High Dose Testosterone for ATM, CDK12 or CHEK2 Altered Prostate Cancers
- Registration Number
- NCT05011383
- Lead Sponsor
- VA Office of Research and Development
- Brief Summary
This study will determine whether the presence of DNA repair deficiency in the form of alterations in the genes ATM, CDK12 or CHEK2 predicts for a high likelihood of responding to the use of intermittent high dose testosterone. This therapy may result in responses in tumors which are genetically unstable because of DNA repair deficiency and this is a prospective study to test that hypothesis
- Detailed Description
This is an unblinded, three cohort phase II study evaluating the efficacy of high dose testosterone (BAT) for patients with mCRPC and inactivating mutations in ATM, CDK12 or CHEK2. Patients will receive BAT until disease progression or intolerance, whichever occurs first. Throughout the study, safety and tolerability will be assessed by frequent recording of adverse events, vital signs and safety laboratory assessments. Progression will be evaluated with bone scan, CT of the abdomen/pelvis and PSA as per PCWG3 criteria.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- Male
- Target Recruitment
- 51
-
Signed informed consent form (ICF) providing agreement to adhere to the dosing schedule, report for all trial visits and authorization, use and release of health and research trial information
-
Male age > 18 years
-
Histologically or cytologically confirmed adenocarcinoma of the prostate
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Ongoing gonadal androgen deprivation therapy with gonadotropin-releasing hormone (GnRH) analogues, antagonists or orchiectomy. Patients who have not had an orchiectomy must be maintained on effective GnRH analogue/antagonist therapy
-
Castration resistant prostate cancer as defined by serum testosterone < 50 ng/ml and one of the following:
- PSA level of at least 2 ng/ml that has risen on at least 2 successive occasions at least 1 week apart.
- Evaluable disease progression by modified RECIST 1.1 (Response Evaluation Criteria in Solid Tumors)
- Progression of metastatic bone disease on bone scan with > 2 new lesions
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Presence of metastatic disease on bone or CT scan
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Patients must have progressed on 1 next-generation AR-signaling inhibitor (e.g. abiraterone, enzalutamide, apalutamide, darolutamide, etc.).
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Asymptomatic or minimal cancer related symptoms
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Eastern Cooperative Oncology Group (ECOG) Performance Status of < 2
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Presence of inactivating mutations in ATM, CDK12 or CHEK2 as determined by a CLIA level assay for DNA sequencing.
- Currently receiving active therapy for other neoplastic disorders will not be eligible.
- Histologic evidence of small cell carcinoma (morphology alone - immunohistochemical evidence of neuroendrocrine differentiation without morphologic evidence is not exclusionary)
- Known parenchymal brain metastasis
- Liver metastases
- Active or symptomatic viral hepatitis or chronic liver disease AST or ALT > 2.5 x ULN or total bilirubin > ULN (unless Gilbert's syndrome is the etiology of hyperbilirubinemia).
- Clinically significant heart disease as evidenced by myocardial infarction, or arterial thrombotic events in the past 6 months, severe or unstable angina, or New York Heart Association (NYHA) Class II-IV heart disease or cardiac ejection fraction measurement of <35 % at baseline
- Patients with pain attributable to their prostate cancer and requiring the use of opioids.
- Tumor causing urinary outlet obstruction that requires catheterization for voiding. Patients that require catheterization to void secondary to benign strictures or other non-cancer causes will be permitted to enroll.
- Presence of dementia, psychiatric illness, and/or social situations limiting compliance with study requirements or understanding and/or giving of informed consent.
- Any condition(s), medical or otherwise, which, in the opinion of the investigators, would jeopardize either the patient or the integrity of the data obtained.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description ATM High dose testosterone Patients with castration resistant prostate cancer which contains ATM alterations are treated with high dose testosterone CDK12 High dose testosterone Patients with castration resistant prostate cancer which contains CDK12 alterations are treated with high dose testosterone CHEK2 High dose testosterone Patients with castration resistant prostate cancer which contains CHEK2 alterations are treated with high dose testosterone
- Primary Outcome Measures
Name Time Method PSA response 12 weeks PSA response as measured by a 50% decline from baseline maintained for 12 weeks
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (17)
Michael E. DeBakey VA Medical Center, Houston, TX
🇺🇸Houston, Texas, United States
VA Puget Sound Health Care System Seattle Division, Seattle, WA
🇺🇸Seattle, Washington, United States
Durham VA Medical Center, Durham, NC
🇺🇸Durham, North Carolina, United States
Tennessee Valley Healthcare System Nashville Campus, Nashville, TN
🇺🇸Nashville, Tennessee, United States
VA Connecticut Healthcare System West Haven Campus, West Haven, CT
🇺🇸West Haven, Connecticut, United States
Memphis VA Medical Center, Memphis, TN
🇺🇸Memphis, Tennessee, United States
Rocky Mountain Regional VA Medical Center, Aurora, CO
🇺🇸Aurora, Colorado, United States
VA Portland Health Care System, Portland, OR
🇺🇸Portland, Oregon, United States
St. Louis VA Medical Center John Cochran Division, St. Louis, MO
🇺🇸Saint Louis, Missouri, United States
Atlanta VA Medical and Rehab Center, Decatur, GA
🇺🇸Decatur, Georgia, United States
Salisbury W.G. (Bill) Hefner VA Medical Center, Salisbury, NC
🇺🇸Salisbury, North Carolina, United States
Robley Rex VA Medical Center, Louisville, KY
🇺🇸Louisville, Kentucky, United States
Orlando VA Medical Center, Orlando, FL
🇺🇸Orlando, Florida, United States
Kansas City VA Medical Center, Kansas City, MO
🇺🇸Kansas City, Missouri, United States
Ralph H. Johnson VA Medical Center, Charleston, SC
🇺🇸Charleston, South Carolina, United States
North Florida/South Georgia Veterans Health System, Gainesville, FL
🇺🇸Gainesville, Florida, United States
William S. Middleton Memorial Veterans Hospital, Madison, WI
🇺🇸Madison, Wisconsin, United States