Trial Title:
Targeted Treatment for Metastatic Prostate Cancer, The PREDICT Trial
NCT ID:
NCT06632977
Condition:
Castration-Resistant Prostate Carcinoma
Stage IVB Prostate Cancer AJCC v8
Conditions: Official terms:
Prostatic Neoplasms
Carboplatin
Abiraterone Acetate
1,4,7,10-tetraazacyclododecane- 1,4,7,10-tetraacetic acid
Study type:
Interventional
Study phase:
Phase 2
Overall status:
Not yet recruiting
Study design:
Allocation:
Non-Randomized
Intervention model:
Parallel Assignment
Primary purpose:
Treatment
Masking:
None (Open Label)
Intervention:
Intervention type:
Other
Intervention name:
Genetic testing
Description:
undergo genetic testing
Arm group label:
Arm A (genetic testing, valemetostat tosylate)
Arm group label:
Arm B (genetic testing, carboplatin, cabazitaxel)
Arm group label:
Arm C (genetic testing, physician choice treatment)
Intervention type:
Drug
Intervention name:
Valemetostat Tosylate
Description:
Given PO
Arm group label:
Arm A (genetic testing, valemetostat tosylate)
Intervention type:
Procedure
Intervention name:
Magnetic Resonance Imaging
Description:
undergo Magnetic Resonance Imaging
Arm group label:
Arm A (genetic testing, valemetostat tosylate)
Arm group label:
Arm B (genetic testing, carboplatin, cabazitaxel)
Arm group label:
Arm C (genetic testing, physician choice treatment)
Other name:
MRI
Intervention type:
Procedure
Intervention name:
Computed Tomography
Description:
undergo Computed Tomography
Arm group label:
Arm A (genetic testing, valemetostat tosylate)
Arm group label:
Arm B (genetic testing, carboplatin, cabazitaxel)
Arm group label:
Arm C (genetic testing, physician choice treatment)
Other name:
CAT Scan
Other name:
CT Scan
Intervention type:
Procedure
Intervention name:
Bone scan
Description:
undergo Bone scan
Arm group label:
Arm A (genetic testing, valemetostat tosylate)
Arm group label:
Arm B (genetic testing, carboplatin, cabazitaxel)
Arm group label:
Arm C (genetic testing, physician choice treatment)
Intervention type:
Procedure
Intervention name:
FDG-Positron Emission Tomography
Description:
Undergo FDG PET
Arm group label:
Arm A (genetic testing, valemetostat tosylate)
Arm group label:
Arm B (genetic testing, carboplatin, cabazitaxel)
Arm group label:
Arm C (genetic testing, physician choice treatment)
Intervention type:
Procedure
Intervention name:
PSMA PET Scan
Description:
Undergo PSMA PET
Arm group label:
Arm A (genetic testing, valemetostat tosylate)
Arm group label:
Arm B (genetic testing, carboplatin, cabazitaxel)
Arm group label:
Arm C (genetic testing, physician choice treatment)
Other name:
Prostate-specific Membrane Antigen PET
Intervention type:
Procedure
Intervention name:
Biospecimen Collection
Description:
undergo blood collection
Arm group label:
Arm A (genetic testing, valemetostat tosylate)
Arm group label:
Arm B (genetic testing, carboplatin, cabazitaxel)
Arm group label:
Arm C (genetic testing, physician choice treatment)
Intervention type:
Drug
Intervention name:
Carboplatin
Description:
Given IV
Arm group label:
Arm B (genetic testing, carboplatin, cabazitaxel)
Intervention type:
Drug
Intervention name:
Cabazitaxel
Description:
Given IV
Arm group label:
Arm B (genetic testing, carboplatin, cabazitaxel)
Arm group label:
Arm C (genetic testing, physician choice treatment)
Intervention type:
Drug
Intervention name:
Abiraterone Acetate
Description:
Given PO
Arm group label:
Arm C (genetic testing, physician choice treatment)
Intervention type:
Drug
Intervention name:
Enzalutamide
Description:
Given PO
Arm group label:
Arm C (genetic testing, physician choice treatment)
Other name:
Xtandi
Intervention type:
Drug
Intervention name:
Lutetium Lu 177 Vipivotide Tetraxetan
Description:
Given IV
Arm group label:
Arm C (genetic testing, physician choice treatment)
Other name:
Pluvicto
Summary:
This phase II trial evaluates whether genetic testing in prostate cancer is helpful in
deciding which study treatment patients are assigned. Patient cancer tissue samples are
obtained from a previous surgery or biopsy procedure and tested for deoxyribonucleic acid
(DNA) and ribonucleic acid (RNA) abnormalities or mutations in their cancer. Valemetostat
tosylate is in a class of medications called EZH1/EZH2 inhibitors. It blocks proteins
called EZH1 and EZH2, which may help slow or stop the spread of tumor cells. Carboplatin
is in a class of medications known as platinum-containing compounds. It works in a way
similar to the anticancer drug cisplatin, but may be better tolerated than cisplatin.
Carboplatin works by killing, stopping or slowing the growth of tumor cells. Cabazitaxel
injection is in a class of medications called microtubule inhibitors. It works by slowing
or stopping the growth of tumor cells. Abiraterone acetate blocks tissues from making
androgens (male hormones), such as testosterone. This may cause the death of tumor cells
that need androgens to grow. It is a type of anti-androgen. Enzalutamide is in a class of
medications called androgen receptor inhibitors. It works by blocking the effects of
androgen (a male reproductive hormone) to stop the growth and spread of tumor cells.
Lutetium Lu 177 vipivotide tetraxetan is in a class of medications called
radiopharmaceuticals. It works by targeting and delivering radiation directly to tumor
cells which damages and kills these cells. Assigning patients to targeted treatment based
on genetic testing may help shrink or slow the cancer from growing
Detailed description:
The primary and secondary objectives of the study:
PRIMARY OBJECTIVE:
I. Evaluate objective response rate in patients with measurable disease by Response
Evaluation Criteria in Solid Tumors (RECIST) version 1.1 for measurable disease, in each
treatment arm.
SECONDARY OBJECITVES:
I. To determine safety and tolerability as determined by Common Terminology Criteria in
Adverse Events (CTCAE) version 5.0 in each treatment arm.
II. To evaluate 9-month radiographic progression free survival in each arm as defined by
Prostate Cancer Clinical Trials Working Group 3 (PCWG-3) for patients with bone
metastases and RECIST version 1.1 for patients with measurable disease.
III. To evaluate radiographic progression free survival in each arm as defined by PCWG-3
for patients with bone metastases and RECIST version 1.1 for patients with measurable
disease.
IV. To evaluate prostate-specific antigen (PSA) response defined as ≥ 50% decline in PSA
from baseline using PCWG-3 criteria in patients in each treatment arm.
V. To evaluate time to PSA progression as defined by PCWG-3 criteria in patients in each
treatment arm.
VI. To evaluate time to occurrence of first symptomatic skeletal event. VII. To evaluate
time to first subsequent anti-cancer therapy (including androgen receptor signaling
agents, cytotoxic chemotherapy, immunotherapy, or investigational agents) or death.
VIII. To evaluate overall survival, defined as time from registration to death due to any
cause censored at the date of last follow-up, in each treatment arm.
IX. To evaluate patient-reported outcomes (PRO) via Patient-Reported Outcomes (PRO)-CTCAE
in each treatment arm.
X. To evaluate duration of response as defined by RECIST version 1.1 for patients with
measurable disease.
CORRELATIVE OBJECTIVES:
I. Correlate presence of molecular abnormalities with baseline clinical characteristics.
II. Evaluate co-occurring molecular alterations within each biomarker arm. III. Evaluate
mechanisms of response and resistance using available tissue (archival or baseline) and
circulating cell free tumor DNA (cfDNA) and circulating tumor cells (CTCs) at baseline,
on treatment, and at progression.
IV. Evaluate efficacy parameters (objective response rate [ORR], PSA response, 9-month
radiographic progression-free survival [rPFS], rPFS) based on arm allocation by:
IVa. DNA versus RNA qualifying molecular alterations; IVb. Blood versus tissue-based
qualifying molecular alteration; IVc. Primary versus metastasis qualifying molecular
alteration.
V. Evaluate efficacy parameters (ORR, PSA response, 9-month rPFS, rPFS) based on the
following clinical parameters:
Va. Presence or absence of visceral metastases at baseline; Vb. Number of prior lines of
therapy for metastatic castration resistant cancer (mCRPC) (one versus > 1); Vc. In
patients having had prior exposure to taxane chemotherapy; Vd. Presence or absence of
neuroendocrine differentiation at baseline. VI. Evaluate exceptional responders (defined
as those with rPFS ≥ 18 months) and exceptional non-responders.
VII. To determine how circulating biomarker quantification correlates with clinical
features and outcomes.
VIII. To determine the clinical impact of lineage plasticity alterations in predicting
outcomes and response to therapy.
EXPLORATORY OBJECTIVE:
I. To compare patient-assessed adverse events via PRO-CTCAE™ with clinician-assessed
adverse events in each treatment arm.
OUTLINE: Patients undergo genetic testing on previously-collected tissue samples.
Patients are then assigned to 1 of 3 arms based on genetic testing results and Molecular
Tumor Board (MTB) decision.
ARM A: Patients receive valemetostat tosylate orally (PO) once daily (QD) on days 1-28 of
each cycle. Cycles repeat every 28 days in the absence of disease progression or
unacceptable toxicity.
ARM B: Patients receive carboplatin intravenously (IV) over 30 minutes and cabazitaxel IV
over 60 minutes on day 1 of each cycle. Cycles repeat every 21 days in the absence of
disease progression or unacceptable toxicity.
ARM C: Patients receive one of the following treatment regimens per treating physician:
1) Cabazitaxel IV over 60 minutes on day 1 of each cycle. Cycles repeat every 21 days in
the absence of disease progression or unacceptable toxicity. 2) Abiraterone acetate PO QD
on days 1-28 of each cycle and prednisone PO twice daily (BID) on days 1-28 of each
cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable
toxicity. 3) Enzalutamide PO QD on days 1-28 of each cycle. Cycles repeat every 28 days
in the absence of disease progression or unacceptable toxicity. 4) Lutetium Lu 177
vipivotide tetraxetan IV on day 1 of each cycle. Treatment repeats every 42 days for up
to 6 cycles in the absence of disease progression or unacceptable toxicity.
All patients also undergo magnetic resonance imaging (MRI) or computed tomography (CT)
and bone scan throughout the trial. Patients may also undergo optional fludeoxyglucose
F-18 (FDG) or prostate-specific membrane antigen (PSMA) positron emission tomography
(PET), as well as optional blood collection throughout the trial.
After completion of study treatment, patients without disease progression are followed
every 2 months for the first 6 months and then every 3 months after that for up to 5
years. Patients with disease progression are followed every 6 months for 5 years.
Criteria for eligibility:
Criteria:
Inclusion Criteria:
- PRE-REGISTRATION: Histological or cytological evidence of prostate cancer. Patients
with variant histologies including neuroendocrine, small cell and sarcomatoid
prostate cancer are allowed to enroll and these will not be used as selection
criteria for individual arms. Central pathology review is not required.
- PRE-REGISTRATION: Measurable disease and/or non-measurable metastatic disease per
RECIST version 1.1.
- PRE-REGISTRATION: Tissue procured within 12 months of pre-registration (metastatic
disease preferred over primary tissue, though both are acceptable) available for
submission per Section 6.2. For patients who have progressed on A032102 and are
pre-registering again, repeat tissue procurement will not be mandated.
- PRE-REGISTRATION: Molecular report available performed as part of standard of care
testing via any Clinical Laboratory Improvement Act (CLIA)-certified next generation
sequencing (NGS) assay. Patients may be assigned based on pre-determined qualifying
molecular/DNA alterations as stated in Section 4.8 after receipt of local molecular
testing by the A032102 molecular tumor board (MTB). Final determination of arm
assignment will be determined by the MTB. For qualifying DNA alteration determined
by the MTB, testing may be from tumor tissue collected at any time or circulating
tumor DNA (ctDNA) within 12 months of pre-registration. If no qualifying DNA
alteration is identified based on the CLIA-certified next generation sequencing
assay and MTB review, Caris testing, should be performed for both DNA/RNA profiling.
Arm assignment based RNA requires testing of tumor tissue collected within 12 months
of pre-registration and MTB review.
- PRE-REGISTRATION: Age ≥ 18 years.
- REGISTRATION: Progressive mCRPC as defined: 1) castrate levels of serum testosterone
< 50 ng/dL AND one or more of the following criteria (choose all the apply):
- PSA progression, defined by at least 2 consecutive rising PSA values at a
minimum of 1-week intervals with the most recent PSA value being 2.0 ng/mL or
higher, if confirmed PSA rise is the only indication of progression. Patients
who received an anti-androgen must have PSA progression after withdrawal of
anti-androgen therapy.
- Radiographic progression per RECIST 1.1 criteria for soft tissue lesions
- Bone metastasis progression per Prostate Cancer Working Group 3 (PCWG3)
criteria.
- REGISTRATION: Patients selected to receive lutetium Lu 177 vipivotide tetraxetan
treatment are required to have prostate-specific membrane antigen (PSMA) positive
mCRPC as determined by investigator assessment. For reference, in the VISION trial
this was defined as at least 1 PSMA+ metastatic lesion (defined as uptake greater
than that of liver parenchyma in lesions of any size in any organ system) and no
PSMA- lesions (defined as uptake equal to or lower than that of liver parenchyma in
any lymph node with a short axis of at least 2.5 cm, in any solid organ lesion with
a short axis of at least 1.0 cm, or in any bone lesion with a soft-tissue component
of at least 1.0 cm in the short axis).
- REGISTRATION: Prior treatment with androgen receptor signaling inhibitor (ARSI) in
either the metastatic hormone sensitive setting or mCRPC is required. Prior taxane
therapy in either metastatic hormone sensitive setting or mCRPC is mandated unless
patient is taxane ineligible or the patient refuses taxane therapy. Prior lutetium
LU177 vipivotide tetraxetan treatment is permitted but not mandated. Patients with
known germline or somatic deleterious BRCA 1/2 mutations must have received a prior
PARPi.
- REGISTRATION: Resolved toxicities from previous anticancer therapy, defined as
toxicities (other than alopecia) resolved to Common Terminology Criteria for Adverse
Events (CTCAE) version 5.0, grade ≤ 1 or baseline. Note: Subjects may be enrolled
with chronic, stable grade 2 toxicities (defined as no worsening to > grade 2 for
at least 3 months prior to registration and managed with standard of care treatment)
that the investigator deems related to previous anticancer therapy, comprised of:
- Chemotherapy-induced neuropathy
- Fatigue
- Residual toxicities from prior treatment: Grade 1 or grade 2 endocrinopathies
which may include: Hypothyroidism/hyperthyroidism. type I diabetes,
hyperglycemia, adrenal insufficiency, adrenalitis, skin hypopigmentation
(vitiligo)
- REGISTRATION: No cytotoxic, biologic, radiopharmaceutical or other non-kinase
inhibitor investigational agent within 4 weeks of registration. Treatment with any
type of small molecular kinase inhibitor (including investigational kinase
inhibitor) within 2 weeks of registration. Treatment with abiraterone acetate,
apalutamide, or darolutamide within 2 weeks of registration. Treatment with
enzalutamide within 4 weeks of registration. No treatment with radiation therapy
within 2 weeks of registration.
- REGISTRATION: No major surgery within 4 weeks of registration.
- REGISTRATION: No prior treatment with EZH inhibitors.
- REGISTRATION: Prior treatment with cabazitaxel + carboplatin.
- REGISTRATION: None of the following conditions:
- Current use of moderate or strong cytochrome P450 (CYP)3A inducers.
- Known or suspected hypersensitivity to valemetostat tosylate (DS-3201b) or any
of the excipients.
- For patients with evidence of chronic hepatitis B virus (HBV) infection, the
HBV viral load must be undetectable on suppressive therapy, if indicated.
Patients with a history of hepatitis C virus (HCV) infection must have been
treated and cured. For patients with HCV infection who are currently on
treatment, they are eligible if they have an undetectable HCV viral load.
* HIV-infected patients on effective anti-retroviral therapy with undetectable viral
load within 6 months are eligible for this trial.
- Imminent or established spinal cord compression based on clinical and/or
imaging findings.
- Known brain metastases or cranial epidural disease unless adequately treated
with radiotherapy and/or surgery (including radiosurgery) and stable for at
least 4 weeks prior to registration after radiotherapy or at least 4 weeks
prior to registration after major surgery (e.g., removal or biopsy of brain
metastasis). Patients must have complete wound healing from major surgery or
minor surgery before registration.
- Significant cardiovascular defined as:
- Myocardial infarction within 6 months prior to enrollment.
- Uncontrolled angina pectoris within 6 months prior to enrollment.
- New York Heart Association Class 3 or 4 congestive heart failure.
- Corrected QT interval calculated by the Fridericia's formula (QTcF) ≥ 470
ms per electrocardiogram (ECG) within 42 days before randomization in any
individual with any history of any cardiac disease or medication which can
impact QTcF. Patients with known history or current symptoms of cardiac
disease, history of treatment with cardiotoxic agents, or agents/conditions
known to impact QTcF should have a clinical risk assessment of cardiac function
using the New York Heart Association Functional Classification and ECG.
- Uncontrolled hypertension (resting systolic blood pressure >160 mmHg or
diastolic blood pressure > 100 mmHg).
- Clinically significant acute infection requiring systemic antibacterial,
antifungal or antiviral therapy.
- Moderate to severe hepatic impairment (Child-Pugh Class C)
- REGISTRATION: No freezing or donating sperm ≤ 14 days prior to registration.
- REGISTRATION: Eastern Cooperative Oncology Group (ECOG) performance status 0-2.
- REGISTRATION: No granulocyte colony-stimulating factor (GCSF) within 2 weeks of
registration.
- REGISTRATION: No red blood cell (RBC) transfusions within 2 weeks of registration.
- REGISTRATION: No platelet transfusions within 2 weeks of registration.
- REGISTRATION: No bleeding diathesis.
- REGISTRATION: White blood cell count (WBC) ≥ 2,500/mcL.
- REGISTRATION: Absolute neutrophil count (ANC) ≥ 1,500/mcL.
- REGISTRATION: Hemoglobin ≥ 9 g/dL.
- REGISTRATION: Platelet count ≥ 100,000/mcL.
- REGISTRATION: Creatinine clearance ≥ 30 mL/min as defined by Cockcroft-Gault
equation.
- REGISTRATION: Total bilirubin ≤ 1.5 x ULN (≤ 3 x upper limit of normal [ULN] for
subjects with documented Gilbert's disease).
- REGISTRATION: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤
3 x ULN.
- REGISTRATION: Albumin ≥ 2.8 g/dL.
- REGISTRATION: The A032102 molecular tumor board will review the local pathology
report and molecular sequencing report, and the Alliance registration/randomization
office will relay the assignment to the submitting site. Once the site receives this
assignment, they can register the patient to A032102. Any questions about the
molecular board treatment assignments can be directed to A032102@alliancenctn.org.
- RE-REGISTRATION: Progressive mCRPC (after receiving the tumor board assigned
therapy) as defined: 1) castrate levels of serum testosterone < 50 ng/dL AND 2)
progressive disease defined by radiographic progression on conventional imaging
(CT/MRI chest, abdomen and pelvis and bone scan within 42 days of re-registration).
- RE-REGISTRATION: Resolved toxicities from previous anticancer therapy, defined as
toxicities (other than alopecia) resolved to CTCAE version 5.0, grade ≤ 1 or
baseline. Note: Subjects may be enrolled with chronic, stable grade 2 toxicities
(defined as no worsening to > grade 2 for at least 3 months prior to registration
and managed with standard of care treatment) that the investigator deems related to
previous anticancer therapy, comprised of:
- Chemotherapy-induced neuropathy
- Fatigue
- Residual toxicities from prior treatment: Grade 1 or grade 2 endocrinopathies
which may include: Hypothyroidism/hyperthyroidism. type I diabetes,
hyperglycemia, adrenal insufficiency, adrenalitis, skin hypopigmentation
(vitiligo).
- RE-REGISTRATION: None of the following conditions:
- Imminent or established spinal cord compression based on clinical and/or
imaging findings.
- Known brain metastases or cranial epidural disease unless adequately treated
with radiotherapy and/or surgery (including radiosurgery) and stable for at
least 4 weeks prior to registration after radiotherapy or at least 4 weeks
prior to re-registration after major surgery (e.g., removal or biopsy of brain
metastasis). Patients must have complete wound healing from major surgery or
minor surgery before re-registration.
- Corrected QT interval calculated by the Fridericia's formula (QTcF) <
470 ms per ECG within 42 days before randomization in any individual with any
history of any cardiac disease or medication which can impact QTcF.
- Significant cardiovascular defined as:
- Myocardial infarction within 6 months prior to enrollment.
- Uncontrolled angina pectoris within 6 months prior to enrollment.
- New York Heart Association Class 3 or 4 congestive heart failure.
- Uncontrolled hypertension (resting systolic blood pressure > 160 mmHg or
diastolic blood pressure > 100 mmHg).
- RE-REGISTRATION: ECOG Performance Status 0-2.
- RE-REGISTRATION: No GCSF within 2 weeks of registration.
- RE-REGISTRATION: No RBC transfusions within 2 weeks of registration.
- RE-REGISTRATION: No platelet transfusions within 2 weeks of registration.
- RE-REGISTRATION: WBC ≥ 2,500/mcL.
- RE-REGISTRATION: ANC ≥ 1,500/mcL.
- RE-REGISTRATION: Hemoglobin ≥ 9 g/dL (transfusions permitted).
- RE-REGISTRATION: Platelet count ≥ 100,000/mcL.
- RE-REGISTRATION: Creatinine clearance ≥ 30 mL/min as defined by Cockcroft-Gault
equation.
- RE-REGISTRATION: Total bilirubin ≤ 1.5 x ULN (≤ 3 x ULN for subjects with documented
Gilbert's disease).
- RE-REGISTRATION: AST and ALT ≤ 3 x ULN.
- RE-REGISTRATION: Albumin ≥ 2.8 g/dL.
- RE-REGISTRATION: QT Interval (QTcF) < 470 ms (in individuals with any cardiac
history of any medication or condition known to impact QTcF).
- RE-REGISTRATION: The A032102 molecular tumor board will review the CARIS molecular
sequencing report, the Alliance registration/randomization office will relay the
assignment to the site. Any questions about the molecular board treatment
assignments can be directed to A032102@alliancenctn.org.
Exclusion Criteria:
-
Gender:
All
Minimum age:
18 Years
Maximum age:
N/A
Healthy volunteers:
No
Start date:
October 13, 2024
Completion date:
October 11, 2034
Lead sponsor:
Agency:
Alliance for Clinical Trials in Oncology
Agency class:
Other
Collaborator:
Agency:
National Cancer Institute (NCI)
Agency class:
NIH
Source:
Alliance for Clinical Trials in Oncology
Record processing date:
ClinicalTrials.gov processed this data on November 12, 2024
Source: ClinicalTrials.gov page:
https://clinicaltrials.gov/ct2/show/NCT06632977