PROMIZE: A Phase I/II Trial to Assess the Safety, Tolerability and Preliminary Anti-tumour Activity of Oral Combination Antibiotic Therapy to Modulate the Microbiome in Combination With Enzalutamide With Metastatic Castration Resistant Prostate Cancer (mCRPC).
PROMIZE is an open-label, multi-centre, single-arm, Phase I/II clinical trial, evaluating the safety, tolerability and anti-tumuor efficacy of an antibiotic combination and enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC).
• Histologically or cytologically proven metastatic castration-resistant prostate cancer or adenocarcinoma refractory to conventional treatment, or for which no conventional therapy exists or is declined by the patient.
• Documented prostate cancer progression as assessed by the investigator with RECIST (v1.1) and PCWG3 criteria with at least one of the following criteria:
∙ Progression of soft tissue/visceral disease by RECIST (v1.1) and/or,
‣ Progression of bone disease by PCWG3 bone scan criteria and/or,
‣ Progression of PSA by PCWG3 PSA criteria and/or
‣ Clinical progression with worsening pain and need for palliative radiotherapy for bone metastases.
• Phase I: Patients that have progressed after at least 12 weeks of treatment with a NAAT within the previous 6 months Phase II: Patients that have progressed after at least 12 weeks of treatment with a NAAT within the previous 6 months (for combination treatment) or more than 6 months prior to trial entry (for enzalutamide alone resistance run-in).
• Previously progressed on at least one line of taxane chemotherapy (or not fit or not willing to receive a taxane).
• Ongoing androgen deprivation maintaining serum testosterone of less than 50 ng/dL (less than 2.0 nM) is mandatory.
• Life expectancy of at least 12-weeks.
• Able to swallow tablets.
• Archival tumour tissue must be available for analyses.
• Willing to have pre- and post-treatment biopsies if biopsy is feasible.
⁃ World Health Organisation (WHO) performance status of 0-2 (Appendix 1).
⁃ Haematological and biochemical indices within the ranges shown below. These measurements must be performed within one week (Day -7 to Day 1) prior to the patient's first dose of IMP.
⁃ Haemoglobin (Hb): ≥ 9.0 g/dL
⁃ Absolute neutrophil count: ≥ 1.5 x 109/L
⁃ Platelet count: ≥ 75 x 109/L
⁃ Serum bilirubin: ≤ 1.5 x upper limit of normal (ULN)
⁃ Alanine aminotransferase (ALT): ≤ 2.5 x (ULN) unless raised due to tumour in which case up to 5 x ULN is permissible
⁃ Aspartate aminotransferase (AST): ≤ 2.5 x (ULN) unless raised due to tumour in which case up to 5 x ULN is permissible
⁃ Serum creatinine / calculated creatinine clearance: ≤ 1.5 x upper limit of normal (ULN) / GFR ≥ 50 mL/min (uncorrected value)
⁃ Serum albumin: \>25 g/L
⁃ 18 years or over
⁃ Written (signed and dated) informed consent and be capable of co-operating with treatment and follow-up
⁃ Willing and able to comply with the study requirement including the collection of blood, fresh tumour biopsy, urine, rectal swab and stool samples.