Clinical trial NCT00630344: RAD001 and Bicalutamide for Androgen Independent Prostate Cancer
Official title: A Phase II Trial of RAD001 and Bicalutamide for Androgen Independent Prostate Cancer
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Prostate Cancer
Keywords: RAD001
bicalutamide
androgen independent prostate cancer
Lead sponsor: Dana-Farber Cancer Institute
Sponsor class: OTHER
Collaborators: name: Beth Israel Deaconess Medical Center
name: Novartis Pharmaceuticals
First posted: 2008-03-07
Enrollment: 36
Sex: MALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: In the treatment of castration-resistant prostate cancer (CRPC), therapies will long response durations remain elusive as a result of the inherent ability of prostate cancer cells to develop iterative resistance. The goal of this study is to learn if the study drug RAD001 together with Bicalutamide can slow the growth of prostate cancer. The safety of the combination will also be studied.

Detailed description: Bicalutamide, an androgen receptor (AR) antagonist, is frequently used as the first 'secondary hormonal therapy' in combination with another established agent (LHRH: luteinizing hormone-releasing hormone agonist/antagonist) to treat CRPC. A series of studies have shown that RAD001 through inhibition of mammalian target of rapamycin (mTOR) pathway has antitumor and anti-angiogenic activities. The hypothesis is that the combination of an antiandrogen and mTOR inhibitor would have additive and clinically significant effects in CRPC.

STATISTICAL CONSIDERATIONS:

The regimen will be considered promising if the rate of response/favorable outcome is 40% or greater. A rate of 20% (similar to that observed for bicalutamide alone) will not be considered worthy of further study. 38 patients (of whom 36 are assumed to be eligible) will be accrued to the study. If 11 or more patients have a favorable outcome (stable disease \> 6 months or response), the combination will be considered worthy of further study. Given this design, there is a 9% probability of declaring the combination effective if the true favorable outcome rate is 20% and a 91% probability of declaring the combination effective if the true favorable outcome rate is 40%.

Eligibility criteria: Inclusion Criteria:

* 18 years of age or older
* Histologically documented prostate cancer
* Castration resistant prostate cancer defined as two rising PSAs on castration therapy
* Baseline PSA of 2ns/mL or greater
* Testosterone of 50ng/mL or less
* Patients on LHRH agonist/antagonist must continue therapy at the recommended dosing intervals
* Prior bicalutamide is allowed as long as treatment was for 6 months or longer
* Metastatic disease is not required
* Minimum of four weeks since any major surgery, completion of radiation, or completion of all prior systemic anticancer therapy
* ECOG Performance Status equal to or less than 2
* Adequate bone marrow and liver function as outlined by parameters in the protocol

Exclusion Criteria:

* Prior treatment with any investigational drug within the preceding 4 weeks
* Prior treatment with an mTOR inhibitor
* Fasting lipids over the parameters outlined in the protocol
* Chronic treatment with systemic steroids or another immunosuppressive agent
* Patients should not receive immunization with attenuated live vaccines during study period or within one week of study entry
* Uncontrolled brain or leptomeningeal metastases, including patients who continue to require glucocorticoids for brain or leptomeningeal metastases
* Other malignancies within the past 3 years except for adequately treated or basal squamous cell carcinomas of the skin
* Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study
* Known history of HIV seropositivity
* Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of RAD001
* Patients with an active, bleeding diathesis or on oral anti-vitamin K medication (except low dose coumarin)
* Men able to conceive and unwilling to practice an effective method of birth control
* Known hypersensitivity to RAD001 or other rapamycins or to its excipients
* History of noncompliance to medical regimens

Primary outcomes:
measure: Overall Response Rate
timeFrame: PSA was measured monthly and measurable disease on imaging assessed every 2 cycles in first 8 weeks and every 3 cycles thereafter. In this study cohort, patients were followed on treatment up to approximately 1 year.
Secondary outcomes:
measure: Incidence of Grade 4 Treatment-Related Toxicity
timeFrame: Assessed each cycle during therapy and up to 30 days post-therapy completion which is approximately 1 year for patients in this study cohort.
measure: Incidence of Grade 1-3 Treatment-Related Mucositis Toxicity
timeFrame: Assessed each cycle during therapy and up to 30 days post-therapy completion which is approximately 1 year for patients in this study cohort.
measure: Incidence of Grade 1-3 Treatment-Related Rash Toxicity
timeFrame: Assessed each cycle during therapy and up to 30 days post-therapy completion which is approximately 1 year for patients in this study cohort.
measure: Incidence of Grade 1-3 Treatment-Related Fatigue Toxicity
timeFrame: Assessed each cycle during therapy and up to 30 days post-therapy completion which is approximately 1 year for patients in this study cohort.
measure: Time to Progression (TTP)
timeFrame: PSA was measured monthly and measurable disease on imaging assessed every 2 cycles in first 8 weeks and every 3 cycles thereafter. In this study cohort, patients were followed on treatment up to approximately 1 year.
Other outcomes:
Locations:
city: Boston
country: United States
facility: Beth Israel Deaconess Medical Center
state: Massachusetts
city: Boston
country: United States
facility: Dana-Farber Cancer Institute
state: Massachusetts
Study officials:
affiliation: Dana-Farber Cancer Institute
name: Mary-Ellen Taplin, MD
role: STUDY_CHAIR
References:
citation: Nakabayashi M, Werner L, Courtney KD, Buckle G, Oh WK, Bubley GJ, Hayes JH, Weckstein D, Elfiky A, Sims DM, Kantoff PW, Taplin ME. Phase II trial of RAD001 and bicalutamide for castration-resistant prostate cancer. BJU Int. 2012 Dec;110(11):1729-35. doi: 10.1111/j.1464-410X.2012.11456.x. Epub 2012 Aug 29.