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CompletedNCT01977651UPWARDUpdated Dec 6, 2024Results posted

A Study to Evaluate the Potential Increased Risk of Seizures Among Metastatic Castration-Resistant Prostate Cancer (mCRPC) Patients Treated With Enzalutamide

A Phase 4 interventional study of Enzalutamide in Metastatic Castration-resistant Prostate Cancer (mCRPC), sponsored by Astellas Pharma Global Development, Inc.. Completed at 76 sites in 20 countries. Open to male participants. Per ClinicalTrials.gov, last updated 2024-12-06.

Sponsored by Astellas Pharma Global Development, Inc. (part of Astellas Pharma Inc) · Phase 4, Interventional, and Treatment

Phase
Phase 4
Study type
Interventional
Enrollment
424
Allocation
Not applicable
Sex
Male
01

Study summary

The objective of this study was to evaluate the incidence of seizures and monitor the safety of enzalutamide treatment in participants with metastatic castration-resistant prostate cancer (mCRPC) known to have risk factor(s) for seizure.

Read the detailed description

This was a multicenter, single-arm, open-label, postmarketing safety study to evaluate the risk of seizure among patients with mCRPC treated with enzalutamide who were at potential increased risk of seizure.

Participants who met all inclusion and none of the exclusion criteria were enrolled into the study and participated in a 4-month treatment period, during which once daily dosing of enzalutamide (160 mg/day) occurred. At the end of the 4-month treatment period, participants who were assessed as deriving benefit from enzalutamide treatment were allowed to continue in the extension period where participants continued to receive enzalutamide until 1 of the following criteria was met:

  1. The participant experienced bone disease progression per Prostate Cancer Working Group 2 (PCWG2) guidelines or soft tissue disease progression per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1
  2. The participant initiated treatment with another anticancer therapy or, in the opinion of the investigator, continued dosing would have led to undue risk to the patient
  3. The participant met a discontinuation criterion
  4. The sponsor terminated the study

Participants who continued to receive clinical benefit from treatment with enzalutamide and did not meet any discontinuation criteria may have transitioned to an open label roll-over extension study upon approval of the study protocol at the institution where they were receiving treatment.

Participants who did not continue in the extension period or who met a discontinuation criterion were discontinued from enzalutamide therapy and completed a follow-up visit 30 days from the last dose of enzalutamide or prior to the initiation of another anticancer therapy, whichever occurred first.

For participants who continued on treatment after the 12-month extension period, data collection was limited to dosing information, concomitant medications, and all adverse events (AEs) including serious adverse events (SAEs).

02

Conditions studied

  • Metastatic Castration-resistant Prostate Cancer (mCRPC)

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Keywords

  • enzalutamide
  • Xtandi
  • seizure
  • Central Nervous System
  • MDV3100
  • metastatic castration-resistant prostate cancer (mCRPC)
03

In context

Seizures

896 studies on the registry are indexed under Seizures; 145 are open to participants now.

This study's enrollment of 424 is above the median of 62 across 621 interventional studies indexed under Seizures.

Browse Seizures studies →

Lead sponsor

Astellas Pharma Global Development, Inc. is the lead sponsor of 207 studies on the registry; 24 are open to participants now.

Of its 81 completed or terminated interventional studies of FDA-regulated products, 38 (47%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
Child (0–17), Adult (18–64), Older adult (65+)
Sexes eligible
Male
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Subject has histologically confirmed metastatic adenocarcinoma of the prostate.
  • Subject has ongoing androgen deprivation therapy with a Gonadotropin-releasing hormone (GnRH) analogue (agonist or antagonist) or bilateral orchiectomy (i.e., surgical or medical castration).
  • Subject has disease progression by at least one of the following:

    1. Prostate-Specific Antigen (PSA) progression defined by a minimum of 2 rising PSA levels with an interval of at least 1 week between each draw;
    2. Bone disease progression as defined by Prostate Cancer Working Group 2 guidelines (at least 2 new lesions) on bone scan; or
    3. Soft tissue disease progression as defined by RECIST 1.1
  • For subjects who have not had an orchiectomy, there must be a plan to maintain effective GnRH-analogue therapy for the duration of the study.
  • Subject must have failed at least one course of androgen deprivation therapy (ADT), i.e., treatment with GnRH analogues.
  • Subject has an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.
  • Subject has been evaluated by a local neurologist prior to study entry who has determined the subject has at least one risk factor for seizure including:

    1. past history of seizure due to any cause except a single febrile seizure in childhood. Patients with a history of seizures should not have had a seizure within 12 months of Screening and must have had no anticonvulsants for 12 months prior to Screening,
    2. history of cerebrovascular accident (CVA) or transient ischemic attack (TIA),
    3. history of traumatic brain or head injury with loss of consciousness
    4. unexplained loss of consciousness within the last 12 months,
    5. presence of a space occupying lesion in the brain including previously treated brain metastasis(es) or primary central nervous system (CNS) tumor,
    6. history of arteriovenous malformations of the brain,
    7. history of brain infection (i.e., abscess, meningitis, or encephalitis),
    8. current use of medication that may lower seizure threshold
    9. presence of Alzheimer's disease, meningioma, leptomeningeal disease from prostate cancer.
  • Subject is able to swallow the study drug and comply with study requirements.
  • Subject agrees not to participate in another interventional study while on treatment.
  • Male subject and his female partner who is of childbearing potential must use two acceptable methods of birth control (one of which must include a condom as a barrier method of contraception) starting at Screening and continuing throughout the study period and for 3 months after final study drug administration.

    1. Two acceptable forms of birth control include:

    1. Condom (barrier method of contraception), AND
    2. One of the following acceptable forms of contraception is required:

      1. Established use of oral, injected or implanted hormonal methods of contraception.
      2. Placement of an intrauterine device (IUD) or intrauterine system (IUS).
      3. Barrier methods of contraception: Occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/suppository).
      4. Vasectomy or surgical castration at least 6 months prior to Screening.
  • Male subject must use a condom, if having sex with a pregnant woman.
  • Male subject must not donate sperm starting at Screening and throughout the study period and for at least 3 months after final drug administration.

Exclusion criteria

Exclusion Criteria:

  • Subject with a history of exposure to enzalutamide.
  • Subject has severe concurrent disease, infection, or co-morbidity that, in the judgment of the Investigator, would make the subject inappropriate for enrollment.
  • Subject is currently being treated with anti-epileptics.
  • Subject has a history of seizure within the past 12 months of Screening as assessed by neurology examination and history.
  • Subject with rapidly progressing visceral disease who has not received and is thought to be able to tolerate cytotoxic chemotherapy. (However, subject who has previously received cytotoxic chemotherapy is permitted).
  • Subject has clinical signs suggestive of high or imminent risks for pathological fracture, spinal cord compression and/or cauda equina syndrome.
  • Subject's absolute neutrophil count is \< 1500/microliter (µL), platelet count is \< 100,000/µL) or hemoglobin is \< 5.6 millimoles(mmol)/liter (L) (9 grams (g)/deciliter (dL) at Screening.
  • Subject's total bilirubin is ≥ 1.5 x upper limit of normal (ULN) (except for subjects with documented Gilbert's disease) or alanine aminotransferase (ALT) or aspartate aminotransferase (AST) is ≥ 2.5x upper limit of normal (ULN) at Screening.
  • Subject's estimated creatinine clearance (Cer) is less than 30 milliliter (mL)/minute (min) by the Cockcroft and Gault formula (Creatinine Clearance (mL/min) = (140 - age)(weight (wt) kilogram (kg) / 72 x serum creatinine (milligram (mg)/100 mL) [Cockcroft, 1976] at Screening.
  • Subject has uncontrolled hypertension as indicated by a resting systolic blood pressure > 160 millimeter of mercury (mmHg) or diastolic blood pressure > 100 millimeter of mercury (mmHg) at Screening.
  • Subject has received an investigational agent within 4 weeks or 5 half lives whichever is longer prior to Day 1.
  • Subject has shown a hypersensitivity reaction to the active pharmaceutical ingredient or any of the capsule components, including Labrasol, butylated hydroxyanisole, and butylated hydroxytoluene.
05

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
424 participants (actual)

Study arms

  • Experimental
    Enzalutamide 160 mg

    Participants received 160 mg of enzalutamide orally once a day, for 4 months. At the end of the 4-month treatment period, participants who were assessed as deriving benefit from enzalutamide treatment continued in the extension period. The total study drug treatment duration for the extended period depended on individual clinical benefit. If a participant experienced a Grade 3 or higher toxicity that was attributed to enzalutamide and could not be ameliorated by the use of adequate medical intervention, treatment with enzalutamide was allowed to be interrupted for 1 week or until the toxicity grade improved to Grade 2 or lower severity. Subsequently, enzalutamide was restarted at the original dose 160 mg per day or a reduced dose 120 or 80 mg per day in consultation with the medical monitor.

    Drug: Enzalutamide

Interventions

  • Participants received 4 capsules (40 mg each) of enzalutamide orally once a day, for a total daily dose of 160 mg. Treatment was given with or without food and as close as possible to the same time each day.

    Also known as: Xtandi, MDV3100

06

What researchers measure

Primary outcomes

  1. The Percentage of Evaluable Participants With at Least One Confirmed Seizure as Adjudicated by the Independent Adjudication Committee (IAC)

    Percentage of evaluable participants with at least one confirmed seizure as adjudicated by the IAC during the first 4 months of treatment were reported.

    Time frame: Day 1 up to week 17 (end of 4-month treatment period)

07

Results

Posted Dec 9, 2020
Limitations and caveats
After completing the extension period participants who were assessed to benefit from enzalutamide completed their treatment in another Astellas study, 9785-CL-0123 (NCT02960022).

Participant flow

Study enrolled male participants with histologically-confirmed metastatic adenocarcinoma of prostate with ongoing androgen deprivation therapy with a gonadotropin-releasing hormone (GnRH) analogue (agonist or antagonist) or a prior orchiectomy. Participants were evaluated by a neurologist who determined they had at least 1 risk factor for seizure.

4 Month Treatment Period
Participant flow — 4 Month Treatment Period
MilestoneEnzalutamide 160 mg
Started423
Completed322
Not completed101
Withdrew: Adverse event34
Withdrew: Death3
Withdrew: Progressive disease43
Withdrew: Withdrawal by subject17
Withdrew: Physician decision4
1 Year Extension Period
Participant flow — 1 Year Extension Period
MilestoneEnzalutamide 160 mg
Started287
Completed157
Not completed130
Withdrew: Adverse event14
Withdrew: Death10
Withdrew: Lost to follow-up2
Withdrew: Progressive disease86
Withdrew: Withdrawal by subject11
Withdrew: Physician decision6
Withdrew: Miscellaneous1
Post 1 Year Extension Period
Participant flow — Post 1 Year Extension Period
MilestoneEnzalutamide 160 mg
Started145
Completed1
Not completed144
Withdrew: Adverse event5
Withdrew: Death13
Withdrew: Progressive disease60
Withdrew: Withdrawal by subject13
Withdrew: Physician decision4
Withdrew: Miscellaneous49

Outcome measures

PrimaryThe Percentage of Evaluable Participants With at Least One Confirmed Seizure as Adjudicated by the Independent Adjudication Committee (IAC)

Percentage of evaluable participants with at least one confirmed seizure as adjudicated by the IAC during the first 4 months of treatment were reported.

Time frame:
Day 1 up to week 17 (end of 4-month treatment period)
Reported as:
Number · percentage of participants
The Percentage of Evaluable Participants With at Least One Confirmed Seizure as Adjudicated by the Independent Adjudication Committee (IAC)
percentage of participantsEnzalutamide 160 mg
The Percentage of Evaluable Participants With at Least One Confirmed Seizure as Adjudicated by the Independent Adjudication Committee (IAC)1.1 (0.3 to 2.8)

Adverse events

Collected over From first dose of study drug up to 30 days after last dose of study drug (approximately 52 months). Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Enzalutamide 160 mg62/423 (14.7%)193/423 (45.6%)318/423 (75.2%)
Most frequent serious events
Showing 10 of 205
Most frequent serious events
EventEnzalutamide 160 mg
Malignant neoplasm progressionNeoplasms benign, malignant and unspecified (incl cysts and polyps)34/423
PneumoniaInfections and infestations13/423
General physical health deteriorationGeneral disorders10/423
FallInjury, poisoning and procedural complications10/423
Confusional statePsychiatric disorders10/423
AnaemiaBlood and lymphatic system disorders9/423
PyrexiaGeneral disorders8/423
Bone painMusculoskeletal and connective tissue disorders8/423
ConvulsionNervous system disorders8/423
HaematuriaRenal and urinary disorders8/423
Most frequent other events
Showing 10 of 21
Most frequent other events
EventEnzalutamide 160 mg
FatigueGeneral disorders92/423
AstheniaGeneral disorders86/423
Decreased appetiteMetabolism and nutrition disorders77/423
Back painMusculoskeletal and connective tissue disorders68/423
NauseaGastrointestinal disorders55/423
AnaemiaBlood and lymphatic system disorders53/423
ArthralgiaMusculoskeletal and connective tissue disorders47/423
ConstipationGastrointestinal disorders46/423
DiarrhoeaGastrointestinal disorders43/423
Oedema peripheralGeneral disorders33/423

Baseline characteristics

The safety analysis set (SAF) consisted of all participants who took at least 1 dose of study drug and for whom any data was reported after first dose of study drug.

Age, Continuous
Age, Continuous(Years)Enzalutamide 160 mg
Mean73.2 ± 9
Sex: Female, Male
Sex: Female, Male(Participants)Enzalutamide 160 mg
Female0
Male423
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Enzalutamide 160 mg
WHITE381
BLACK OR AFRICAN AMERICAN9
ASIAN25
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER1
NO DATA3
OTHER4
Ethnicity
Ethnicity(Participants)Enzalutamide 160 mg
NOT HISPANIC OR LATINO331
HISPANIC OR LATINO89
NO DATA3
Eastern Cooperative Oncology Group (ECOG) At Study Entry
Eastern Cooperative Oncology Group (ECOG) At Study Entry(participants)Enzalutamide 160 mg
Grade 0188
Grade 1190
Grade 245
08

Study locations

76 sites
  • Site US10005
    Anchorage, Alaska 99503, United States
  • Site US10024
    Detroit, Michigan 48202, United States
  • Site US10001
    New York, New York 10065, United States
  • Site US10014
    New York, New York 10065, United States
  • Site US10039
    Syracuse, New York 13210, United States
  • Site US10026
    The Bronx, New York 10461, United States
  • Site US10016
    Durham, North Carolina 27710, United States
  • Site US10008
    Dallas, Texas 75231, United States
  • Site US10025
    Seattle, Washington 98109, United States
  • Site AR54001
    Berazategui, Buenos Aires B1880BBF, Argentina
  • Site AR54006
    Ciudad Autonoma de BuenosAires, Buenos Aires C1426ANZ, Argentina
  • Site AR54002
    Buenos Aires, Buenos Aires F.D. C1120AAT, Argentina
  • Site AR54003
    Córdoba, 5000, Argentina
  • Site AR54005
    San Miguel de Tucumán, 4000, Argentina
  • Site AR54004
    Santa Fe, S3000FFU, Argentina
  • Site AU61012
    Kogarah, New South Wales 2217, Australia
  • Site AU61005
    Randwick, New South Wales 2031, Australia
  • Site AU61011
    Sydney, New South Wales 2109, Australia
  • Site AU61001
    Tweed Heads, New South Wales 2485, Australia
  • Site AU61002
    Nambour, Queensland 4560, Australia
  • Site AU61007
    Adelaide, South Australia 5042, Australia
  • Site AU61004
    Ballarat, Victoria 3350, Australia
  • Site BE32004
    Anderlecht, 1070, Belgium
  • Site BE32001
    Kortrijk, 8500, Belgium
  • Site BE32003
    Liège, B-4000, Belgium
  • Site CA15005
    Abbotsford British Columbia, British Columbia V2S 3N5, Canada
  • Site CA15014
    Halifax, Nova Scotia B3H 2Y9, Canada
  • Site CA15004
    Brampton, Ontario L6T 4S5, Canada
  • Site CA15010
    Scarborough Village, Ontario M1S 4V5, Canada
  • Site CA15001
    Québec, Quebec G1R3S1, Canada
  • Site CL56001
    Temuco, Araucania 4810469, Chile
  • Site CL56004
    Santiago, 8420383, Chile
  • Site CL56002
    Temuco, 4781156, Chile
  • Site CL56003
    Viña del Mar, 2540364, Chile
  • Site CZ42004
    Prague, 12000, Czechia
  • Site CZ42002
    Prague, 16000, Czechia
  • Site FI35803
    Helsinki, 00290, Finland
  • Site FI35801
    Oulu, 90220, Finland
  • Site FI35802
    Tampere, 33520, Finland
  • Site FR33002
    Lyon, 69437, France
  • Site FR33004
    Rouen, 76031, France
  • Site FR33005
    Suresnes, 92151, France
  • Site DE49009
    Nürtingen, Baden-Wurttemberg 72622, Germany
  • Site DE49003
    Berlin, 12200, Germany
  • Site DE49001
    Münster, 48149, Germany
  • Site HU36002
    Sopron, Győr-Moson-Sopron 9400, Hungary
  • Site IL97202
    Kfar Saba, Central District 44281, Israel
  • Site IL97203
    Beersheba, 84101, Israel
  • Site IL97201
    Be’er Ya‘aqov, 70300, Israel
  • Site IL97205
    Haifa, 31096, Israel
  • Site IL97204
    Jerusalem, 91120, Israel
  • Site IL97208
    Nahariya, 21000, Israel
  • Site IL97206
    Petah Tikva, 49100, Israel
  • Site IL97207
    Ramat Gan, 52621, Israel
  • Site IT39005
    Meldola, Emilia-Romagna 47014, Italy
  • Site IT39001
    Cremona, Lombardy 26100, Italy
  • Site IT39002
    Arezzo, 52100, Italy
  • Site IT39003
    Roma, 00144, Italy
  • Site NZ64001
    Hamilton, 3204, New Zealand
  • Site SG65002
    Singapore, 119228, Singapore
  • Site KR82006
    Seongnam-si, Gyeonggi-do 013620, South Korea
  • Site KR82007
    Seoul, 03080, South Korea
  • Site KR82003
    Seoul, 135-710, South Korea
  • Site KR82001
    Seoul, 135-720, South Korea
  • Site KR82004
    Seoul, 137-701, South Korea
  • Site ES34007
    L'Hospitalet de Llobregat, Barcelona 08908, Spain
  • Site ES34005
    Sabadell, Barcelona 08208, Spain
  • Site ES34001
    Pamplona, Navarre 31008, Spain
  • Site ES34003
    Barcelona, 08025, Spain
  • Site ES34004
    Barcelona, 08035, Spain
  • Site ES34006
    Madrid, 28050, Spain
  • Site SE46001
    Gothenburg, 41345, Sweden
  • Site SE46002
    Örebro, 701 85, Sweden
  • Site TW88601
    Kaohsiung City, 81362, Taiwan
  • Site TW88603
    Taipei, 10048, Taiwan
  • Site GB44002
    Sutton, Surrey SM2 5PT, United Kingdom
09

References and documents

Study documents

  • Study protocol · Oct 20, 2016
  • Statistical analysis plan · Mar 25, 2014

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No — Access to anonymized individual participant level data will not be provided for this trial. Further details on Astellas' data sharing policy can be found at https://www.clinicaltrials.astellas.com/transparency/.

10

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Ran from Sep 2013 to primary completion in Feb 2016, 28 months.

Results were first posted in Dec 2020, 4 years 10 months after primary completion.

Of 34 phase 4 interventional studies under Seizures, half reached primary completion within 23 months of starting (the median), counting those still running; a quarter within 12 and three quarters within 42. This study's 28 months is above that.

How these figures are worked out, and which studies are left out of them.

Registered
Oct 31, 2013
First posted
Nov 7, 2013
StartActual
Sep 25, 2013
Primary completionActual
Feb 1, 2016
CompletionActual
Jan 11, 2019
Results first posted
Dec 9, 2020
Last update
Dec 6, 2024
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Dec 6, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT01977651
Collaborators
Medivation LLC, a wholly owned subsidiary of Pfizer Inc.
Responsible party
Sponsor
First posted
Nov 7, 2013
Start date
Sep 25, 2013
Primary completion
Feb 1, 2016
Completion
Jan 11, 2019
Results posted
Dec 9, 2020
Last update
Dec 6, 2024

Study contacts

Sr. Medical Director
study director · Astellas Pharma Global Development, Inc.

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Enzalutamide

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