Abiraterone Acetate and Prednisone With or Without Veliparib in Treating Patients With Metastatic Hormone-Resistant Prostate Cancer

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Basic Trial Information

PhaseTypeAgeTrial IDs
Phase IIBiomarker/Laboratory analysis, Treatment18 and over12-0109
NCI-2012-01149, CDR0000730114, NCI-2012-01919, UCCRC-IL057, 9012, IL057, NCT01576172

Trial Description



This randomized phase II trial studies abiraterone acetate and prednisone together with veliparib to see how well it works compared to abiraterone acetate and prednisone alone in treating patients with metastatic hormone-resistant prostate cancer. Androgens can cause the growth of prostate cancer cells. Antiandrogen drugs, such as abiraterone acetate, may lessen the amount of androgens made by the body. Veliparib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether giving abiraterone acetate together with prednisone and veliparib is more effective than abiraterone acetate and prednisone alone in treating prostate cancer.

Further Study Information


I. To evaluate the role of v-ets erythroblastosis virus E26 oncogene (ETS) gene fusion as a predictive biomarker for response to hormone therapy (abiraterone [abiraterone acetate]) alone or hormone therapy plus poly adenosine diphosphate-ribose polymerase 1 (PARP-1) targeted therapy (ABT-888 [veliparib]) in patients with metastatic castration resistant prostate cancer.

II. To evaluate whether the addition of PARP-1 targeted therapy is superior to hormone therapy alone based on ETS gene fusion status.


I. Rate of prostate-specific antigen (PSA) declines.

II. Objective response rate.

III. Progression-free survival.

IV. Evaluate the qualitative and quantitative toxicity of abiraterone acetate with and without ABT-888.


I. To determine the concordance in fusion status among prostate cancer samples from the primary site, biopsied metastasis, and circulating tumor cells (CTCs).

II. To assess if ETS fusion status in the CTCs, at baseline, 12 weeks, and disease progression (or when off study) is associated with response to therapy.

III. To evaluate if the number of CTCs, as well as the expression levels of androgen receptor, RAD51 recombinase (RAD51), and gamma-H2A histone family, member X (H2aX) foci in the CTCs at baseline, at 12 weeks, and at disease progression in all patients is associated with response to therapy.

IV. To determine the role of phosphatase and tensin homolog (PTEN) loss as a predictive biomarker of response to abiraterone, alone or in combination with ABT-888.

V. To determine the role of PARP1 activity as a predictive biomarker of response to abiraterone, alone or in combination with ABT-888.

VI. To perform next-generation sequencing for discovery of novel gene fusions in prostate cancers negative for ETS fusions.

VII. To perform germline single nucleotide polymorphism (SNP) analysis of genes involved in hormone synthesis, transport, binding, metabolism, and degradation for discovery of novel SNPs predictive of response to abiraterone, alone or in combination with ABT-888.

VIII. To determine if ETS fusion ribonucleic acid (RNA) levels in blood are predictive of response to abiraterone, alone or in combination with ABT-888.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive abiraterone acetate orally (PO) once daily (QD) and prednisone PO twice daily (BID) on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive veliparib PO BID on days 1-28. Patients also receive abiraterone acetate PO QD and prednisone PO BID on day 1 (day 8 of course 1).Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 6 months for up to 2 years.

Eligibility Criteria

Inclusion Criteria:

Have a histologic or cytologic diagnosis of prostate cancer

Have progressive metastatic castration-resistant prostate cancer, on androgen-deprivation therapy, based on at least one of the following criteria:

PSA progression defined as 25% increase over baseline value with an increase in the absolute value of at least 2 ng/mL that is confirmed by another PSA level with a minimum of a 1-week interval with a minimum PSA of 2 ng/mL

Progression of bidimensionally measurable soft tissue (nodal metastasis) assessed within one month prior to registration by a computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen and pelvis

Progression of bone disease (evaluable disease) (new bone lesion[s]) by bone scan

Agree to undergo a biopsy of at least 1 metastatic site for gene-fusion status analysis; adequate archival metastatic tissue can be used if available in lieu of a biopsy; patients will only be eligible for protocol therapy if the biopsy has tumor and the tissue is evaluable for ETS fusion status

Eastern Cooperative Oncology Group (ECOG) performance status of 0-2

Have testosterone < 50 ng/dL; patients must continue primary androgen-deprivation with a luteinizing hormone-releasing hormone (LHRH) analogue if they have not undergone orchiectomy

Patients must discontinue antiandrogen therapy for at least 4 weeks (e.g. flutamide, bicalutamide, nilutamide) prior to registration with no evidence of a falling PSA after washout; patients on steroids are eligible as long as they will be switched to prednisone

Have no prior exposure to cytochrome 450 family 17(CYP-17) (other than ketoconazole) or PARP inhibitors for prostate cancer; patients with prior exposure to ketoconazole are eligible

Patients with up to 2 prior chemotherapy regimens are eligible

White blood cells (WBC) >= 3,000/uL

Absolute neutrophil count (ANC) >= 1,500/uL

Platelet count >= 100,000/uL

Serum creatinine =< 1.5 x the institutional upper limits of normal or corrected creatinine clearance of >= 50 mg/ml/hr/1.73 m^2 body surface area (BSA)

Potassium >= 3.5 mmol/L

Bilirubin within the institutional limits of normal

Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) =< 2 times upper limit of normal

Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 2 times upper limit of normal

Must agree to use effective contraception during treatment and for at least 1 week after the last administration of therapy

Patients must be able to take oral medication without crushing, dissolving, or chewing tablets

Patients may have received prior radiation therapy or surgery; however, at least 21 days must have elapsed since completion of radiation therapy or surgery and patient must have recovered from all side effects at the time of registration

Ability to understand and the willingness to sign a written informed-consent document that is approved by the local institutional review board

Exclusion Criteria:

Patients may not be receiving any other investigational agents; any prior investigational products must be stopped at least 14 days (2-week washout) prior to registration

Patients who have had chemotherapy, radiotherapy or oral antifungal agents (Ketoconazole, itraconazole, fluconazole) within 3 weeks prior to entering the study or those who have not recovered (e.g. back to baseline or grade 1) from adverse events due to agents administered more than 3 weeks earlier

There is a potential drug interaction when abiraterone is concomitantly used with a cytochrome P450 family 2, subfamily D, polypeptide 6 (CYP2D6) substrate narrow therapeutic index (e.g., thioridazine, dextromethorphan), or strong cytochrome P450 family 3, subfamily A, polypeptide 4 [CYP3A4] inhibitors (e.g., atazanavir, erythromycin, indinavir, itraconazole, Ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, and voriconazole) or strong inducers (e.g., carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, rifapentine); caution should be used when patients are on one of these drugs

Patients with history of active seizures are not eligible

Patients with a history of pituitary or adrenal dysfunction, active or symptomatic viral hepatitis, or chronic liver disease are not eligible

Patients with known brain metastases should be excluded from this clinical trial

History of allergic reactions attributed to compounds of similar chemical or biologic composition to ABT-888 or abiraterone

Patients may continue on a daily multi-vitamin, calcium and vitamin D, but all other herbal, alternative and food supplements (i.e. PC-Spes, Saw Palmetto, St John’s wort, etc.) must be discontinued before registration; patients must not be planning to receive any concurrent cytotoxic chemotherapy, surgery, or radiation therapy during protocol treatment; hormonal-acting agents (including diethylstilbestrol/DES, aldosterone, and spironolactone) are forbidden during the trial and must be stopped prior to registration; no washout period will be required for any of these agents; patients on megestrol acetate for hot flashes are allowed to continue therapy

Patients on stable doses of bisphosphonates or denosumab which have been started prior to registration may continue on this medication, patients who are not on bisphosphonates or denosumab are eligible as long as they initiate therapy prior to registration

Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure (New York Heart Association class III and IV heart failure), unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements or concurrent medications that alter cardiac conduction

Patients with a "currently active" second malignancy other than non-melanoma skin cancers are not eligible; patients are not considered to have a "currently active" malignancy if they have completed all therapy and are now considered without evidence of disease for 1 year

Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy are ineligible

Trial Contact Information

Trial Lead Organizations / Sponsors / Collaborators

National Cancer Institute

  • National Cancer Institute
Maha H. A. Hussain, Principal Investigator

Trial Sites



City of Hope Comprehensive Cancer Center

Przemyslaw W. Twardowski
Ph: 626-256-4673ext68218
Email: ptwardowski@coh.org

Przemyslaw W. Twardowski
Principal Investigator

Los Angeles

USC / Norris Comprehensive Cancer Center

David Ian Quinn
Ph: 323-865-3956
Email: diquinn@usc.edu

David Ian Quinn
Principal Investigator

South Pasadena

City of Hope South Pasadena

Stephen C. Koehler
Ph: 626-396-2900
Email: skhoehler@cohmg.com

Stephen C. Koehler
Principal Investigator


University of Chicago Comprehensive Cancer Center

Walter M. Stadler
Ph: 773-702-4150
Email: wstadler@medicine.bsd.uchicago.edu

Walter M. Stadler
Principal Investigator


NorthShore University HealthSystem-Evanston Hospital

Daniel H. Shevrin
Ph: 847-570-2515
Email: DShevrin@northshore.org

Daniel H. Shevrin
Principal Investigator


Indiana University/Melvin and Bren Simon Cancer Center

Costantine Albany
Ph: 317-948-8310
Email: calbany@iupui.edu

Costantine Albany
Principal Investigator


Johns Hopkins University/Sidney Kimmel Cancer Center

Emmanuel S. Antonarakis
Ph: 410-502-7528
Email: eantona1@jhmi.edu

Emmanuel S. Antonarakis
Principal Investigator

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital

Emmanuel S. Antonarakis
Ph: 410-502-7528
Email: eantona1@jhmi.edu

Emmanuel S. Antonarakis
Principal Investigator

Ann Arbor

University of Michigan Comprehensive Cancer Center

Maha H. A. Hussain
Ph: 734-936-8906
Email: mahahuss@umich.edu

Maha H. A. Hussain
Principal Investigator

New Jersey
New Brunswick

Rutgers Cancer Institute of New Jersey

Mark Nathan Stein
Ph: 732-235-3336
Email: steinmn@umdnj.edu

Mark Nathan Stein
Principal Investigator

North Carolina
Chapel Hill

University of North Carolina at Chapel Hill

Young E. Whang
Ph: 919-843-9983
Email: ywhang@med.unc.edu

Young E. Whang
Principal Investigator


M D Anderson Cancer Center

Paul G. Corn
Ph: 713-792-2830
Email: pcorn@mdanderson.org

Paul G. Corn
Principal Investigator


University of Washington Medical Center

Robert Bruce Montgomery
Ph: 206-598-0860
Email: rbmontgo@u.washington.edu

Robert Bruce Montgomery
Principal Investigator


University of Wisconsin Hospital and Clinics

Glenn Liu
Ph: 608-265-8689
Email: gxl@medicine.wisc.edu

Glenn Liu
Principal Investigator

Link to the current ClinicalTrials.gov record.
NLM Identifer NCT01576172

Note: Information about participating sites on pharmaceutical industry trials may be incomplete. Please visit the ClinicalTrials.gov record via the link above for more information about participating sites.