ARRx in Combination With Enzalutamide in Metastatic Castration Resistant Prostate Cancer
Primary Purpose
Prostate Cancer
Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
ARRx
Enzalutamide
Sponsored by

About this trial
This is an interventional treatment trial for Prostate Cancer
Eligibility Criteria
Inclusion Criteria:
- Ability to understand and voluntarily agree to participate by providing written informed consent for the trial.
- Histologically confirmed prostate adenocarcinoma cancer, either pure or mixed. Small cell/neuroendocrine differentiation is not allowed.
- Castrate levels of serum testosterone (≤ 50 ng/dL). Patients must continue androgen deprivation therapy with an LHRH analogue or antagonist if they have not undergone bilateral orchiectomy.
- Patients must have metastatic disease; either non-measurable disease OR measurable disease per RECIST 1.1.
- Progressive disease despite ongoing treatment with Androgen Deprivation Therapy (ADT).
- Patients treated with first generation anti-androgen as most recent systemic therapy (e.g. bicalutamide, nilutamide) must have at least 4 weeks elapsed from treatment discontinuation to start of protocol therapy with evidence of disease progression (per protocol) following discontinuation of prior anti-androgen.
- Minimum PSA at entry of 1 ng/mL is required.
- ECOG Performance Status 0, 1 or 2.
- Be ≥18 years of age on the day of signing informed consent.
- Demonstrate adequate organ function.
- Subjects must agree to use an adequate method of contraception as outlined in the protocol starting with the time of informed consent through 120 days after the last dose trial therapy.
Exclusion Criteria:
- Prior chemotherapy and/or enzalutamide for metastatic castration-resistant prostate cancer. Chemotherapy administered in the castration-sensitive setting is allowed provided last dose of chemotherapy was greater than 6 months prior to study entry.
- Is currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigation device within 4 weeks prior to enrollment.
- Has not recovered (i.e., AE ≤Grade 1 or at baseline) from AEs due to a previously administered agent. Subjects with ≤Grade 2 neuropathy or ≤Grade 2 alopecia are an exception to this criterion and are allowed if relevant toxicity is stabilized.
- If subjects received major surgery they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting trial therapy.
- Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin.
- Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial. At the time of signing informed consent is a known regular user (including "recreational use") of any illicit drug(s) or had a recent history (within the last year) of drug or alcohol abuse.
- Has a known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies).
- Has known active hepatitis B (e.g., HBsAg reactive) or hepatitis C (e.g., HCV RNA [qualitative] is detected).
- Has received a live virus vaccine within 30 days of planned start of trial therapy.
- Has known active CNS metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they have stable brain metastases (stability is normally defined as a period of 1 to 3 months in which there is no evidence of new or enlarging CNS metastases).
- Has symptomatic ascites or pleural effusion; a subject who is clinically stable following treatment for these conditions is eligible.
- Has had a prior allogeneic stem cell or bone marrow transplant.
- Has known contraindication to aspirin (81 mg).
Sites / Locations
- University of Michigan Rogel Cancer Center
- Barbara Ann Karmanos Cancer Institute
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
ARRx + Enzalutamide
Arm Description
Phase 1b: All registered subjects will be treated with ARRx (ASO) in combination with enzalutamide. ARRx will be given intravenously on Days 1, 4, 8, 11, 15 on cycle 1, then on days 1, 8, 15 in subsequent 21-day cycles. Enzalutamide will be taken daily in 21 day cycles starting Day 1 of cycle 1. Treatment will continue until clinical or radiologic progression or unacceptable toxicity. Phase 2: Subjects will be treated with ARRx (ASO) at the maximum tolerated (MTD), in combination with enzalutamide until clinical or radiologic progression or unacceptable toxicity. (Schedule of administration as in phase 1b.)
Outcomes
Primary Outcome Measures
Number of subjects with dose-limiting toxicity (DLT) during the first cycle of ARRx (in combination with enzalutamide)
DLTs will be counted based on the number of subjects with DLT at a given dose level. No single subject can trigger more than one DLT event. DLT is defined as any Grade 3 or higher toxicity as defined by CTCAE v5.0. Toxicity that is clearly and directly related to the primary disease or to another etiology is excluded from this definition.
Best PSA response
Using the Prostate Cancer Clinical Trials Working Group 3 (PCWG3) criteria. From the start of the treatment until disease progression/recurrence.
Secondary Outcome Measures
Time to radiographic progression-free survival (rPFS)
Using PCWG3-modified RECIST 1.1 (Response Evaluation Criteria in Solid Tumors).
Percentage of patients with a reduction in PSA of at least 30% from baseline
Using PCWG3 criteria
Time to PSA progression
Using PCWG3 criteria
PSA progression-free survival (PFS)
PSA PFS is defined as the duration of time from start of treatment to time of PSA progression. PSA progression is defined by PCWG3 criteria.
Duration of therapy (DOT)
Defined by the time interval from the start of treatment to the day of permanent discontinuation of treatment (including death).
Duration of PSA Response (DOR)
From the time measurement criteria are met for PSA response until the first date that recurrent or progressive disease is objectively documented.
Progression-free survival
From start of treatment to time of progression, whether PSA progression by PCWG3 criteria and/or RECIST 1.1 criteria as applicable.
Overall survival
Defined as the time from the start of treatment until death from any cause. Patients alive or lost to follow-up at the time of analysis will be censored at their last date of follow-up.
Intrapatient dose delays
Median number of dose delays per patient while on treatment (with minimum and maximum as measures of variability of the statistic)
Intrapatient dose reductions
Median number of dose reductions per patient while on treatment (with minimum and maximum as measures of variability of the statistic)
Full Information
NCT ID
NCT03300505
First Posted
September 28, 2017
Last Updated
April 3, 2023
Sponsor
University of Michigan Rogel Cancer Center
1. Study Identification
Unique Protocol Identification Number
NCT03300505
Brief Title
ARRx in Combination With Enzalutamide in Metastatic Castration Resistant Prostate Cancer
Official Title
ARRO-CITO: (UMCC 2017.055) Phase Ib/II Single-Arm Multi-Center Study of IONIS-AR-2.5Rx, a Next Generation Androgen Receptor Antisense Oligonucleotide, in Combination With Enzalutamide in Metastatic Castration Resistant Prostate Cancer
Study Type
Interventional
2. Study Status
Record Verification Date
April 2023
Overall Recruitment Status
Terminated
Why Stopped
Cancelled by the sponsor
Study Start Date
May 31, 2019 (Actual)
Primary Completion Date
January 24, 2023 (Actual)
Study Completion Date
January 24, 2023 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Michigan Rogel Cancer Center
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this study is to test the effectiveness (how well the drug works), safety, and tolerability of the investigational drug combination of ARRx (also known as AZD5312) plus enzalutamide in patients with metastatic castration resistant prostate cancer.
Detailed Description
This is a single dose-finding one-arm phase Ib/II trial to determine the maximum tolerated dose (MTD) from among three dose levels of ARRx in combination with a fixed dose of enzalutamide and to obtain a preliminary estimate of efficacy at this MTD, as measured by PSA response rate. Success for the trial is defined as finding a dose level that is likely to be both tolerable and effective.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prostate Cancer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
9 (Actual)
8. Arms, Groups, and Interventions
Arm Title
ARRx + Enzalutamide
Arm Type
Experimental
Arm Description
Phase 1b: All registered subjects will be treated with ARRx (ASO) in combination with enzalutamide. ARRx will be given intravenously on Days 1, 4, 8, 11, 15 on cycle 1, then on days 1, 8, 15 in subsequent 21-day cycles. Enzalutamide will be taken daily in 21 day cycles starting Day 1 of cycle 1. Treatment will continue until clinical or radiologic progression or unacceptable toxicity.
Phase 2: Subjects will be treated with ARRx (ASO) at the maximum tolerated (MTD), in combination with enzalutamide until clinical or radiologic progression or unacceptable toxicity. (Schedule of administration as in phase 1b.)
Intervention Type
Drug
Intervention Name(s)
ARRx
Other Intervention Name(s)
AZD5312
Intervention Description
Given intravenously (IV)
Intervention Type
Drug
Intervention Name(s)
Enzalutamide
Other Intervention Name(s)
Xtandi
Intervention Description
Given by mouth (PO)
Primary Outcome Measure Information:
Title
Number of subjects with dose-limiting toxicity (DLT) during the first cycle of ARRx (in combination with enzalutamide)
Description
DLTs will be counted based on the number of subjects with DLT at a given dose level. No single subject can trigger more than one DLT event. DLT is defined as any Grade 3 or higher toxicity as defined by CTCAE v5.0. Toxicity that is clearly and directly related to the primary disease or to another etiology is excluded from this definition.
Time Frame
Up to day 21 of treatment
Title
Best PSA response
Description
Using the Prostate Cancer Clinical Trials Working Group 3 (PCWG3) criteria. From the start of the treatment until disease progression/recurrence.
Time Frame
Up to ~3 years
Secondary Outcome Measure Information:
Title
Time to radiographic progression-free survival (rPFS)
Description
Using PCWG3-modified RECIST 1.1 (Response Evaluation Criteria in Solid Tumors).
Time Frame
Up to ~5 years
Title
Percentage of patients with a reduction in PSA of at least 30% from baseline
Description
Using PCWG3 criteria
Time Frame
Up to ~3 years
Title
Time to PSA progression
Description
Using PCWG3 criteria
Time Frame
Up to ~5 years
Title
PSA progression-free survival (PFS)
Description
PSA PFS is defined as the duration of time from start of treatment to time of PSA progression. PSA progression is defined by PCWG3 criteria.
Time Frame
Up to ~5 years
Title
Duration of therapy (DOT)
Description
Defined by the time interval from the start of treatment to the day of permanent discontinuation of treatment (including death).
Time Frame
Up to ~3 years
Title
Duration of PSA Response (DOR)
Description
From the time measurement criteria are met for PSA response until the first date that recurrent or progressive disease is objectively documented.
Time Frame
Up to ~5 years
Title
Progression-free survival
Description
From start of treatment to time of progression, whether PSA progression by PCWG3 criteria and/or RECIST 1.1 criteria as applicable.
Time Frame
Up to ~5 years
Title
Overall survival
Description
Defined as the time from the start of treatment until death from any cause. Patients alive or lost to follow-up at the time of analysis will be censored at their last date of follow-up.
Time Frame
Up to ~5 years
Title
Intrapatient dose delays
Description
Median number of dose delays per patient while on treatment (with minimum and maximum as measures of variability of the statistic)
Time Frame
Up to ~3 years
Title
Intrapatient dose reductions
Description
Median number of dose reductions per patient while on treatment (with minimum and maximum as measures of variability of the statistic)
Time Frame
Up to ~3 years
10. Eligibility
Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Ability to understand and voluntarily agree to participate by providing written informed consent for the trial.
Histologically confirmed prostate adenocarcinoma cancer, either pure or mixed. Small cell/neuroendocrine differentiation is not allowed.
Castrate levels of serum testosterone (≤ 50 ng/dL). Patients must continue androgen deprivation therapy with an LHRH analogue or antagonist if they have not undergone bilateral orchiectomy.
Patients must have metastatic disease; either non-measurable disease OR measurable disease per RECIST 1.1.
Progressive disease despite ongoing treatment with Androgen Deprivation Therapy (ADT).
Patients treated with first generation anti-androgen as most recent systemic therapy (e.g. bicalutamide, nilutamide) must have at least 4 weeks elapsed from treatment discontinuation to start of protocol therapy with evidence of disease progression (per protocol) following discontinuation of prior anti-androgen.
Minimum PSA at entry of 1 ng/mL is required.
ECOG Performance Status 0, 1 or 2.
Be ≥18 years of age on the day of signing informed consent.
Demonstrate adequate organ function.
Subjects must agree to use an adequate method of contraception as outlined in the protocol starting with the time of informed consent through 120 days after the last dose trial therapy.
Exclusion Criteria:
Prior chemotherapy and/or enzalutamide for metastatic castration-resistant prostate cancer. Chemotherapy administered in the castration-sensitive setting is allowed provided last dose of chemotherapy was greater than 6 months prior to study entry.
Is currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigation device within 4 weeks prior to enrollment.
Has not recovered (i.e., AE ≤Grade 1 or at baseline) from AEs due to a previously administered agent. Subjects with ≤Grade 2 neuropathy or ≤Grade 2 alopecia are an exception to this criterion and are allowed if relevant toxicity is stabilized.
If subjects received major surgery they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting trial therapy.
Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin.
Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial. At the time of signing informed consent is a known regular user (including "recreational use") of any illicit drug(s) or had a recent history (within the last year) of drug or alcohol abuse.
Has a known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies).
Has known active hepatitis B (e.g., HBsAg reactive) or hepatitis C (e.g., HCV RNA [qualitative] is detected).
Has received a live virus vaccine within 30 days of planned start of trial therapy.
Has known active CNS metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they have stable brain metastases (stability is normally defined as a period of 1 to 3 months in which there is no evidence of new or enlarging CNS metastases).
Has symptomatic ascites or pleural effusion; a subject who is clinically stable following treatment for these conditions is eligible.
Has had a prior allogeneic stem cell or bone marrow transplant.
Has known contraindication to aspirin (81 mg).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ajjai Alva, MD
Organizational Affiliation
University of Michigan
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Michigan Rogel Cancer Center
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48105
Country
United States
Facility Name
Barbara Ann Karmanos Cancer Institute
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
ARRx in Combination With Enzalutamide in Metastatic Castration Resistant Prostate Cancer
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