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CompletedNCT03456804Updated Jul 14, 2023Results posted

ESK981 in Treating Patients With Metastatic Castrate-Resistant Prostate Cancer

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

Phase
Phase 2
Study type
Interventional
Enrollment
13
Allocation
Not applicable
Ages
18 Years and older
Sex
Male
01

Study summary

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.

Read the detailed description

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.

02

Conditions studied

  • Castration Levels of Testosterone
  • Castration-Resistant Prostate Carcinoma
  • Metastatic Prostate Carcinoma
  • PSA Progression
  • Stage IV Prostate Adenocarcinoma AJCC v7
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
Male
Accepts healthy volunteers
No

Inclusion criteria

  • Have signed an informed consent document indicating that the subject understands the purpose of and procedures required for the study and are willing to participate in the study
  • Be willing/able to adhere to the prohibitions and restrictions specified in this protocol
  • Eastern Cooperative Group (ECOG) performance status =\< 1
  • Patient must have evidence of castrate resistant prostate cancer as evidenced by a confirmed rising PSA (per PCWG3 criteria) and a castrate serum testosterone level (i.e. =\< 50 mg/dL)
  • Documented histologically confirmed adenocarcinoma of the prostate
  • Metastatic prostate cancer (M1) as documented by appropriate medical imaging (i.e. computed tomography [CT]-scan, positron emission tomography [PET] scan or bone scan)
  • Treatment failure of either abiraterone and/or enzalutamide as evidenced by a confirmed rising PSA (per PCWG3 criteria) and a castrate serum testosterone level (i.e. =\< 50 mg/dL) while receiving treatment with either abiraterone and/or enzalutamide
  • Willingness to use contraception by a method that is deemed effective by the Investigator throughout the treatment period and for at least 30 days following the last dose of therapy
  • Willingness and ability to comply with study procedures and follow-up examination
  • Able to swallow and retain oral medication

Exclusion criteria

Exclusion Criteria:

  • Current systemic therapy (other than a gonadotrophin releasing hormone [GnRH] agonist/antagonist) for CRPC including:

    • CYP-17 inhibitors (e.g. ketoconazole, abiraterone)
    • Antiandrogens (e.g. bicalutamide, nilutamide)
    • Second generation antiandrogens (e.g. enzalutamide, ARN-509, Galeterone)
    • Immunotherapy (e.g. sipuleucel-T, ipilimumab)
    • Chemotherapy (e.g. docetaxel, cabazitaxel)
  • Greater than 2 lines of prior systemic therapy for CRPC
  • Prior chemotherapy (e.g. docetaxel, cabazitaxel) for CRPC; prior docetaxel administered in the castrate-sensitive space is allowed
  • Prior radiopharmaceutical therapy (e.g. radium-223, strontium-89, samarium-153, etc.) within the past year
  • Have any condition that, in the opinion of the investigator, would compromise the well-being of the subject or the study or prevent the subject from meeting or performing study requirements
  • Absolute neutrophil count (ANC) less than 1500/mm\^3
  • Platelet count less than 100000/mm\^3
  • Hemoglobin less than 9 g/dL
  • Bilirubin greater than 1.5 times the upper limit of normal (ULN)
  • Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) greater than 2.0 times the ULN in the absence of known hepatic metastases, or ALT or AST greater than 3.0 times the ULN in the presence of known hepatic metastases
  • The patient has a serum creatinine value greater than 1.5 mg/dL
  • The patient has active brain metastases
  • The patient is currently on warfarin or heparin therapy
  • The patient has any pre-existing coagulopathy, recent hemoptysis, gross hematuria, or gastrointestinal bleeding, and a history of a clinically significant cardiovascular or cerebrovascular event within 12 months prior to study entry
  • The patient has uncontrolled hypertension defined as a blood pressure measurement greater than 150 mm Hg systolic or 90 mm Hg diastolic with medication
  • The patient has received any investigational drug within the past 4 weeks
  • The patient has previously been enrolled in the study or received ESK981
  • The patient has known hypersensitivity to gelatin or lactose monohydrate
  • The patient has taken a medication known to be a potent inducer of CYP1A2, CYP2C8, or CYP3A4 within 4 weeks prior to the first dose of study drug
  • The patient has taken a medication known to be a potent inhibitor of CYP1A2, CYP2C8, or CYP3A4 within 2 weeks prior to the first dose of study drug
04

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
13 participants (actual)

Study arms

  • Experimental
    Treatment ESK981

    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

Interventions

  • DrugESK981

    Treatment with ESK981 for patients with metastatic castrate resistant prostate cancer

05

What researchers measure

Primary outcomes

  1. 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

Secondary outcomes

  1. 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

  2. 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

  3. 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

Other outcomes

  1. 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

  2. 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

  3. 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

  4. Metastatic Kinome Activity Profiles as Predictive Biomarkers

    Description of immunohistochemistry of the kinases, graded 0,1,2,3

    Time frame: Up to 1 year

  5. 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

  6. DNA Sequencing of Prostate Tumor

    copy number, Loss of heterozygosity, mutation, amplification, graded 0,1

    Time frame: Up to 1 year

06

Results

Posted Jul 14, 2023

Participant flow

Participant flow — Overall Study
MilestoneTreatment ESK981
Started13
Completed13
Not completed0

Outcome measures

PrimaryPSA 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
Reported as:
Number · percentage of participants
PSA Decline of >= 50% (PSA50) From Baseline
percentage of participantsTreatment ESK981
PSA Decline of >= 50% (PSA50) From Baseline7.7 (1.7 to 28.2)
SecondaryDuration 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
Reported as:
Number · months
Duration of PSA Response (RD)
monthsTreatment ESK981
Duration of PSA Response (RD)1.9
SecondaryPSA 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
Reported as:
Median · months
PSA Progression Free Survival (PFS)
monthsTreatment ESK981
PSA Progression Free Survival (PFS)0.9 (0.2 to 1.9)
SecondaryTime 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
Reported as:
Number · months
Time to PSA Response
monthsTreatment ESK981
Time to PSA Response10.0
Other pre-specifiedAndrogen 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

No measurements were reported for this outcome.

Other pre-specifiedCirculating 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

No measurements were reported for this outcome.

Other pre-specifiedETS/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

No measurements were reported for this outcome.

Other pre-specifiedMetastatic Kinome Activity Profiles as Predictive Biomarkers

Description of immunohistochemistry of the kinases, graded 0,1,2,3

Time frame:
Up to 1 year

No measurements were reported for this outcome.

Other pre-specifiedImmunohistochemistry (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

No measurements were reported for this outcome.

Other pre-specifiedDNA Sequencing of Prostate Tumor

copy number, Loss of heterozygosity, mutation, amplification, graded 0,1

Time frame:
Up to 1 year

No measurements were reported for this outcome.

Adverse events

Collected over 2 years. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Treatment ESK98110/13 (76.9%)5/13 (38.5%)13/13 (100%)
Most frequent serious events
Showing 10 of 12
Most frequent serious events
EventTreatment ESK981
Cardiac disorders - Other, specifyCardiac disorders2/13
Alanine aminotransferase increasedInvestigations1/13
Aspartate aminotransferase increasedInvestigations1/13
DehydrationMetabolism and nutrition disorders1/13
DiarrheaGastrointestinal disorders1/13
HyperglycemiaMetabolism and nutrition disorders1/13
HypertensionVascular disorders1/13
HyponatremiaMetabolism and nutrition disorders1/13
HypotensionVascular disorders1/13
Lymphocyte count decreasedInvestigations1/13
Most frequent other events
Showing 10 of 38
Most frequent other events
EventTreatment ESK981
Back painMusculoskeletal and connective tissue disorders4/13
FatigueGeneral disorders4/13
PainGeneral disorders4/13
Gastrointestinal disorders - Other, specifyGastrointestinal disorders3/13
ConstipationGastrointestinal disorders2/13
DiarrheaGastrointestinal disorders2/13
HypertensionVascular disorders2/13
Localized edemaGeneral disorders2/13
Musculoskeletal and connective tissue disorderMusculoskeletal and connective tissue disorders2/13
Pain in extremityMusculoskeletal and connective tissue disorders2/13

Baseline characteristics

Age, Continuous
Age, Continuous(years)Treatment ESK981
Median71 (58 to 84)
Sex: Female, Male
Sex: Female, Male(Participants)Treatment ESK981
Female0
Male13
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Treatment ESK981
American Indian or Alaska Native0
Asian0
Native Hawaiian or Other Pacific Islander0
Black or African American4
White9
More than one race0
Unknown or Not Reported0
Region of Enrollment
Region of Enrollment(participants)Treatment ESK981
United States13
Performance Status
Performance Status(Participants)Treatment ESK981
PS = 113
PS = 00
Gleason Score
Gleason Score(Participants)Treatment ESK981
Gleason Score 61
Gleason Score 73
Gleason Score 8~106
Gleason Score unknown3
07

Study locations

2 sites
  • Wayne State University/Karmanos Cancer Institute
    Detroit, Michigan 48201, United States
  • Seattle Cancer Care Alliance
    Seattle, Washington 98109, United States
08

References and documents

Study documents

  • Protocol and statistical analysis plan · Jul 2, 2019

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

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT03456804
Lead sponsor
Barbara Ann Karmanos Cancer Institute
Collaborators
National Cancer Institute (NCI)
Responsible party
Elisabeth Heath (Principal Investigator, Barbara Ann Karmanos Cancer Institute) — Principal investigator
First posted
Mar 7, 2018
Start date
Mar 8, 2018
Primary completion
Mar 15, 2023
Completion
May 9, 2023
Results posted
Jul 14, 2023
Last update
Jul 14, 2023

Study contacts

Elisabeth I. Heath
principal investigator · Barbara Ann Karmanos Cancer Institute

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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