search
Back to results

Biomarkers for Neoadjuvant Pembrolizumab in Non-Metastatic Prostate Cancer Positive by 18FDG-PET Scanning (PICT-01)

Primary Purpose

Prostate Cancer

Status
Recruiting
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Pembrolizumab
Sponsored by
CHU de Quebec-Universite Laval
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostate Cancer focused on measuring Prostate Cancer, Pembrolizumab, 18FDG-PET Scanning

Eligibility Criteria

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

Inclusion Criteria:

  • Male Age≥ 18 years old
  • Non-metastatic prostate cancer with histologically confirmed Gleason sum ≥8
  • Eligible for radical prostatectomy with a delay of 6 to 9 weeks
  • Intraprostatic maximum standardized uptake value (SUVmax) ≥4 at 18-FDG-PET/CT exam.
  • Not be castrated or under androgen deprivation therapy
  • Not have received prior neo adjuvant hormonotherapy.
  • Provided archival formalin-fixed, paraffin embedded tumor biopsy of the prostate tumor lesion not previously irradiated
  • Performance status of Eastern Cooperative Oncology Group 0 to 1
  • Adequate organ function

Exclusion Criteria:

  • Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4 (Cytotoxic T-lymphocyte-Associated Protein 4), OX-40, CD137).
  • Has received prior systemic anti-cancer therapy including investigational agents within 4 weeks prior to allocation.
  • Has received prior radiotherapy to the prostate or other organs within 2 weeks of start of study treatment.
  • Has received a live vaccine within 30 days prior to the first dose of study drug.
  • Is participating or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study treatment.
  • Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug
  • Other primary cancer within 3 years
  • Has severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its excipients.
  • Has active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (eg., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
  • Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis.
  • Has an active infection requiring systemic therapy.
  • Has a known history of Human Immunodeficiency Virus (HIV).
  • Has a known history of Hepatitis B or known active Hepatitis C virus infection. Note: no testing for Hepatitis B and Hepatitis C is required unless mandated by local health authority.
  • Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the subject's participation for the full duration of the study, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
  • Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
  • Is expecting to father children within the projected duration of the study, starting with the screening visit through the date of prostatectomy.

Sites / Locations

  • CHU de Québec-Université LavalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Prostate Cancer

Arm Description

Participants will receive 3 cycles of pembrolizumab regardless of PD-L1 status. After completion of the second cycle of pembrolizumab treatment, and just before the third injection of pembrolizumab an 18FDG-PET/CT scan will be performed to assess a potential metabolic response. Then between 2 to 4 weeks after the third treatment, subjects will undergo radical prostatectomy. Subjects will be followed every 3 months during the first year post-surgery and according to physician decision during the following years.

Outcomes

Primary Outcome Measures

The antitumor activity of pembrolizumab assessed as the tumor response rate based on the change in tumor volume as measured by 18FDG-PET
The change in tumor volume will be assessed by change in tumor volume from baseline after 3 cycles of pembrolizumab treatment
Mean difference change in proliferative index in prostate cancer patients between patients treated with pembrolizumab and the control cohort
Proliferative index is measured by Ki67/apoptosis rate
Immune cell infiltration and immune checkpoint expression
Compare large panel of ICP (Immune CheckPoints) ligand expression between patients treated by pembrolizumab and cohort control by imaging mass cytometry

Secondary Outcome Measures

One year PSA (Prostate Specific Antigen) failure rate
A statistically significant difference in the 1 year PSA failure rate compared to a historical cohort of untreated patients will indicate that the study has met this secondary objective.
Incidence of Treatment-Emergent Adverse Events as assessed by CTCAE v4.0
Number of participants with decrease in SUV uptake after 3 cycles of pembrolizumab
Assess a possible correlation between deficient mismatched repair (dMMR) and microsatellite instability-high (MSI-H) and response to pembrolizumab.
dMMR and MSI-H status will be determined by immunochemistry and PCR (Polymerase Chain Reaction) respectively
Assess the expression of a series of cytokines and eicosanoids
The concentration of 27 cytokines and 37 eicosanoids in tumor sample will be evaluated

Full Information

First Posted
June 17, 2019
Last Updated
February 28, 2023
Sponsor
CHU de Quebec-Universite Laval
Collaborators
Merck Sharp & Dohme LLC
search

1. Study Identification

Unique Protocol Identification Number
NCT04009967
Brief Title
Biomarkers for Neoadjuvant Pembrolizumab in Non-Metastatic Prostate Cancer Positive by 18FDG-PET Scanning
Acronym
PICT-01
Official Title
Phase II Clinical and Translational Study of Neoadjuvant Pembrolizumab Before Radical Prostatectomy in Non-metastatic Gleason ≥8 Prostate Cancer Patients Positive by 18FDG-PET Scanning ( PICT-01)
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 10, 2020 (Actual)
Primary Completion Date
November 1, 2023 (Anticipated)
Study Completion Date
May 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
CHU de Quebec-Universite Laval
Collaborators
Merck Sharp & Dohme LLC

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
Various approaches are currently being developed for prostate cancer immunotherapy. However, a major challenge facing the development of cancer immunotherapy is the identification of tumors that would best respond to this type of treatment. Different studies suggest that prostate cancer more likely to progress are more infiltrated by exhausted T cells expressing the cell surface protein PD1 (Programmed cell death 1). Therefore, there is a strong rationale for selecting patients at higher risk of progression for testing the efficacy of anti-PD1 therapy. High glucose metabolism as detected by fludeoxyglucose F18 (FDG)-positron emission tomography (PET) (18FDG-PET) imagery is an innovative biological biomarker-based method to identify patients at higher risk of recurrence and early failure to hormonotherapy. Recent study demonstrated that high intra-prostatic 18-FDG-uptake was associated with higher Gleason grades. Therefore the one third of Gleason ≥ 8 prostate cancer patients with higher 18FDG uptake would be ideal candidates for early immunotherapy treatments based on anti-PD-1 such as pembrolizumab. The study aimed to identify biomarkers predictive the response to Pembrolizumab given prior to radical prostatectomy in participants with primary prostate cancer at high risk of progression.
Detailed Description
This is a Phase II, single-arm and open-label trial of pembrolizumab (MK-3475) in localized prostate cancer patients with newly diagnosed non-metastatic prostate cancer (Gleason grade ≥8 on biopsy) with positive tumor by FDG-PET (SUV max >4) who chose to undergo radical prostatectomy and lymph node dissection as primary treatment. The trial will meet its endpoint if a reduction in cancer extent, proliferative index and increased apoptosis, as well as an induction of favorable immune cell infiltration and immune checkpoint expression profiles are observed after treatment compare to baseline..

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prostate Cancer
Keywords
Prostate Cancer, Pembrolizumab, 18FDG-PET Scanning

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Prostate Cancer
Arm Type
Experimental
Arm Description
Participants will receive 3 cycles of pembrolizumab regardless of PD-L1 status. After completion of the second cycle of pembrolizumab treatment, and just before the third injection of pembrolizumab an 18FDG-PET/CT scan will be performed to assess a potential metabolic response. Then between 2 to 4 weeks after the third treatment, subjects will undergo radical prostatectomy. Subjects will be followed every 3 months during the first year post-surgery and according to physician decision during the following years.
Intervention Type
Drug
Intervention Name(s)
Pembrolizumab
Other Intervention Name(s)
Keytruda
Intervention Description
Pembrolizumab 200 mg every three weeks for 3 cycles only
Primary Outcome Measure Information:
Title
The antitumor activity of pembrolizumab assessed as the tumor response rate based on the change in tumor volume as measured by 18FDG-PET
Description
The change in tumor volume will be assessed by change in tumor volume from baseline after 3 cycles of pembrolizumab treatment
Time Frame
Through study completion, an average of 1 year
Title
Mean difference change in proliferative index in prostate cancer patients between patients treated with pembrolizumab and the control cohort
Description
Proliferative index is measured by Ki67/apoptosis rate
Time Frame
Through study completion, an average of 1 year
Title
Immune cell infiltration and immune checkpoint expression
Description
Compare large panel of ICP (Immune CheckPoints) ligand expression between patients treated by pembrolizumab and cohort control by imaging mass cytometry
Time Frame
Through study completion, an average of 1 year
Secondary Outcome Measure Information:
Title
One year PSA (Prostate Specific Antigen) failure rate
Description
A statistically significant difference in the 1 year PSA failure rate compared to a historical cohort of untreated patients will indicate that the study has met this secondary objective.
Time Frame
At the end of study completion, an average of 3 years
Title
Incidence of Treatment-Emergent Adverse Events as assessed by CTCAE v4.0
Time Frame
Through study completion, an average of 2 years
Title
Number of participants with decrease in SUV uptake after 3 cycles of pembrolizumab
Time Frame
Through study completion, an average of 2 years
Title
Assess a possible correlation between deficient mismatched repair (dMMR) and microsatellite instability-high (MSI-H) and response to pembrolizumab.
Description
dMMR and MSI-H status will be determined by immunochemistry and PCR (Polymerase Chain Reaction) respectively
Time Frame
At the end of study completion, an average of 3 years
Title
Assess the expression of a series of cytokines and eicosanoids
Description
The concentration of 27 cytokines and 37 eicosanoids in tumor sample will be evaluated
Time Frame
At the end of study completion, an average of 3 years

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male Age≥ 18 years old Non-metastatic prostate cancer with histologically confirmed Gleason sum ≥8 Eligible for radical prostatectomy with a delay of 6 to 9 weeks Intraprostatic maximum standardized uptake value (SUVmax) ≥4 at 18-FDG-PET/CT exam. Not be castrated or under androgen deprivation therapy Not have received prior neo adjuvant hormonotherapy. Provided archival formalin-fixed, paraffin embedded tumor biopsy of the prostate tumor lesion not previously irradiated Performance status of Eastern Cooperative Oncology Group 0 to 1 Adequate organ function Exclusion Criteria: Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4 (Cytotoxic T-lymphocyte-Associated Protein 4), OX-40, CD137). Has received prior systemic anti-cancer therapy including investigational agents within 4 weeks prior to allocation. Has received prior radiotherapy to the prostate or other organs within 2 weeks of start of study treatment. Has received a live vaccine within 30 days prior to the first dose of study drug. Is participating or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study treatment. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug Other primary cancer within 3 years Has severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its excipients. Has active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (eg., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment. Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis. Has an active infection requiring systemic therapy. Has a known history of Human Immunodeficiency Virus (HIV). Has a known history of Hepatitis B or known active Hepatitis C virus infection. Note: no testing for Hepatitis B and Hepatitis C is required unless mandated by local health authority. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the subject's participation for the full duration of the study, or is not in the best interest of the subject to participate, in the opinion of the treating investigator. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial. Is expecting to father children within the projected duration of the study, starting with the screening visit through the date of prostatectomy.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Alain Bergeron, Ph.D
Phone
418-525-4444
Ext
15530
Email
Alain.Bergeron@crchudequebec.ulaval.ca
First Name & Middle Initial & Last Name or Official Title & Degree
Marjorie Besançon, Ph.D
Phone
418-525-4444
Ext
20417
Email
marjorie.besancon@crchudequebec.ulaval.ca
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yves Fradet, MD
Organizational Affiliation
CHU de Québec-Université Laval
Official's Role
Principal Investigator
Facility Information:
Facility Name
CHU de Québec-Université Laval
City
Québec
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yves Fradet, MD
Phone
418 525-4444
Ext
15555
Email
yves.fradet@crchudequebec.ulaval.ca
First Name & Middle Initial & Last Name & Degree
Marjorie Besançon, PhD
Phone
418 525-4444
Ext
20417
Email
marjorie.besancon@crchudequebec.ulaval.ca
First Name & Middle Initial & Last Name & Degree
Yves Fradet, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Biomarkers for Neoadjuvant Pembrolizumab in Non-Metastatic Prostate Cancer Positive by 18FDG-PET Scanning

We'll reach out to this number within 24 hrs