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Neoadjuvant Study of In-situ REIC/Dkk-3 in Prostate Cancer

Primary Purpose

Prostate Cancer

Status
Withdrawn
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ad-REIC/Dkk-3
Sponsored by
Momotaro-Gene Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostate Cancer focused on measuring Prostate Cancer, Prostatectomy, Postectomy, Oncology, REIC, Dikkoff, Apoptosis

Eligibility Criteria

20 Years - 75 Years (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male aged between 20 and 75 years (inclusive) with histologically documented clinically localized, adenocarcinoma of the prostate scheduled to undergo a radical prostatectomy.
  2. Patient with clinical stage T1c, T2 or T3 with Primary Gleason score of 4 [total Gleason score of between 7 (4+3) and 10] at time of assessment for this trial.
  3. Recent (≤ 3 months prior to study entry) negative bone scan and CT scan of abdomen/pelvis.
  4. Life expectancy of at least 10 years.
  5. In good general health, free from clinically significant illness or disease (as determined by medical/surgical history, physical examination, weight, 12-lead ECG, and clinical laboratory tests)
  6. Appropriate surgical candidate for radical prostatectomy and a performance status of ≤ 2 (Zubrod scale)
  7. Patients should have adequate bone marrow function defined as an absolute peripheral granulocyte count ≥ 1,500 and platelet count of ≥ 100,000, adequate hepatic function with a total bilirubin ≤ 1.5 mg/dl and ALT < 4x the upper limits of normal, adequate renal function defined as serum creatinine ≤ 2.0 mg/dl
  8. Body Mass Index ≥ 18 and ≤ 35 kg/m2
  9. Patients must have normal coagulation profile (PT, PTT) and no history of substantial non-iatrogenic bleeding diatheses. Use of anticoagulants is limited to local use only (for control of central line patency).
  10. Patient is willing to refrain from sexual activity or agrees to use a barrier contraceptive device (e.g. condom) after treatment with Ad-REIC/Dkk-3 and until the prostatectomy operation.
  11. Patients must sign an informed consent indicating that they are aware of the investigational nature of the study, in keeping with the policies of the institution.

Exclusion Criteria:

  1. Previous or current hormonal treatment, chemotherapy, radiation therapy, immunotherapy or other investigational status drug within the past 4 weeks.
  2. Unable to tolerate transrectal ultrasound.
  3. Patients who are not appropriate surgical candidates for radical prostatectomy based on the evaluation of co-existent medical diseases and competing causes of death.
  4. Patients with uncontrolled cardiac, hepatic, renal or neurologic/psychiatric disorders are not eligible.
  5. Patients who are HIV positive or have chronic hepatitis B or C infections are not eligible (because of possible immune effects of these conditions).
  6. Patients with a clinical history of primary or secondary immunodeficiency, autoimmune disease or patients taking immunosuppressive drugs such as corticosteroids continuously for > 4 months [> 5 mg hydrocortisone/day] are ineligible. (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who have a decreased immune competence may be less responsive to the experimental treatment and more susceptible to its toxicities.)
  7. As a result of medical review, physical examination, the Principal Investigator (or medically qualified nominee) considers the subject unfit for the study.

Sites / Locations

  • Mount Sinai School of Medicine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ad-REIC/Dkk-3 Arm

Arm Description

Active arm on Ad-REIC/Dkk-3

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose
To define the Maximum Tolerated Dose (MTD) for intertumoral injection (IT) of Ad-REIC/Dkk-3 viral vector.
Safety evaluation of adverse drug experiences compared with historical precedence
To assess the safety of in-situ therapy with REIC/Dkk-3 gene in prostate cancer patients with high risk of local recurrence after radical prostatectomy. Safety events will be evaluated and assessed with regards to causality and in comparison with historical precedence for this patient population.

Secondary Outcome Measures

Pharmacodynamic Efficacy Markers
To assess the effectiveness of Ad-REIC/Dkk-3 in the treatment of prostate cancer as evaluated by the PSA biomarker and histologic examination of extracted prostate tissue.

Full Information

First Posted
September 3, 2010
Last Updated
August 21, 2013
Sponsor
Momotaro-Gene Inc.
Collaborators
Icahn School of Medicine at Mount Sinai
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1. Study Identification

Unique Protocol Identification Number
NCT01197209
Brief Title
Neoadjuvant Study of In-situ REIC/Dkk-3 in Prostate Cancer
Official Title
A Phase I Neoadjuvant Study of In-situ REIC/Dkk-3 Therapy Followed By Prostatectomy in Patients With High Risk Localized Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
August 2013
Overall Recruitment Status
Withdrawn
Why Stopped
Suspended due to change in development plans and investigator
Study Start Date
September 2010 (undefined)
Primary Completion Date
December 2010 (Actual)
Study Completion Date
December 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Momotaro-Gene Inc.
Collaborators
Icahn School of Medicine at Mount Sinai

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a phase I neoadjuvant gene therapy followed by prostatectomy, open-label, dose-escalation trial for prostate cancer patients with high risk of local recurrence after radical prostatectomy. Patients entered into this trial will have Prostate Cancer of Clinical stage T1c, T2 or T3 with a Gleason Score of between 7 (4+3) and 10 at the time of enrollment. Patients will receive three 1 mL injections (3 mL total volume) of Ad-REIC/Dkk-3 into the prostate prior to undergoing a radical prostatectomy. Three patients will be treated at each dose level unless a dose-limiting toxicity (DLT) is observed or MFD (defined as 1 x 10e12 vp/treatment) is achieved with expansion for up to 6 more patients at the MTD or MFD.
Detailed Description
This is a phase I neoadjuvant gene therapy followed by prostatectomy, open-label, dose-escalation trial for prostate cancer patients with high risk of local recurrence after radical prostatectomy. Patients entered into this trial will have Prostate Cancer of Clinical stage T1c, T2 or T3 with a Gleason Score of between 7 (4+3) and 10 at the time of enrollment. Patients will receive three 1 mL injections (3 mL total volume) of Ad-REIC/Dkk-3 into the prostate under transrectal ultrasound-guidance (TRUS) and, patients will undergo a radical prostatectomy four weeks after the injection. Patients will receive treatment at one of three dose levels in a sequential dose-escalating design. Three patients will be treated at each dose level unless a dose-limiting toxicity (DLT) is observed or MFD (defined as 1 x 10e12 vp/treatment) is achieved. Enrollment will proceed to the next dose level if 0 of 3 patients experiences a DLT; if one of the first 3 patients experiences a DLT, three additional patients will be enrolled until a second patient experiences a DLT (which defines the toxic dose) or until six total patients have been treated at that dose level, whichever comes first. If a second DLT is not experienced within that cohort, dose escalation may continue. Additional patients will be enrolled a minimum of 14 days after treatment of the first patient in the cohort (sentinel patient). If 2 DLTs are observed within a cohort, enrollment into the cohort will cease and the dose level immediately preceding that dose will be determined to be the MTD. If 2 non-lethal DLTs are observed in Cohort 1, a lower dose cohort (Cohort -1) may be initiated. Once the MTD is defined, an additional 3-6 patients may be enrolled at that dose level to further evaluate safety of the MTD. Patients will undergo a scheduled radical prostatectomy approximately 4 weeks after the Ad-REIC/Dkk-3 injection. The prostate tissue removed will be retained and for those patients treated at the MTD, assessed for REIC expression and evidence of apoptosis by TUNEL staining.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prostate Cancer
Keywords
Prostate Cancer, Prostatectomy, Postectomy, Oncology, REIC, Dikkoff, Apoptosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ad-REIC/Dkk-3 Arm
Arm Type
Experimental
Arm Description
Active arm on Ad-REIC/Dkk-3
Intervention Type
Biological
Intervention Name(s)
Ad-REIC/Dkk-3
Intervention Description
REIC (Reduced Expression in Immortalized Cells) protein is down regulated in a variety of cancer cell lines including prostate tumors. The REIC gene is identical to the Dickkopf-3 (Dkk-3) gene that is a member of the Dickkopf gene family. Ad-REIC/Dkk-3 is designed as a viral vector that delivers a DNA plasmid capable of producing intracellular REIC protein. The expression plasmid includes the full-length human cDNA sequence for REIC. The adenovirus vector is a transport mechanism to infuse the REIC/Dkk-3 plasmid into the cell providing a temporary transfusion of REIC protein.
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose
Description
To define the Maximum Tolerated Dose (MTD) for intertumoral injection (IT) of Ad-REIC/Dkk-3 viral vector.
Time Frame
7-days
Title
Safety evaluation of adverse drug experiences compared with historical precedence
Description
To assess the safety of in-situ therapy with REIC/Dkk-3 gene in prostate cancer patients with high risk of local recurrence after radical prostatectomy. Safety events will be evaluated and assessed with regards to causality and in comparison with historical precedence for this patient population.
Time Frame
28-days
Secondary Outcome Measure Information:
Title
Pharmacodynamic Efficacy Markers
Description
To assess the effectiveness of Ad-REIC/Dkk-3 in the treatment of prostate cancer as evaluated by the PSA biomarker and histologic examination of extracted prostate tissue.
Time Frame
28-days

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male aged between 20 and 75 years (inclusive) with histologically documented clinically localized, adenocarcinoma of the prostate scheduled to undergo a radical prostatectomy. Patient with clinical stage T1c, T2 or T3 with Primary Gleason score of 4 [total Gleason score of between 7 (4+3) and 10] at time of assessment for this trial. Recent (≤ 3 months prior to study entry) negative bone scan and CT scan of abdomen/pelvis. Life expectancy of at least 10 years. In good general health, free from clinically significant illness or disease (as determined by medical/surgical history, physical examination, weight, 12-lead ECG, and clinical laboratory tests) Appropriate surgical candidate for radical prostatectomy and a performance status of ≤ 2 (Zubrod scale) Patients should have adequate bone marrow function defined as an absolute peripheral granulocyte count ≥ 1,500 and platelet count of ≥ 100,000, adequate hepatic function with a total bilirubin ≤ 1.5 mg/dl and ALT < 4x the upper limits of normal, adequate renal function defined as serum creatinine ≤ 2.0 mg/dl Body Mass Index ≥ 18 and ≤ 35 kg/m2 Patients must have normal coagulation profile (PT, PTT) and no history of substantial non-iatrogenic bleeding diatheses. Use of anticoagulants is limited to local use only (for control of central line patency). Patient is willing to refrain from sexual activity or agrees to use a barrier contraceptive device (e.g. condom) after treatment with Ad-REIC/Dkk-3 and until the prostatectomy operation. Patients must sign an informed consent indicating that they are aware of the investigational nature of the study, in keeping with the policies of the institution. Exclusion Criteria: Previous or current hormonal treatment, chemotherapy, radiation therapy, immunotherapy or other investigational status drug within the past 4 weeks. Unable to tolerate transrectal ultrasound. Patients who are not appropriate surgical candidates for radical prostatectomy based on the evaluation of co-existent medical diseases and competing causes of death. Patients with uncontrolled cardiac, hepatic, renal or neurologic/psychiatric disorders are not eligible. Patients who are HIV positive or have chronic hepatitis B or C infections are not eligible (because of possible immune effects of these conditions). Patients with a clinical history of primary or secondary immunodeficiency, autoimmune disease or patients taking immunosuppressive drugs such as corticosteroids continuously for > 4 months [> 5 mg hydrocortisone/day] are ineligible. (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who have a decreased immune competence may be less responsive to the experimental treatment and more susceptible to its toxicities.) As a result of medical review, physical examination, the Principal Investigator (or medically qualified nominee) considers the subject unfit for the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Simon Hall, MD
Organizational Affiliation
Icahn School of Medicine at Mount Sinai
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mount Sinai School of Medicine
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States

12. IPD Sharing Statement

Links:
URL
http://www.mt-gene.com
Description
Momotaro-Gene Website

Learn more about this trial

Neoadjuvant Study of In-situ REIC/Dkk-3 in Prostate Cancer

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