Abiraterone Acetate Plus LHRH Agonist and Abiraterone Acetate Plus LHRH Agonist and Enzalutamide
Condition: Prostate Cancer
MeSH terms: Prostatic Neoplasms
Intervention: Abiraterone Acetate; Prednisone; Enzalutamide; LHRHa
Intervention description: 1,000 mg by mouth daily for each 28 day cycle.; 5 mg by mouth once daily for each 28 day cycle.; 160 mg by mouth daily for each 28 day cycle.; Patients receive a LHRHa (monthly injection or three-month injection) for a maximum of 7 months before a prostatectomy is performed. Study doctor will decide what hormone therapy patient receives.
Intervention MeSH terms: Prednisone; Abiraterone Acetate
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 69.0
Sex: Male
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Prostate Cancer; High risk prostate cancer; Abiraterone acetate; Zytiga; Prednisone; Enzalutamide; MDV3100; XTANDI; Androgen ablation; LHRHa; Hormonal therapy

Summary:

      The goal of this clinical research study is to learn if adding the combination of abiraterone
      acetate and prednisone with or without enzalutamide to hormonal therapy can help to control
      prostate cancer when given before surgery. The safety of the drug combination will also be
      studied.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Be willing/able to adhere to the prohibitions and restrictions specified in this
             protocol

          2. Have signed an informed consent document indicating that the subjects understand the
             purpose of and procedures required for the study and are willing to participate in the
             study

          3. Written Authorization for Use and Release of Health and Research Study Information has
             been obtained.

          4. Male age >/=18 years.

          5. Histologically or cytologically confirmed adenocarcinoma of the prostate with no
             histological variants (such as small cell, sarcomatoid, pure ductal cancer,
             transitional cell carcinoma).

          6. Pathology review at treating academic institution or member institution (Note: if
             patient's prostate biopsy was not read at the treating institution, it must be
             reviewed at the study site to confirm eligibility).

          7. At least three core biopsies involved with cancer (a minimum of 6 core biopsies must
             be obtained at baseline). A prostate biopsy within 3 months from screening is allowed
             for entry requirements. Patients must have a Gleason score > 5 (total).

          8. At least one of the following features: a) PSA > 10 ng/ml; b) PSA velocity > 2
             ng/ml/year (defined as a rise in PSA of > 2 ng/ml in the preceding 12 month period);
             c) Gleason score >/= 7; d) Gleason score 6 if either PSA >/= 10 ng/ml or PSA velocity
             >/=2 ng/ml/year

          9. Serum testosterone >200 ng/dL. For patients treated with up to 1 month of LHRH
             agonist, a testosterone measurement prior to the LHRH treatment will be used to
             determine eligibility, and must have been > 200 ng/dL.

         10. Urologist must agree that patient is suitable for prostatectomy.

         11. No evidence of metastatic disease as determined by imaging procedures.

         12. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1.

         13. Hemoglobin >/= 10.0 g/dL independent of transfusion.

         14. Platelet count >/=100,000/µL.

         15. Patients should have adequate bone marrow function defined as an absolute peripheral
             neutrophil count (ANC) >/= 1,500.

         16. Creatinine clearance >/= 60 mL/min

         17. Serum potassium >/= 3.5 mmol/L.

         18. Serum albumin >/= 3.5 g/dL.

         19. Liver function test with serum bilirubin </= 1.5x upper limit of normal (ULN) and ALT
             and AST </= 1.5x ULN.

         20. Able to swallow the study drug whole as a tablet.

         21. Patients must have normal coagulation profile and no history of substantial non-
             iatrogenic bleeding diathesis.

         22. Agree to use a double-barrier method of contraception which involves the use of a
             condom in combination with one of the following: contraceptive sponge, diaphragm, or
             cervical ring with spermicidal gel or foam, if having sex with a woman of
             child-bearing potential during the length of the study and for one week after
             abiraterone is discontinued and for at least three months after enzalutamide is
             discontinued.

         23. Willing to take abiraterone acetate on an empty stomach; no food should be consumed at
             least two hours before and for at least one hour after the dose of abiraterone acetate
             is taken.

        Exclusion Criteria:

          1. Serious or uncontrolled co-existent non-malignant disease, including active and
             uncontrolled infection.

          2. Chronically uncontrolled hypertension, defined conventionally as consistent systolic
             pressures above 140 or diastolic pressures above 90 despite anti-hypertensive therapy.
             Note that this is NOT a criterion related to particular BP results at the time of
             assessment for eligibility, nor does it apply to acute BP excursions that are related
             to iatrogenic causes, acute pain or other transient, reversible causes.

          3. Requirement for corticosteroids greater than the equivalent of 5 mg of prednisone
             daily.

          4. Poorly controlled diabetes defined by Hemoglobin A1C > 7.0 at screening.

          5. Active or symptomatic viral hepatitis or chronic liver disease.

          6. History of pituitary or adrenal dysfunction.

          7. Clinically significant cardiovascular disease including: a) Myocardial infarction
             within 6 months of Screening visit; b) Uncontrolled angina within 3 months of
             Screening visit; c) Congestive heart failure New York Heart Association (NYHA) class 3
             or 4, or subjects with history of congestive heart failure NYHA class 3 or 4 in the
             past, or history of anthracycline or anthracenedione (mitoxantrone) treatment, unless
             a screening echocardiogram or multi-gated acquisition scan (MUGA) performed within
             three months of the Screening visit results in a left ventricular ejection fraction
             that is >/= 50%; d) History of clinically significant ventricular arrhythmias (e.g.,
             ventricular tachycardia, ventricular fibrillation, torsade de pointes); e) Prolonged
             corrected QT interval by the Fridericia correction formula (QTcF) on the screening
             Electrocardiogram (ECG) > 470 msec; f) History of Mobitz II second degree or third
             degree heart block without a permanent pacemaker in place;

          8. (Exclusion #7 continued): g) Hypotension (systolic blood pressure < 86 mmHg or
             bradycardia with a heart rate of <50 beats per minute on the Screening ECG, unless
             pharmaceutically induced and thus reversible (i.e. beta blockers).

          9. Other malignancy, except non-melanoma skin cancer, that is active or has a >/= 30%
             probability of recurrence within 12 months.

         10. History of gastrointestinal disorders (medical disorders or extensive surgery) which
             may interfere with the absorption of the study drug.

         11. Prior hormone therapy for prostate cancer including orchiectomy, antiandrogens,
             ketoconazole, or estrogens (5-alpha reductase inhibitors allowed), or LHRH
             agonists/antagonists (*Note: LHRH allowed if begun within 1 month of Day 1). Patients
             having previous or current antiandrogen treatment of greater than 4 weeks in duration
             prior to Cycle 1 Day 1 are eligible with appropriate washout.

         12. Prior systemic treatment with an azole drug within four weeks of Cycle 1 Day1.

         13. Current enrollment in an investigational drug or device study or participation in such
             a study within 30 days of Cycle 1 Day 1.

         14. Allergies, hypersensitivity, or intolerance to prednisone, LHRH analog or excipients
             of prednisone LHRH analog, and abiraterone acetate and enzalutamide.

         15. Previous use of abiraterone acetate or other investigational CYP17 inhibitor (e.g.,
             TAK-700).

         16. Previous investigational antiandrogens (e.g., Enzalutamide, BMS-641988).

         17. Patients receiving anti-coagulant therapy who are unable to stop prior to surgery.

         18. Condition or situation which, in the investigator's opinion, may put the patient at
             significant risk, may confound the study results, or may interfere significantly with
             patient's participation in the study.

         19. Severely compromised immunological state, including being positive for the human
             immunodeficiency virus (HIV).

         20. Patients who are not appropriate surgical candidates for radical prostatectomy based
             on the evaluation of co-existent medical diseases and competing potential causes of
             death (such as but not limited to, unstable angina, myocardial infarction within the
             previous 6 months, or use of ongoing maintenance therapy for life-threatening
             ventricular arrhythmia, uncontrolled hypertension).

         21. Prior chemotherapy, radiation or immune therapy for prostate cancer.

         22. Patients unable to tolerate transrectal ultrasound.

         23. Concomitant therapy with any of the following: a) Chemotherapeutic, biologic, or other
             agents with anti-tumor activity against prostate cancer other than assigned study
             drug; b) Anti-androgens (steroidal or non-steroidal) such as cyproterone acetate,
             flutamide, nilutamide, bicalutamide, etc. other than assigned study drug; c) 5-alpha
             reductase inhibitors such as finasteride, dutasteride, anabolic steroids, etc.; d)
             Estrogens, progestational agents such as megestrol, medroxyprogesterone, DES,
             cyproterone, spironolactone > 50 mg/kg, etc.; e) Androgens such as testosterone,
             dehydroepiandrosterone [DHEA], etc.; f) Ketoconazole; g) Herbal products that may
             decrease PSA levels (e.g., saw palmetto)

         24. Active infection or other medical condition that would make prednisone/ prednisolone
             (corticosteroid) use contraindicated.

         25. Severe hepatic impairment (Child-Pugh Class C).

         26. History of seizure or any condition that may predispose to seizure including, but not
             limited to underlying brain injury, stroke, primary brain tumors, brain metastases, or
             alcoholism. Also, history of loss of consciousness or transient ischemic attack within
             12 months of enrollment (Day 1 visit).

         27. History of significant bleeding disorder unrelated to cancer, including: a) Diagnosed
             congenital bleeding disorders (e.g., von Willebrand's disease); b) Diagnosed acquired
             bleeding disorder within one year (e.g., acquired anti-factor VIII antibodies) of
             Screening visit; c) History of GI bleeding within 6 months of Screening visit.