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Maintaining Suppression of Testosterone With Transdermal Estradiol Gel (MASTERS)

Primary Purpose

Cancer of the Prostate

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
BHR-200 (0.36% transdermal 17β-estradiol gel)
Placebo
Sponsored by
BHR Pharma, LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cancer of the Prostate

Eligibility Criteria

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

Inclusion Criteria:

  1. Males, Ages 18 and older
  2. Body Mass Index (BMI) between 18 and 35 kg/m2 (inclusive)
  3. Not currently hospitalized
  4. Clinical indication of adenocarcinoma of the prostate evidenced by a biopsy report on record
  5. At present receiving ADT treatment with a GnRH agonist for at least 2 months but not longer than 36 months without interruption - Note: If the patient received GnRH agonist treatment prior to the treatment described under 5, there must be evidence of a period without GnRH agonist treatment for a minimum of 2 months prior to starting the present treatment as is seen, for example with intermittent treatment regimens.
  6. Able to initiate Screening procedures 2 weeks prior to the next scheduled injection with a GnRH agonist
  7. Willing to discontinue current ADT regimen for the duration of the study
  8. T level less than 50 ng/dL at Screening
  9. WHO/ECOG performance status of 0 or 1
  10. Life expectancy of at least 1 year
  11. Adequate renal function demonstrated by having normal blood urea nitrogen (BUN) and Creatinine Screening lab values

Exclusion Criteria:

  1. History or presence of allergic or adverse response to estradiol
  2. Presence of symptomatic metastatic disease, risk of spinal cord compression or urinary obstruction
  3. History within the past 2 years of deep vein thrombosis (DVT), pulmonary embolism (PE2), a known thrombophilic disorder (eg.protein C, protein S, or antithrombin deficiency), or cerebrovascular accident (CVA)
  4. History within the past 2 years of myocardial infarction or a coronary vascular procedure (e.g. percutaneous coronary intervention, coronary artery bypass graft)
  5. History of congestive heart failure
  6. Use of any investigational drug, biologic, or device within 28 days prior to the first dose of study gel
  7. Use of any of the following known inducers or inhibitors of cytochrome P450 3A4 (CYP3A4): phenobarbital, carbamazepine, rifampin, erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir, St. John's Wort preparations (Hypericum perforatum), and grapefruit juice
  8. Hematological parameters (Hematocrit or Hemoglobin) outside 20% of the upper or lower limits of normal at Screening
  9. Active skin rash, sunburn, or other skin disorder on the upper arm(s) that requires treatment or may affect skin absorption of study gel
  10. Resting uncontrolled hypertension (HTN) (160/100 mmHg) at Screening
  11. Co-existent malignancy or a history of malignancy during the past 5 years, with the exception of basal and/or squamous cell carcinoma of the skin
  12. Any other significant concurrent illness or disease or condition that in the opinion of the Investigator might interfere with the patient's ability to receive the treatment outlined in the protocol or might put him at additional risk

Sites / Locations

  • Urological Associates of Southern Arizona
  • South Florida Medical Research
  • Advanced Urology Institute
  • Adult Pediatric Urology, PC
  • Adult Pediatric Urology, PC
  • Delaware Valley Urology
  • AccumetRX Clinical Trials
  • Associated Medical Professionals of NY (AMP of NY)
  • Eastern Urological Associates
  • Urologic Consultants of Southeastern Pennsylvania (UCSEPA)
  • Carolina Urologic Research Center
  • Urology Clinics of North Texas

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

BHR-200 Low Dose

BHR-200 Mid Dose

BHR-200 High Dose

Placebo

Arm Description

3 mg estradiol per 1 mL 0.36% BHR-200 (transdermal 17β-estradiol gel) applied daily to the skin for up to 52 weeks.

6 mg estradiol per 2 mL 0.36% BHR-200 (transdermal 17β-estradiol gel) applied daily to the skin for up to 52 weeks.

9 mg estradiol per 3 mL 0.36% BHR-200 (transdermal 17β-estradiol gel) applied daily to the skin for up to 52 weeks.

1, 2 or 3 mL of Placebo gel containing 0 mg estradiol applied daily for up to 52 weeks.

Outcomes

Primary Outcome Measures

Maintenance of Testosterone Suppression at Week 12
Primary Efficacy Endpoint was the percentage of patients failing to maintain castrate levels of T (T < 50 ng/dL). Testosterone suppression, defined as the absence of any T level measurement over 50 ng/dL during Weeks 4 to 12.

Secondary Outcome Measures

Maintenance of Testosterone Suppression at Week 24
Pproportion of patients failing to maintaincastrate levels of T (T < 50 ng/dL). Testosterone suppression, defined as the absence of any T level measurement over 50 ng/dL during Weeks 4 to 24.
Number of Patients Reporting Thromboembolic Adverse Events
Number of patients and severity of thromboembolic adverse events

Full Information

First Posted
January 23, 2015
Last Updated
March 8, 2022
Sponsor
BHR Pharma, LLC
Collaborators
H2O Clinical LLC, Q2 Solutions
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1. Study Identification

Unique Protocol Identification Number
NCT02349386
Brief Title
Maintaining Suppression of Testosterone With Transdermal Estradiol Gel
Acronym
MASTERS
Official Title
A Randomized, Double-Blind, Placebo-Controlled, Dose-Finding Study of BHR-200 (0.36% Transdermal Estradiol Gel) for the Maintenance of Testosterone Suppression in Men With Advanced Androgen-Sensitive Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
April 2018
Overall Recruitment Status
Terminated
Why Stopped
Inability to recruit patients
Study Start Date
July 2015 (Actual)
Primary Completion Date
June 14, 2017 (Actual)
Study Completion Date
January 10, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
BHR Pharma, LLC
Collaborators
H2O Clinical LLC, Q2 Solutions

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The objective of this clinical study is to evaluate the safety and efficacy of three different doses of BHR-200 (0.36% transdermal estradiol gel) compared to placebo for the maintenance of testosterone (T) suppression in men with advanced androgen-sensitive prostate cancer.
Detailed Description
This is a multi-center, randomized, double-blind, placebo-controlled, dose finding study in men with advanced androgen-sensitive prostate cancer. Patients who give informed consent will have screening evaluations, and if fulfilling the entry criteria, will be randomized to one of 4 treatment groups: 1mL, 2mL or 3mL of 0.36% BHR-200 (transdermal estradiol gel) or Placebo. Study drug will be initiated on the day they were scheduled to receive next depot GnRH agonist injection. Patients will be offered low-dose radiation to aid in the prevention of gynecomastia. Patients will apply the study drug once per day. The first dose of study gel will be applied under the supervision of the PI/designee. Subsequent doses will be self-administered daily by the patient until he is no longer chemically castrated (testosterone levels increase above 50 ng/dL), a rise over baseline PSA of > 0.5 ng/mL is observed, or he has completed 52 weeks of study drug administration. At the conclusion of study participation, patients will be advised to resume standard of care treatment under the supervision of their healthcare provider. While on treatment, patients will be evaluated at Day 1 and every 2 weeks, for the first 24 weeks and every 4 weeks thereafter with a final post-treatment follow-up visit 2 weeks (+/- 1 week) post last dose administration.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
34 (Actual)

8. Arms, Groups, and Interventions

Arm Title
BHR-200 Low Dose
Arm Type
Experimental
Arm Description
3 mg estradiol per 1 mL 0.36% BHR-200 (transdermal 17β-estradiol gel) applied daily to the skin for up to 52 weeks.
Arm Title
BHR-200 Mid Dose
Arm Type
Experimental
Arm Description
6 mg estradiol per 2 mL 0.36% BHR-200 (transdermal 17β-estradiol gel) applied daily to the skin for up to 52 weeks.
Arm Title
BHR-200 High Dose
Arm Type
Experimental
Arm Description
9 mg estradiol per 3 mL 0.36% BHR-200 (transdermal 17β-estradiol gel) applied daily to the skin for up to 52 weeks.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
1, 2 or 3 mL of Placebo gel containing 0 mg estradiol applied daily for up to 52 weeks.
Intervention Type
Drug
Intervention Name(s)
BHR-200 (0.36% transdermal 17β-estradiol gel)
Other Intervention Name(s)
BHR-200
Intervention Description
An absorptive hydroalcoholic gel preparation containing 17β-estradiol.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
An absorptive hydroalcoholic gel preparation gel of the same ingredients as BHR-200, but without 17β-estradiol.
Primary Outcome Measure Information:
Title
Maintenance of Testosterone Suppression at Week 12
Description
Primary Efficacy Endpoint was the percentage of patients failing to maintain castrate levels of T (T < 50 ng/dL). Testosterone suppression, defined as the absence of any T level measurement over 50 ng/dL during Weeks 4 to 12.
Time Frame
Week 12
Secondary Outcome Measure Information:
Title
Maintenance of Testosterone Suppression at Week 24
Description
Pproportion of patients failing to maintaincastrate levels of T (T < 50 ng/dL). Testosterone suppression, defined as the absence of any T level measurement over 50 ng/dL during Weeks 4 to 24.
Time Frame
Week 24
Title
Number of Patients Reporting Thromboembolic Adverse Events
Description
Number of patients and severity of thromboembolic adverse events
Time Frame
To Week 52/End of Study: Both 24-Week Main Study and Optional 28-Week Extension Study
Other Pre-specified Outcome Measures:
Title
Luteinizing Hormone (LH)
Description
Serum concentrations of luteinizing hormone (LH)
Time Frame
Reported for Baseline, Week 12, Week 24, Week 36 and Week 48
Title
Sex Hormone Binding Globulin (SHBG)
Description
Serum concentrations of sex hormone binding globulin (SHBG)
Time Frame
Reported for Baseline, Week 12, Week 24, Week 36 and Week 48
Title
Prostate Specific Antigen (PSA)
Description
Serum concentrations of prostate specific antigen (PSA)
Time Frame
To Week 52/End of Study: Both 24-Week Main Study and Optional 28-Week Extension Study
Title
Follicle-stimulating Hormone (FSH)
Description
Serum concentrations of follicle-stimulating hormone (FSH)
Time Frame
Reported for Baseline, Week 12, Week 24, Week 36 and Week 48
Title
Maintenance of Testosterone Suppression at Week 52/ End of Study
Description
Proportion of patients failing to maintain castrate levels of T (T < 50 ng/dL). Testosterone suppression, defined as the absence of any T level measurement over 50 ng/dL during Weeks 24 to 52/End of Study
Time Frame
Double-blind 28-Week Optional Extension Study from Week 24 to Week 52/End of Study

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males, Ages 18 and older Body Mass Index (BMI) between 18 and 35 kg/m2 (inclusive) Not currently hospitalized Clinical indication of adenocarcinoma of the prostate evidenced by a biopsy report on record At present receiving ADT treatment with a GnRH agonist for at least 2 months but not longer than 36 months without interruption - Note: If the patient received GnRH agonist treatment prior to the treatment described under 5, there must be evidence of a period without GnRH agonist treatment for a minimum of 2 months prior to starting the present treatment as is seen, for example with intermittent treatment regimens. Able to initiate Screening procedures 2 weeks prior to the next scheduled injection with a GnRH agonist Willing to discontinue current ADT regimen for the duration of the study T level less than 50 ng/dL at Screening WHO/ECOG performance status of 0 or 1 Life expectancy of at least 1 year Adequate renal function demonstrated by having normal blood urea nitrogen (BUN) and Creatinine Screening lab values Exclusion Criteria: History or presence of allergic or adverse response to estradiol Presence of symptomatic metastatic disease, risk of spinal cord compression or urinary obstruction History within the past 2 years of deep vein thrombosis (DVT), pulmonary embolism (PE2), a known thrombophilic disorder (eg.protein C, protein S, or antithrombin deficiency), or cerebrovascular accident (CVA) History within the past 2 years of myocardial infarction or a coronary vascular procedure (e.g. percutaneous coronary intervention, coronary artery bypass graft) History of congestive heart failure Use of any investigational drug, biologic, or device within 28 days prior to the first dose of study gel Use of any of the following known inducers or inhibitors of cytochrome P450 3A4 (CYP3A4): phenobarbital, carbamazepine, rifampin, erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir, St. John's Wort preparations (Hypericum perforatum), and grapefruit juice Hematological parameters (Hematocrit or Hemoglobin) outside 20% of the upper or lower limits of normal at Screening Active skin rash, sunburn, or other skin disorder on the upper arm(s) that requires treatment or may affect skin absorption of study gel Resting uncontrolled hypertension (HTN) (160/100 mmHg) at Screening Co-existent malignancy or a history of malignancy during the past 5 years, with the exception of basal and/or squamous cell carcinoma of the skin Any other significant concurrent illness or disease or condition that in the opinion of the Investigator might interfere with the patient's ability to receive the treatment outlined in the protocol or might put him at additional risk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Roland Gerritsen van der Hoop, MD, PhD
Organizational Affiliation
BHR Pharma, LLC
Official's Role
Study Director
Facility Information:
Facility Name
Urological Associates of Southern Arizona
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85741
Country
United States
Facility Name
South Florida Medical Research
City
Aventura
State/Province
Florida
ZIP/Postal Code
33180
Country
United States
Facility Name
Advanced Urology Institute
City
Daytona Beach
State/Province
Florida
ZIP/Postal Code
32114
Country
United States
Facility Name
Adult Pediatric Urology, PC
City
Council Bluffs
State/Province
Iowa
ZIP/Postal Code
51501
Country
United States
Facility Name
Adult Pediatric Urology, PC
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68114
Country
United States
Facility Name
Delaware Valley Urology
City
Voorhees
State/Province
New Jersey
ZIP/Postal Code
08043
Country
United States
Facility Name
AccumetRX Clinical Trials
City
Albuquerque
State/Province
New Mexico
ZIP/Postal Code
87109
Country
United States
Facility Name
Associated Medical Professionals of NY (AMP of NY)
City
Syracuse
State/Province
New York
ZIP/Postal Code
13210
Country
United States
Facility Name
Eastern Urological Associates
City
Greenville
State/Province
North Carolina
ZIP/Postal Code
27834
Country
United States
Facility Name
Urologic Consultants of Southeastern Pennsylvania (UCSEPA)
City
Bala-Cynwyd
State/Province
Pennsylvania
ZIP/Postal Code
19044
Country
United States
Facility Name
Carolina Urologic Research Center
City
Myrtle Beach
State/Province
South Carolina
ZIP/Postal Code
29572
Country
United States
Facility Name
Urology Clinics of North Texas
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
12686820
Citation
Ockrim JL, Lalani EN, Laniado ME, Carter SS, Abel PD. Transdermal estradiol therapy for advanced prostate cancer--forward to the past? J Urol. 2003 May;169(5):1735-7. doi: 10.1097/01.ju.0000061024.75334.40.
Results Reference
background
PubMed Identifier
16006886
Citation
Ockrim JL, Lalani el-N, Kakkar AK, Abel PD. Transdermal estradiol therapy for prostate cancer reduces thrombophilic activation and protects against thromboembolism. J Urol. 2005 Aug;174(2):527-33; discussion 532-3. doi: 10.1097/01.ju.0000165567.99142.1f.
Results Reference
background
PubMed Identifier
18809586
Citation
Ockrim JL, Abel PD. Long term androgen deprivation therapy in prostate cancer. BMJ. 2008 Sep 22;337:a1361. doi: 10.1136/bmj.a1361. No abstract available.
Results Reference
background
PubMed Identifier
17019433
Citation
Ockrim J, Lalani el-N, Abel P. Therapy Insight: parenteral estrogen treatment for prostate cancer--a new dawn for an old therapy. Nat Clin Pract Oncol. 2006 Oct;3(10):552-63. doi: 10.1038/ncponc0602.
Results Reference
background
PubMed Identifier
18422771
Citation
Langley RE, Godsland IF, Kynaston H, Clarke NW, Rosen SD, Morgan RC, Pollock P, Kockelbergh R, Lalani el-N, Dearnaley D, Parmar M, Abel PD. Early hormonal data from a multicentre phase II trial using transdermal oestrogen patches as first-line hormonal therapy in patients with locally advanced or metastatic prostate cancer. BJU Int. 2008 Aug;102(4):442-5. doi: 10.1111/j.1464-410X.2008.07583.x. Epub 2008 Apr 16.
Results Reference
background
PubMed Identifier
23465742
Citation
Langley RE, Cafferty FH, Alhasso AA, Rosen SD, Sundaram SK, Freeman SC, Pollock P, Jinks RC, Godsland IF, Kockelbergh R, Clarke NW, Kynaston HG, Parmar MK, Abel PD. Cardiovascular outcomes in patients with locally advanced and metastatic prostate cancer treated with luteinising-hormone-releasing-hormone agonists or transdermal oestrogen: the randomised, phase 2 MRC PATCH trial (PR09). Lancet Oncol. 2013 Apr;14(4):306-16. doi: 10.1016/S1470-2045(13)70025-1. Epub 2013 Mar 4.
Results Reference
background
PubMed Identifier
15641029
Citation
Bland LB, Garzotto M, DeLoughery TG, Ryan CW, Schuff KG, Wersinger EM, Lemmon D, Beer TM. Phase II study of transdermal estradiol in androgen-independent prostate carcinoma. Cancer. 2005 Feb 15;103(4):717-23. doi: 10.1002/cncr.20857.
Results Reference
background
PubMed Identifier
7500443
Citation
Cox RL, Crawford ED. Estrogens in the treatment of prostate cancer. J Urol. 1995 Dec;154(6):1991-8.
Results Reference
background
PubMed Identifier
17239273
Citation
Lycette JL, Bland LB, Garzotto M, Beer TM. Parenteral estrogens for prostate cancer: can a new route of administration overcome old toxicities? Clin Genitourin Cancer. 2006 Dec;5(3):198-205. doi: 10.3816/CGC.2006.n.037.
Results Reference
background
PubMed Identifier
14644018
Citation
Sayed Y, Taxel P. The use of estrogen therapy in men. Curr Opin Pharmacol. 2003 Dec;3(6):650-4. doi: 10.1016/j.coph.2003.07.004.
Results Reference
background

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Maintaining Suppression of Testosterone With Transdermal Estradiol Gel

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