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Neo-DAB: Darolutamide and Abemaciclib in Prostate Cancer

Primary Purpose

Metastatic Prostate Cancer, Non-metastatic Prostate Cancer, Prostate Cancer

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Darolutamide
Abemaciclib
GNRH-A Leuprolide Acetate
GNRH-A Goserelin
Degarelix
Sponsored by
Praful Ravi, MB BCHir, MRCP
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Prostate Cancer focused on measuring Prostate Cancer, Hormone Therapy, Androgen Deprivation Therapy, Metastatic Prostate Cancer, Non-metastatic Prostate Cancer, Radical Prostatectomy

Eligibility Criteria

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

Inclusion Criteria For Phase 1: Provision of signed informed consent prior to any study specific procedures, or have a legally authorized representative sign on the participant's behalf. Ability to swallow oral medications and comply with study procedures and requirements. Males ≥18 years Histologically or cytologically confirmed adenocarcinoma of the prostate without histologic variants (including neuroendocrine differentiation, small cell, sarcomatoid, ductal adenocarcinoma, squamous or transitional cell carcinoma) comprising >50% of the sample as determined by academic medical center pathology review; men without histologic confirmation are eligible provided there is unequivocal evidence of prostate cancer (eg. very high PSA) in the view of the treating physician. M0 or M1 (by CT/MRI and bone scans) CRPC with evidence of progression at study entry demonstrated during continuous androgen deprivation therapy (LHRH/GnRH agonists/antagonists/post orchiectomy) and castrate level of serum testosterone (≤50 ng/dl). Progression is defined as one or more of the following: Sequence of at least 2 rising PSA values at a minimum of 1-week intervals with the last result being at least 1.0 ng/mL if confirmed PSA rise is the only indication of progression. Patients who received an anti-androgen (flutamide, bicalutamide or nilutamide) must have PSA progression ≥4 weeks after the last dose. Radiographic progression per RECIST 1.1 for soft tissue and/or per PCWG3 for bone (i.e., appearance of ≥2 new bone lesions), with or without PSA progression. Serum testosterone level must be ≤50 ng/dL (1.73 nmol/L) at the screening visit. Participants who have not undergone bilateral orchiectomy are required to continue LHRH/GnRH agonists/antagonists) throughout the study. ECOG performance status ≤2 (Karnofsky ≥60%, see Appendix A). Participants must have adequate organ and marrow function as below: System Laboratory Value Hematologic ANC ≥1.5×109/L Platelets ≥100×109/L Hemoglobin ≥9g/dL (≥90g/L) independent of transfusions Hepatic Total Bilirubin ≤1.5 × ULN OR <2 × ULN if known or suspected Gilbert's syndrome ALT and AST ≤3 × ULN OR ≤5 × ULN if liver metastases present Renal eGFR ≥30 mL/min/1.73 m2 (based on Cockcroft-Gault formula [Appendix D] OR 24 hour urine collection. Abbreviations: ALT = alanine aminotransferase; AST = aspartate aminotransferase; ANC = absolute neutrophil count; eGFR = estimated glomerular filtration rate; ULN = upper limit of normal. The effects of darolutamide and abemaciclib on the developing human fetus are unknown. Participants and their partners must agree to use an effective contraception method (hormonal or barrier method of birth control, or abstinence) during the study and for 3 weeks after the last dose of study treatment (darolutamide and/or abemaciclib) if engaged in sex with a woman of childbearing potential, and participants must not donate sperm during this period. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform her treating physician immediately. Inclusion Criteria for Phase 2: Provision of signed informed consent prior to any study specific procedures, or have a legally authorized representative sign on the participant's behalf. Ability to swallow oral medications and comply with study procedures and requirements. Males ≥18 years. Histologically confirmed adenocarcinoma of the prostate without histologic variants (including neuroendocrine differentiation, small cell, sarcomatoid, ductal adenocarcinoma, squamous or transitional cell carcinoma) comprising >50% of the sample as determined by academic medical center pathology review. ≥3 biopsy cores (either systematic or targeted, or a combination) involved with prostate cancer. Prostate biopsy must have been performed within 6 months of screening. <3 biopsy cores with cancer are allowed if the patient has >1cm of tumor or ≥cT3 disease on MRI prostate. Participants must have at least 1 biopsy core with either: Gleason ≥8 OR Gleason 4+3=7 AND at least one of the following: PSA >20ng/dL ≥cT3 disease by MRI Evidence of EPE on biopsy No evidence of metastatic disease as determined by radionuclide bone scan and CT/MRI, and/or PSMA-PET. Pelvic lymph nodes <2cm in short axis are permitted. If PSMA-PET does not show evidence of metastatic disease, CT/MRI and bone scan is not required. Either PSMA-PET or CT/MRI abdomen and bone scan is required before C1D1. NOTE: participants with possible evidence of bone, nodal or visceral metastatic disease on PSMA-PET imaging at baseline (but not CT/MRI or bone scan) are eligible and their participation is encouraged. All participants treated at DFCI must undergo PSMA-PET at baseline or within 28 days of C1D1 (per institutional practice) and will also undergo a research-only PSMA-PET after completion of therapy and prior to RP. Participants must be candidates for RP and be considered surgically resectable by a Urologist. ECOG performance status ≤1 (Karnofsky ≥70%, see Appendix A). Participants must have adequate organ and marrow function as defined below: System Laboratory Value Hematologic ANC ≥1.5×109/L Platelets ≥100×109/L Hemoglobin≥9g/dL (≥90g/L) independent of transfusions Hepatic Total Bilirubin ≤1.5 × ULN, <2 × ULN if known or suspected Gilbert's syndrome ALT and AST ≤3 × ULN Renal eGFR ≥30 mL/min/1.73 m2 (based on Cockcroft-Gault formula [Appendix D] OR 24 hour urine collection. Abbreviations: ALT = alanine aminotransferase; AST = aspartate aminotransferase; ANC = absolute neutrophil count; eGFR = estimated glomerular filtration rate; ULN = upper limit of normal. The effects of darolutamide and abemaciclib on the developing human fetus are unknown. Participants and their partners must agree to use an effective contraception method (hormonal or barrier method of birth control, or abstinence) during the study and for 3 weeks after the last dose of study treatment (darolutamide and/or abemaciclib) if engaged in sex with a woman of childbearing potential, and participants must not donate sperm during this period. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform her treating physician immediately. Exclusion Criteria for Phase 1: Participants who have had chemotherapy or radiotherapy within 4 weeks prior to planned cycle 1 day 1 of study treatment. Participants who have received anti-neoplastic intervention or experimental antineoplastic therapy within 14 days of planned cycle 1 day 1 of study therapy. Participants who are receiving any other investigational agents. Participants who have previously received darolutamide, abemaciclib or another CDK4/6 inhibitor. Participants who have not recovered from adverse events due to prior anti-cancer therapy (i.e. have residual toxicities ≥Grade 2) with the exception of alopecia. Any of the following within 6 months before planned cycle 1 day 1 of study therapy: Stroke Myocardial infarction Severe/unstable angina pectoris Coronary/peripheral artery bypass graft Congestive heart failure New York Heart Association (NYHA) Class III or IV. Known or suspected contraindications, hypersensitivity or allergy to darolutamide or abemaciclib or to any of their excipients. Participants with hepatitis C, hepatitis B or human immunodeficiency (HIV) who are on anti-viral therapy that has the potential to interact with darolutamide or abemaciclib. Participants with untreated brain metastases. Participants with treated brain metastases are eligible if follow-up brain imaging at least 4 weeks after central nervous system (CNS)-directed therapy shows no evidence of progression and ongoing corticosteroids are not required. Participants with new or progressive brain metastases (active brain metastases) or leptomeningeal disease are eligible if the treating physician determines that immediate CNS specific treatment is not required and is unlikely to be required during the first cycle of therapy. Participants treated with drugs known to be strong inhibitors and/or inducers of cytochrome P450 3A4 (CYP3A4) and the treatment cannot be discontinued or switched to a different medication at least 5 half-lives prior to starting study drug. NOTE: precaution is warranted with concomitant use of agents with a narrow therapeutic index that are substrates of P-gp, BCRP and OCT1. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the participant will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the participant is considering a new over-the-counter medicine or herbal product. The participant has serious and/or uncontrolled preexisting medical condition(s) that, in the judgment of the investigator, would preclude participation in this study (for example, interstitial lung disease, severe dyspnea at rest or requiring oxygen therapy, severe renal impairment [e.g. estimated creatinine clearance <30ml/min], history of major surgical resection involving the stomach or small bowel, or preexisting Crohn's disease or ulcerative colitis or a preexisting chronic condition resulting in baseline Grade 2 or higher diarrhea). Concurrent active malignancy whose natural history or treatment has the potential to interfere with safety or efficacy assessment of the investigational regimen. Patients with non-melanomatous skin cancer, superficial bladder cancer, cancer not needing active therapy for at least 2 years, cancer for which the treating investigator deems the subject to be in remission, or any prior malignancy that was treated with curative intent (no evidence of disease for at least 3 years) are permitted to enroll. Exclusion Criteria for Phase 2: 3.4.1 Prior radiotherapy, bilateral orchiectomy, investigational therapy or systemic therapy (including LHRH/GnRH agonists/antagonists, anti-androgens, CYP17 inhibitors, AR antagonists) for prostate cancer. LHRH/GnRH agonists/antagonists are permitted if begun within 4 weeks of day 1; up to 4 weeks of bicalutamide is permitted if it is stopped 2 weeks prior to day 1. Prior therapy with 5-⍺-reductase inhibitors is allowed but must be stopped 2 weeks prior to day 1. Hypogonadism or severe androgen deficiency as defined by screening serum testosterone < 200ng/dL. Patients who have a low screening testosterone due to prior ADT (per 3.4.1) will still be allowed to enroll on study if they do not have a known history of hypogonadism or severe androgen deficiency. Major surgery or radiotherapy within 4 weeks of start of treatment. Any of the following within 6 months before randomization: Stroke Myocardial infarction Severe/unstable angina pectoris Coronary/peripheral artery bypass graft Congestive heart failure New York Heart Association (NYHA) Class III or IV. Known or suspected contraindications, hypersensitivity or allergy to darolutamide or abemaciclib or to any of their excipients. Participants with hepatitis C, hepatitis B or human immunodeficiency (HIV) who are on anti-viral therapy that has the potential to interact with darolutamide or abemaciclib. Patient treated with drugs known to be moderate or strong inhibitors or inducers of cytochrome P450 3A4 (CYP3A4) and the treatment cannot be discontinued or switched to a different medication at least 5 half-lives prior to starting study drug. NOTE: precaution is warranted with concomitant use of agents with a narrow therapeutic index that are substrates of CYP3A4, P-gp, BCRP and OCT1. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the participant will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the participant is considering a new over-the-counter medicine or herbal product. The participant has serious and/or uncontrolled preexisting medical condition(s) that, in the judgment of the investigator, would preclude participation in this study (for example, interstitial lung disease, severe dyspnea at rest or requiring oxygen therapy, severe renal impairment [e.g. estimated creatinine clearance <30ml/min] or history of renal transplant, history of major surgical resection involving the stomach or small bowel, or preexisting Crohn's disease or ulcerative colitis or a preexisting chronic condition resulting in baseline Grade 2 or higher diarrhea). Concurrent active malignancy whose natural history or treatment has the potential to interfere with safety or efficacy assessment of the investigational regimen. Patients with non-melanomatous skin cancer, superficial bladder cancer, cancer not needing active therapy for at least 2 years, cancer for which the treating investigator deems the subject to be in remission, or any prior malignancy that was treated with curative intent (no evidence of disease for at least 3 years) are permitted to enroll.

Sites / Locations

  • Dana-Farber Cancer InstituteRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Phase 1 Lead In in CRPC

Phase 2 - Neoadjuvant Darolutamide and ADT prior to Radical Prostatectomy

Phase 2 - Neoadjuvant Darolutamide, Ademaciclib, and ADT prior to Radical Prostatectomy

Arm Description

Standard 3+3 dose escalation scheme with 3 dose levels of abemaciclib and a constant dose of darolutamide, per protocol, for 6, 28-day cycles

per protocol, for 6, 28-day cycles

per protocol, for 6, 28-day cycles

Outcomes

Primary Outcome Measures

Phase 1 - Maximum Tolerated Dose (MTD)
The Maximum Tolerated Dose (MTD) for the study drug combination is defined as the maximum dose combination at which <33% of patients experience a Dose limiting toxicity (DLT) during Cycle 1 (the DLT-evaluation period). If a DLT is observed in 1 of 3 patients, then 3 additional patients will be enrolled at that same dose level. Dose escalation will continue to a dose of abemaciclib 200mg bid, which is the maximal dose levels. If DLTs are seen in 0-1 of 6 patients at dose level +1 (darolutamide 600mg bid and abemaciclib 200mg bid), then this will be the RP2D; otherwise the maximally tolerated dose (MTD) will be the RP2D.
Phase 1 - Dose Limiting Toxicity (DLT)
Dose Limiting Toxicity (DLT) for Phase 1 is defined as an adverse event that is related to Darolutamide and Abemaciclib with an attribution of possible, probable or definite and occurs during and/or begins during the first 28 days of the study treatment, using NCI CTCAE criteria version 5.0.
Phase 1 - Recommended Phase 2 Dose (RP2D)
RP2D will be determined after an Maximum Tolerated Dose (MTD) is identified or the maximum planned dose is achieved. Recommended Phase 2 Dose (RP2D) is defined as no more than 0-1 patients with dose limiting toxicity out of 6 at maximal dose level. Otherwise, the maximally tolerated dose will be used.
Phase 2 - Pathological Response Rate
Pathologic response is defined as achieving either a complete response (pCR) or minimal residual disease (MRD, defined as ≤5mm residual tumor) at Radical Prostatectomy (RP) in both arms

Secondary Outcome Measures

Phase 1 - Objective Response Rate (ORR)
The objective response rate (ORR) is defined as the proportion of participants achieving complete response (CR) or partial response (PR) based on RECIST 1.1 criteria on treatment. Per RECIST 1.1 for target lesions: CR is complete disappearance of all target lesions and PR is at least a 30% decrease in the sum of longest diameter (LD) of target lesions, taking as reference baseline sum LD. PR or better overall response assumes at a minimum incomplete response/stable disease (SD) for the evaluation of non-target lesions and absence of new lesions.
Phase 1 - Median Radiographic Progression-Free Survival (rPFS)
Radiographic Progression-Free Survival (rPFS) is defined as the time from protocol treatment initiation to the earlier of progression by PCWG3 criteria73 or death due to any cause. PCWG3 progression is defined as when it is felt by the treating physician that the patient is "no longer clinically benefiting" (NLCB) from therapy. Per RECIST 1.1 criteria: progressive disease (PD) is at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. PD for the evaluation of non-target lesions is the appearance of one or more new lesions and/or unequivocal progression of non-target lesions.
Phase 1 & 2 - Grade 3 or Higher Treatment-Related Toxicity Rate
Defined as all grade 3 or higher adverse events (AE) with treatment attribution of possibly, probably or definite based on CTCAEv5 as reported on case report forms were counted. Rate is the proportion of treated participants experiencing at least one treatment-related grade 3 or higher AE of any type during the time of observation.
Phase 2 - Frequency of Certain Adverse Event (AE)
Certain Adverse Event (AE) includes frequency of positive surgical margins, extracapsular extension, seminal vesicle invasion and lymph node positivity.
Phase 2 - Change in Prostate Specific Antigen (PSA)
A prostate-specific antigen (PSA) test is a blood test that measures the level of PSA in a sample of blood. PSA test will be done by local institutional labs and reported as nanograms of PSA per milliliter (ng/mL) of blood
Phase 2 - 3-year biochemical progression-free survival (bPFS) Rate
3-year bPFS rate is the proportion of participants remaining alive and free of biochemical progression at 3 years. Biochemical progression is defined as a PSA rising to >0.1ng/mL after surgery.
Phase 2 - 5-year progression-free survival (bPFS) Rate
5-year bPFS rate is the proportion of participants remaining alive and free of biochemical progression at 5 years. Biochemical progression is defined as a PSA rising to >0.1ng/mL after surgery.
Phase 2 - Proportion free from Prostate Cancer Therapy
Proportion free from further prostate cancer therapy will be estimated from the Kaplan Meier methodology by each arm. Further prostate cancer therapy includes salvage radiotherapy and/or ADT.

Full Information

First Posted
November 8, 2022
Last Updated
August 28, 2023
Sponsor
Praful Ravi, MB BCHir, MRCP
Collaborators
Eli Lilly and Company, Bayer
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1. Study Identification

Unique Protocol Identification Number
NCT05617885
Brief Title
Neo-DAB: Darolutamide and Abemaciclib in Prostate Cancer
Official Title
A Phase 1/2 Study of Darolutamide and Abemaciclib in High-Risk Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 9, 2023 (Actual)
Primary Completion Date
June 1, 2024 (Anticipated)
Study Completion Date
June 1, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Praful Ravi, MB BCHir, MRCP
Collaborators
Eli Lilly and Company, Bayer

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 trying to determine the safety and efficacy of the combination of two oral drugs, abemaciclib and darolutamide, with androgen deprivation therapy (ADT) in the treatment of metastatic, non-metastatic, and advanced prostate cancers. The first phase of the study is to establish a recommended dose for the second phase. The names of the study drugs and interventions involved in this study are: Darolutamide Abemaciclib Androgen deprivation therapy (ADT) - this includes several different treatments, including Gonadotropin-Releasing Hormone (GnRH) antagonists and agonists It is expected that about 93 people will take part in the research study. Treatment is expected to last 6 months with a follow up period of up to 4.5 years.
Detailed Description
This research study is a Phase I/II clinical trial to determine the safety and efficacy of the combination of abemaciclib and darolutamide with androgen deprivation therapy (ADT) in the treatment of metastatic and non-metastatic castration-resistance prostate cancer (CRPC) and for participants with high-risk, localized prostate cancer who will be undergoing radical prostatectomy (RP). A Phase I/II clinical trial tests the safety of investigational drugs with a lead-in phase and attempts to define the maximum tolerated dose of the investigational drugs to use for the second phase. "Investigational" means that the drugs are being studied together for the first time. The names of the study drugs and interventions involved in this study are: Darolutamide Abemaciclib Androgen deprivation therapy (ADT) - this includes several different treatments, including Gonadotropin-Releasing Hormone (GnRH) agonists, Leuprolide and Goserelin, and GnRH antagonist, Degarelix In Phase I, participants will receive abemaciclib in combination with darolutamide and ADT at different dosages. In Phase II, participants will be randomized into two groups of treatment: abemaciclib, darolutamide, and ADT versus darolutamide and ADT. Randomization means that participants are placed into one of the treatment groups by chance, like flipping a coin. The U.S Food and Drug Administration (FDA) has approved androgen deprivation therapy as a treatment for prostate cancer. The FDA has not approved abemaciclib for prostate cancer but it has been approved for other uses. Abemaciclib is approved for use in advanced breast cancer. The FDA has approved darolutamide as a treatment option in men with non-metastatic CRPC but it is not approved in men with metastatic CRPC or localized prostate cancer. Research procedures include screening for eligibility, study treatment including evaluations, blood collection, and radiology scans of the prostate. It is expected about 93 participants will take part in this research study. Treatment is expected to last 6 months with a follow up period of up to 4.5 years. Lilly is supporting this research study by providing funding and the study drug, abemaciclib. Bayer is supporting the study by providing the study drug, darolutamide.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Prostate Cancer, Non-metastatic Prostate Cancer, Prostate Cancer
Keywords
Prostate Cancer, Hormone Therapy, Androgen Deprivation Therapy, Metastatic Prostate Cancer, Non-metastatic Prostate Cancer, Radical Prostatectomy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
93 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Phase 1 Lead In in CRPC
Arm Type
Experimental
Arm Description
Standard 3+3 dose escalation scheme with 3 dose levels of abemaciclib and a constant dose of darolutamide, per protocol, for 6, 28-day cycles
Arm Title
Phase 2 - Neoadjuvant Darolutamide and ADT prior to Radical Prostatectomy
Arm Type
Experimental
Arm Description
per protocol, for 6, 28-day cycles
Arm Title
Phase 2 - Neoadjuvant Darolutamide, Ademaciclib, and ADT prior to Radical Prostatectomy
Arm Type
Experimental
Arm Description
per protocol, for 6, 28-day cycles
Intervention Type
Drug
Intervention Name(s)
Darolutamide
Other Intervention Name(s)
Nubeqa
Intervention Description
Tablet administered orally, per protocol, 2 x daily. Darolutamide is an orally administered molecular drug therapy that blocks the action of testosterone, the male sex hormone which can stimulate growth of prostate cancer.
Intervention Type
Drug
Intervention Name(s)
Abemaciclib
Other Intervention Name(s)
Verzenio
Intervention Description
Tablet administered orally, per protocol, 2 x daily. Abemaciclib is an orally administered molecular drug therapy that is called a "CDK4/6 inhibitor". CDK4 and CDK6 are enzymes that are involved in helping healthy and cancerous cells divide and blocking these enzymes can stop cancerous cells from growing.
Intervention Type
Drug
Intervention Name(s)
GNRH-A Leuprolide Acetate
Other Intervention Name(s)
Eligard, Lupron Depot, Lupron Depot-Ped
Intervention Description
Administered via intramuscular injection, per standard of care. GnRH agonist is a hormonal therapy drug.
Intervention Type
Drug
Intervention Name(s)
GNRH-A Goserelin
Other Intervention Name(s)
Zoladex
Intervention Description
Administered via subcutaneous injection, per standard of care. GnRH agonist is a hormonal therapy drug.
Intervention Type
Drug
Intervention Name(s)
Degarelix
Other Intervention Name(s)
Firmagon
Intervention Description
Administered via subcutaneous injection, per standard of care. GnRH antagonist is a hormonal therapy drug.
Primary Outcome Measure Information:
Title
Phase 1 - Maximum Tolerated Dose (MTD)
Description
The Maximum Tolerated Dose (MTD) for the study drug combination is defined as the maximum dose combination at which <33% of patients experience a Dose limiting toxicity (DLT) during Cycle 1 (the DLT-evaluation period). If a DLT is observed in 1 of 3 patients, then 3 additional patients will be enrolled at that same dose level. Dose escalation will continue to a dose of abemaciclib 200mg bid, which is the maximal dose levels. If DLTs are seen in 0-1 of 6 patients at dose level +1 (darolutamide 600mg bid and abemaciclib 200mg bid), then this will be the RP2D; otherwise the maximally tolerated dose (MTD) will be the RP2D.
Time Frame
28 days/Cycle 1, up to 6 months
Title
Phase 1 - Dose Limiting Toxicity (DLT)
Description
Dose Limiting Toxicity (DLT) for Phase 1 is defined as an adverse event that is related to Darolutamide and Abemaciclib with an attribution of possible, probable or definite and occurs during and/or begins during the first 28 days of the study treatment, using NCI CTCAE criteria version 5.0.
Time Frame
28 days/Cycle 1, up to 6 months
Title
Phase 1 - Recommended Phase 2 Dose (RP2D)
Description
RP2D will be determined after an Maximum Tolerated Dose (MTD) is identified or the maximum planned dose is achieved. Recommended Phase 2 Dose (RP2D) is defined as no more than 0-1 patients with dose limiting toxicity out of 6 at maximal dose level. Otherwise, the maximally tolerated dose will be used.
Time Frame
28 days/Cycle 1, up to 6 months
Title
Phase 2 - Pathological Response Rate
Description
Pathologic response is defined as achieving either a complete response (pCR) or minimal residual disease (MRD, defined as ≤5mm residual tumor) at Radical Prostatectomy (RP) in both arms
Time Frame
Disease evaluated from baseline to Pre-Radical Prostatectomy (RP), up to 6 months
Secondary Outcome Measure Information:
Title
Phase 1 - Objective Response Rate (ORR)
Description
The objective response rate (ORR) is defined as the proportion of participants achieving complete response (CR) or partial response (PR) based on RECIST 1.1 criteria on treatment. Per RECIST 1.1 for target lesions: CR is complete disappearance of all target lesions and PR is at least a 30% decrease in the sum of longest diameter (LD) of target lesions, taking as reference baseline sum LD. PR or better overall response assumes at a minimum incomplete response/stable disease (SD) for the evaluation of non-target lesions and absence of new lesions.
Time Frame
Disease evaluated every 12 weeks, up to 6 months
Title
Phase 1 - Median Radiographic Progression-Free Survival (rPFS)
Description
Radiographic Progression-Free Survival (rPFS) is defined as the time from protocol treatment initiation to the earlier of progression by PCWG3 criteria73 or death due to any cause. PCWG3 progression is defined as when it is felt by the treating physician that the patient is "no longer clinically benefiting" (NLCB) from therapy. Per RECIST 1.1 criteria: progressive disease (PD) is at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. PD for the evaluation of non-target lesions is the appearance of one or more new lesions and/or unequivocal progression of non-target lesions.
Time Frame
Evaluated every 12 weeks, up to 6 months
Title
Phase 1 & 2 - Grade 3 or Higher Treatment-Related Toxicity Rate
Description
Defined as all grade 3 or higher adverse events (AE) with treatment attribution of possibly, probably or definite based on CTCAEv5 as reported on case report forms were counted. Rate is the proportion of treated participants experiencing at least one treatment-related grade 3 or higher AE of any type during the time of observation.
Time Frame
28 days, up to 6 months
Title
Phase 2 - Frequency of Certain Adverse Event (AE)
Description
Certain Adverse Event (AE) includes frequency of positive surgical margins, extracapsular extension, seminal vesicle invasion and lymph node positivity.
Time Frame
28 days, up to 6 months
Title
Phase 2 - Change in Prostate Specific Antigen (PSA)
Description
A prostate-specific antigen (PSA) test is a blood test that measures the level of PSA in a sample of blood. PSA test will be done by local institutional labs and reported as nanograms of PSA per milliliter (ng/mL) of blood
Time Frame
PSA is measured day 1 of each cycle, up to 6 months. Each cycle is 28 days.
Title
Phase 2 - 3-year biochemical progression-free survival (bPFS) Rate
Description
3-year bPFS rate is the proportion of participants remaining alive and free of biochemical progression at 3 years. Biochemical progression is defined as a PSA rising to >0.1ng/mL after surgery.
Time Frame
at 3 years
Title
Phase 2 - 5-year progression-free survival (bPFS) Rate
Description
5-year bPFS rate is the proportion of participants remaining alive and free of biochemical progression at 5 years. Biochemical progression is defined as a PSA rising to >0.1ng/mL after surgery.
Time Frame
at 5 years
Title
Phase 2 - Proportion free from Prostate Cancer Therapy
Description
Proportion free from further prostate cancer therapy will be estimated from the Kaplan Meier methodology by each arm. Further prostate cancer therapy includes salvage radiotherapy and/or ADT.
Time Frame
at 2, 3, and 5 years.

10. Eligibility

Sex
Male
Gender Based
Yes
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria For Phase 1: Provision of signed informed consent prior to any study specific procedures, or have a legally authorized representative sign on the participant's behalf. Ability to swallow oral medications and comply with study procedures and requirements. Males ≥18 years Histologically or cytologically confirmed adenocarcinoma of the prostate without histologic variants (including neuroendocrine differentiation, small cell, sarcomatoid, ductal adenocarcinoma, squamous or transitional cell carcinoma) comprising >50% of the sample as determined by academic medical center pathology review; men without histologic confirmation are eligible provided there is unequivocal evidence of prostate cancer (eg. very high PSA) in the view of the treating physician. M0 or M1 (by CT/MRI and bone scans) CRPC with evidence of progression at study entry demonstrated during continuous androgen deprivation therapy (LHRH/GnRH agonists/antagonists/post orchiectomy) and castrate level of serum testosterone (≤50 ng/dl). Progression is defined as one or more of the following: Sequence of at least 2 rising PSA values at a minimum of 1-week intervals with the last result being at least 1.0 ng/mL if confirmed PSA rise is the only indication of progression. Patients who received an anti-androgen (flutamide, bicalutamide or nilutamide) must have PSA progression ≥4 weeks after the last dose. Radiographic progression per RECIST 1.1 for soft tissue and/or per PCWG3 for bone (i.e., appearance of ≥2 new bone lesions), with or without PSA progression. Serum testosterone level must be ≤50 ng/dL (1.73 nmol/L) at the screening visit. Participants who have not undergone bilateral orchiectomy are required to continue LHRH/GnRH agonists/antagonists) throughout the study. ECOG performance status ≤2 (Karnofsky ≥60%, see Appendix A). Participants must have adequate organ and marrow function as below: System Laboratory Value Hematologic ANC ≥1.5×109/L Platelets ≥100×109/L Hemoglobin ≥9g/dL (≥90g/L) independent of transfusions Hepatic Total Bilirubin ≤1.5 × ULN OR <2 × ULN if known or suspected Gilbert's syndrome ALT and AST ≤3 × ULN OR ≤5 × ULN if liver metastases present Renal eGFR ≥30 mL/min/1.73 m2 (based on Cockcroft-Gault formula [Appendix D] OR 24 hour urine collection. Abbreviations: ALT = alanine aminotransferase; AST = aspartate aminotransferase; ANC = absolute neutrophil count; eGFR = estimated glomerular filtration rate; ULN = upper limit of normal. The effects of darolutamide and abemaciclib on the developing human fetus are unknown. Participants and their partners must agree to use an effective contraception method (hormonal or barrier method of birth control, or abstinence) during the study and for 3 weeks after the last dose of study treatment (darolutamide and/or abemaciclib) if engaged in sex with a woman of childbearing potential, and participants must not donate sperm during this period. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform her treating physician immediately. Inclusion Criteria for Phase 2: Provision of signed informed consent prior to any study specific procedures, or have a legally authorized representative sign on the participant's behalf. Ability to swallow oral medications and comply with study procedures and requirements. Males ≥18 years. Histologically confirmed adenocarcinoma of the prostate without histologic variants (including neuroendocrine differentiation, small cell, sarcomatoid, ductal adenocarcinoma, squamous or transitional cell carcinoma) comprising >50% of the sample as determined by academic medical center pathology review. ≥3 biopsy cores (either systematic or targeted, or a combination) involved with prostate cancer. Prostate biopsy must have been performed within 6 months of screening. <3 biopsy cores with cancer are allowed if the patient has >1cm of tumor or ≥cT3 disease on MRI prostate. Participants must have at least 1 biopsy core with either: Gleason ≥8 OR Gleason 4+3=7 AND at least one of the following: PSA >20ng/dL ≥cT3 disease by MRI Evidence of EPE on biopsy No evidence of metastatic disease as determined by radionuclide bone scan and CT/MRI, and/or PSMA-PET. Pelvic lymph nodes <2cm in short axis are permitted. If PSMA-PET does not show evidence of metastatic disease, CT/MRI and bone scan is not required. Either PSMA-PET or CT/MRI abdomen and bone scan is required before C1D1. NOTE: participants with possible evidence of bone, nodal or visceral metastatic disease on PSMA-PET imaging at baseline (but not CT/MRI or bone scan) are eligible and their participation is encouraged. All participants treated at DFCI must undergo PSMA-PET at baseline or within 28 days of C1D1 (per institutional practice) and will also undergo a research-only PSMA-PET after completion of therapy and prior to RP. Participants must be candidates for RP and be considered surgically resectable by a Urologist. ECOG performance status ≤1 (Karnofsky ≥70%, see Appendix A). Participants must have adequate organ and marrow function as defined below: System Laboratory Value Hematologic ANC ≥1.5×109/L Platelets ≥100×109/L Hemoglobin≥9g/dL (≥90g/L) independent of transfusions Hepatic Total Bilirubin ≤1.5 × ULN, <2 × ULN if known or suspected Gilbert's syndrome ALT and AST ≤3 × ULN Renal eGFR ≥30 mL/min/1.73 m2 (based on Cockcroft-Gault formula [Appendix D] OR 24 hour urine collection. Abbreviations: ALT = alanine aminotransferase; AST = aspartate aminotransferase; ANC = absolute neutrophil count; eGFR = estimated glomerular filtration rate; ULN = upper limit of normal. The effects of darolutamide and abemaciclib on the developing human fetus are unknown. Participants and their partners must agree to use an effective contraception method (hormonal or barrier method of birth control, or abstinence) during the study and for 3 weeks after the last dose of study treatment (darolutamide and/or abemaciclib) if engaged in sex with a woman of childbearing potential, and participants must not donate sperm during this period. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform her treating physician immediately. Exclusion Criteria for Phase 1: Participants who have had chemotherapy or radiotherapy within 4 weeks prior to planned cycle 1 day 1 of study treatment. Participants who have received anti-neoplastic intervention or experimental antineoplastic therapy within 14 days of planned cycle 1 day 1 of study therapy. Participants who are receiving any other investigational agents. Participants who have previously received darolutamide, abemaciclib or another CDK4/6 inhibitor. Participants who have not recovered from adverse events due to prior anti-cancer therapy (i.e. have residual toxicities ≥Grade 2) with the exception of alopecia. Any of the following within 6 months before planned cycle 1 day 1 of study therapy: Stroke Myocardial infarction Severe/unstable angina pectoris Coronary/peripheral artery bypass graft Congestive heart failure New York Heart Association (NYHA) Class III or IV. Known or suspected contraindications, hypersensitivity or allergy to darolutamide or abemaciclib or to any of their excipients. Participants with hepatitis C, hepatitis B or human immunodeficiency (HIV) who are on anti-viral therapy that has the potential to interact with darolutamide or abemaciclib. Participants with untreated brain metastases. Participants with treated brain metastases are eligible if follow-up brain imaging at least 4 weeks after central nervous system (CNS)-directed therapy shows no evidence of progression and ongoing corticosteroids are not required. Participants with new or progressive brain metastases (active brain metastases) or leptomeningeal disease are eligible if the treating physician determines that immediate CNS specific treatment is not required and is unlikely to be required during the first cycle of therapy. Participants treated with drugs known to be strong inhibitors and/or inducers of cytochrome P450 3A4 (CYP3A4) and the treatment cannot be discontinued or switched to a different medication at least 5 half-lives prior to starting study drug. NOTE: precaution is warranted with concomitant use of agents with a narrow therapeutic index that are substrates of P-gp, BCRP and OCT1. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the participant will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the participant is considering a new over-the-counter medicine or herbal product. The participant has serious and/or uncontrolled preexisting medical condition(s) that, in the judgment of the investigator, would preclude participation in this study (for example, interstitial lung disease, severe dyspnea at rest or requiring oxygen therapy, severe renal impairment [e.g. estimated creatinine clearance <30ml/min], history of major surgical resection involving the stomach or small bowel, or preexisting Crohn's disease or ulcerative colitis or a preexisting chronic condition resulting in baseline Grade 2 or higher diarrhea). Concurrent active malignancy whose natural history or treatment has the potential to interfere with safety or efficacy assessment of the investigational regimen. Patients with non-melanomatous skin cancer, superficial bladder cancer, cancer not needing active therapy for at least 2 years, cancer for which the treating investigator deems the subject to be in remission, or any prior malignancy that was treated with curative intent (no evidence of disease for at least 3 years) are permitted to enroll. Exclusion Criteria for Phase 2: 3.4.1 Prior radiotherapy, bilateral orchiectomy, investigational therapy or systemic therapy (including LHRH/GnRH agonists/antagonists, anti-androgens, CYP17 inhibitors, AR antagonists) for prostate cancer. LHRH/GnRH agonists/antagonists are permitted if begun within 4 weeks of day 1; up to 4 weeks of bicalutamide is permitted if it is stopped 2 weeks prior to day 1. Prior therapy with 5-⍺-reductase inhibitors is allowed but must be stopped 2 weeks prior to day 1. Hypogonadism or severe androgen deficiency as defined by screening serum testosterone < 200ng/dL. Patients who have a low screening testosterone due to prior ADT (per 3.4.1) will still be allowed to enroll on study if they do not have a known history of hypogonadism or severe androgen deficiency. Major surgery or radiotherapy within 4 weeks of start of treatment. Any of the following within 6 months before randomization: Stroke Myocardial infarction Severe/unstable angina pectoris Coronary/peripheral artery bypass graft Congestive heart failure New York Heart Association (NYHA) Class III or IV. Known or suspected contraindications, hypersensitivity or allergy to darolutamide or abemaciclib or to any of their excipients. Participants with hepatitis C, hepatitis B or human immunodeficiency (HIV) who are on anti-viral therapy that has the potential to interact with darolutamide or abemaciclib. Patient treated with drugs known to be moderate or strong inhibitors or inducers of cytochrome P450 3A4 (CYP3A4) and the treatment cannot be discontinued or switched to a different medication at least 5 half-lives prior to starting study drug. NOTE: precaution is warranted with concomitant use of agents with a narrow therapeutic index that are substrates of CYP3A4, P-gp, BCRP and OCT1. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the participant will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the participant is considering a new over-the-counter medicine or herbal product. The participant has serious and/or uncontrolled preexisting medical condition(s) that, in the judgment of the investigator, would preclude participation in this study (for example, interstitial lung disease, severe dyspnea at rest or requiring oxygen therapy, severe renal impairment [e.g. estimated creatinine clearance <30ml/min] or history of renal transplant, history of major surgical resection involving the stomach or small bowel, or preexisting Crohn's disease or ulcerative colitis or a preexisting chronic condition resulting in baseline Grade 2 or higher diarrhea). Concurrent active malignancy whose natural history or treatment has the potential to interfere with safety or efficacy assessment of the investigational regimen. Patients with non-melanomatous skin cancer, superficial bladder cancer, cancer not needing active therapy for at least 2 years, cancer for which the treating investigator deems the subject to be in remission, or any prior malignancy that was treated with curative intent (no evidence of disease for at least 3 years) are permitted to enroll.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Praful Ravi, MB BChir, MRCP
Phone
617-632-3466
Email
praful_ravi@dfci.harvard.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Praful Ravi, MB BChir, MRCP
Organizational Affiliation
Dana-Farber Cancer Institute
Official's Role
Principal Investigator
Facility Information:
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
Praful Ravi, MB BChir, MRCP
Phone
617-632-3466
Email
praful_ravi@dfci.harvard.edu

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
IPD Sharing Time Frame
Data can be shared no earlier than 1 year following the date of publication
IPD Sharing Access Criteria
Contact the Belfer Office for Dana-Farber Innovations (BODFI) at innovation@dfci.harvard.edu

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Neo-DAB: Darolutamide and Abemaciclib in Prostate Cancer

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