Oxaliplatin and Pemetrexed Disodium in Treating Patients With Refractory Hormone-Resistant Prostate Cancer

Study Overview
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Brief Summary
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This phase II trial studies how well giving oxaliplatin and pemetrexed disodium together works in treating patients with refractory hormone-resistant prostate cancer. Drugs used in chemotherapy, such as oxaliplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Pemetrexed disodium may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving oxaliplatin together with pemetrexed disodium may kill more tumor cells.

Detailed Description
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PRIMARY OBJECTIVES: I. To determine the response rate by Response Evaluation Criteria In Solid Tumors (RECIST) criteria, prostate-specific antigen (PSA) response by the PSA Working Group criteria, and overall clinical benefit defined by summation of RECIST complete responses (CR) plus RECIST partial responses (PR) plus PSA PRs. SECONDARY OBJECTIVES: I. To determine time to progression in patients with hormone-refractory prostate cancer (HRPC) receiving oxaliplatin and pemetrexed. II. To describe the safety profile of this treatment. III. Pain response will be evaluated in an exploratory manner. IV. Undertake a pilot analysis of excision repair cross-complementing 1 (ERCC1) expression levels and polymorphisms, looking at their ability to predict response to platinum therapy. OUTLINE: Patients receive oxaliplatin intravenously (IV) over 2 hours and pemetrexed disodium IV on day 1. Courses repeat every 21 days for up to 1 year in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 6 months.

Official Title
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A Phase II Trial of Oxaliplatin and Pemetrexed in Hormone Refractory Prostate Cancer

Conditions
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Hormone-resistant Prostate Cancer, Recurrent Prostate Cancer

Intervention / Treatment
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* Drug: oxaliplatin
* Drug: pemetrexed disodium
* Other: questionnaire administration
* Other: laboratory biomarker analysis
* Genetic: reverse transcriptase-polymerase chain reaction
* Genetic: polymorphism analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Histologically confirmed prostate cancer Measurable disease on computed tomography (CT) or evaluable disease on bone scan with an elevated PSA For patients who did not initially present with metastatic disease, definitive treatment with either radical prostatectomy or external beam radiation is permitted Documented progression on (a) two prior hormone treatments AND (b) one or two chemotherapy regimens Documented progression on two prior hormone therapies is defined as orchiectomy followed by anti-adrenal medication upon progression OR gonadotropin-releasing hormone (GnRH) analog +/- androgen receptor blocker with addition or subtraction upon progression; castrate level of testosterone must be documented at study entry Documented progression on taxane-based chemotherapy; in addition, patients may have failed a second prior chemotherapy regimen Palliative radiation therapy for metastatic disease is allowed only if less than 25% of total body bone marrow was irradiated; 28 days must have elapsed since completion of radiation therapy (RT) with bone marrow recovery; soft tissue disease irradiated in the prior 2 months may not be designated as measurable disease ECOG performance score of 0-2 Absolute neutrophil count (ANC) >= 1500/uL Platelet count >= 100,000/uL Creatinine clearance >= 45 mL/min Serum total bilirubin =<1.5 mg/dL Alkaline phosphatase =< 3x the upper limit of normal (ULN) for the reference lab (=< 5x the ULN for patients with known hepatic metastases) and no upper limit for patients with known bone metastases Serum glutamic oxaloacetic transaminase (SGOT)/serum glutamic pyruvic transaminase (SGPT) =< 3x the ULN for the reference lab (=< 5x the ULN for patients with known hepatic metastases) Patients must be recovered from both acute and late effects of any prior surgery, radiotherapy or other antineoplastic therapy Patients or their legal representatives must be able to read, understand and provide informed consent to participate in the trial Men of childbearing potential must consent to use barrier contraception while on treatment and for 90 days thereafter Patients with pleural or peritoneal effusions are eligible Willingness and ability to take vitamin supplementation and steroid premedication as specified in protocol Patients with superficial bladder cancer or skin cancer who have second malignancy within 5 years which was removed with curative intent Exclusion Criteria: Active infection or with a fever >= 38.5 degrees Celsius (C) within 3 days of the first scheduled protocol treatment Patients with brain metastases Prior malignancy within the past 5 years, except for curatively treated basal cell or squamous cell carcinoma of the skin or superficial bladder cancer Known hypersensitivity to any of the components of oxaliplatin or pemetrexed Received radiotherapy to more than 25% of their bone marrow, or patients who received any radiotherapy within 4 weeks of entry Received treatment with strontium Receiving concurrent investigational therapy or who have received investigational therapy within 30 days of the first scheduled day of protocol treatment Life expectancy < 6 months Peripheral neuropathy >= Grade 2 Any other medical condition, including mental illness or substance abuse History of allogeneic transplant Known human immunodeficiency virus (HIV) or Hepatitis B or C (active, previously treated, or both) Inability to stop nonsteroidal anti-inflammatory drugs (NSAIDS) for a period of 2 days before, the day of, and 2 days following administration of Alimta; 5 days before, the day of, and 2 days following administration of Alimta for long-acting NSAIDS

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: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment (chemotherapy and enzyme inhibitor)<br>Patients receive oxaliplatin IV over 2 hours and pemetrexed disodium IV on day 1. Courses repeat every 21 days for up to 1 year in the absence of disease progression or unacceptable toxicity. | Drug: oxaliplatin<br>* Given IV<br>* Other names: L-OHP;Drug: pemetrexed disodium<br>* Given IV<br>* Other names: MTA;Other: questionnaire administration<br>* Ancillary studies<br>Other: laboratory biomarker analysis<br>* Correlative studies<br>Genetic: reverse transcriptase-polymerase chain reaction<br>* Correlative studies<br>* Other names: RT-PCR;Genetic: polymorphism analysis<br>* Correlative studies<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Best Overall Response | For patients with measurable disease, the RECIST 1.0 criteria was used to determine response. Complete Response = disappearance of all target lesions, Partial Response = greater or equal to 30% decrease in sum of longest diameter or target lesions, Stable Disease = <30% decrease or <20% increase, Progressive Disease = greater or equal to 20% increase in longest diameter of target lesions. For patients who do not have measurable disease by RECIST, the response was based on PSA response defined by Prostate Cancer Working Group criteria (1999) as 50% reduction in PSA confirmed on a second measurement at least 4 weeks later. | RECIST evaluation: Baseline, after every 2 courses, and then every 6 months after off-study, up to 1 year. PSA evaluation: baseline, day 1 of each course, final evaluation, and then every 6 months after off-study, up to 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to Disease Progression and Overall Survival | Progression-free survival was defined as the time from the first infusion of study treatment to the date of radiographic disease progression according to RECIST 1.0, or until two consecutive PSA rises occurred with an absolute increase of 5 ng/mL and a 50% relative increase over baseline. For patients without documented disease progression, the date of death or last follow-up without disease progression was used. | Baseline, after every 2 courses, and then every 6 months after off-study (RECIST) until progression; or baseline, day 1 of each course, at the final evaluation, and then every 6 months after off-study (PSA) until progression | 
| Number of Participants With Serious Adverse Events (SAEs) | Safety evaluation according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. | Baseline, days 1 and 7 of each course, and at last evaluation, up to 1 year |