Bicalutamide With or Without Akt Inhibitor MK2206 in Treating Patients With Previously Treated Prostate Cancer
Condition: Recurrent Prostate Carcinoma; Stage I Prostate Cancer AJCC v7; Stage IIA Prostate Cancer AJCC v7; Stage IIB Prostate Cancer AJCC v7; Stage III Prostate Cancer AJCC v7
MeSH terms: Prostatic Neoplasms
Intervention: Akt Inhibitor MK2206; Bicalutamide; Clinical Observation; Laboratory Biomarker Analysis
Intervention description: Given PO; Given PO; Undergo clinical observation; Correlative studies
Intervention MeSH terms: Bicalutamide
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 108.0
Sex: Male
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial studies how well giving bicalutamide with or without Akt inhibitor MK2206
      works in treating patients with previously treated prostate cancer. Androgens can cause the
      growth of prostate cancer cells. Antihormone therapy, such as bicalutamide, may lessen the
      amount of androgens made by the body. Akt inhibitor MK2206 may stop the growth of tumor cells
      by blocking some of the enzymes needed for cell growth. It is not yet known whether
      bicalutamide is more effective with or without Akt inhibitor MK2206 in treating prostate
      cancer.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patient must have histologically confirmed diagnosis of prostate cancer

          -  Patient must have had previous treatment with definitive surgery or radiation therapy
             or cryoablation

          -  Patient may have prior salvage therapy (surgery, radiation or other local ablative
             procedures) within 4 weeks prior to randomization if the intent was for cure;
             prophylactic radiotherapy to prevent gynecomastia within 4 weeks prior to
             randomization is allowed

          -  Patient must have no evidence of metastatic disease on physical exam, computed
             tomography (CT) abdomen/pelvis (or magnetic resonance imaging [MRI]), chest x-ray (or
             CT chest) and bone scan within 8 weeks prior to randomization

          -  Patient may have had prior neoadjuvant and/or adjuvant therapy (chemotherapy, vaccines
             or experimental agents) within 4 weeks prior to randomization, if the PSA rise and PSA
             doubling time (PSADT) were documented after the testosterone level was > 150 ng/dL

          -  Patient may not have had therapy modulating testosterone levels (such as
             luteinizing-hormone, releasing-hormone agonists/antagonists and antiandrogens) within
             1 year prior to randomization, unless it was in the neoadjuvant and/or adjuvant
             setting; agents such as 5 alpha reductase inhibitors, ketoconazole, abiraterone,
             systemic steroids, or herbal supplements known to decrease PSA levels including any
             dose of megestrol acetate, finasteride (e.g., Saw Palmetto and PC-SPES, African pygeum
             extract, lycopene, alanine, glutamic acid and glycine, beta-sitosterol, lycopene,
             nettle root extract, quercitin, Belizian Man Vine extract, mulra puama extract and
             epimedium extract campesterol, beta-sitosterol, stigmasterol, sitostanol and
             brassicasterol) are not permitted at any time during the period that the PSA values
             are being collected

          -  Patient must have hormone-sensitive prostate cancer as evident by a serum total
             testosterone level > 150 ng/dL within 12 weeks prior to randomization

          -  Patient must have evidence of biochemical failure after primary therapy and subsequent
             progression

               -  Biochemical failure is declared when the PSA reaches a threshold value after
                  primary treatment and it differs for radical prostatectomy or radiation therapy

               -  For radical prostatectomy the threshold for this study is PSA >= 0.4 ng/mL

               -  For radiation therapy the threshold is a PSA rise of 2 ng/mL above the nadir PSA
                  achieved post radiation with or without hormone therapy (2006 Radiation Therapy
                  Oncology Group [RTOG]-American Society for Radiation Oncology [ASTRO] Consensus
                  definition)

               -  PSA progression requires a PSA rise above the threshold (PSA1) measured at any
                  time point since the threshold was reached

               -  The PSADT must be < 12 months; requires two consecutive PSA rises (PSA2 and PSA3)
                  above the PSA1; PSA2 and PSA3 must be obtained within 6 months of study entry;
                  all baseline PSAs should be obtained, preferably, at the same reference lab

          -  PSADT calculation needs 3 PSA values:

               -  PSA1 is any PSA value that is equal or greater than the threshold PSA (0.4 ng/mL
                  for radical prostatectomy or 2 ng/mL above the nadir for primary radiation
                  therapy) indicating biochemical relapse

               -  PSA2 must be higher than PSA1, obtained at least 2 weeks after PSA1 and within 6
                  months or less from randomization

               -  PSA3 must be higher than PSA2 and obtained at least 2 weeks after PSA2

               -  Baseline PSA must have reached a minimum of 2 ng/mL but be no greater than 50
                  ng/mL and equal or higher than PSA3; PSA3 may be used as baseline PSA if obtained
                  within 1 week of randomization

          -  Patient's PSA doubling time (PSADT) must be less than 12 months

          -  Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0
             or 1

          -  Granulocytes >= 1,500/mm^3

          -  Platelet count >= 100,000/mm^3

          -  Serum creatinine within normal institutional limits or creatinine clearance >= 50
             ml/min for patients with creatinine levels above institutional normal

          -  Serum total bilirubin =< 1.5 times upper limit of normal (ULN)

          -  Alkaline phosphatase (ALP) =< 2.5 x ULN

          -  Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) and
             serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 2.5 x
             institutional upper limit of normal

          -  Human immunodeficiency virus (HIV)-positive patients are excluded from this study

          -  Patient cannot receive concurrent therapeutic administration of anticoagulant therapy;
             low dosage aspirin =< 325 mg per day is allowed

          -  Patients with impaired cardiac function including any one of the following will be
             excluded from entry on study:

               -  Baseline corrected QT interval (QTc) > 450 msec (male) (patients with QTc 450-480
                  msec will be allowed to participate in this trial if they do not have any of the
                  other cardiac conditions mentioned in this section)

               -  Patients with congenital long QT syndrome

               -  History of sustained ventricular tachycardia

               -  Any history of ventricular fibrillation or torsades de pointes

               -  Concomitant use of drugs with a risk of causing torsades de pointes

               -  Bradycardia defined as heart rate < 50 beats per minute; patients with a
                  pacemaker and heart rate >= 50 beats per minute are eligible

               -  Myocardial infarction or unstable angina within 6 months of study entry

               -  Congestive heart failure (New York Heart Association class III or IV)

               -  Right bundle branch block and left anterior hemi-block (bifascicular block)

          -  Patient must not have gastrointestinal (GI) tract disease resulting in an inability to
             take oral medication, malabsorption syndrome, a requirement for intravenous (IV)
             alimentation, prior surgical procedures affecting absorption, uncontrolled
             inflammatory GI disease (e.g., Crohn's, ulcerative colitis)

          -  Patient may not be receiving any other investigational agents or receiving concurrent
             anticancer therapy (chemotherapy, immunotherapy, radiation therapy, surgery for
             cancer, or experimental medications) at time of randomization

          -  Patient may not have a history of allergic reactions attributed to compounds of
             similar chemical or biologic composition to MK-2206 or bicalutamide

          -  Patient must not have any uncontrolled intercurrent illness including, but not limited
             to, ongoing or active infection, cardiac arrhythmia, or psychiatric illness/social
             situations that would limit compliance with study requirements

          -  Patients with diabetes or at risk for hyperglycemia MUST not be excluded from trials
             with MK-2206, but the hyperglycemia should be well controlled before the patient
             enters the trial

          -  Patients receiving any medications or substances that are inhibitors or inducers of
             cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) are ineligible

          -  Patient must NOT have previous or concurrent malignancy; exceptions are made for
             patients who meet any of the following conditions:

               -  Basal cell or squamous cell carcinoma of the skin OR

               -  Prior malignancy has been adequately treated and patient has been continuously
                  disease free for >= 2 years

          -  Patient must agree to use barrier contraception during and for 3 months after
             discontinuation of study treatment; if patient impregnates a woman while on treatment
             or within 3 months of discontinuing treatment, he should inform his treating physician
             immediately

          -  Patients must discontinue use of enzyme-inducing anti-epileptic drugs (EIAEDs) >= 14
             days prior to study enrollment; the investigator may prescribe non-EIAEDs; patients
             who must begin EIAED therapy while on study will be allowed to remain

          -  Patients must not be taking cytochrome P450 enzyme-inducing antiepileptic drugs
             (phenytoin, carbamazepine or phenobarbital), St John's Wort, ketoconazole,
             dexamethasone, the dysrhythmic drugs (terfenadine, quinidine, procainamide, sotalol,
             probucol, bepridil, indapamide or flecainide), haloperidol, risperidone, rifampin,
             grapefruit, or grapefruit juice within two weeks of randomization and during the
             course of therapy

          -  Patients may have received targeted agents (angiogenesis inhibitors, epidermal growth
             factor receptor [EGFR] inhibitors, mammalian target of rapamycin [mTOR] inhibitors,
             phosphatidylinositol 3 kinase [PI3K] inhibitors, etc.), however patients must have
             discontinued treatment with the targeted agent(s) at least 4 weeks prior to
             enrollment; if the patient stopped targeted agent(s) due to unresolved or persistent
             grade 3 or 4 toxicity, patient cannot be enrolled onto the study regardless of the
             length of time since discontinuation of treatment with targeted agent(s)