Clinical trial NCT06014255: Trial of Neoadjuvant Enoblituzumab vs SOC in Men With High-Risk Localized Prostate Cancer
Official title: A Phase 2 Randomized Trial of Neoadjuvant Enoblituzumab Versus Standard of Care in Men With High-Risk Localized Prostate Cancer: The Help Elucidate & Attack Longitudinally (HEAT) Prostate Cancer Randomized Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
Conditions: Prostate Cancer
Keywords: enoblituzumab
Lead sponsor: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Sponsor class: OTHER
Collaborators: name: MacroGenics
First posted: 2023-08-28
Enrollment: 219
Sex: MALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: This study evaluates the efficacy, anti-tumor effect, and immunogenicity of neoadjuvant enoblituzumab given before radical prostatectomy. Patients will be randomized to enoblituzumab for a total of 12 weeks beginning 84 days before radical prostatectomy or standard of care arms.

Detailed description: This is a multi-center, randomized, phase 2 study evaluating the efficacy, anti-tumor effect, and immunogenicity of neoadjuvant enoblituzumab given prior to radical prostatectomy in men with high-risk localized prostate cancer. Patients will be recruited from the outpatient Urology clinics and Multidisciplinary Prostate Cancer ("Precision Medicine") Clinics at four participating institutions including: Harvard/Dana-Farber Cancer Centers, Northwestern Lurie Comprehensive Cancer Center, Mayo Clinic, and the University of Minnesota Masonic Cancer Center. Eligible patients will undergo a pre-treatment prostate biopsy and conventional imaging (CT and bone scan) as well as PSMA-PET and optional prostate MRI as per institutional preferences. Patients who have N0 M0 disease by conventional imaging (N1 by PSMA allowed with up to 3 LNs each ≤1 cm) will be trial eligible as long as concurrent hormonal or radiation therapy is not given. Patients will then be randomized to enoblituzumab for a total of 12 weeks beginning 84 days prior to radical prostatectomy or SOC arms. Fourteen days after the last treatment, prostate glands will be harvested at radical prostatectomy, and prostate tissue will be examined for pathologic response and secondary pharmacodynamic/immunologic endpoints as described herein. Pre-treatment, on-treatment, and post-treatment biomarkers of response and resistance will be collected including: plasma, PBMC. Repeat PSMA scan will be obtained prior to radical prostatectomy. Follow-up evaluation for adverse events will occur 30 and 90 days after surgery. Patients will then be followed by the patient's urologists/oncologists according to standard institutional practices but will require PSA evaluations every 3 (±1) months during year 1 and every 6 (±2) months during years 2-3.

Eligibility criteria: Inclusion Criteria:

To be eligible for this study, patients must meet all of the following criteria:

* Histologically confirmed adenocarcinoma of the prostate (clinical stage T1c-T3b, N0, M0) without involvement of lymph nodes, bone, or visceral organs by CT or NM bone scan. N1 by PSMA allowed with up to 3 LNs each ≤1 cm. If there is no frank bone disease, but PSMA scan and CT scan are in discordance, then investigators will discuss.
* Initial prostate biopsy, obtained within 3 months of enrollment, is available for central pathologic review, and is confirmed to show at least 3 positive cores (at least 1 core with at least 50% disease involvement with ≥4+3=7 disease) and a Gleason sum of ≥8 (or 4+3=7 with at least 1 additional high-risk feature such as PSA\>20 or cT3)
* Radical prostatectomy has been scheduled
* Age ≥18 years
* ECOG performance status 0-1, or Karnofsky score ≥ 70% (see Appendix A)
* Adequate bone marrow, hepatic, and renal function:

  * WBC \>3,000 cells/mm3
  * ANC \>1,500 cells/mm3
  * Hemoglobin \>9.0 g/dL
  * Platelet count \>100,000 cells/mm3
  * Serum creatinine \<1.5 × upper limit of normal (ULN)
  * Serum bilirubin \<1.5 × ULN
  * ALT \<3 × ULN
  * AST \<3 × ULN
  * Alkaline phosphatase \<3 × ULN
* The etiology of abnormal bilirubin and transaminase levels should be evaluated prior to study entry.
* Willingness to provide written informed consent and HIPAA authorization for the release of personal health information, and the ability to comply with the study requirements (note: HIPAA authorization will be included in the informed consent)
* Willingness to use barrier contraception from the time of first dose of Enoblituzumab (MGA271) until the time of prostatectomy.

Exclusion Criteria:

To be eligible for this study, patients should not meet any of the following criteria:

* Presence of known lymph node involvement on CT (N1 by PSMA allowed with up to 3 LNs each ≤1 cm) or distant metastases by CT and NM bone scan
* Other histologic types of prostate cancers such as ductal, sarcomatous, lymphoma, small cell, and neuroendocrine tumors
* Prior radiation therapy, hormonal therapy, biologic therapy, or chemotherapy for prostate cancer
* Prior immunotherapy/vaccine therapy for prostate cancer
* Prior use of experimental agents for prostate cancer
* Concomitant treatment with other hormonal therapy or 5α-reductase inhibitors
* Current use of systemic corticosteroids or use of systemic corticosteroids within 4 weeks of enrollment (inhaled corticosteroids for asthma or COPD are permitted as are other non-systemic steroids such as topical corticosteroids)
* History or presence of autoimmune disease requiring systemic immunosuppression (including but not limited to: inflammatory bowel disease, systemic lupus erythematosus, vasculitis, rheumatoid arthritis, scleroderma, multiple sclerosis, hemolytic anemia, Sjögren syndrome, and sarcoidosis)
* History of malignancy within the last 3 years, with the exception of non-melanoma skin cancers and superficial bladder cancer
* Uncontrolled major active infectious, cardiovascular, pulmonary, hematologic, or psychiatric illnesses that would make the patient a poor study candidate
* Known prior or current history of HIV and/or hepatitis B/C, with the exception of patients who have been successfully treated for hepatitis B/C (i.e. documented confirmation of cure at least 6 months after initial treatment).

Primary outcomes:
measure: Recurrence-free survival (RFS)
timeFrame: 3 years post-prostatectomy
Secondary outcomes:
measure: Time to PSA recurrence
timeFrame: 5 years post-prostatectomy
measure: Overall survival
timeFrame: 5 years post-prostatectomy
measure: Metastasis-free survival
timeFrame: 5 years post-prostatectomy
measure: PSA response
timeFrame: 3 months post-prostatectomy.
measure: Recurrence free survival
timeFrame: 3 years from randomization
measure: Number of participants with treatment-related adverse events
timeFrame: 90 days post-prostatectomy
measure: Anti-tumor response (cleaved PARP staining and quantification of tumor cell apoptosis) to enoblituzumab versus SOC
timeFrame: Day 84
measure: Anti-tumor response (central pathological response graded according to standard criteria) to enoblituzumab versus SOC
timeFrame: Day 84
measure: Assess the immune response (CD8 T cell infiltration into the tumor / peritumoral area) to enoblituzumab versus SOC
timeFrame: Day 84
measure: Assess the immune response (CD8 Granzyme B) to enoblituzumab versus SOC
timeFrame: Day 84
measure: Change in number of participants with change in Gleason grade group change
timeFrame: Baseline and Day 84
measure: Pathological complete responses (pCR)
timeFrame: Day 84
Other outcomes:
measure: Quality of life assessment
timeFrame: 6 months from randomization
measure: Quantify B7-H3 IHC expression
timeFrame: 5 years post-prostatectomy
measure: Quantify checkpoint IHC expression
timeFrame: Day 84
measure: FC Receptor Genotyping
timeFrame: Day 84
measure: cfDNA, ctDNA, and tumor vesicle associated DNA/RNA prevalence
timeFrame: Day 84
measure: IHC Analyses of CD137, CD16 and/or CD107A
timeFrame: Day 84
measure: Global Expression Profiling of Tumor Tissues
timeFrame: Day 84
measure: Global Metabolomic Profiling of Tumor Tissues
timeFrame: Day 84
measure: Whole genome sequencing
timeFrame: Day 84
measure: Long-read whole-genome sequencing analysis of DNA methylation
timeFrame: Day 84
measure: Single cell RNA sequencing of tumor tissue
timeFrame: Day 84
measure: PBL (peripheral blood lymphocytes)
timeFrame: 30 days post-prostatectomy
measure: Cytokines and chemokines
timeFrame: Day 84
measure: PSMA dynamics
timeFrame: 90 day post-prostatectomy
measure: PSMA and Conventional imaging congruence
timeFrame: 90 day post-prostatectomy
Locations:
city: Chicago
country: United States
facility: Northewestern University
state: Illinois
city: Baltimore
country: United States
facility: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
state: Maryland
city: Minneapolis
country: United States
facility: University of Minnesota
state: Minnesota
city: Rochester
country: United States
facility: Mayo Clinic
state: Minnesota
city: Omaha
country: United States
facility: XCancer - Omaha, LLC
state: Nebraska
Study officials:
affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
name: Eugene Shenderov
role: PRINCIPAL_INVESTIGATOR
References: