Clinical trial NCT01807065: Sipuleucel-T With or Without Radiation Therapy in Treating Patients With Hormone-Resistant Metastatic Prostate Cancer
Official title: Randomized Phase II Trial of Sipuleucel T Immunotherapy Preceded by Sensitizing Radiation Therapy and Sipuleucel-T Alone in Patients With Castrate Resistant Metastatic Prostate Cancer
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Adenocarcinoma of the Prostate
Bone Metastases
Hormone-resistant Prostate Cancer
Recurrent Prostate Cancer
Soft Tissue Metastases
Stage IV Prostate Cancer
Lead sponsor: City of Hope Medical Center
Sponsor class: OTHER
Collaborators: name: National Cancer Institute (NCI)
First posted: 2013-03-08
Enrollment: 51
Sex: MALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This randomized phase II trial studies how well giving sipuleucel-T with or without radiation therapy works in treating patients with hormone-resistant metastatic prostate cancer. Vaccines may help the body build an effective immune response to kill tumor cells. Radiation therapy uses high energy x rays to kill tumor cells. It is not yet known whether giving sipuleucel-T vaccine is more effective with or without radiation therapy in treating prostate cancer

Detailed description: PRIMARY OBJECTIVES:

I. To assess the feasibility, based on percent able or willing to receive all three infusions of sipuleucel-T immunotherapy, when combining sipuleucel-T with radiation therapy to a single site of metastasis delivered one week prior to beginning of sipuleucel-T therapy.

SECONDARY OBJECTIVES:

I. To assess the effect of radiation therapy to single metastasis on immune response (antibody and T-cell proliferation to prostate acid phosphate \[PAP\] and fusion protein PA2024) generated by sipuleucel-T immunotherapy.

II. To assess the effect of external beam radiotherapy to single metastasis on prostate specific antigen (PSA) response to therapy with sipuleucel-T.

III. To assess the effect of external beam radiotherapy to single metastasis on radiographic response rate to therapy with sipuleucel-T.

IV. To assess the time from the onset of therapy with sipuleucel-T +/- radiation to the need for subsequent therapy for prostate cancer.

V. To assess the toxicity associated with sipuleucel-T +/- radiation.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM A: Patients receive sipuleucel-T intravenously (IV) over 60 minutes days 22, 36, and 50.

ARM B: Patients undergo external beam radiation therapy in weeks 1-2. Patients also receive sipuleucel-T as in Arm A.

In both arms, treatment continues in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up until week 60.

Eligibility criteria: Inclusion Criteria:

* Histologically documented adenocarcinoma of the prostate
* Life expectancy of \>= 6 months, Eastern Cooperative Oncology Group (ECOG) performance status =\< 2
* Metastatic disease as evidenced by soft tissue and/or bony metastases on baseline bone scan and/or computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen or pelvis
* Castration resistant prostatic adenocarcinoma; subjects must have current or historical evidence of disease progression despite castrated level of testosterone (\< 50 ng/dL) achieved by orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist or antagonist therapy; disease progression has to be demonstrated by PSA progression OR progression of measurable disease OR progression of non-measurable disease as defined below:

  * PSA: Two consecutive rising PSA values, at least 7 days apart
  * Measurable disease: \>= 20% increase in the sum of the longest diameters of all measurable lesions or the development of any new lesions; the change will be measured against the best response to castration therapy or against the pre-castration measurements if there was no response
  * Non-measurable disease:

    * Soft tissue disease: The appearance of 1 or more lesions, and/or unequivocal worsening of non-measurable disease when compared to imaging studies acquired during castration therapy or against the pre-castration studies if there was no response
    * Bone disease: Appearance of 2 or more new areas of abnormal uptake on bone scan when compared to imaging studies acquired during castration therapy or against the pre-castration studies if there was no response; increased uptake of pre-existing lesions on bone scan does not constitute progression
* White blood cell (WBC) \>= 2,500 cells/uL
* Absolute neutrophil count (ANC) \>= 1,000 cells/uL
* Platelet count \>= 75,000 cells/uL
* Hemoglobin (HgB) \>= 9.0 g/dL
* Creatinine =\< 2.5 mg/dL
* Total bilirubin =\< 2 x institutional upper limit of normal (ULN)
* Aspartate aminotransferase (AST, serum glutamic oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT, serum glutamate pyruvate transaminase \[SGPT\]) =\< 2.5 x institutional ULN
* Prior chemotherapy with 0-2 regimens is allowed
* Prior radiation therapy to prostate or prostate bed is allowed provided it occurred \> 3 months before enrollment to the study

Exclusion Criteria:

* The presence of liver, or known brain metastases, malignant pleural effusions, or malignant ascites
* Moderate or severe symptomatic metastatic disease, defined as a requirement for treatment with opioid analgesics for cancer-related pain within 21 days prior to registration
* Eastern Cooperative Oncology Group (ECOG) performance status \> 2
* Treatment with chemotherapy within 3 months of registration
* Treatment with any of the following medications or interventions within 28 days of registration:

  * Systematic corticosteroids; use of inhaled, intranasal, and topical steroids is acceptable
  * Any other systemic therapy for prostate cancer (except for medical castration)
* History of external beam radiation therapy to metastatic sites within 1 year of enrollment to the study
* Participation in any previous study involving sipuleucel-T
* Pathologic long-bone fractures, imminent pathologic long-bone fracture (cortical erosion on radiography \> 50%) or spinal cord compression
* Concurrent other malignancy with the exception of:

  * Cutaneous squamous cell and basal carcinomas
  * Adequately treated stage 1-2 malignancy
  * Adequately treated stage 3-4 malignancy that has been in remission for \>= 2 years at the time of registration
* A requirement for systemic immunosuppressive therapy for any reason
* Any infection requiring parenteral antibiotic therapy or causing fever (temperature \> 100.5 degrees Fahrenheit \[F\] or 38.1 degrees Celsius \[C\]) within 1 week prior to registration
* Any medical intervention or other condition which, in the opinion of the principal investigator could compromise adherence with study requirements or otherwise compromise the study's objectives

Primary outcomes:
measure: Progression-free Survival
timeFrame: Until progression or death, Up to 2 years.
Secondary outcomes:
measure: Number of Participants With Grade 2 or Above Adverse Events
timeFrame: Up to 60 weeks
Other outcomes:
Locations:
city: Duarte
country: United States
facility: City of Hope Medical Center
state: California
city: Pasadena
country: United States
facility: South Pasadena Cancer Center
state: California
city: Salt Lake City
country: United States
facility: Huntsman Cancer Institute, Univ. of Utah
state: Utah
Study officials:
affiliation: City of Hope Medical Center
name: Cy Stein, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Twardowski P, Wong JYC, Pal SK, Maughan BL, Frankel PH, Franklin K, Junqueira M, Prajapati MR, Nachaegari G, Harwood D, Agarwal N. Randomized phase II trial of sipuleucel-T immunotherapy preceded by sensitizing radiation therapy and sipuleucel-T alone in patients with metastatic castrate resistant prostate cancer. Cancer Treat Res Commun. 2019;19:100116. doi: 10.1016/j.ctarc.2018.100116. Epub 2018 Dec 20.