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Sirolimus Before Surgery in Treating Patients With Advanced Localized Prostate Cancer

Primary Purpose

Prostate Cancer

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Rapamycin 3mg
Rapamycin 6mg
Radical prostatectomy
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostate Cancer focused on measuring stage III prostate cancer, stage I prostate cancer, stage IIB prostate cancer, stage IIA prostate cancer, adenocarcinoma of the prostate

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)MaleDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically determined adenocarcinoma of the prostate Stage T1c-T3b disease No evidence of disease that has spread beyond the prostate or seminal vesicles No metastatic prostate cancer, including bone, visceral, brain, and lymph node metastases Tumor Gleason score sum of 7-10 (4+3 and 3+4 allowed) with tumor involving at least 2 discrete core biopsy sections Scheduled to undergo radical prostatectomy No other subtypes of prostate cancer, including any of the following: Sarcoma Neuroendocrine tumors Small cell cancer Ductal cancer Lymphoma PATIENT CHARACTERISTICS: ECOG performance status 0-1 WBC > 3,500/mm^3 Absolute neutrophil count > 1,500/mm^3 Platelet count > 100,000/mm^3 Hemoglobin > 9 g/dL Creatinine < 2.0 mg/dL Bilirubin < 2 mg/dL ALT and AST < 2 times upper limit of normal (ULN) Alkaline phosphatase < 2 times ULN Triglycerides and total cholesterol < 2 times ULN No history of allergy to sirolimus (rapamycin) or its derivatives No uncontrolled medical condition that would increase risk or limit compliance with study requirements, including the following: Immunodeficiency Gastrointestinal disease that would limit ability to swallow, take oral medications, or absorb them No active infections No other concurrent malignancy PRIOR CONCURRENT THERAPY: See Disease Characteristics No prior chemotherapy, biologic therapy, radiotherapy, or immunotherapy for prostate cancer No concurrent chronic treatment with immunosuppressants or medications that interfere with the metabolism of sirolimus (rapamycin) No concurrent medication or agents that would interfere with the metabolism or excretion of rapamycin or its derivatives, including any of the following: Phenytoin Carbamazepine Cyclosporine Clarithromycin Clotrimazole Erythromycin Amiodarone Protease inhibitors used to treated HIV infection Cisapride Grapefruit juice Diltiazem Tacrolimus Hypericum perforatum (St. John's wort) Barbiturates Rifampin Phenobarbital Rifabutin Efavirenz Nevirapine At least 7 days since prior herbal medicines and medications, including any of the following: Hydrastis canadensis (goldenseal) Uncaria tomentosa (cat's claw) Echinacea angustifolia roots Trifolium pretense (wild cherry) Chamomile Glycyrrhiza glabra (licorice) Dillapiol Naringenin Norfloxacin Atorvastatin Pravastatin Cimetidine Fluconazole

Sites / Locations

  • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • University of Michigan Comprehensive Cancer Center
  • Duke Comprehensive Cancer Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Experimental

Experimental

Arm Label

Control group

Low-dose Rapamycin (3mg)

High-dose Rapamycin (6mg)

Arm Description

Men >18years old with prostate cancer clinical stages T1c to T3, no metastases, Gleason sum of 7-10, multiple positive diagnostic cores, Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, candidates for radical prostatectomy. Receive no intervention on Days 1-14. Surgery performed on Day 15.

Men >18years old with prostate cancer clinical stages T1c to T3, no metastases, Gleason sum of 7-10, multiple positive diagnostic cores, Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, candidates for radical prostatectomy. Must have adequate hepatic, renal and bone marrow function, no allergy to rapamycins, avoid medications interfering with rapamycin metabolism, no active infection, no prior therapies for prostate cancer. Will receive rapamycin 3mg (Wyeth Pharmaceuticals, 1mg tablets) oral (PO) once daily on Days 1-14 with the last dose given on the morning before surgery (Day 15).

Men >18years old with prostate cancer clinical stages T1c to T3, no metastases, Gleason sum of 7-10, multiple positive diagnostic cores, Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, candidates for radical prostatectomy. Must have adequate hepatic, renal and bone marrow function, no allergy to rapamycins, avoid medications interfering with rapamycin metabolism, no active infection, no prior therapies for prostate cancer. Will receive rapamycin 6mg (Wyeth Pharmaceuticals, 2mg tablets) oral (PO) once daily on Days 1-14 with the last dose given on the morning before surgery (Day 15).

Outcomes

Primary Outcome Measures

Pharmocodynamically Optimal Dose (POD) of Rapamycin as Determined by Number of Participants With Greater Than or Equal to 60% Tumor S6 Kinase Inhibition by Immunohistochemistry (IHC).
Median S6 Kinase Inhibition in Prostate Tumor Tissue at the POD
Pharmacodynamic Response as Assessed by Median Post-treatment S6 Activity H-score
Pharmocodynamic response was taken as ≥60% decrease in the H-score for S6 phosphorylation in the radical prostatectomy tumor tissue compared with the pretreatment (baseline) biopsy tumor tissue. The H-score is a semiquantitative measure of the percentage of cells scoring positive (0-100) multiplied by the intensity of staining (0-3).

Secondary Outcome Measures

Pharmacokinetic Response of Rapamycin 3mg as Assessed by Whole Blood Analysis
Snap-frozen prostate tissue was evaluated for tissue rapamycin levels.
Pharmacokinetic Response of Rapamycin 6mg as Assessed by Whole Blood Analysis
Snap-frozen prostate tissue was evaluated for tissue rapamycin levels.
Number of Participants With Change in Akt Phosphorylation as Measured by Immunohistochemistry (IHC)
Number of participants with change (increased, decreased or no change) in Akt phosphorylation as measured by immunohistochemistry (IHC)
PTEN Loss as Measured by Immunohistochemistry (IHC)
Determine the relationship of PD target inhibition of S6 kinase activity with pretreatment PTEN loss by IHC in prostate cancer.
p27 as Measured by Immunohistochemistry (IHC)
p27 by IHC in prostate cancer.
Change in Gleason Sum
pretreatment biopsy compared to post-treatment radical prostatectomy specimen
Increased Apoptosis as Measured by Activated Caspase 3
Correlate PD efficacy as measured by downstream S6 kinase activity inhibition with markers of increased apoptosis (activated caspase 3) in prostate tumor specimens.
Reduction in Proliferation as Measured by Decrease in Ki-67
Correlate PD efficacy as measured by downstream S6 kinase activity inhibition with markers of reduction in markers of proliferation (change in Ki-67) in prostate tumor specimens.
Toxicity as Per National Cancer Institute Common Toxicity Criteria v3.0
Dose-limiting toxicity was defined as grade 3/4 neutropenia with fever lasting >7 days, platelets of <100,000/mm3 or associated with bleeding, grade ≥3 non-hematologic toxicity, or irreversible grade 2 toxicity related to rapamycine.
Activity of Rapamycin as Measured by Prostate Specific Antigen (PSA) Response Prior to Surgery
PSA response to daily rapamycin

Full Information

First Posted
April 5, 2006
Last Updated
February 19, 2019
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00311623
Brief Title
Sirolimus Before Surgery in Treating Patients With Advanced Localized Prostate Cancer
Official Title
A Pharmacodynamic Study of Pre-Prostatectomy Rapamycin in Men With Advanced Localized Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
February 2019
Overall Recruitment Status
Completed
Study Start Date
August 2006 (Actual)
Primary Completion Date
January 2008 (Actual)
Study Completion Date
June 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy, such as sirolimus, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. PURPOSE: This clinical trial is studying the best dose of sirolimus and to see how well it works before surgery in treating patients with advanced localized prostate cancer.
Detailed Description
OBJECTIVES: Primary Determine the pharmacodynamically optimal dose (POD) of continuous daily oral sirolimus (rapamycin) in patients with advanced localized prostate cancer when given prior to radical prostatectomy, as measured by tumor S6 kinase inhibition by immunohistochemistry (IHC). Determine the proportion of men with downstream target inhibition in prostate tumor tissue at the POD using paired tumor biopsies from before and after rapamycin administration. Correlate tumor pharmacodynamic (PD) efficacy with a surrogate marker of tumor PD efficacy, peripheral blood mononuclear cell (PBMC) S6 kinase activity inhibition. Secondary Characterize the serum and prostate tissue pharmacokinetics of daily oral rapamycin at 2 dose levels. Determine the relationship of PD target inhibition of S6 kinase activity with pretreatment Akt activity and PTEN loss by IHC in prostate cancer. Describe the relationship between PD inhibition with the mTOR inhibitor rapamycin and pretreatment prostate biopsy Gleason sum, Ki-67 index of proliferation, Akt activity, p27 IHC, and PTEN. Correlate PD efficacy as measured by downstream S6 kinase activity inhibition with markers of increased apoptosis (activated caspase 3) and reduction in markers of proliferation (change in Ki-67) in prostate tumor specimens. Quantify and characterize the toxicity of daily continuous rapamycin at 2 dose levels in generally healthy men with prostate cancer prior to surgery. Evaluate the activity of rapamycin in prostate cancer as measured in prostate specific antigen response prior to surgery. OUTLINE: This is a multicenter, dose-escalation study. Patients receive oral sirolimus (rapamycin) once daily on days 1-14 in the absence of unacceptable toxicity. Cohorts of 12-21 patients receive escalating doses of rapamycin until the pharmacodynamically optimal dose is determined. Patients undergo radical prostatectomy on day 15. Patients undergo blood collection and tumor biopsies periodically during study for pharmacologic and correlative biomarker studies. After completion of study treatment, patients are followed at 30 and 90 days. PROJECTED ACCRUAL: A total of 42 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prostate Cancer
Keywords
stage III prostate cancer, stage I prostate cancer, stage IIB prostate cancer, stage IIA prostate cancer, adenocarcinoma of the prostate

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
32 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Control group
Arm Type
Active Comparator
Arm Description
Men >18years old with prostate cancer clinical stages T1c to T3, no metastases, Gleason sum of 7-10, multiple positive diagnostic cores, Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, candidates for radical prostatectomy. Receive no intervention on Days 1-14. Surgery performed on Day 15.
Arm Title
Low-dose Rapamycin (3mg)
Arm Type
Experimental
Arm Description
Men >18years old with prostate cancer clinical stages T1c to T3, no metastases, Gleason sum of 7-10, multiple positive diagnostic cores, Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, candidates for radical prostatectomy. Must have adequate hepatic, renal and bone marrow function, no allergy to rapamycins, avoid medications interfering with rapamycin metabolism, no active infection, no prior therapies for prostate cancer. Will receive rapamycin 3mg (Wyeth Pharmaceuticals, 1mg tablets) oral (PO) once daily on Days 1-14 with the last dose given on the morning before surgery (Day 15).
Arm Title
High-dose Rapamycin (6mg)
Arm Type
Experimental
Arm Description
Men >18years old with prostate cancer clinical stages T1c to T3, no metastases, Gleason sum of 7-10, multiple positive diagnostic cores, Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, candidates for radical prostatectomy. Must have adequate hepatic, renal and bone marrow function, no allergy to rapamycins, avoid medications interfering with rapamycin metabolism, no active infection, no prior therapies for prostate cancer. Will receive rapamycin 6mg (Wyeth Pharmaceuticals, 2mg tablets) oral (PO) once daily on Days 1-14 with the last dose given on the morning before surgery (Day 15).
Intervention Type
Drug
Intervention Name(s)
Rapamycin 3mg
Other Intervention Name(s)
sirolimus
Intervention Description
Rapamycin 3mg (Wyeth Pharmaceuticals, 1mg tablets) PO once daily on Days 1-14 with the last dose given on the morning before surgery (Day 15).
Intervention Type
Drug
Intervention Name(s)
Rapamycin 6mg
Other Intervention Name(s)
sirolimus
Intervention Description
Rapamycin 6mg (Wyeth Pharmaceuticals, 2mg tablets) PO once daily on Days 1-14 with the last dose given on the morning before surgery (Day 15).
Intervention Type
Procedure
Intervention Name(s)
Radical prostatectomy
Intervention Description
Radical prostatectomy performed on Day 15
Primary Outcome Measure Information:
Title
Pharmocodynamically Optimal Dose (POD) of Rapamycin as Determined by Number of Participants With Greater Than or Equal to 60% Tumor S6 Kinase Inhibition by Immunohistochemistry (IHC).
Time Frame
Day 15 post-intervention
Title
Median S6 Kinase Inhibition in Prostate Tumor Tissue at the POD
Time Frame
Change from baseline to 15 days post-intervention
Title
Pharmacodynamic Response as Assessed by Median Post-treatment S6 Activity H-score
Description
Pharmocodynamic response was taken as ≥60% decrease in the H-score for S6 phosphorylation in the radical prostatectomy tumor tissue compared with the pretreatment (baseline) biopsy tumor tissue. The H-score is a semiquantitative measure of the percentage of cells scoring positive (0-100) multiplied by the intensity of staining (0-3).
Time Frame
Change from baseline to 15 days post-intervention
Secondary Outcome Measure Information:
Title
Pharmacokinetic Response of Rapamycin 3mg as Assessed by Whole Blood Analysis
Description
Snap-frozen prostate tissue was evaluated for tissue rapamycin levels.
Time Frame
Change from baseline to 15 days post-intervention
Title
Pharmacokinetic Response of Rapamycin 6mg as Assessed by Whole Blood Analysis
Description
Snap-frozen prostate tissue was evaluated for tissue rapamycin levels.
Time Frame
Change from baseline to 15 days post-intervention
Title
Number of Participants With Change in Akt Phosphorylation as Measured by Immunohistochemistry (IHC)
Description
Number of participants with change (increased, decreased or no change) in Akt phosphorylation as measured by immunohistochemistry (IHC)
Time Frame
Change from baseline to 15 days post-intervention
Title
PTEN Loss as Measured by Immunohistochemistry (IHC)
Description
Determine the relationship of PD target inhibition of S6 kinase activity with pretreatment PTEN loss by IHC in prostate cancer.
Time Frame
Change from baseline to 15 days post-intervention
Title
p27 as Measured by Immunohistochemistry (IHC)
Description
p27 by IHC in prostate cancer.
Time Frame
Change from baseline to 15 days post-intervention
Title
Change in Gleason Sum
Description
pretreatment biopsy compared to post-treatment radical prostatectomy specimen
Time Frame
Change from baseline to 15 days post-intervention
Title
Increased Apoptosis as Measured by Activated Caspase 3
Description
Correlate PD efficacy as measured by downstream S6 kinase activity inhibition with markers of increased apoptosis (activated caspase 3) in prostate tumor specimens.
Time Frame
Baseline, 14 days post-intervention, 90-days post-operative
Title
Reduction in Proliferation as Measured by Decrease in Ki-67
Description
Correlate PD efficacy as measured by downstream S6 kinase activity inhibition with markers of reduction in markers of proliferation (change in Ki-67) in prostate tumor specimens.
Time Frame
Baseline, 14 days post-intervention, 90-days post-operative
Title
Toxicity as Per National Cancer Institute Common Toxicity Criteria v3.0
Description
Dose-limiting toxicity was defined as grade 3/4 neutropenia with fever lasting >7 days, platelets of <100,000/mm3 or associated with bleeding, grade ≥3 non-hematologic toxicity, or irreversible grade 2 toxicity related to rapamycine.
Time Frame
Baseline, 14 days post-intervention, 90-days post-operative
Title
Activity of Rapamycin as Measured by Prostate Specific Antigen (PSA) Response Prior to Surgery
Description
PSA response to daily rapamycin
Time Frame
Change from baseline to Day 14

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically determined adenocarcinoma of the prostate Stage T1c-T3b disease No evidence of disease that has spread beyond the prostate or seminal vesicles No metastatic prostate cancer, including bone, visceral, brain, and lymph node metastases Tumor Gleason score sum of 7-10 (4+3 and 3+4 allowed) with tumor involving at least 2 discrete core biopsy sections Scheduled to undergo radical prostatectomy No other subtypes of prostate cancer, including any of the following: Sarcoma Neuroendocrine tumors Small cell cancer Ductal cancer Lymphoma PATIENT CHARACTERISTICS: ECOG performance status 0-1 WBC > 3,500/mm^3 Absolute neutrophil count > 1,500/mm^3 Platelet count > 100,000/mm^3 Hemoglobin > 9 g/dL Creatinine < 2.0 mg/dL Bilirubin < 2 mg/dL ALT and AST < 2 times upper limit of normal (ULN) Alkaline phosphatase < 2 times ULN Triglycerides and total cholesterol < 2 times ULN No history of allergy to sirolimus (rapamycin) or its derivatives No uncontrolled medical condition that would increase risk or limit compliance with study requirements, including the following: Immunodeficiency Gastrointestinal disease that would limit ability to swallow, take oral medications, or absorb them No active infections No other concurrent malignancy PRIOR CONCURRENT THERAPY: See Disease Characteristics No prior chemotherapy, biologic therapy, radiotherapy, or immunotherapy for prostate cancer No concurrent chronic treatment with immunosuppressants or medications that interfere with the metabolism of sirolimus (rapamycin) No concurrent medication or agents that would interfere with the metabolism or excretion of rapamycin or its derivatives, including any of the following: Phenytoin Carbamazepine Cyclosporine Clarithromycin Clotrimazole Erythromycin Amiodarone Protease inhibitors used to treated HIV infection Cisapride Grapefruit juice Diltiazem Tacrolimus Hypericum perforatum (St. John's wort) Barbiturates Rifampin Phenobarbital Rifabutin Efavirenz Nevirapine At least 7 days since prior herbal medicines and medications, including any of the following: Hydrastis canadensis (goldenseal) Uncaria tomentosa (cat's claw) Echinacea angustifolia roots Trifolium pretense (wild cherry) Chamomile Glycyrrhiza glabra (licorice) Dillapiol Naringenin Norfloxacin Atorvastatin Pravastatin Cimetidine Fluconazole
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael A. Carducci, MD
Organizational Affiliation
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21231
Country
United States
Facility Name
University of Michigan Comprehensive Cancer Center
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48109-0942
Country
United States
Facility Name
Duke Comprehensive Cancer Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20501622
Citation
Armstrong AJ, Netto GJ, Rudek MA, Halabi S, Wood DP, Creel PA, Mundy K, Davis SL, Wang T, Albadine R, Schultz L, Partin AW, Jimeno A, Fedor H, Febbo PG, George DJ, Gurganus R, De Marzo AM, Carducci MA. A pharmacodynamic study of rapamycin in men with intermediate- to high-risk localized prostate cancer. Clin Cancer Res. 2010 Jun 1;16(11):3057-66. doi: 10.1158/1078-0432.CCR-10-0124. Epub 2010 May 25.
Results Reference
result

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Sirolimus Before Surgery in Treating Patients With Advanced Localized Prostate Cancer

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