Phase III Study of DCVAC/PCa Added to Standard Chemotherapy for Men With Metastatic Castration Resistant Prostate Cancer

Study Overview
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Brief Summary
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The VIABLE study sought to confirm the hypothesis that the combination of docetaxel with DCVAC/PCa followed by a maintenance therapy with DCVAC/PCa would improve overall survival in patients with metastatic castration-resistant prostate cancer.

Detailed Description
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This was a randomized, double blind, placebo-controlled, multicenter, international, parallel-group phase III study. Patients with metastatic castration-resistant prostate cancer who were candidates to receive standard of care first-line chemotherapy with docetaxel plus prednisone were randomized 2:1 into one of two arms: an investigational arm (DCVAC/PCa) and a control arm (placebo) in addition to chemotherapy (docetaxel plus prednisone).

Official Title
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A Randomized, Double Blind, Multicenter, Parallel-group, Phase III Study to Evaluate Efficacy and Safety of DCVAC/PCa Versus Placebo in Men With Metastatic Castration Resistant Prostate Cancer Eligible for 1st Line Chemotherapy

Conditions
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Metastatic Castration-resistant Prostate Cancer

Intervention / Treatment
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* Biological: DCVAC/PCa
* Biological: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Male 18 years and older. Histologically or cytologically confirmed prostate adenocarcinoma. Presence of skeletal, or soft-tissue/visceral/nodal metastases according to one of the following criteria: Confirmed pathological fracture related to the disease OR Confirmation of distant bone and/or soft-tissue and/or visceral metastases on CT or MRI scan or bone scintigraphy OR Positive pathology report of metastatic lesion Disease progression despite androgen-deprivation therapy (ADT) as indicated by: Prostate-specific antigen (PSA) increase that is ≥ 2 ng/mL and ≥ 25% above the minimum PSA as reached during ADT or above the pre-treatment level, if no response was observed and which is confirmed by a second value 1 or more weeks later OR Progression of measurable lymph nodes (short axis ≥ 15 mm) or visceral lesion measurable per RECIST v1.1 criteria, confirmation by an independent review facility (IRF) required OR Two or more new lesions appearing on bone scan/imaging compared with a previous scan (confirmation by IRF required) Maintenance of castrate conditions: patients, who have not had a surgical orchiectomy, must continue with hormone therapy with gonadotropin releasing hormone/ luteinizing hormone-releasing hormone (GnRH/LHRH) agonists or antagonists to reach levels of serum testosterone of ≤ 1.7 nmol/L (50 ng/dL). The duration of the castration period must be at least 4 months before screening as evidenced by combination of clinical/laboratory data (see section 6.8.1). Laboratory criteria: White blood cells (WBC) greater than 4,000/mm3 (4.0 x109/L) Neutrophil count greater than 1,500/mm3 (1.5 x109/L). Hemoglobin of at least 10 g/dL (100 g/L). Platelet count of at least 100,000/mm3 (100 x 109/L). Total bilirubin within normal limits (benign hereditary hyperbilirubinemias, e.g. Gilbert's syndrome, are permitted). Serum alanine aminotransferase, aspartate aminotransferase, and creatinine < 1.5x times the upper limit of normal (ULN). Life expectancy of at least 6 months based on Investigator's judgment. Eastern Cooperative Oncology Group (ECOG) Performance status 0-2. At least 4 weeks after surgery or radiotherapy before randomization. A minimum of 28 days beyond initiation of bisphosphonate or denosumab therapy before randomization. Recovery from primary local surgical treatment, radiotherapy or orchiectomy before randomization. Signed informed consent including patient's ability to comprehend its contents. Exclusion criteria: Confirmed brain and/or leptomeningeal metastases (other visceral metastases are acceptable). Current symptomatic spinal cord compression requiring surgery or radiation therapy. Prior chemotherapy for prostate cancer. Patient co-morbidities: Subjects who are not indicated for chemotherapy treatment with first line Standard of Care chemotherapy (docetaxel and prednisone). HIV positive, human T-lymphotropic virus positive. Active hepatitis B (active hepatitis B), active hepatitis C (HCV), active syphilis. Evidence of active bacterial, viral or fungal infection requiring systemic treatment. Clinically significant cardiovascular disease including: symptomatic congestive heart failure. unstable angina pectoris. serious cardiac arrhythmia requiring medication. uncontrolled hypertension. myocardial infarction or ventricular arrhythmia or stroke within a 6 months before screening, known left ventricular ejection fraction (LVEF) < 40% or serious cardiac conduction system disorders, if a pacemaker is not present. Pleural and pericardial effusion of any NCI CTCAE grade. Peripheral neuropathy having a NCI CTCAE ≥ grade 2. History of malignant disease (with the exception of non-melanoma skin tumors) in the preceding five years. Active autoimmune disease requiring treatment. History of severe forms of primary immune deficiencies. History of anaphylaxis or other serious reaction following vaccination. Known hypersensitivity to any constituent of the DCVAC/PCa or placebo product. Uncontrolled co-morbidities including, psychiatric or social conditions which, in the Investigator's opinion, would prevent participation in the trial. Systemic corticosteroids at doses greater than 40 mg hydrocortisone daily or equivalent for any reason other than treatment of PCa within 6 months before randomization. Ongoing systemic immunosuppressive therapy for any reason. Treatment with anti-androgens, inhibitors of adrenal-produced androgens or other hormonal tumor-focused treatment performed on the day of randomization (except for GnRH/LHRH agonists or antagonists) to exclude possible anti-androgen withdrawal response. This criterion is not applicable to subjects who have never responded to anti-androgen treatment, as there is no risk of anti-androgen withdrawal response. Treatment with immunotherapy against PCa within 6 months before randomization. Treatment with radiopharmaceutical within 8 weeks before randomization. Participation in a clinical trial using non-immunological experimental therapy within 4 weeks before randomization. Participation in a clinical trial using immunological experimental therapy (e.g., monoclonal antibodies, cytokines or active cellular immunotherapies) within 6 months before randomization. Refusal to sign the informed consent.

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: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: DCVAC/PCa with standard of care chemotherapy<br>Combination therapy with DCVAC/PCa and standard of care chemotherapy (docetaxel and prednisone) | Biological: DCVAC/PCa<br>* DCVAC/PCa concurrently with docetaxel plus prednisone every 3 weeks (± 7 days). DCVAC/PCa was administered at least 7 days before or and at least 7 days after the nearest chemotherapy (days 8-15 of chemotherapy cycles). After discontinuation of chemotherapy for any reason, each following dose of DCVAC/PCa was given every 4 weeks (-7/+14 days) for up to a total of 15 doses.<br>* Other names: Stapuldencel;|
| Placebo Comparator: Placebo with standard of care chemotherapy<br>Combination therapy with placebo and standard of care chemotherapy (docetaxel and prednisone) as comparator | Biological: Placebo<br>* Placebo concurrently with docetaxel plus prednisone every 3 weeks (± 7 days). Placebo was administered at least 7 days before or and at least 7 days after the nearest chemotherapy (days 8-15 of chemotherapy cycles). After discontinuation of chemotherapy for any reason, each following dose of placebo was given every 4 weeks (-7/+14 days) for up to a total of 15 doses.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Survival, Intention-to-treat Population | Overall survival is defined as the time from randomization until death due to any cause. | From randomization to death due to any cause, up to 58 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Survival, Per Protocol Population | Overall survival is defined as the time from randomization until death due to any cause. | From randomization to death due to any cause, up to 58 months | 
| Overall Survival, Intention-to-treat Population, Abiraterone as Prior Therapy | Overall survival is defined as the time from randomization until death due to any cause. | From randomization to death due to any cause, up to 58 months | 
| Overall Survival, Intention-to-treat Population, Enzalutamide as Prior Therapy | Overall survival is defined as the time from randomization until death due to any cause. | From randomization to death due to any cause, up to 58 months | 
| Overall Survival, Intention-to-treat Population, no Prior Abiraterone or Enzalutamide | Overall survival is defined as the time from randomization until death due to any cause. | From randomization to death due to any cause, up to 58 months | 
| Radiological Progression-free Survival, Intention-to-treat Population | Progressive disease on bone scans was defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan. | Time from randomization to the date of the earliest objective evidence of either radiographic progression of bone lesions, radiographic progression of soft tissue lesions, or death due to any cause, up to 58 months | 
| Radiological Progression-free Survival, Per Protocol Population | Progressive disease on bone scans was defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan. | Time from randomization to the date of the earliest objective evidence of either radiographic progression of bone lesions, radiographic progression of soft tissue lesions, or death due to any cause, up to 58 months | 
| Time to PSA Progression, Intention-to-treat Population | The evidence of PSA progression is defined as: time from randomization to the date of PSA absolute increase ≥ 2 ng/mL and ≥ 25% above nadir or baseline values confirmed by a second consecutive value obtained at least 3 weeks later. | Time from randomization to the date of objective evidence of PSA progression (PSA absolute increase ≥ 2 ng/mL and ≥ 25% above nadir or baseline values providing confirmation by a second consecutive value obtained at least 3 weeks later), up to 39 months | 
| Time to PSA Progression, Per Protocol Population | The evidence of PSA progression is defined as: time from randomization to the date of PSA absolute increase ≥ 2 ng/mL and ≥ 25% above nadir or baseline values confirmed by a second consecutive value obtained at least 3 weeks later. | Time from randomization to the date of objective evidence of PSA progression (PSA absolute increase ≥ 2 ng/mL and ≥ 25% above nadir or baseline values providing confirmation by a second consecutive value obtained at least 3 weeks later), up to 39 months | 
| Time to First Skeletal-related Event, Intention-to-treat Population | Skeletal-related events included: Radiation therapy to bone Pathologic bone fracture Spinal cord compression Surgery to bone Change in antineoplastic therapy to treat bone pain | Time from randomization to the date of the first skeletal-related event, up to 58 months | 
| Time to First Skeletal-related Event, Per Protocol Population | Skeletal-related events included: Radiation therapy to bone Pathologic bone fracture Spinal cord compression Surgery to bone Change in antineoplastic therapy to treat bone pain | Time from randomization to the date of the first skeletal-related event, up to 58 months | 
| Time to Radiological Progression or Skeletal-related Event, Intention-to-treat Population | Progressive disease on bone scans defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan. Skeletal-related events included: Radiation therapy to bone Pathologic bone fracture Spinal cord compression Surgery to bone Change in antineoplastic therapy to treat bone pain | Time from randomization to the date of the first radiological progression or skeletal-related event, up to 58 months | 
| Time to Radiological Progression or Skeletal-related Event, Per Protocol Population | Progressive disease on bone scans defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan. Skeletal-related events included: Radiation therapy to bone Pathologic bone fracture Spinal cord compression Surgery to bone Change in antineoplastic therapy to treat bone pain | Time from randomization to the date of the first radiological progression or skeletal-related event, up to 58 months | 
| Proportion of Patients With Skeletal-related Events, Intention-to-treat Population | Progressive disease on bone scans defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan. Skeletal-related events included: Radiation therapy to bone Pathologic bone fracture Spinal cord compression Surgery to bone Change in antineoplastic therapy to treat bone pain | From randomization to the end of the study, up to 57 months | 
| Proportion of Patients With Skeletal-related Events, Per Protocol Population | Progressive disease on bone scans defined as a minimum of two new lesions. Visceral and nodal disease was evaluated according to RECIST 1.1 with modifications as described in the Statistical Analysis Plan. Skeletal-related events included: Radiation therapy to bone Pathologic bone fracture Spinal cord compression Surgery to bone Change in antineoplastic therapy to treat bone pain | From randomization to the end of the study, up to 57 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Immunotherapy, Metastatic, Castration-resistant, Prostate cancer, Biological, Vaccine