Lenalidomide and GM-CSF in Treating Patients With Prostate Cancer

Study Overview
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Brief Summary
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RATIONALE: Lenalidomide may stop the growth of prostate cancer by blocking blood flow to the tumor. GM-CSF may stimulate the immune system in different ways and stop tumor cells from growing. Giving lenalidomide together with GM-CSF may kill more tumor cells. PURPOSE: This phase I/II trial is studying the side effects and best dose of lenalidomide when given together with GM-CSF and to see how well it works in treating patients with prostate cancer.

Detailed Description
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OBJECTIVES: Establish the safety of a predetermined target dose or, if the target dose is not tolerable, find the maximum tolerated dose of lenalidomide when administered in combination with sargramostim in patients with androgen-independent prostate cancer. Evaluate the preliminary efficacy of this regimen to ascertain whether additional study of lenalidomide is warranted in patients with androgen-independent prostate cancer. Evaluate the safety of this regimen in these patients. Describe the effects of this regimen on serum cytokines (e.g., TNF-α, bFGF, sIL2R, IL-8, and IL-12) and on serum VEGF levels. Assess the co-stimulatory effects of this regimen on CD4+, CD8+, CD83, and CD86 cells. OUTLINE: This is a phase I, dose-escalation study of lenalidomide followed by a phase II study. Patients receive oral lenalidomide on days 1-21 and sargramostim subcutaneously on days 1, 3, 5, 8, 10, 12, 15, 17, 19, 22, 24, and 26. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Blood samples are collected periodically for correlative biomarker and immunological laboratory studies. After completion of study therapy, patients are followed up at 30 days and then every 3 months thereafter.

Official Title
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Phase I/II Study of Lenalidomide (RevlimidTM ) and GM-CSF in Androgen Independent Prostate Cancer

Conditions
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Prostate Cancer

Intervention / Treatment
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* Biological: sargramostim
* Drug: lenalidomide
* Other: laboratory biomarker analysis


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed adenocarcinoma of the prostate Androgen-independent disease Testosterone ≤ 50 ng/mL Is currently receiving luteinizing hormone-releasing hormone agonists as maintenance or has undergone prior orchiectomy for testosterone suppression Progressive disease, as defined by ≥ 1 of the following: Clinical or radiographic evidence of metastases that have progressed irrespective of PSA changes Asymptomatic (non-opioid requiring) bone-only metastatic disease with a rising PSA on separate measurements ≥ 1 week apart No symptomatic bone metastases Biochemical progression (PSA-only disease), defined as having an absolute PSA value of ≥ 2.0 ng/mL on 3 separate measurements ≥ 2 weeks apart with a PSA doubling time of ≤ 10 months No evidence of CNS (brain or leptomeningeal) metastases or pleural and/or pericardial effusions PATIENT CHARACTERISTICS: ECOG performance status of 0-1 ANC ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Serum creatinine ≤ 2.0 mg/dL AST < 3 times normal Bilirubin < 1.5 mg/dL PT and PTT normal Calcium normal Fertile patients must use effective contraception during and for ≥ 28 days after completion of study therapy Agrees to abstain from donating blood, semen, or sperm during and for ≥ 28 days after completion of study therapy No pre-existing peripheral neuropathy > grade 1 No active unresolved infection No known contraindication to lenalidomide or sargramostim No other malignancies within the past 5 years, except for curatively treated basal cell or squamous cell carcinoma of the skin or stage Ta transitional cell carcinoma of the bladder PRIOR CONCURRENT THERAPY: See Disease Characteristics No prior chemotherapy for metastatic prostate cancer More than 1 year since prior adjuvant and/or neoadjuvant therapy More than 4 weeks since prior flutamide (6 weeks for other antiandrogens) No prior thalidomide or lenalidomide At least 4 weeks since prior surgery or external-beam radiotherapy and recovered At least 6 weeks since prior radiopharmaceutical therapy, including samarium-153 or strontium-89, and recovered No initiation of bisphosphonate therapy within 1 month before and during study therapy Patients on stable doses of bisphosphonates who show subsequent tumor progression may continue to receive bisphosphonates Concurrent daily aspirin for the prevention of thrombotic events required Patients intolerant to aspirin may receive low-dose warfarin as prophylaxis No other concurrent investigational agents No other concurrent anticancer therapy, including radiotherapy or thalidomide

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lenalidomide (RevlimidTM ) and GM-CSF<br> | Biological: sargramostim<br>* All patients will receive GM-CSF at a dose of 250 mcg subcutaneously on Mondays, Wednesdays and Fridays every week. No dose escalation or de-escalations will be made to GM-CSF.<br>* Other names: GM-CSF;Drug: lenalidomide<br>* Lenalidomide will be administered at 25 mg/day orally on days 1-21 of a 28-day cycle. Initially 6 patients will be entered at the 25 mg/day level. If 0 or 1 patients have a dose limiting toxicity, then the 25 mg lenalidomide + GM-CSF 250 mcg subcutaneously on Mondays, Wednesdays and Fridays every week will be accepted as the phase II dose.<br>Other: laboratory biomarker analysis<br>* Prior to the initiation of each cycle of therapy for the first 3 cycles, and at discontinuation from study blood will be collected for assessments of a prostate cancer specific immune response.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients With a PSA Response | Number of patients with a PSA Response defined as a PSA decline greater or equal to 50% compared with baseline value. | reevaluated for response every eight weeks | 
| RECIST-defined Measurable Disease | Patients who have a response of Complete Response (CR), Partial Response (PR), or Stable Disease (SD) by RECIST criteria. To be assigned a status of PR or CR, changes in tumor measurements must be confirmed by repeat assessments that should be performed no less than 4 weeks after the criteria for response are first met. In the case of SD, follow-up measurements must have met the SD criteria at least once after study entry at a minimum interval of 6-8 weeks | every 8 weeks and at end of treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients With Statistically Significant Change in Immune Response From Baseline to End of Study | The change in mean T cell immunohistochemical markers and dendritic cells over time will be evaluated using analysis of variance methods for repeated measures with additional main factors included in the analysis for subset comparisons. The pattern of immune response will be evaluated based upon overall clinical response using these same techniques. | every 28 days for first 3 cycles, end of study | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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adenocarcinoma of the prostate, hormone-resistant prostate cancer, recurrent prostate cancer, stage IV prostate cancer