Abiraterone With Discontinuation of Gonadotropin-Releasing Hormone Analogues in Metastatic Prostate Cancer
Overview
- Phase
- Phase 2
- Intervention
- Abiraterone Acetate
- Conditions
- Prostatic Neoplasms
- Sponsor
- Montefiore Medical Center
- Enrollment
- 31
- Locations
- 1
- Primary Endpoint
- Percentage of Patients With Castrate Level of Serum Testosterone
- Status
- Completed
- Last Updated
- 3 months ago
Overview
Brief Summary
The goal of this study is to find out if patients with prostate cancer being treated with the medications abiraterone and prednisone can discontinue hormone injections (examples include leuprolide, goserelin, triptorelin and degarelix). Abiraterone and prednisone are pills used to treat patients with prostate cancer. When abiraterone and prednisone are used, hormone injections are usually continued to maintain a low testosterone level in the blood. This study is being done to find out if testosterone in the blood will stay low while abiraterone and prednisone are used without continued hormone injections.
Detailed Description
Abiraterone inhibits the CYP17A enzyme, which is a critical enzyme in androgen biosynthesis. Abiraterone has regulatory approval in metastatic castration-resistant prostate cancer (mCRPC) in both chemotherapy-naïve and in the post-docetaxel setting based upon results from two randomized phase III studies. Abiraterone is also proven to extend survival in the metastatic, hormone-naïve population based on two phase III studies. Abiraterone is a castrating agent, but, other than a small first in human study, all clinical studies have been done in conjunction with gonadotropin-releasing hormone (GnRH) analogues. Maintaining castrate level of serum testosterone is critical in the treatment of metastatic prostate cancer. It is unknown if GnRH analogues must be continued to maintain castrate levels of serum testosterone in patients treated with abiraterone.
Investigators
Benjamin Gartrell
Principal Investigator
Montefiore Medical Center
Eligibility Criteria
Inclusion Criteria
- •The patient must be able to provide study-specific informed consent prior to study entry
- •Eastern Cooperative Oncology Group (ECOG) Performance Status 0-2
- •Pathologically proven diagnosis of prostate adenocarcinoma
- •Patients must have metastatic prostate cancer
- •Patients may have mCRPC or may have metastatic castration-sensitive disease.
- •Patients must be maintained on a GnRH analogue (agonist (leuprolide, goserelin, triptorelin, histrelin, deslorelin) or antagonist (degarelix))
- •The patient and the investigator have decided that the next line of cancer therapy will be abiraterone plus prednisone and the initial dose of abiraterone will be 1000 mg daily. Or patients may already be on abiraterone with prednisone at a dose of 1000 mg daily along with a GnRH analogue.
- •Lab values meeting the following criteria
- •Total testosterone level of \<50 ng/dl
- •Total bilirubin \< 2.0 X Upper Limit of Normal (ULN)
Exclusion Criteria
- •History of bilateral orchiectomy
- •History of hypopituitarism
- •For patients not yet started on abiraterone with prednisone, uncontrolled hypertension (systolic blood pressure \>170 mm Hg or diastolic blood pressure \>100 mm Hg)
- •Patients must not have New York Heart Association Class III or IV heart failure at the time of screening. Patients must not have any unstable angina, myocardial infarction, or serious uncontrolled cardiac arrhythmia within 6 months prior to registration
- •Any other serious illness or medical condition that the principal investigator feels would make the patient a poor candidate for this study
Arms & Interventions
Abiraterone and Prednisone without a GnRH Analogue
Abiraterone (1000 mg daily) with Prednisone (5 mg) with Discontinuation of GnRH Analogue Injection
Intervention: Abiraterone Acetate
Abiraterone and Prednisone without a GnRH Analogue
Abiraterone (1000 mg daily) with Prednisone (5 mg) with Discontinuation of GnRH Analogue Injection
Intervention: Prednisone
Outcomes
Primary Outcomes
Percentage of Patients With Castrate Level of Serum Testosterone
Time Frame: Approximately 24 weeks
The number/percentage of patients with a castrate serum testosterone level, defined as having a serum castrate concentration \<50 ng/dL when Abiraterone acetate plus prednisone (AAP) is used without GnRH analogues in metastatic prostate cancer, will be determined. Results are summarized as a number/percentage of participants.
Secondary Outcomes
- Serum Testosterone (T) Levels(Baseline and 6 months, 12 months, 18 months, 24 months, and 30 months following initiation of treatment)
- Serum Luteinizing Hormone (LH) Levels(Baseline and 6 months, 12 months, 18 months, 24 months, and 30 months following initiation of treatment)
- Prostate-specific Antigen (PSA) Response(Baseline and 6 months, 12 months, 18 months, 24 months, and 30 months following initiation of treatment)
- Treatment-related Adverse Events Due to Toxicity(24 weeks)
- Radiographic Progression-free Survival (rPFS)(From initiation of treatment to the end of treatment, up to approximately 41 months (~178 weeks))
- Overall Survival (OS)(From initiation of treatment until the end of treatment, up to approximately 41 months)