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Randomized Trial of Suicide Gene Therapy and Prostate Cancer (ReCAP)

Primary Purpose

Prostate Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Ad5-yCD/mutTKSR39rep-ADP
IMRT
Sponsored by
Henry Ford Health System
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostate Cancer focused on measuring Prostatic Neoplasms, Prostate Cancer, Adenocarinomas, Tumors of the Prostate, Gene Therapy, IMRT

Eligibility Criteria

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

Inclusion Criteria:

  • Men with histologically-confirmed adenocarcinoma of the prostate within 180 days prior to registration. To be eligible, the subjects must have one of the following conditions:

    • Stage T1 or T2, Gleason Score 7, PSA <= 20 ng/mL, Any number positive biopsy cores
    • Stage T1 or T2, Gleason Score 5 or 6, PSA >=10 ng/mL and <20 ng/mL, Any number positive biopsy cores
    • Stage T1 or T2, Gleason Score 5 or 6, PSA <10 ng/mL and >=50% positive biopsy cores
  • Negative lymph nodes as established by imaging, nodal sampling, or dissection within 90 days prior to registration.
  • No evidence of metastatic disease as evaluated by bone scan and CT scan of the abdomen and pelvis within 90 days prior to registration
  • Karnofsky performance status >=70
  • Subjects must have adequate baseline organ function, as assessed by the following laboratory values, within 30 days before initiating the study
  • Adequate renal function with serum creatinine <=1.5 mg/dL or creatinine clearance >=45 mL/min/m2.
  • Platelet count > 100,000/μL.
  • Absolute neutrophil count > 1,000/μL.
  • Hemoglobin > 10.0 g/dL.
  • Normal partial thromboplastin time (PTT) and prothrombin (PT).
  • Bilirubin < 1.5 mg/dL; SGOT and SGPT < 2.5 times upper limit of normal (ULN).
  • Men of child-producing potential must be willing to consent to use effective contraception while on treatment and for at least 3 months afterwards.
  • Subjects must possess the ability to give informed consent and express a willingness to meet all of the expected requirements of the protocol for the duration of the study.

Exclusion Criteria:

Subjects with the following conditions will be excluded from the study:

  • Stage >= T3.
  • Prostate specific antigen (PSA) > 20 ng/mL.
  • Gleason score >= 8.
  • Prostate volume >120cc.
  • Pathologically positive lymph nodes or nodes > 1.5 cm on imaging. Note: nodes > 1.5 cm but biopsy negative are allowed.
  • Evidence of M1 metastatic disease.
  • Prior invasive malignancy except for non-melanoma skin cancer within 5 years of enrollment.
  • Prognosis for survival of < 5 years.
  • Prior radical prostatectomy, cryosurgery for prostate cancer, or bilateral orchiectomy for any reason.
  • Prior radiotherapy, including brachytherapy, to the region of the study cancer that would result in overlap of radiation fields.
  • Prior or planned androgen suppression therapy or prior systemic chemotherapy for the study cancer. Note that prior chemotherapy for a different cancer is allowed; however, patients must be >2 years post-completion of chemotherapy at time of registration. Patients on Proscar therapy must stop to be eligible.
  • Severe, active co-morbidity defined as:
  • Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months.
  • Transmural myocardial infarction within the last 6 months.
  • Acute infection. Acute infection is defined by any viral, bacterial, or fungal infection that requires specific therapy within 72 hours of initiation of the study therapy.
  • Positive serological test for HIV at baseline.
  • Previous history of liver disease including hepatitis.
  • Immunosuppressive therapy including systemic corticosteroids. Use of inhaled and topical corticosteroids is permitted.
  • Impaired immunity or susceptibility to serious viral infections.
  • Allergy to any product used in the protocol. (If the subject has an allergy to Ciprofloxacin, another antibiotic can be substituted at the discretion of the treating physician.
  • Serious medical or psychiatric illness or concomitant medication, which, in the judgment of the principal investigator, might interfere with the subject's ability to respond to or tolerate the treatment or complete the trial.

Sites / Locations

  • Johns Hopkins University School of Medicine
  • Henry Ford Health System

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Ad5-yCD/mutTKSR39rep-ADP + IMRT

IMRT Alone

Arm Description

Gene Therapy + IMRT

IMRT: 40 x 2 Gy for a total dose of 80 Gy or 44 x 1.8 Gy for a total dose of 79.2 Gy

Outcomes

Primary Outcome Measures

Freedom From Biochemical/Clinical Failure (FFF)
Biochemical/Clinical Failure was defined as PSA nadir plus 2 ng/mL

Secondary Outcome Measures

Acute >= Grade 3 Treatment-related Toxicity
This metric includes both expected and unexpected events Toxicities were graded using the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 3
Positive Prostate Biopsy at 2 Years
Freedom From Distant Metastases
Disease-specific Survival
Decrease in Quality of Life
Quality of Life was measured using the comprehensive Expanded Prostate Cancer Index Composite (EPIC) instrument 19 and 20

Full Information

First Posted
December 20, 2007
Last Updated
February 18, 2016
Sponsor
Henry Ford Health System
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1. Study Identification

Unique Protocol Identification Number
NCT00583492
Brief Title
Randomized Trial of Suicide Gene Therapy and Prostate Cancer
Acronym
ReCAP
Official Title
A Randomized, Controlled Trial of Replication-Competent Adenovirus-Mediated Suicide Gene Therapy in Combination With IMRT Versus IMRT Alone for the Treatment of Newly-Diagnosed Prostate Cancer With an Intermediate Risk Profile
Study Type
Interventional

2. Study Status

Record Verification Date
February 2016
Overall Recruitment Status
Completed
Study Start Date
December 2007 (undefined)
Primary Completion Date
September 2013 (Actual)
Study Completion Date
September 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Henry Ford Health System

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a randomized, controlled trial that will test the hypothesis that replication-competent adenovirus-mediated suicide gene therapy in combination with 80 Gy intensity modulated radiotherapy (IRMT)will improve freedom from failure (FFF) relative to 80 Gy IMRT alone in patients with newly-diagnosed prostate cancer with an intermediate-risk profile.
Detailed Description
OBJECTIVES This is a randomized, controlled trial that will test the hypothesis that replication-competent adenovirus-mediated suicide gene therapy in combination with 80 Gy intensity modulated radiotherapy (IRMT)will improve freedom from failure (FFF) relative to 80 Gy IMRT alone in patients with newly-diagnosed prostate cancer with an intermediate-risk profile. The trial contains two treatment arms: Arm 1- Gene Therapy + IMRT Arm 2- IMRT The study will be stratified by clinical site and pre-treatment risk factors (e.g., % positive biopsy cores, Gleason score. Gleason score 5/6 AND PSA <10 ng/mL; AND >=50% positive biopsy cores (Gleason score 5/6 and PSA 10-20 ng/mL) OR (Gleason score 7 and PSA 0 - 20 ng/mL); AND <50% positive biopsy cores Gleason score 5/6 and PSA 10-20 ng/mL) OR (Gleason score 7 and PSA 0-20 ng/mL) AND >=50% positive biopsy cores. An interim safety analysis (Interim Analysis 1) will be conducted after the first 21 patients in the investigational therapy arm, and a total of 42 subjects in both arms, have completed the 90 day toxicity assessment following randomization (phase 2 component). If, at this point, there are no safety concerns as determined by the Data and Safety Monitoring Board (DSMB), the trial will continue as a phase 3 study with two additional interim analyses (Interim Analyses 2 & 3). The primary analysis for treatment efficacy will be based on all randomized subjects. Primary To assess the relative efficacy of replication-competent adenovirus-mediated suicide gene therapy in combination with 80 Gy intensity modulated radiotherapy (IMRT) versus 80 Gy IMRT alone in patients with newly-diagnosed prostate cancer with an intermediate-risk profile. The primary endpoint is freedom from failure (FFF) (biochemical or clinical). Secondary To assess the difference between the two treatment arms for: Acute (<= 90 days) and long-term (> 90 days) toxicity. Prostate biopsy status (12 cores) at 2 years. Freedom from distant metastases. Disease-specific and overall survival. Quality of life. Exploratory To examine: Possible effect of gene therapy on PSA doubling time (PSADT) after PSA failure. Possible association between the primary and secondary outcomes and Ad5-yCD/mutTKSR39rep-ADP adenovirus persistence (as measured by adenoviral DNA in blood). Possible association between the primary and secondary outcomes and specific immunological endpoints including levels of circulating CD4+ and CD8+ T lymphocytes, T-cell proliferation response, cytotoxic T lymphocyte (CTL) response, and development of antibodies to prostate-specific antigens.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prostate Cancer
Keywords
Prostatic Neoplasms, Prostate Cancer, Adenocarinomas, Tumors of the Prostate, Gene Therapy, IMRT

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
44 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ad5-yCD/mutTKSR39rep-ADP + IMRT
Arm Type
Experimental
Arm Description
Gene Therapy + IMRT
Arm Title
IMRT Alone
Arm Type
Active Comparator
Arm Description
IMRT: 40 x 2 Gy for a total dose of 80 Gy or 44 x 1.8 Gy for a total dose of 79.2 Gy
Intervention Type
Biological
Intervention Name(s)
Ad5-yCD/mutTKSR39rep-ADP
Intervention Description
Ad5-yCD/mutTKSR39rep-ADP (1 x 10^12 vp) on day 1 Plus Radiation - 40 x 2 Gy for a total dose of 80 Gy or 44 x 1.8 Gy for a total dose of 79.2 Gy Plus 2 week course (weekdays only) of 5-FC and vGCV prodrug therapy
Intervention Type
Radiation
Intervention Name(s)
IMRT
Intervention Description
40 x 2 Gy for a total dose of 80 Gy or 44 x 1.8 Gy for a total dose of 79.2 Gy
Primary Outcome Measure Information:
Title
Freedom From Biochemical/Clinical Failure (FFF)
Description
Biochemical/Clinical Failure was defined as PSA nadir plus 2 ng/mL
Time Frame
5 years
Secondary Outcome Measure Information:
Title
Acute >= Grade 3 Treatment-related Toxicity
Description
This metric includes both expected and unexpected events Toxicities were graded using the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 3
Time Frame
90 days
Title
Positive Prostate Biopsy at 2 Years
Time Frame
2 years
Title
Freedom From Distant Metastases
Time Frame
10 years
Title
Disease-specific Survival
Time Frame
10 years
Title
Decrease in Quality of Life
Description
Quality of Life was measured using the comprehensive Expanded Prostate Cancer Index Composite (EPIC) instrument 19 and 20
Time Frame
3 years

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men with histologically-confirmed adenocarcinoma of the prostate within 180 days prior to registration. To be eligible, the subjects must have one of the following conditions: Stage T1 or T2, Gleason Score 7, PSA <= 20 ng/mL, Any number positive biopsy cores Stage T1 or T2, Gleason Score 5 or 6, PSA >=10 ng/mL and <20 ng/mL, Any number positive biopsy cores Stage T1 or T2, Gleason Score 5 or 6, PSA <10 ng/mL and >=50% positive biopsy cores Negative lymph nodes as established by imaging, nodal sampling, or dissection within 90 days prior to registration. No evidence of metastatic disease as evaluated by bone scan and CT scan of the abdomen and pelvis within 90 days prior to registration Karnofsky performance status >=70 Subjects must have adequate baseline organ function, as assessed by the following laboratory values, within 30 days before initiating the study Adequate renal function with serum creatinine <=1.5 mg/dL or creatinine clearance >=45 mL/min/m2. Platelet count > 100,000/μL. Absolute neutrophil count > 1,000/μL. Hemoglobin > 10.0 g/dL. Normal partial thromboplastin time (PTT) and prothrombin (PT). Bilirubin < 1.5 mg/dL; SGOT and SGPT < 2.5 times upper limit of normal (ULN). Men of child-producing potential must be willing to consent to use effective contraception while on treatment and for at least 3 months afterwards. Subjects must possess the ability to give informed consent and express a willingness to meet all of the expected requirements of the protocol for the duration of the study. Exclusion Criteria: Subjects with the following conditions will be excluded from the study: Stage >= T3. Prostate specific antigen (PSA) > 20 ng/mL. Gleason score >= 8. Prostate volume >120cc. Pathologically positive lymph nodes or nodes > 1.5 cm on imaging. Note: nodes > 1.5 cm but biopsy negative are allowed. Evidence of M1 metastatic disease. Prior invasive malignancy except for non-melanoma skin cancer within 5 years of enrollment. Prognosis for survival of < 5 years. Prior radical prostatectomy, cryosurgery for prostate cancer, or bilateral orchiectomy for any reason. Prior radiotherapy, including brachytherapy, to the region of the study cancer that would result in overlap of radiation fields. Prior or planned androgen suppression therapy or prior systemic chemotherapy for the study cancer. Note that prior chemotherapy for a different cancer is allowed; however, patients must be >2 years post-completion of chemotherapy at time of registration. Patients on Proscar therapy must stop to be eligible. Severe, active co-morbidity defined as: Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months. Transmural myocardial infarction within the last 6 months. Acute infection. Acute infection is defined by any viral, bacterial, or fungal infection that requires specific therapy within 72 hours of initiation of the study therapy. Positive serological test for HIV at baseline. Previous history of liver disease including hepatitis. Immunosuppressive therapy including systemic corticosteroids. Use of inhaled and topical corticosteroids is permitted. Impaired immunity or susceptibility to serious viral infections. Allergy to any product used in the protocol. (If the subject has an allergy to Ciprofloxacin, another antibiotic can be substituted at the discretion of the treating physician. Serious medical or psychiatric illness or concomitant medication, which, in the judgment of the principal investigator, might interfere with the subject's ability to respond to or tolerate the treatment or complete the trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Benjamin Movsas, M.D.
Organizational Affiliation
Henry Ford Health System
Official's Role
Principal Investigator
Facility Information:
Facility Name
Johns Hopkins University School of Medicine
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21231
Country
United States
Facility Name
Henry Ford Health System
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48202
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
12208748
Citation
Freytag SO, Khil M, Stricker H, Peabody J, Menon M, DePeralta-Venturina M, Nafziger D, Pegg J, Paielli D, Brown S, Barton K, Lu M, Aguilar-Cordova E, Kim JH. Phase I study of replication-competent adenovirus-mediated double suicide gene therapy for the treatment of locally recurrent prostate cancer. Cancer Res. 2002 Sep 1;62(17):4968-76.
Results Reference
background
PubMed Identifier
17228316
Citation
Freytag SO, Stricker H, Peabody J, Pegg J, Paielli D, Movsas B, Barton KN, Brown SL, Lu M, Kim JH. Five-year follow-up of trial of replication-competent adenovirus-mediated suicide gene therapy for treatment of prostate cancer. Mol Ther. 2007 Mar;15(3):636-42. doi: 10.1038/sj.mt.6300068. Epub 2007 Jan 16.
Results Reference
background
PubMed Identifier
14612551
Citation
Freytag SO, Stricker H, Pegg J, Paielli D, Pradhan DG, Peabody J, DePeralta-Venturina M, Xia X, Brown S, Lu M, Kim JH. Phase I study of replication-competent adenovirus-mediated double-suicide gene therapy in combination with conventional-dose three-dimensional conformal radiation therapy for the treatment of newly diagnosed, intermediate- to high-risk prostate cancer. Cancer Res. 2003 Nov 1;63(21):7497-506.
Results Reference
background
PubMed Identifier
17375076
Citation
Freytag SO, Movsas B, Aref I, Stricker H, Peabody J, Pegg J, Zhang Y, Barton KN, Brown SL, Lu M, Savera A, Kim JH. Phase I trial of replication-competent adenovirus-mediated suicide gene therapy combined with IMRT for prostate cancer. Mol Ther. 2007 May;15(5):1016-23. doi: 10.1038/mt.sj.6300120. Epub 2007 Mar 20.
Results Reference
background
PubMed Identifier
24837889
Citation
Freytag SO, Stricker H, Lu M, Elshaikh M, Aref I, Pradhan D, Levin K, Kim JH, Peabody J, Siddiqui F, Barton K, Pegg J, Zhang Y, Cheng J, Oja-Tebbe N, Bourgeois R, Gupta N, Lane Z, Rodriguez R, DeWeese T, Movsas B. Prospective randomized phase 2 trial of intensity modulated radiation therapy with or without oncolytic adenovirus-mediated cytotoxic gene therapy in intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2014 Jun 1;89(2):268-76. doi: 10.1016/j.ijrobp.2014.02.034. Epub 2014 May 5.
Results Reference
result

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Randomized Trial of Suicide Gene Therapy and Prostate Cancer

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