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Nivolumab in Patients With High-Risk Biochemically Recurrent Prostate Cancer

Primary Purpose

Prostate Cancer

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Nivolumab
Sponsored by
Beth Israel Deaconess Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostate Cancer focused on measuring Prostate Cancer

Eligibility Criteria

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

Inclusion Criteria:

  • Patients must have signed an informed-consent form indicating that the patient understands the purpose of and procedures required for the study and is willing to participate in the study.
  • Patients must have a history of prostate adenocarcinoma (adenocarcinoma must be the primary histology; secondary components of variant histologies are acceptable) confirmed on biopsy and treated with primary radical prostatectomy (RP) or definitive radiation (RT). Prior salvage RT is acceptable.
  • Patients must have experienced biochemical recurrence (BCR) plus have minimum PSA values noted below:

    • Following primary RP: Any detectable rising PSA after RP (or after salvage RT if performed), minimum PSA 1.0 at time of screening
    • Following primary RT: PSA rise to ≥2 ng/mL above the nadir
    • No evidence of metastases on conventional imaging (CT or MRI plus bone scan)
  • PSA doubling time (PSADT) <10 months --PSADT: calculated as per Prostate Cancer Working Group 3 (PCWG3) and the Memorial Sloan Kettering Cancer Center calculator: (https://www.mskcc.org/nomograms/prostate/psa_doubling_time)

With linear regression model of normal logarithm of PSA and time, based on:

  • At least 3 consecutive PSA values with each value ≥0.2 ng/mL
  • Interval between first and last PSA values is ≥8 weeks but ≤12 months.

    -Archival tissue is mandatory, either prostatectomy specimen or (in patients who received primary RT) diagnostic core biopsies. Patients must consent to next-generation sequencing performed on this tissue.

  • If diagnostic core biopsies are only available tissue, at least 3 cores must be involved by tumor

    • Easteron Cooperative Oncology Group (ECOG) performance status 0-1
    • Age ≥18 years
    • Adequate organ and marrow function:
    • System Laboratory Value
  • Hematological
  • White blood cell (WBC) ≥ 2000/µL
  • Absolute Neutrophil Count (ANC) ≥ 1500/μL
  • Platelets (Plt) ≥ 100 x103/μL
  • Hemoglobin (Hgb) > 9.0 g/dL (with or without transfusion)

    -Renal

  • Serum Creatinine ≤ 2 x ULN
  • Hepatic
  • Bilirubin1 ≤ 1.5× upper limit of normal (ULN)
  • Aspartate aminotransferase (AST) ≤ 3 × ULN
  • Alanine aminotransferase (ALT) ≤ 3 × ULN

    • Except subjects with Gilbert Syndrome, who can have total bilirubin < 3.0 mg/dL
    • Baseline testosterone ≥100 ng/dL
    • Recovery from acute toxicity related to prior therapy, including surgery and radiation, or no treatment-related toxicity ≥ grade 2.
    • History of prior malignancy or concurrent separate malignancy is not an exclusion criterion so long as the non-prostate malignancy is stable and does not require any treatment.
    • Able to understand and sign informed consent and adhere to study procedures.
    • Male patients whose female partners are of reproductive potential must agree to use a contraception during the trial period

Exclusion Criteria:

  • Current use of ADT or plan to initiate ADT during trial period
  • Major surgery or radiation therapy within 14 days of starting study treatment
  • Subjects with active autoimmune disease. Patients with a history of autoimmune disease that has not required systemic immunosuppressive therapy or does not threaten vital organ function including central nervous system, heart, lungs, kidneys, skin, and gastrointestinal tract will be allowed.
  • Known history of immune deficiencies or chronic viral infections including HIV, hepatitis B (HBV), and hepatitis C (HCV) (patients with prior therapy for HBV or HCV is permitted if viral clearance was documented).
  • Concurrent medical condition requiring use of systemic corticosteroids with prednisone >10 mg per day or equivalent. Use of inhaled, nasal, and topical steroids (applied to small body areas) is allowed.
  • Current use (within past 4 weeks) of other prohibited medications including anti-cancer therapies, hormonal therapies, 5-alpha reductase inhibitors, and alternative medications known to alter PSA (e.g. phytoestrogens and saw palmetto).
  • Prior treatment with immune checkpoint inhibitors. (Prior cancer vaccines are allowed.)
  • Serious intercurrent medical or psychiatric illness that, in the judgment of the investigator, would interfere with patient's ability to carry out the treatment program

Sites / Locations

  • St. Elizabeth's Medical CenterRecruiting
  • Beth Israel Deaconess Medical CenterRecruiting
  • Dana Farber Cancer InstituteRecruiting
  • DFCI South ShoreRecruiting
  • DFCI LondonderryRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

PD-L1 Positive

PD-L1 Negative

Arm Description

-Nivolumab will be given on day 1 of a 28-day cycle intravenously

-Nivolumab will be given on day 1 of a 28-day cycle intravenously

Outcomes

Primary Outcome Measures

Disease Control
Proportion of patients with high-risk biochemically-recurrent (BCR) prostate cancer (PCa) that experiences decline or stabilization in PSA (without symptomatic/radiographic progression) after 12 weeks of nivolumab treatment

Secondary Outcome Measures

Maximal change in prostate specific antigen (PSA) during nivolumab treatment
Best PSA response during nivolumab treatment as an absolute change relative to baseline
Change in PSA doubling time (PSADT) at end-of-study relative to baseline
Time from enrollment to development of radiographic metastatic disease
Time from enrollment to initiation of androgen deprivation therapy (ADT)
Treatment-related adverse events as assessed by CTCAE v5.0

Full Information

First Posted
August 16, 2018
Last Updated
July 7, 2023
Sponsor
Beth Israel Deaconess Medical Center
Collaborators
Bristol-Myers Squibb, Dana-Farber Cancer Institute
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1. Study Identification

Unique Protocol Identification Number
NCT03637543
Brief Title
Nivolumab in Patients With High-Risk Biochemically Recurrent Prostate Cancer
Official Title
A Phase 2 Study of Nivolumab in Patients With High-Risk Biochemically Recurrent Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 18, 2018 (Actual)
Primary Completion Date
September 30, 2023 (Anticipated)
Study Completion Date
March 31, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Beth Israel Deaconess Medical Center
Collaborators
Bristol-Myers Squibb, Dana-Farber Cancer Institute

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
This research study is studying an immune-based cancer drug as a possible treatment for prostate cancer. The drug involved in this study is: -Nivolumab
Detailed Description
This research study is a Phase II clinical trial. Phase II clinical trials test the safety and effectiveness of an investigational drug to learn whether the drug works in treating a specific disease. "Investigational" means that the drug is being studied. The FDA (the U.S. Food and Drug Administration) has not approved nivolumab for this specific disease but it has been approved for other uses. Nivolumab is an antibody inhibitor of the programmed death-1 (PD-1) pathway. By blocking PD-1, this medication may allow the immune system to recognize and fight cancer. In this research study, the investigators are investigating whether nivolumab has any activity in patients who have a rising PSA (prostate specific antigen) after previously undergoing surgery or radiation for prostate cancer. Although nivolumab was previously not found to have significant effect in advanced prostate cancer after all other therapies had failed, based on new research, the investigators are testing whether nivolumab could have a greater effect earlier in the disease course and before patients receive hormone therapies.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
34 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
PD-L1 Positive
Arm Type
Experimental
Arm Description
-Nivolumab will be given on day 1 of a 28-day cycle intravenously
Arm Title
PD-L1 Negative
Arm Type
Experimental
Arm Description
-Nivolumab will be given on day 1 of a 28-day cycle intravenously
Intervention Type
Drug
Intervention Name(s)
Nivolumab
Other Intervention Name(s)
Opdivo
Intervention Description
Nivolumab is an antibody inhibitor of the programmed death-1 (PD-1) pathway. By blocking PD-1, this medication may allow the immune system to recognize and fight cancer
Primary Outcome Measure Information:
Title
Disease Control
Description
Proportion of patients with high-risk biochemically-recurrent (BCR) prostate cancer (PCa) that experiences decline or stabilization in PSA (without symptomatic/radiographic progression) after 12 weeks of nivolumab treatment
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Maximal change in prostate specific antigen (PSA) during nivolumab treatment
Time Frame
2 years
Title
Best PSA response during nivolumab treatment as an absolute change relative to baseline
Time Frame
2 years
Title
Change in PSA doubling time (PSADT) at end-of-study relative to baseline
Time Frame
2 years
Title
Time from enrollment to development of radiographic metastatic disease
Time Frame
2 years
Title
Time from enrollment to initiation of androgen deprivation therapy (ADT)
Time Frame
2 years
Title
Treatment-related adverse events as assessed by CTCAE v5.0
Time Frame
2 years

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have signed an informed-consent form indicating that the patient understands the purpose of and procedures required for the study and is willing to participate in the study. Patients must have a history of prostate adenocarcinoma (adenocarcinoma must be the primary histology; secondary components of variant histologies are acceptable) confirmed on biopsy and treated with primary radical prostatectomy (RP) or definitive radiation (RT). Prior salvage RT is acceptable. Patients must have experienced biochemical recurrence (BCR) plus have minimum PSA values noted below: Following primary RP: Any detectable rising PSA after RP (or after salvage RT if performed), minimum PSA 1.0 at time of screening Following primary RT: PSA rise to ≥2 ng/mL above the nadir No evidence of metastases on conventional imaging (CT or MRI plus bone scan) PSA doubling time (PSADT) <10 months --PSADT: calculated as per Prostate Cancer Working Group 3 (PCWG3) and the Memorial Sloan Kettering Cancer Center calculator: (https://www.mskcc.org/nomograms/prostate/psa_doubling_time) With linear regression model of normal logarithm of PSA and time, based on: At least 3 consecutive PSA values with each value ≥0.2 ng/mL Interval between first and last PSA values is ≥8 weeks but ≤12 months. -Archival tissue is mandatory, either prostatectomy specimen or (in patients who received primary RT) diagnostic core biopsies. Patients must consent to next-generation sequencing performed on this tissue. If diagnostic core biopsies are only available tissue, at least 3 cores must be involved by tumor Easteron Cooperative Oncology Group (ECOG) performance status 0-1 Age ≥18 years Adequate organ and marrow function: System Laboratory Value Hematological White blood cell (WBC) ≥ 2000/µL Absolute Neutrophil Count (ANC) ≥ 1500/μL Platelets (Plt) ≥ 100 x103/μL Hemoglobin (Hgb) > 9.0 g/dL (with or without transfusion) -Renal Serum Creatinine ≤ 2 x ULN Hepatic Bilirubin1 ≤ 1.5× upper limit of normal (ULN) Aspartate aminotransferase (AST) ≤ 3 × ULN Alanine aminotransferase (ALT) ≤ 3 × ULN Except subjects with Gilbert Syndrome, who can have total bilirubin < 3.0 mg/dL Baseline testosterone ≥100 ng/dL Recovery from acute toxicity related to prior therapy, including surgery and radiation, or no treatment-related toxicity ≥ grade 2. History of prior malignancy or concurrent separate malignancy is not an exclusion criterion so long as the non-prostate malignancy is stable and does not require any treatment. Able to understand and sign informed consent and adhere to study procedures. Male patients whose female partners are of reproductive potential must agree to use a contraception during the trial period Exclusion Criteria: Current use of ADT or plan to initiate ADT during trial period Major surgery or radiation therapy within 14 days of starting study treatment Subjects with active autoimmune disease. Patients with a history of autoimmune disease that has not required systemic immunosuppressive therapy or does not threaten vital organ function including central nervous system, heart, lungs, kidneys, skin, and gastrointestinal tract will be allowed. Known history of immune deficiencies or chronic viral infections including HIV, hepatitis B (HBV), and hepatitis C (HCV) (patients with prior therapy for HBV or HCV is permitted if viral clearance was documented). Concurrent medical condition requiring use of systemic corticosteroids with prednisone >10 mg per day or equivalent. Use of inhaled, nasal, and topical steroids (applied to small body areas) is allowed. Current use (within past 4 weeks) of other prohibited medications including anti-cancer therapies, hormonal therapies, 5-alpha reductase inhibitors, and alternative medications known to alter PSA (e.g. phytoestrogens and saw palmetto). Prior treatment with immune checkpoint inhibitors. (Prior cancer vaccines are allowed.) Serious intercurrent medical or psychiatric illness that, in the judgment of the investigator, would interfere with patient's ability to carry out the treatment program
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
David J. Einstein, MD
Phone
617-667-2100
Email
deinstei@bidmc.harvard.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David J. Einstein, MD
Organizational Affiliation
Beth Israel Deaconess Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
St. Elizabeth's Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02135
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Olga Kozyreva, MD
Email
Olga_Kozyreva@DFCI.HARVARD.EDU
Facility Name
Beth Israel Deaconess Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
David J. Einstein, MD
Phone
617-667-2100
Email
deinstei@bidmc.harvard.edu
First Name & Middle Initial & Last Name & Degree
David J. Einstein, MD
Facility Name
Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Xiao Wei, MD
Email
XiaoX_Wei@DFCI.HARVARD.EDU
First Name & Middle Initial & Last Name & Degree
Xiao Wei, MD
Facility Name
DFCI South Shore
City
South Weymouth
State/Province
Massachusetts
ZIP/Postal Code
02190
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Thomams O'Connor, MD
Email
thomasp_o'connor@dfci.harvard.edu
Facility Name
DFCI Londonderry
City
Londonderry
State/Province
New Hampshire
ZIP/Postal Code
03053
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Frederick Briccetti, MD
Email
fred_briccetti@dfci.harvard.edu

12. IPD Sharing Statement

Plan to Share IPD
No

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Nivolumab in Patients With High-Risk Biochemically Recurrent Prostate Cancer

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