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Sipuleucel-T With or Without Radiation Therapy in Treating Patients With Hormone-Resistant Metastatic Prostate Cancer

Primary Purpose

Adenocarcinoma of the Prostate, Bone Metastases, Hormone-resistant Prostate Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
sipuleucel-T
external beam radiation therapy
laboratory biomarker analysis
Sponsored by
City of Hope Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Adenocarcinoma of the Prostate

Eligibility Criteria

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

Inclusion Criteria:

  • Histologically documented adenocarcinoma of the prostate
  • Life expectancy of >= 6 months, Eastern Cooperative Oncology Group (ECOG) performance status =< 2
  • Metastatic disease as evidenced by soft tissue and/or bony metastases on baseline bone scan and/or computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen or pelvis

  • Castration resistant prostatic adenocarcinoma; subjects must have current or historical evidence of disease progression despite castrated level of testosterone (< 50 ng/dL) achieved by orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist or antagonist therapy; disease progression has to be demonstrated by PSA progression OR progression of measurable disease OR progression of non-measurable disease as defined below:

    • PSA: Two consecutive rising PSA values, at least 7 days apart
    • Measurable disease: >= 20% increase in the sum of the longest diameters of all measurable lesions or the development of any new lesions; the change will be measured against the best response to castration therapy or against the pre-castration measurements if there was no response

    • Non-measurable disease:

      • Soft tissue disease: The appearance of 1 or more lesions, and/or unequivocal worsening of non-measurable disease when compared to imaging studies acquired during castration therapy or against the pre-castration studies if there was no response
      • Bone disease: Appearance of 2 or more new areas of abnormal uptake on bone scan when compared to imaging studies acquired during castration therapy or against the pre-castration studies if there was no response; increased uptake of pre-existing lesions on bone scan does not constitute progression
  • White blood cell (WBC) >= 2,500 cells/uL
  • Absolute neutrophil count (ANC) >= 1,000 cells/uL
  • Platelet count >= 75,000 cells/uL
  • Hemoglobin (HgB) >= 9.0 g/dL
  • Creatinine =< 2.5 mg/dL
  • Total bilirubin =< 2 x institutional upper limit of normal (ULN)
  • Aspartate aminotransferase (AST, serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT, serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional ULN
  • Prior chemotherapy with 0-2 regimens is allowed
  • Prior radiation therapy to prostate or prostate bed is allowed provided it occurred > 3 months before enrollment to the study

Exclusion Criteria:

  • The presence of liver, or known brain metastases, malignant pleural effusions, or malignant ascites
  • Moderate or severe symptomatic metastatic disease, defined as a requirement for treatment with opioid analgesics for cancer-related pain within 21 days prior to registration
  • Eastern Cooperative Oncology Group (ECOG) performance status > 2
  • Treatment with chemotherapy within 3 months of registration

  • Treatment with any of the following medications or interventions within 28 days of registration:

    • Systematic corticosteroids; use of inhaled, intranasal, and topical steroids is acceptable
    • Any other systemic therapy for prostate cancer (except for medical castration)
  • History of external beam radiation therapy to metastatic sites within 1 year of enrollment to the study
  • Participation in any previous study involving sipuleucel-T
  • Pathologic long-bone fractures, imminent pathologic long-bone fracture (cortical erosion on radiography > 50%) or spinal cord compression

  • Concurrent other malignancy with the exception of:

    • Cutaneous squamous cell and basal carcinomas
    • Adequately treated stage 1-2 malignancy
    • Adequately treated stage 3-4 malignancy that has been in remission for >= 2 years at the time of registration
  • A requirement for systemic immunosuppressive therapy for any reason
  • Any infection requiring parenteral antibiotic therapy or causing fever (temperature > 100.5 degrees Fahrenheit [F] or 38.1 degrees Celsius [C]) within 1 week prior to registration
  • Any medical intervention or other condition which, in the opinion of the principal investigator could compromise adherence with study requirements or otherwise compromise the study's objectives

Sites / Locations

  • City of Hope Medical Center
  • South Pasadena Cancer Center
  • Huntsman Cancer Institute, Univ. of Utah

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm A (sipuleucel-T)

Arm B (radiation therapy, sipuleucel-T)

Arm Description

Patients receive sipuleucel-T IV over 60 minutes days 22, 36, and 50.

Patients undergo external beam radiation therapy in weeks 1-2. Patients also receive sipuleucel-T as in Arm A.

Outcomes

Primary Outcome Measures

Progression-free Survival
Estimated using the product-limit method of Kaplan and Meier. Progression is defined as one or more of the following: 20% increase in the sum of the longest diameters of target measurable lesions over the smallest sum observed (over baseline if no decrease during therapy) using the same techniques as baseline; unequivocal progression of non-measurable disease in the opinion of the treating physician; appearance of any new lesions; PSA increase of 25% from baseline or nadir and by 2ng/uL or greater at 12 weeks; death due to disease without prior documentation of progression and without symptomatic deterioration.

Secondary Outcome Measures

Number of Participants With Grade 2 or Above Adverse Events
Number of participants with specified adverse event that is grade 2 or above and related to treatment. Graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v4.0

Full Information

First Posted
March 6, 2013
Last Updated
August 21, 2020
Sponsor
City of Hope Medical Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT01807065
Brief Title
Sipuleucel-T With or Without Radiation Therapy in Treating Patients With Hormone-Resistant Metastatic Prostate Cancer
Official Title
Randomized Phase II Trial of Sipuleucel T Immunotherapy Preceded by Sensitizing Radiation Therapy and Sipuleucel-T Alone in Patients With Castrate Resistant Metastatic Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
June 2019
Overall Recruitment Status
Completed
Study Start Date
June 7, 2013 (undefined)
Primary Completion Date
December 31, 2018 (Actual)
Study Completion Date
December 31, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
City of Hope Medical Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This randomized phase II trial studies how well giving sipuleucel-T with or without radiation therapy works in treating patients with hormone-resistant metastatic prostate cancer. Vaccines may help the body build an effective immune response to kill tumor cells. Radiation therapy uses high energy x rays to kill tumor cells. It is not yet known whether giving sipuleucel-T vaccine is more effective with or without radiation therapy in treating prostate cancer
Detailed Description
PRIMARY OBJECTIVES: I. To assess the feasibility, based on percent able or willing to receive all three infusions of sipuleucel-T immunotherapy, when combining sipuleucel-T with radiation therapy to a single site of metastasis delivered one week prior to beginning of sipuleucel-T therapy. SECONDARY OBJECTIVES: I. To assess the effect of radiation therapy to single metastasis on immune response (antibody and T-cell proliferation to prostate acid phosphate [PAP] and fusion protein PA2024) generated by sipuleucel-T immunotherapy. II. To assess the effect of external beam radiotherapy to single metastasis on prostate specific antigen (PSA) response to therapy with sipuleucel-T. III. To assess the effect of external beam radiotherapy to single metastasis on radiographic response rate to therapy with sipuleucel-T. IV. To assess the time from the onset of therapy with sipuleucel-T +/- radiation to the need for subsequent therapy for prostate cancer. V. To assess the toxicity associated with sipuleucel-T +/- radiation. OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM A: Patients receive sipuleucel-T intravenously (IV) over 60 minutes days 22, 36, and 50. ARM B: Patients undergo external beam radiation therapy in weeks 1-2. Patients also receive sipuleucel-T as in Arm A. In both arms, treatment continues in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up until week 60.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adenocarcinoma of the Prostate, Bone Metastases, Hormone-resistant Prostate Cancer, Recurrent Prostate Cancer, Soft Tissue Metastases, Stage IV Prostate Cancer

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Arm A (sipuleucel-T)
Arm Type
Experimental
Arm Description
Patients receive sipuleucel-T IV over 60 minutes days 22, 36, and 50.
Arm Title
Arm B (radiation therapy, sipuleucel-T)
Arm Type
Experimental
Arm Description
Patients undergo external beam radiation therapy in weeks 1-2. Patients also receive sipuleucel-T as in Arm A.
Intervention Type
Biological
Intervention Name(s)
sipuleucel-T
Other Intervention Name(s)
APC 8015, Provenge
Intervention Description
Given IV
Intervention Type
Radiation
Intervention Name(s)
external beam radiation therapy
Other Intervention Name(s)
EBRT
Intervention Description
Undergo external beam radiation therapy
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Progression-free Survival
Description
Estimated using the product-limit method of Kaplan and Meier. Progression is defined as one or more of the following: 20% increase in the sum of the longest diameters of target measurable lesions over the smallest sum observed (over baseline if no decrease during therapy) using the same techniques as baseline; unequivocal progression of non-measurable disease in the opinion of the treating physician; appearance of any new lesions; PSA increase of 25% from baseline or nadir and by 2ng/uL or greater at 12 weeks; death due to disease without prior documentation of progression and without symptomatic deterioration.
Time Frame
Until progression or death, Up to 2 years.
Secondary Outcome Measure Information:
Title
Number of Participants With Grade 2 or Above Adverse Events
Description
Number of participants with specified adverse event that is grade 2 or above and related to treatment. Graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v4.0
Time Frame
Up to 60 weeks

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 Life expectancy of >= 6 months, Eastern Cooperative Oncology Group (ECOG) performance status =< 2 Metastatic disease as evidenced by soft tissue and/or bony metastases on baseline bone scan and/or computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen or pelvis Castration resistant prostatic adenocarcinoma; subjects must have current or historical evidence of disease progression despite castrated level of testosterone (< 50 ng/dL) achieved by orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist or antagonist therapy; disease progression has to be demonstrated by PSA progression OR progression of measurable disease OR progression of non-measurable disease as defined below: PSA: Two consecutive rising PSA values, at least 7 days apart Measurable disease: >= 20% increase in the sum of the longest diameters of all measurable lesions or the development of any new lesions; the change will be measured against the best response to castration therapy or against the pre-castration measurements if there was no response Non-measurable disease: Soft tissue disease: The appearance of 1 or more lesions, and/or unequivocal worsening of non-measurable disease when compared to imaging studies acquired during castration therapy or against the pre-castration studies if there was no response Bone disease: Appearance of 2 or more new areas of abnormal uptake on bone scan when compared to imaging studies acquired during castration therapy or against the pre-castration studies if there was no response; increased uptake of pre-existing lesions on bone scan does not constitute progression White blood cell (WBC) >= 2,500 cells/uL Absolute neutrophil count (ANC) >= 1,000 cells/uL Platelet count >= 75,000 cells/uL Hemoglobin (HgB) >= 9.0 g/dL Creatinine =< 2.5 mg/dL Total bilirubin =< 2 x institutional upper limit of normal (ULN) Aspartate aminotransferase (AST, serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT, serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional ULN Prior chemotherapy with 0-2 regimens is allowed Prior radiation therapy to prostate or prostate bed is allowed provided it occurred > 3 months before enrollment to the study Exclusion Criteria: The presence of liver, or known brain metastases, malignant pleural effusions, or malignant ascites Moderate or severe symptomatic metastatic disease, defined as a requirement for treatment with opioid analgesics for cancer-related pain within 21 days prior to registration Eastern Cooperative Oncology Group (ECOG) performance status > 2 Treatment with chemotherapy within 3 months of registration Treatment with any of the following medications or interventions within 28 days of registration: Systematic corticosteroids; use of inhaled, intranasal, and topical steroids is acceptable Any other systemic therapy for prostate cancer (except for medical castration) History of external beam radiation therapy to metastatic sites within 1 year of enrollment to the study Participation in any previous study involving sipuleucel-T Pathologic long-bone fractures, imminent pathologic long-bone fracture (cortical erosion on radiography > 50%) or spinal cord compression Concurrent other malignancy with the exception of: Cutaneous squamous cell and basal carcinomas Adequately treated stage 1-2 malignancy Adequately treated stage 3-4 malignancy that has been in remission for >= 2 years at the time of registration A requirement for systemic immunosuppressive therapy for any reason Any infection requiring parenteral antibiotic therapy or causing fever (temperature > 100.5 degrees Fahrenheit [F] or 38.1 degrees Celsius [C]) within 1 week prior to registration Any medical intervention or other condition which, in the opinion of the principal investigator could compromise adherence with study requirements or otherwise compromise the study's objectives
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Cy Stein, MD, PhD
Organizational Affiliation
City of Hope Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
City of Hope Medical Center
City
Duarte
State/Province
California
ZIP/Postal Code
91010
Country
United States
Facility Name
South Pasadena Cancer Center
City
Pasadena
State/Province
California
ZIP/Postal Code
91030
Country
United States
Facility Name
Huntsman Cancer Institute, Univ. of Utah
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84112
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
30682445
Citation
Twardowski P, Wong JYC, Pal SK, Maughan BL, Frankel PH, Franklin K, Junqueira M, Prajapati MR, Nachaegari G, Harwood D, Agarwal N. Randomized phase II trial of sipuleucel-T immunotherapy preceded by sensitizing radiation therapy and sipuleucel-T alone in patients with metastatic castrate resistant prostate cancer. Cancer Treat Res Commun. 2019;19:100116. doi: 10.1016/j.ctarc.2018.100116. Epub 2018 Dec 20.
Results Reference
derived

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Sipuleucel-T With or Without Radiation Therapy in Treating Patients With Hormone-Resistant Metastatic Prostate Cancer

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