Repeat Difluoromethylornithine and High Dose Testosterone With Enzalutamide in Asymptomatic Patients With Metastatic Castration-Resistant Prostate Cancer: The APEX (Androgen and Polyamine Elimination Alternating With Xtandi) Trial

Status: Recruiting
Location: See location...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 2
SUMMARY

Asymptomatic patients with metastatic castrate resistant prostate cancer (mCRPC) without pain due to prostate cancer will be treated on an open label study to evaluate effectiveness of sequential treatment with the combination of difluoromethylornithine (DFMO) and high dose testosterone in sequence with enzalutamide to improve primary and secondary outcomes.

Eligibility
Participation Requirements
Sex: Male
Minimum Age: 18
Healthy Volunteers: f
View:

• Eastern Cooperative Oncology Group (ECOG) Performance status ≤2.

• Age ≥18 years.

• Histologically-confirmed adenocarcinoma of the prostate.

• Treated with continuous androgen ablative therapy (either surgical castration or LHRH agonist/antagonist).

• Documented castrate level of serum testosterone (\<50 ng/dl).

• Metastatic disease radiographically documented by CT or bone scan.

• Must have had disease progression while on abiraterone acetate based on:

‣ PSA progression defined as an increase in PSA, as determined by 2 separate measurements taken at least 1 week apart And/ Or

⁃ Radiographic disease progression, based on RECIST 1.1 in patients with measurable soft tissue lesions or Prostate Cancer Working Group 3 (PCWG3) for patients with bone disease

• Screening PSA must be ≥ 1.0 ng/mL.

• Patients with soft tissue lesion amenable to biopsy must agree to biopsy collection pre-treatment and at a defined point on treatment to perform tumor tissue analysis.

⁃ Prior treatment with Provenge vaccine, 223Radium (Xofigo), Poly (ADP-ribose) polymerase (PARP) inhibitors, taxane chemotherapy, Lutetium prostate-specific membrane antigen (LuPSMA), antiandrogens (including enzalutamide, darolutamide, and apalutamide), and radiation is allowed if \>4 weeks from last dose.

⁃ Prior treatment with bipolar androgen therapy (BAT) is allowed if the patient has progressed on an AR-axis inhibitor (i.e. abiraterone or antiandrogen) since BAT treatment.

⁃ Patients must be withdrawn from abiraterone for ≥ 2 weeks.

⁃ Attempts must be made to wean patients off prednisone prior to starting therapy. Patients who cannot be weaned due to symptoms may continue on lowest dose of prednisone achieved during weaning period.

⁃ Acceptable liver function:

• Bilirubin \< 2.5 times institutional upper limit of normal (ULN)

∙ Aspartate transaminase (AST) (SGOT) and alanine transaminase (AST) (SGPT) \< 2.5 times ULN

⁃ Acceptable renal function:

⁃ Glomerular filtration rate (GFR) of 50 mL/min/1.73 m2 or higher. GFR will be estimated by the 2021 chronic kidney disease epidemiology (CKD-EPI) creatinine equation (REF: Inker LA, Eneanya ND, Coresh J, et al. Chronic Kidney Disease Epidemiology Collaboration. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med 2021; 385:1737) using the online calculator found on UpToDate (https://www.uptodate.com/contents/calculator-glomerular-filtration-rate-gfr-by-ckd-epiequation-in-adults-conventional-and-si-units search=gfr\&topicRef=2359\&source=see\_link).

⁃ Acceptable hematologic status:

• Absolute neutrophil count (ANC) ≥ 1500 cells/mm3 (1.5 ×109/L)

∙ Platelet count ≥ 100,000 platelet/mm3 (100 ×109/L)

∙ Hemoglobin ≥ 8 g/dL.

⁃ Ability to understand and willingness to sign a written informed consent document.

⁃ Sexually active participants with female partners of childbearing potential are eligible to participate if they agree to follow 1 of the following methods of contraception consistently, starting from screening, during the study and for at least 3 months after the last dose of DFMO and/or enzalutamide:

∙ Are abstinent from penile-vaginal intercourse as their usual and preferred lifestyle (abstinent on a longterm and persistent basis) and agree to remain abstinent.

‣ Are sterilized (with the appropriate post-vasectomy documentation of the absence of sperm in the ejaculate);

‣ Agree to use a male condom and have their partner use a contraceptive method with a failure rate of \<1% per year as described below when having penile-vaginal intercourse with a woman of childbearing potential who is not currently pregnant, and who agrees to the use of a condom by her partner.

⁃ In addition, participants must refrain from donating sperm starting from Screening, during the study and for at least 3 months after the last dose of DFMO and/or enzalutamide.

⁃ Sexually active participants with a pregnant or breastfeeding partner must agree to remain abstinent from penile-vaginal intercourse; or use a male condom during each episode of penile penetration during the study

⁃ Patients with soft-tissue disease amenable to biopsy as determined by Interventional Radiology must agree to serial biopsies as per the study schedule to be eligible.

Locations
United States
Maryland
Johns Hopkins University: Sidney Kimmel Comprehensive Cancer Center
RECRUITING
Baltimore
Contact Information
Primary
Laura Sena, MD, PhD
laura.sena@jhmi.edu
410-502-3825
Backup
Kathy Schultz, RN
kschult3@jhmi.edu
410-614-9482
Time Frame
Start Date: 2023-10-04
Estimated Completion Date: 2029-11-30
Participants
Target number of participants: 50
Treatments
Experimental: Repeat Sequential DFMO and High dose Testosterone in Sequence with Enzalutamide
Eligible patients will receive 7 days of DFMO (1000 mg PO bid) (days 1-7 of cycle), followed by 56 days of combined testosterone (testosterone cypionate 400 mg IM on day 8 and day 36) and DFMO (1000 mg PO bid) (days 8-63 of cycle), followed by 56 days of enzalutamide (160 mg PO daily) (days 64-119).
Related Therapeutic Areas
Sponsors
Collaborators: Panbela Therapeutics, United States Department of Defense, Prostate Cancer Foundation
Leads: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

This content was sourced from clinicaltrials.gov