Genomic Guided Therapy With Dasatinib or Nilutamide in Metastatic Castration-Resistant Prostate Cancer
Condition: Prostate Cancer
MeSH terms: Prostatic Neoplasms
Intervention: Nilutamide; Dasatinib
Intervention description: Nilutamide 150mg orally each day for 28 days per cycle. After first progression, Nilutamide 150mg orally each day in combination with Dasatinib 100mg orally each day for 28 days per cycle.; Dasatinib 100mg orally daily x 28 days per cycle. After first progression, Dasatinib 100mg orally each day in combination with Nilutamide 150mg orally each day for 28 days per cycle.
Intervention MeSH terms: Dasatinib; Nilutamide
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 57.0
Sex: Male
Minimum age: 18 Years
Healthy volunteers: No
Keywords: hormone resistant prostate cancer; castration resistant prostate cancer; hormone refractory prostate cancer; metastatic prostate cancer; hormonal therapy; antiandrogen therapy; androgen receptor; nilutamide; dasatinib; genomics; genomic signature; genomic predictor; genomic analysis; genomic expression profile

Summary:

      This is a phase II multi-center study to determine the clinical impact of using a
      patient-specific genomic expression signature of androgen receptor (AR) activity to determine
      therapy for patients with castration-resistant metastatic prostate cancer (CRPC). After
      patient eligibility is determined, the genomic signature will be applied to fresh frozen
      tissue harvested from a metastatic lesion during image-guided biopsy. After assessing for
      androgen receptor activity, the investigators will select patients for either continued
      androgen manipulation with nilutamide (high AR activity) or targeted therapy with dasatinib
      (low AR activity). Once patients develop a first progression on either arm, patients will
      receive combination therapy with dasatinib and nilutamide. The primary aim is to estimate the
      median progression free survival in men with CRPC treated according to tumor AR activity. The
      investigators hypothesize that by treating men based upon AR activity, median progression
      free survival (PFS) will improve from a historical median of 3.0 months to 6.0 months.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Confirmed diagnosis of adenocarcinoma of the prostate.

          2. Radiographic evidence of metastatic disease amenable to image-guided biopsy.

          3. Testosterone <50ng/dL on androgen deprivation therapy (ADT). ADT must continue while
             on study.

          4. The patient must have discontinued antiandrogens 30 days prior to baseline PSA unless
             the patient did not respond to anti-androgen therapy or experienced a decline in PSA
             lasting < 3 months after starting antiandrogen therapy.

          5. Evidence of disease progression on ADT.

          6. Patients must have adequate organ and marrow function as defined below:

               -  Hemoglobin >9.0g/dL (without transfusion of PRBC)

               -  ANC/AGC >1,500/μl

               -  Platelets >75,000/μl

               -  Total bilirubin < 2.0 times the institutional ULN

               -  Creatinine <1.5 times the institutional ULN

               -  PT or INR and aPTT < 1.5 times the institutional ULN

               -  AST and ALT <2.5 x ULN

          7. Age > 18 years

          8. Ability to take oral medications (pills must be swallowed whole)

          9. ECOG performance status 0-2

         10. Concomitant Medications:

               -  Patient agrees to discontinue and not to initiate taking St. Johns Wort while
                  receiving dasatinib therapy (discontinue St. Johns Wort at least 5 days before
                  starting dasatinib)

               -  Patient agrees not to initiate IV bisphosphonates while on dasatinib. Patients on
                  IV bisphosphonates for > 4 weeks prior to dasatinib will continue on therapy

         11. Men of reproductive potential who have not had a radical prostatectomy must agree to
             use an effective contraceptive method. Patients who have had a prostatectomy are
             sterile and do not need to use contraception

         12. Ability to understand and the willingness to sign a written informed consent document

        Exclusion Criteria:

          1. Patients who have received prior treatment with nilutamide or dasatinib

          2. Patients who have not recovered to Grade 1 or Grade 0 from the toxic effects of prior
             investigational therapy, biologic therapy, hormonal therapy (other than ADT),
             immunotherapy, or chemotherapy

          3. Medical contraindications to stopping aspirin or coumadin for 1 week prior to
             image-guided tumor biopsy AND while on dasatinib treatment.

          4. History of the following cardiac related conditions:

               -  Uncontrolled angina, congestive heart failure or MI within (6 months)

               -  Diagnosed congenital long QT syndrome

               -  Any history of clinically significant ventricular arrhythmias (such as
                  ventricular tachycardia, ventricular fibrillation, or Torsades de pointes)

               -  Prolonged QTc interval on pre-entry electrocardiogram (> 450 msec)

               -  Subjects with hypokalemia or hypomagnesemia if it cannot be corrected prior to
                  dasatinib administration

          5. History of significant bleeding disorder unrelated to cancer.

          6. Concomitant use of Category I drugs that are generally accepted to have a risk of
             causing Torsades de Pointes including: (These medications can be stopped while the
             patient is on the protocol and the patient needs to be off the drugs for at least 7
             days prior to starting dasatinib)

          7. Patients who have a history of amiodarone use.

          8. Clinically significant pericardial or pleural effusion or severe respiratory
             insufficiency

          9. Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection (requiring antifungal, antibiotic or antiviral therapy), symptomatic
             congestive heart failure (NYHC II or greater, unstable angina pectoris, cardiac
             arrhythmia (uncontrolled SVT or any VT), or psychiatric illness/social situations that
             would limit compliance with study requirements.

         10. Patients with a medical contraindication to image-guided biopsies