of this study is to find out the effects of giving durvalumab alone or in
      combination with tremelimumab on this type of cancer. In addition, this study will look at
      the side effects of durvalumab when given alone or in combination with tremelimumab.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have histologically confirmed adenocarcinoma of the prostate that is
             castrate resistant.

          -  Disease progression as defined as one or both of the following: PSA Progression: A
             rising PSA with 2 subsequent rises over a reference value (not necessarily
             consecutively), measured a minimum of one week apart. The PSA that confirms
             progression must have a value of ≥ 2 ng/ml (ug/L).

        OR Objective Progression:

          -  RECIST 1.1

          -  PCWG 3 Criteria for bone progression

          -  Patients must be surgically or medically castrated, with testosterone levels of < 50
             ng/dL (< 1.7 nM). Patients who have not undergone orchiectomy must continue (or
             restart if previously discontinued) LHRH therapy throughout the study.

          -  All patients must have a tumour block from their primary or metastatic tumour
             available and consent to release the block/recently cut slides for correlative
             analyses and the centre/pathologist must have agreed to the submission of the
             specimen(s). The site of planned biopsy must not be the measurable lesion.

          -  Presence of clinically and/or radiologically documented disease. All radiology studies
             must be performed within 28 days prior to randomization (within 35 days if negative).

          -  All patients must have at least one measurable lesion as defined by RECIST 1.1 that
             has not been the site of the protocol mandated biopsy. The criteria for defining
             measurable disease are as follows: CT scan (with slice thickness of 5 mm) ≥ 10 mm -->
             longest diameter; Lymph nodes by CT scan ≥ 15 mm --> measured in short axis

          -  Patients must be ≥ 18 years of age.

          -  ECOG performance status 0 or 1.

          -  Prior Therapy

        Systemic Therapy:

        0-1 prior regimen of cytotoxic chemotherapy in the CRPC setting is permitted.

        Hormonal Therapy:

          -  Patients must be castrate resistant.

          -  Have failed/progressed on prior abiraterone and/or enzalutamide.

          -  Patients must have discontinued anti-androgens for at least 4 weeks prior to study
             entry (at least 6 weeks for bicalutamide).

        Other therapy:

        Prior treatment with other agents, such as tyrosine kinase or other targeted agents is
        permissible.

          -  Systemic corticosteroids are permitted at a dose equivalent to ≤10 mg prednisone daily
             and are only permitted for reasons other than prostate cancer treatment (ex: fatigue,
             anorexia, etc); topical applications (e.g. rash), inhaled sprays (e.g. obstructive
             airways diseases), eye drops or local injections (e.g. intra-articular) are permitted.

          -  Bisphosphonates/denosumab are permitted for treatment of hypercalcemia, osteoporosis
             and skeletal-related events.

        Immunotherapy:

        Patients may not have received prior immune check point inhibitors (anti PDL1 and anti
        CTL-4). Vaccines and treatment with oncolytic viruses is permissible.

        Patients must have recovered from all reversible toxicity related to prior systemic therapy
        (chemotherapy and hormone) and have adequate washout as follows:

        Longest of one of the following:

          -  Two weeks;

          -  The longer of 30 days or 5 half-lives for investigational agents;

          -  Standard cycle length of standard therapies.

        Radiation:

        Prior external beam radiation or radium-223 is permitted provided a minimum of 28 days (4
        weeks) have elapsed between the last dose of radiation and the date of randomization.
        Exceptions may be made for low-dose non-myelosuppressive radiotherapy after consultation
        with CCTG. Concurrent radiotherapy is not permitted. Prior strontium-89 at any time is not
        permitted

        Prior Surgery:

        Prior major surgery is permitted provided that a minimum of 28 days (4 weeks) have elapsed
        between any major surgery and date of randomization, and that wound healing has occurred.

          -  Laboratory Requirements (Must be done within 7 days prior to randomization):

        Abs Neutrophils ≥ 1.5 x 10^9/L Platelets ≥ 100 x 10^9/L Hemoglobin ≥ 90 g/L Bilirubin ≤ 1.5
        x ULN AST and ALT ≤ 2.5 x ULN ≤ 5.0 ULN (if patient has liver mets) Serum Creatinine < 1.25
        x ULN or Creatinine clearance ≥ 40mL/min

          -  Non-sterilized male patients who are sexually active with a female partner of
             childbearing potential must use male condom plus spermicide while on study and for 6
             months after the last dose of durvalumab and tremelimumab, or for 3 months after the
             last dose of durvalumab alone. Female partners of a male subject must use a highly
             effective method of contraception throughout this period.

          -  Male patients should also refrain from donating sperm during the study and for 6
             months after the last dose of durvalumab and tremelimumab or for 3 months after the
             last dose of durvalumab alone.

          -  Subjects should not donate blood while participating in this study, or for at least 90
             days following the last infusion of durvalumab or tremelimumab.

          -  Patient consent must be appropriately obtained in accordance with applicable local and
             regulatory requirements. Each patient must sign a consent form prior to enrollment in
             the trial to document their willingness to participate. Patients who cannot give
             informed consent (i.e. mentally incompetent patients, or those physically
             incapacitated such as comatose patients) are not to be recruited into the study.
             Patients competent but physically unable to sign the consent form may have the
             document signed by their nearest relative or legal guardian. Each patient will be
             provided with a full explanation of the study before consent is requested.

          -  Patients must be accessible for treatment and follow up. Patients registered on this
             trial must be treated and followed at the participating centre. This implies there
             must be reasonable geographical limits (for example: 1 ½ hour's driving distance)
             placed on patients being considered for this trial. The patient's city of residence
             may be required to verify their geographical proximity. Investigators must assure
             themselves the patients registered on this trial will be available for complete
             documentation of the tretment, adverse events, and follow-up.

          -  Patients must agree to return to their primary care facility for any adverse events
             which may occur through the course of the trial.

          -  In accordance with CCTG policy, protocol treatment is to begin within 5 working days
             of patient randomization.

        Exclusion Criteria:

          -  Patients with a history of other malignancies requiring concurrent anticancer therapy.

          -  Patients with brain metastases are not eligible.

          -  Active or prior documented autoimmune or inflammatory disorders (including
             inflammatory bowel disease (e.g. colitis or Crohn's disease), diverticulitis with the
             exception of diverticulosis, celiac disease or other serious gastrointestinal chronic
             conditions associated with diarrhea), systemic lupus erythematosus, Sarcoidosis
             syndrome, or Wegener syndrome (granulomatosis with polyangiitis), rheumatoid
             arthritis, hypophysitis, uveitis, etc., within the past 3 years prior to the start of
             treatment. The following are exceptions to this criterion:

               -  Patients with alopecia.

               -  Patients with Grave's disease, vitiligo or psoriasis not requiring systemic
                  treatment (within the last 2 years).

               -  Patients with hypothyroidism (e.g. following Hashimoto syndrome) stable on
                  hormone replacement.

          -  History of primary immunodeficiency, history of allogenic organ transplant that
             requires therapeutic immunosuppression and the use of immunosuppressive agents within
             28 days of randomization or a prior history of severe (grade 3 or 4) immune mediated
             toxicity from other immune therapy or grade ≥ 3 infusion reaction.

          -  Live attenuated vaccination administered within 30 days prior to randomization or
             within 30 days of receiving durvalumab.

          -  History of hypersensitivity to durvalumab or tremelimumab or any excipient. Any
             previous treatment with a PD1 or PD-L1 inhibitor, including durvalumab or an
             anti-CTLA4, including tremelimumab.

          -  Patients who have experienced untreated and/or uncontrolled cardiovascular conditions
             and/or have symptomatic cardiac dysfunction (unstable angina, congestive heart
             failure, myocardial infarction within the previous year or cardiac ventricular
             arrhythmias requiring medication, history of 2nd or 3rd degree atrioventricular
             conduction defects). Patients with a significant cardiac history, even if controlled,
             should have a LVEF ≥ 50%.

          -  Concurrent treatment with other investigational drugs or anti-cancer therapy (except
             LHRH in patients not surgically castrated).

          -  Patients with serious illnesses or medical conditions which would not permit the
             patient to be managed according to the protocol (including corticosteroid
             administration), or would put the patient at risk. This includes but is not limited
             to:

               -  History of significant neurologic or psychiatric disorder which would impair the
                  ability to obtain consent or limit compliance with study requirements.

               -  Active infection requiring systemic therapy; (including any patient known to have
                  active hepatitis B, hepatitis C or human immunodeficiency virus (HIV) or
                  tuberculosis or any infection requiring systemic therapy).

               -  Active peptic ulcer disease or gastritis.

               -  Pneumonitis.