Efficacy of Rotations Between Abiraterone Acetate and Apalutamide in mCRPC Patients

Study Overview
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Brief Summary
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A randomized phase II study comparing the sequential use of abiraterone followed after progression by apalutamide with alternating cycles of abiraterone and apalutamide

Detailed Description
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This is an open-label, randomized phase II study to investigate the feasibility of alternating cycles of treatment with abiraterone plus prednisone and apalutamide compared to sequential treatment of abiratereone plus prednisone followed by apalutamide. 7 centers in Greece will participate in the study. The study population consists of adult patients (over 18 years old) with histologically confirmed metastatic prostate adenocarcinoma who have disease progression - as defined by PCWG2 criteria - despite androgen deprivation therapy and who have not received prior therapy for their castration resistant disease. The purpose of the study is to determine the progression free survival, feasibility and safety profile of the experimental arm compared to standard of care. In the experimental arm alternating treatment will consist of repeating cycles of 24 weeks of treatment consisting of 12 weeks of abiraterone acetate 1000mg orally qd and prednisone 5mg orally bid, followed by 12 weeks of apalutamide 240 mg per day. There will be no wash out period between cycles. The comparative arm will be the standard regimen of abiraterone 1000mg orally qd plus prednisone 5mg orally bid until progression, followed thereafter by apalutamide 240mg orally qd until progression.

Official Title
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A Randomized Phase II Study to Investigate the Efficacy of Rotations Between Abiraterone Acetate and Apalutamide Versus Sequential Administration in Chemo-naïve Metastatic Castration Resistant Prostate Cancer Patients

Conditions
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Prostatic Neoplasms, Castration-Resistant

Intervention / Treatment
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* Drug: Abiraterone
* Drug: Apalutamide


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Signed Informed Consent Age >18 years Histologically confirmed metastatic or advanced prostate cancer adenocarcinoma that has received no treatment for the castration resistant disease and has progressed during treatment with complete androgen blockade (luteinizing hormone releasing hormone agonist or antagonist and an antiandrogen eg. Bicalutamide). Availability of a representative formalin-fixed, paraffin-embedded tumor specimen (FFPE) that enabled definitive diagnosis of prostate cancer. Two rising PSA levels >2ng/ml measured 1 week apart during or following the most recent prior therapy for prostate cancer (PCWG2 criteria) or radiographic evidence of disease progression in bone with or without biochemical disease progression on the basis of the PSA value. Ongoing androgen deprivation, with serum testosterone <50ng/dl ECOG performance status 0-1 at screening Adequate hematologic and organ function within 14 days before the first study treatment (hematologic parameters must be assessed >14 days after a prior transfusion, if any) as defined by Hemoglobin >9g/dl Neutrophils >1500/μL Platelet count >100000/μL Total bilirubin <1,5xULN with the following exception: o Patients with known Gilbert syndrome who have serum bilirubin<3xULN AST and ALT<2,5xULN with the following exception o Patients with bone-only metastasis may have AST<5xULN, provided that ALT <2,5xULN and total bilirubin <1,5xULN Serum albumin >3g/dl Serum potassium ≥3.5mmol/L Serum creatinine <1,5xULN or creatinine clearance of >50ml/min based on Cockcroft-Gault equation Agreement by patient and/or partner to use an effective form of contraception including surgical sterilization, reliable barrier method, birth control pills, contraceptive hormone implants or true abstinence and to continue its use for the duration of the study and for 6 months after the last dose of study treatment. Exclusion Criteria: Small cell or neuroendocrine prostate carcinoma Inability or unwillingness to swallow pills Malabsorption syndrome or other condition that would interfere with enteral absorption Congenital long QT syndrome or QTc>480msec NYHA Class II to IV heart failure or LVEF <50% or ventricular arrhythmia requiring medication Previous therapy for prostate cancer with CYP17 inhibitors including ketoconazole or investigational agents (VMT-VT-464, Orteronel etc) or novel antiandrogens (enzalutamide of OMD-208) for more than 7 days Presence of visceral metastasis History of another invasive cancer within 3 years from screening, with the exception of fully treated cancers with a remote probability of recurrence Duration of previous Androgen Deprivation Therapy <12months Active infection requiring IV antibiotics Clinically significant cardiovascular disease including the following: unstable angina, myocardial infarction within 6 months from screening, or cerebrovascular accident within 6 months from screening Major surgical procedure within 4 weeks prior to initiation of study treatment Treatment with an investigational agent within 4 weeks prior to initiation of study treatment Unresolved, clinical significant toxicity from prior treatment Hypersensitivity reaction to the active pharmaceutical ingredient or any of the tablet components Any medical condition that restrain the patient to comply with study and follow-up procedures Inability to comply with study and follow up procedures

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
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Rotational<br>Abiraterone acetate 1000mg qD and prednisone 5mg bid administered orally starting on Day 1 of Cycle 1 for 3 cycles, followed by apalutamide 240mg qD orally for 3 cycles. The duration of each cycle is 28 days | Drug: Abiraterone<br>* Abiraterone acetate 1000mg qD and prednisone 5mg bid administered orally<br>* Other names: Zytiga;Drug: Apalutamide<br>* apalutamide 240mg qD orally<br>|
| Active Comparator: Sequential<br>Abiraterone acetate 1000mg qD and prednisone 5mg bid administered orally starting on Day 1 of Cycle 1 until disease progression, followed by apalutamide 240mg qD orally until second disease progression. | Drug: Abiraterone<br>* Abiraterone acetate 1000mg qD and prednisone 5mg bid administered orally<br>* Other names: Zytiga;Drug: Apalutamide<br>* apalutamide 240mg qD orally<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Radiographic progression-free survival | time until radiographic progression as assessed by PCWG2 criteria | Estimated up to 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall survival | time until death or lost to follow up | estimated up to 36 months | 
| Time to cytotoxic therapy initiation | time until the beginning of chemotherapy | Estimated up to 24 months | 
| Time until PSA progression | time until PSA progression as defined by PCWG2 criteria | Estimated up to 24 months | 
| Incidence, nature and severity of AEs | recording of all AE/SAEs | Estimated up to 24 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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prostate cancer, abiraterone, apalutamide