A Phase 2 interventional study of ESK981 in Castration Levels of Testosterone, Castration-Resistant Prostate Carcinoma and Metastatic Prostate Carcinoma, sponsored by Barbara Ann Karmanos Cancer Institute. Completed at 2 sites in United States. Open to male participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2023-07-14.
Sponsored by Barbara Ann Karmanos Cancer Institute · Phase 2, Interventional, and Treatment
This phase II trials studies the side effects and how well ESK981 works in treating patients with castration-resistant prostate cancer that has spread to other places in the body. ESK981 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.
PRIMARY OBJECTIVES:
I. To determine the PSA >= 50% response rate (PSA50) from baseline using the Prostate Cancer Working Group 3 (PCWG3) criteria to pan-VEGFR/TIE2 tyrosine kinase inhibitor CEP-11981 (ESK981) as a single agent in men with castration-resistant prostate cancer (CRPC) who have progressed on enzalutamide (an oral androgen-receptor inhibitor) and/or abiraterone acetate (an androgen synthesis inhibitor).
II. To assess the safety and tolerability of ESK981 as a single agent.
SECONDARY OBJECTIVES:
I. To determine the time to PSA response to ESK981 in metastatic CRPC patients. II. To determine the duration of PSA response to ESK981 in metastatic CRPC patients.
III. To determine PSA progression rates and PSA progression free survival (PFS), as defined by the PCWG3 criteria.
TERTIARY OBJECTIVES:
I. To assess exploratory biomarkers from blood and tumor biopsies.
OUTLINE:
Patients receive pan-VEGFR/TIE2 tyrosine kinase inhibitor CEP-11981 orally (PO) once daily (QD) for 5 days (Monday-Friday). Treatment repeats for up to 8 weeks in the absence of disease progression or unacceptable toxicity. If treatment is successful after 8 weeks, patients may receive up to 6 months of pan-VEGFR/TIE2 tyrosine kinase inhibitor CEP-11981.
After completion of study treatment, patients are followed up periodically.
Exclusion Criteria:
Current systemic therapy (other than a gonadotrophin releasing hormone [GnRH] agonist/antagonist) for CRPC including:
Patients receive pan-VEGFR/TIE2 (Vascular Endothelial Growth Factor Receptor/angopoeitin receptor2) tyrosine kinase inhibitor CEP-11981 PO QD for 5 days (Monday-Friday). Treatment repeats for up to 8 weeks in the absence of disease progression or unacceptable toxicity. If treatment is successful after 8 weeks, patients may receive up to 6 months of pan-VEGFR/TIE2 tyrosine kinase inhibitor CEP-11981.
Drug: ESK981
Treatment with ESK981 for patients with metastatic castrate resistant prostate cancer
PSA Decline of >= 50% (PSA50) From Baseline
PSA decline of \>= 50% (PSA50) from baseline using Prostate Cancer Working Group 3 (PCWG3) definition with point estimate and (1-sided Wilson type 90% lower) confidence interval (CI) estimates.
Time frame: Up to 1 year
Duration of PSA Response (RD)
Will be summarized with the Kaplan-Meier (K-M) survivorship estimate. A graph of the K-M curve for RD will be generated along with the Hall-Wellner 90% confidence band, and a display of the number of patients at risk at several time points, below the X-axis. Summary statistics (6-month rate, 12-month rate, median, etc.) will be calculated from the K-M life table, each one with its respective 80% CI.
Time frame: From start of PSA50 until PSA progression, assessed up to 1 year
PSA Progression Free Survival (PFS)
Will be summarized with the Kaplan-Meier (K-M) survivorship estimate. A graph of the K-M curve for PFS will be generated along with the Hall-Wellner 90% confidence band, and a display of the number of patients at risk at several time points, below the X-axis. Summary statistics (6-month rate, 12-month rate, median, etc.) will be calculated from the K-M life table, each one with its respective 80% CI.
Time frame: Date that a 25% or greater increase and an absolute increase of 2.0 ng/mL or more from the nadir is documented and confirmed by a second value obtained 3 or more weeks later, assessed up to 1 year
Time to PSA Response
Will be used to summarize the time to PSA response. These descriptives will include sample size (N), median, mean, standard deviation (SD), interquartile range (IQR), minimum, and maximum.
Time frame: From treatment start until the first documented occurrence of PSA50, assessed up to 1 year
Androgen Receptor (AR) Signaling
Will examine the association of somatic and germline mutations with exceptional response/resistance to pan-VEGFR/TIE2 tyrosine kinase inhibitor CEP-11981.
Time frame: Up to 1 year
Circulating and Disseminated Tumor Cells as Pharmacodynamic Biomarkers
Number of Circulating and disseminated tumor cells per 7.5ml as a pharmacodynamic biomarker.
Time frame: Up to 1 year
ETS/Kinase Gene Fusions
Will examine the association of somatic and germline mutations with exceptional response/resistance to pan-VEGFR/TIE2 tyrosine kinase inhibitor CEP-11981.
Time frame: Up to 1 year
Metastatic Kinome Activity Profiles as Predictive Biomarkers
Description of immunohistochemistry of the kinases, graded 0,1,2,3
Time frame: Up to 1 year
Immunohistochemistry (IHC) of Protein Markers
Ki67, Receptor, CD31, NG2, desmin, PDGFR1/2, VEGFR1/2 immunohistochemistry graded 0, 1, 2, 3
Time frame: Up to 1 year
DNA Sequencing of Prostate Tumor
copy number, Loss of heterozygosity, mutation, amplification, graded 0,1
Time frame: Up to 1 year
| Milestone | Treatment ESK981 |
|---|---|
| Started | 13 |
| Completed | 13 |
| Not completed | 0 |
PSA decline of \>= 50% (PSA50) from baseline using Prostate Cancer Working Group 3 (PCWG3) definition with point estimate and (1-sided Wilson type 90% lower) confidence interval (CI) estimates.
| percentage of participants | Treatment ESK981 |
|---|---|
| PSA Decline of >= 50% (PSA50) From Baseline | 7.7 (1.7 to 28.2) |
Will be summarized with the Kaplan-Meier (K-M) survivorship estimate. A graph of the K-M curve for RD will be generated along with the Hall-Wellner 90% confidence band, and a display of the number of patients at risk at several time points, below the X-axis. Summary statistics (6-month rate, 12-month rate, median, etc.) will be calculated from the K-M life table, each one with its respective 80% CI.
| months | Treatment ESK981 |
|---|---|
| Duration of PSA Response (RD) | 1.9 |
Will be summarized with the Kaplan-Meier (K-M) survivorship estimate. A graph of the K-M curve for PFS will be generated along with the Hall-Wellner 90% confidence band, and a display of the number of patients at risk at several time points, below the X-axis. Summary statistics (6-month rate, 12-month rate, median, etc.) will be calculated from the K-M life table, each one with its respective 80% CI.
| months | Treatment ESK981 |
|---|---|
| PSA Progression Free Survival (PFS) | 0.9 (0.2 to 1.9) |
Will be used to summarize the time to PSA response. These descriptives will include sample size (N), median, mean, standard deviation (SD), interquartile range (IQR), minimum, and maximum.
| months | Treatment ESK981 |
|---|---|
| Time to PSA Response | 10.0 |
Will examine the association of somatic and germline mutations with exceptional response/resistance to pan-VEGFR/TIE2 tyrosine kinase inhibitor CEP-11981.
No measurements were reported for this outcome.
Number of Circulating and disseminated tumor cells per 7.5ml as a pharmacodynamic biomarker.
No measurements were reported for this outcome.
Will examine the association of somatic and germline mutations with exceptional response/resistance to pan-VEGFR/TIE2 tyrosine kinase inhibitor CEP-11981.
No measurements were reported for this outcome.
Description of immunohistochemistry of the kinases, graded 0,1,2,3
No measurements were reported for this outcome.
Ki67, Receptor, CD31, NG2, desmin, PDGFR1/2, VEGFR1/2 immunohistochemistry graded 0, 1, 2, 3
No measurements were reported for this outcome.
copy number, Loss of heterozygosity, mutation, amplification, graded 0,1
No measurements were reported for this outcome.
Collected over 2 years. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Treatment ESK981 | 10/13 (76.9%) | 5/13 (38.5%) | 13/13 (100%) |
| Event | Treatment ESK981 |
|---|---|
| Cardiac disorders - Other, specifyCardiac disorders | 2/13 |
| Alanine aminotransferase increasedInvestigations | 1/13 |
| Aspartate aminotransferase increasedInvestigations | 1/13 |
| DehydrationMetabolism and nutrition disorders | 1/13 |
| DiarrheaGastrointestinal disorders | 1/13 |
| HyperglycemiaMetabolism and nutrition disorders | 1/13 |
| HypertensionVascular disorders | 1/13 |
| HyponatremiaMetabolism and nutrition disorders | 1/13 |
| HypotensionVascular disorders | 1/13 |
| Lymphocyte count decreasedInvestigations | 1/13 |
| Event | Treatment ESK981 |
|---|---|
| Back painMusculoskeletal and connective tissue disorders | 4/13 |
| FatigueGeneral disorders | 4/13 |
| PainGeneral disorders | 4/13 |
| Gastrointestinal disorders - Other, specifyGastrointestinal disorders | 3/13 |
| ConstipationGastrointestinal disorders | 2/13 |
| DiarrheaGastrointestinal disorders | 2/13 |
| HypertensionVascular disorders | 2/13 |
| Localized edemaGeneral disorders | 2/13 |
| Musculoskeletal and connective tissue disorderMusculoskeletal and connective tissue disorders | 2/13 |
| Pain in extremityMusculoskeletal and connective tissue disorders | 2/13 |
| Age, Continuous(years) | Treatment ESK981 |
|---|---|
| Median | 71 (58 to 84) |
| Sex: Female, Male(Participants) | Treatment ESK981 |
|---|---|
| Female | 0 |
| Male | 13 |
| Race (NIH/OMB)(Participants) | Treatment ESK981 |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 0 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 4 |
| White | 9 |
| More than one race | 0 |
| Unknown or Not Reported | 0 |
| Region of Enrollment(participants) | Treatment ESK981 |
|---|---|
| United States | 13 |
| Performance Status(Participants) | Treatment ESK981 |
|---|---|
| PS = 1 | 13 |
| PS = 0 | 0 |
| Gleason Score(Participants) | Treatment ESK981 |
|---|---|
| Gleason Score 6 | 1 |
| Gleason Score 7 | 3 |
| Gleason Score 8~10 | 6 |
| Gleason Score unknown | 3 |
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Barbara Ann Karmanos Cancer Institute