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Pemetrexed as Second-Line Therapy in Treating Patients With Hormone Refractory Prostate Cancer

Primary Purpose

Prostate Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Pemetrexed
Folic Acid
Vitamin B12
Sponsored by
Christopher Sweeney, MBBS
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostate Cancer focused on measuring Prostate Cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria: Histologically documented adenocarcinoma of the prostate Clinically refractory or resistant to hormone therapy as assessed by progression following at least one hormonal therapy (orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist) One prior taxane based chemotherapy regimen for HRPC Documented progression of disease after one taxane based prior chemotherapy regimen for HRPC. Progression is defined as at least one of the following: An increase in PSA > 50% over nadir value on prior Taxane-based therapy Progression of measurable disease as defined by RECIST Progression of bone disease as defined by the appearance of one or more new bone lesions or worsening symptoms Orchiectomy or testosterone levels < 50 ng/dL maintained by LHRH agonist Prior chemotherapy, or other experimental anticancer agents must be completed > 4 weeks prior to being registered for protocol therapy Palliative radiotherapy must be completed at least 14 days prior to registration. Exclusion Criteria: Intravenous radio-isotopes therapy must be completed at least 6 weeks prior to registration No brain metastasis that are untreated and/or not controlled and/or still requiring corticosteroids No history of other malignancies within 5 years prior to being registered for protocol therapy, except for adequately treated basal or squamous cell skin cancer No history of uncontrolled psychiatric illness or serious systemic disease, including active infection, uncontrolled hypertension No surgery or significant traumatic injury within 21 days prior to being registered for protocol therapy Patients must be willing to interrupt aspirin or other non-steroidal anti-inflammatory agents for a 5-day period (8 day period for long acting agents such as piroxicam) Patients must be willing to take folic acid or vitamin B12 supplementation

Sites / Locations

  • Medical & Surgical Specialists, LLC
  • Elkhart Clinic
  • Fort Wayne Oncology & Hematology, Inc
  • Indiana University Cancer Center
  • Quality Cancer Center (MCGOP)
  • Community Regional Cancer Center
  • Arnett Cancer Care
  • Medical Consultants, P.C.
  • Northern Indiana Cancer Research Consortium
  • AP&S Clinic
  • Center for Hematology/Oncology of S. Michigan
  • Methodist Cancer Center
  • Hematology Oncology Associates S.J., P.A.
  • Consultants in Medical Oncology & Hematology
  • Pennsylvania Oncology-Hematology Associates

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Investigational Treatment

Arm Description

Pemetrexed 500 mg/m2 IV over 10 minutes, day 1 of 21-day cycle Oral Folic Acid, once per day for 7 days preceding pemetrexed dose, continued daily, and for 21 days after the last dose of pemetrexed. Vitamin B12, 1000ug intramuscular injection 7 days preceding pemetrexed dose, and every three cycles thereafter on the same day of pemetrexed administration

Outcomes

Primary Outcome Measures

Best Overall PSA Response
Best overall Prostate-Specific Antigen (PSA) response PSA response is defined by a greater than or equal to 50% decline in PSA confirmed by a second PSA value at least 4 weeks after the first PSA response timepoint PSA Stable Disease is defined as less than a 50% decline in PSA and less than a 50% increase in PSA from baseline PSA progression is defined as greater than or equal to a 50% increase in PSA compared to baseline

Secondary Outcome Measures

Overall Survival
OBJECTIVE Overall Response Rate
Response Evaluation Criteria in Solid Tumors (RECIST). Objective overall response rate is defined as Complete Response (CR) + Partial Response (PR) Per RECIST: CR= Disappearance of all target and non-target lesions and normalization of tumor marker level PR= Disappearance of all target lesions and persistence of non-target lesion(s) or maintenance of tumor marker level above normal limits OR at least a 30% decrease in the sum of the longest diameter, taking as reference the baseline sum longest diameter and disappearance of all non-target lesions or persistence of non-target lesion(s) or maintenance of tumor marker level above normal limits
Rate of Clinical Benefit
A clinical benefit is defined as an improvement for at least 3 consecutive weeks in at least one of the following parameters without any sustained worsening in any other: > 50% reduction in analgesic consumption or > 50% reduction in pain intensity or > 20 point gain in performance status.
Safety and Tolerability
Safety and Tolerability was evaluated by reporting the percentage of patient who experienced grade 3 or 4 toxicities using Common Terminology Criteria for Adverse Events CTCAE v3.0 criteria. CTCAE grades the severity of an adverse event from 1-5 where 1=least severe and 5=death.
RFC1 G80A Genotype
Samples for RFC1 G80A pharmacogenetic analysis were collected at screening
Time to Progression
Progression per Response Evaluation Criteria in Solid Tumors (RECIST) or Prostate-Specific Antigen (PSA) Progression RECIST PD=at least a 20% increase in the sum of the longest diameter (LD) of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions or Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions PSA progression=increase in PSA to >50% above lowest level recorded on study. Two consecutive increases required at least 4 weeks apart, but time to progression will be determined at time of first PSA showing increase > 50% above baseline *Note, upper confidence interval was not reached*
Time to Prostate-Specific Antigen (PSA)/Serological Progression
Serological Progression (sPD) - increase in PSA to >50% above lowest level recorded on study. Two consecutive increases required at least 4 weeks apart, but time to progression will be determined at time of first PSA showing increase > 50% above baseline

Full Information

First Posted
September 12, 2005
Last Updated
June 18, 2016
Sponsor
Christopher Sweeney, MBBS
Collaborators
Eli Lilly and Company, Walther Cancer Institute
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1. Study Identification

Unique Protocol Identification Number
NCT00216099
Brief Title
Pemetrexed as Second-Line Therapy in Treating Patients With Hormone Refractory Prostate Cancer
Official Title
A Phase II Study of Pemetrexed (Alimta) as Second-Line Therapy for Hormone Refractory Prostate Cancer: Hoosier Oncology Group GU03-67
Study Type
Interventional

2. Study Status

Record Verification Date
June 2016
Overall Recruitment Status
Completed
Study Start Date
February 2005 (undefined)
Primary Completion Date
March 2009 (Actual)
Study Completion Date
March 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Christopher Sweeney, MBBS
Collaborators
Eli Lilly and Company, Walther Cancer Institute

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Docetaxel-based therapy has been shown to prolong survival as first-line therapy for patients with hormone refractory prostate cancer (HRPC), and has become the standard of care. The beneficial effects of any therapy in HRPC may be diverse and include reduction in tumor bulk (when measurable), reduction in prostate-specific antigen PSA, reduction in symptoms (particularly pain), or stabilization of disease. Clear reductions in tumor bulk or PSA may provide objective evidence of a treatment effect, and stabilization of disease may be just as clinically meaningful in patients who are actively progressing prior to starting therapy. Pemetrexed has shown a broad array of activity in many diseases that until now were thought to be non-responsive to chemotherapy in the second-line setting. This trial is designed to further assess the efficacy, safety, tolerability, and pharmacogenetics of pemetrexed as a single agent in subjects with HRPC whose disease has progressed following one prior taxane-based chemotherapy regimen for HRPC.
Detailed Description
OUTLINE: This is a multi-center study. Pemetrexed 500mg/m2 will be administered intravenously over approximately 10-minutes on Day 1 of a 21-day cycle. Folic Acid (350-1000 mcg. PO daily) will be taken by patients to reduce toxicity. At least 5 daily doses of folic acid must be taken during the 7-day period preceding the first dose of pemetrexed, and dosing should continue during the full course of therapy and for 21 days after the last dose of pemetrexed. Vitamin B12 (1000 µg) will be administered as an intramuscular injection during the week preceding the first dose of pemetrexed and every 3 cycles thereafter. Subsequent vitamin B12 injections may be given the same day as pemetrexed. Performance Status: Karnofsky Performance Status 70-100 Life expectancy > 12 weeks Hematopoietic: Absolute Neutrophil Count (ANC) > 1500/mm3 Platelet count > 100,000/mm3 Hemoglobin > 9 g/dL Hepatic: Bilirubin < 1.5 X upper limit of normal (unless due to Gilbert's disease) Alkaline phosphatase and Alanine Transanimase (ALT) (SGPT) < 3 X upper limit of normal (ULN); may be < 5 X ULN for patients with liver metastases. Alkaline phosphatase may be any value for patients with bone metastases. Renal: Calculated creatinine clearance >45 mL/min based on the standard Cockroft and Gault formula Cardiovascular: No congestive heart failure requiring therapy or New York Heart Association (NYHA) class II or greater or active angina or known myocardial infarction within 12 months prior to study No unstable angina, uncontrolled congestive heart failure, or unstable symptomatic arrhythmia requiring medication within 6 months prior to being registered for protocol therapy Subjects with chronic atrial arrhythmia, i.e., atrial fibrillation, paroxysmal supraventricular tachycardia, or controlled hypertension are eligible Pulmonary: Not specified

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prostate Cancer
Keywords
Prostate Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
49 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Investigational Treatment
Arm Type
Experimental
Arm Description
Pemetrexed 500 mg/m2 IV over 10 minutes, day 1 of 21-day cycle Oral Folic Acid, once per day for 7 days preceding pemetrexed dose, continued daily, and for 21 days after the last dose of pemetrexed. Vitamin B12, 1000ug intramuscular injection 7 days preceding pemetrexed dose, and every three cycles thereafter on the same day of pemetrexed administration
Intervention Type
Drug
Intervention Name(s)
Pemetrexed
Other Intervention Name(s)
Alimta
Intervention Description
Pemetrexed 500 mg/m2 IV over 10 minutes, day 1 of 21-day cycle
Intervention Type
Dietary Supplement
Intervention Name(s)
Folic Acid
Intervention Description
All participants received oral Folic Acid 350-100ug once per day for 7 days preceding the first pemetrexed dose and continuing throughout the study and and for 21 days after the last dose of pemetrexed.
Intervention Type
Dietary Supplement
Intervention Name(s)
Vitamin B12
Intervention Description
All patients received vitamin B12 1000ug intramuscular injection the week preceding the first pemetrexed dose and received additional 1000ug intramuscular injections every three cycles thereafter on the same day of pemetrexed administration.
Primary Outcome Measure Information:
Title
Best Overall PSA Response
Description
Best overall Prostate-Specific Antigen (PSA) response PSA response is defined by a greater than or equal to 50% decline in PSA confirmed by a second PSA value at least 4 weeks after the first PSA response timepoint PSA Stable Disease is defined as less than a 50% decline in PSA and less than a 50% increase in PSA from baseline PSA progression is defined as greater than or equal to a 50% increase in PSA compared to baseline
Time Frame
Start of treatment until disease progression/recurrence (for life)
Secondary Outcome Measure Information:
Title
Overall Survival
Time Frame
From study enrollment until death (for life)
Title
OBJECTIVE Overall Response Rate
Description
Response Evaluation Criteria in Solid Tumors (RECIST). Objective overall response rate is defined as Complete Response (CR) + Partial Response (PR) Per RECIST: CR= Disappearance of all target and non-target lesions and normalization of tumor marker level PR= Disappearance of all target lesions and persistence of non-target lesion(s) or maintenance of tumor marker level above normal limits OR at least a 30% decrease in the sum of the longest diameter, taking as reference the baseline sum longest diameter and disappearance of all non-target lesions or persistence of non-target lesion(s) or maintenance of tumor marker level above normal limits
Time Frame
Start of treatment until disease progression/recurrence (for life)
Title
Rate of Clinical Benefit
Description
A clinical benefit is defined as an improvement for at least 3 consecutive weeks in at least one of the following parameters without any sustained worsening in any other: > 50% reduction in analgesic consumption or > 50% reduction in pain intensity or > 20 point gain in performance status.
Time Frame
Any time among evaluable subjects (for life)
Title
Safety and Tolerability
Description
Safety and Tolerability was evaluated by reporting the percentage of patient who experienced grade 3 or 4 toxicities using Common Terminology Criteria for Adverse Events CTCAE v3.0 criteria. CTCAE grades the severity of an adverse event from 1-5 where 1=least severe and 5=death.
Time Frame
18 months
Title
RFC1 G80A Genotype
Description
Samples for RFC1 G80A pharmacogenetic analysis were collected at screening
Time Frame
Screening
Title
Time to Progression
Description
Progression per Response Evaluation Criteria in Solid Tumors (RECIST) or Prostate-Specific Antigen (PSA) Progression RECIST PD=at least a 20% increase in the sum of the longest diameter (LD) of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions or Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions PSA progression=increase in PSA to >50% above lowest level recorded on study. Two consecutive increases required at least 4 weeks apart, but time to progression will be determined at time of first PSA showing increase > 50% above baseline *Note, upper confidence interval was not reached*
Time Frame
Study enrollment until progression per RECIST or PSA (for life)
Title
Time to Prostate-Specific Antigen (PSA)/Serological Progression
Description
Serological Progression (sPD) - increase in PSA to >50% above lowest level recorded on study. Two consecutive increases required at least 4 weeks apart, but time to progression will be determined at time of first PSA showing increase > 50% above baseline
Time Frame
From study enrollment to progression per PSA criteria (for life)

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically documented adenocarcinoma of the prostate Clinically refractory or resistant to hormone therapy as assessed by progression following at least one hormonal therapy (orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist) One prior taxane based chemotherapy regimen for HRPC Documented progression of disease after one taxane based prior chemotherapy regimen for HRPC. Progression is defined as at least one of the following: An increase in PSA > 50% over nadir value on prior Taxane-based therapy Progression of measurable disease as defined by RECIST Progression of bone disease as defined by the appearance of one or more new bone lesions or worsening symptoms Orchiectomy or testosterone levels < 50 ng/dL maintained by LHRH agonist Prior chemotherapy, or other experimental anticancer agents must be completed > 4 weeks prior to being registered for protocol therapy Palliative radiotherapy must be completed at least 14 days prior to registration. Exclusion Criteria: Intravenous radio-isotopes therapy must be completed at least 6 weeks prior to registration No brain metastasis that are untreated and/or not controlled and/or still requiring corticosteroids No history of other malignancies within 5 years prior to being registered for protocol therapy, except for adequately treated basal or squamous cell skin cancer No history of uncontrolled psychiatric illness or serious systemic disease, including active infection, uncontrolled hypertension No surgery or significant traumatic injury within 21 days prior to being registered for protocol therapy Patients must be willing to interrupt aspirin or other non-steroidal anti-inflammatory agents for a 5-day period (8 day period for long acting agents such as piroxicam) Patients must be willing to take folic acid or vitamin B12 supplementation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christopher Sweeney, M.B.B.S.
Organizational Affiliation
Hoosier Oncology Group, LLC
Official's Role
Study Chair
Facility Information:
Facility Name
Medical & Surgical Specialists, LLC
City
Galesburg
State/Province
Illinois
ZIP/Postal Code
61401
Country
United States
Facility Name
Elkhart Clinic
City
Elkhart
State/Province
Indiana
ZIP/Postal Code
46515
Country
United States
Facility Name
Fort Wayne Oncology & Hematology, Inc
City
Fort Wayne
State/Province
Indiana
ZIP/Postal Code
46815
Country
United States
Facility Name
Indiana University Cancer Center
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
Quality Cancer Center (MCGOP)
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
Community Regional Cancer Center
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46256
Country
United States
Facility Name
Arnett Cancer Care
City
Lafayette
State/Province
Indiana
ZIP/Postal Code
47904
Country
United States
Facility Name
Medical Consultants, P.C.
City
Muncie
State/Province
Indiana
ZIP/Postal Code
47303
Country
United States
Facility Name
Northern Indiana Cancer Research Consortium
City
South Bend
State/Province
Indiana
ZIP/Postal Code
46601
Country
United States
Facility Name
AP&S Clinic
City
Terre Haute
State/Province
Indiana
ZIP/Postal Code
47804
Country
United States
Facility Name
Center for Hematology/Oncology of S. Michigan
City
Jackson
State/Province
Michigan
ZIP/Postal Code
49201
Country
United States
Facility Name
Methodist Cancer Center
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68114
Country
United States
Facility Name
Hematology Oncology Associates S.J., P.A.
City
Mt. Holly
State/Province
New Jersey
ZIP/Postal Code
08060
Country
United States
Facility Name
Consultants in Medical Oncology & Hematology
City
Drexel Hill
State/Province
Pennsylvania
ZIP/Postal Code
19026
Country
United States
Facility Name
Pennsylvania Oncology-Hematology Associates
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19106
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
19605506
Citation
Hahn NM, Zon RT, Yu M, Ademuyiwa FO, Jones T, Dugan W, Whalen C, Shanmugam R, Skaar T, Sweeney CJ. A phase II study of pemetrexed as second-line chemotherapy for the treatment of metastatic castrate-resistant prostate cancer (CRPC); Hoosier Oncology Group GU03-67. Ann Oncol. 2009 Dec;20(12):1971-6. doi: 10.1093/annonc/mdp244. Epub 2009 Jul 15.
Results Reference
result
Links:
URL
http://hoosieroncologygroup.org/
Description
Hoosier Oncology Group Home Page

Learn more about this trial

Pemetrexed as Second-Line Therapy in Treating Patients With Hormone Refractory Prostate Cancer

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