Alternate Title
Basic Trial Information
Objectives
Entry Criteria
Expected Enrollment
Outcomes
Outline
Trial Contact Information
Registry Information

Alternate Title

Docetaxel and Prednisone With or Without Cediranib in Treating Patients With Metastatic Prostate Cancer That Did Not Respond to Hormone Therapy

Basic Trial Information

Phase	Type	Status	Age	Sponsor	Protocol IDs
Phase II	Biomarker/Laboratory analysis, Treatment	Active	18 and over	NCI	WSU-2007-015 2007-015, 7451, NCT00527124

Objectives

Primary

1. To determine the 6-month progression-free survival rate of patients with hormone refractory metastatic adenocarcinoma of the prostate treated with docetaxel and prednisone with vs without cediranib.

Secondary

1. To evaluate the safety profile of cediranib, docetaxel, and prednisone in patients with metastatic hormone-refractory prostate cancer.
2. To determine the duration of prostate-specific antigen (PSA) response and PSA control in patients with metastatic hormone-refractory prostate cancer treated with cediranib, docetaxel, and prednisone.
3. To determine the partial and complete response rate in patients with measurable disease treated with cediranib, docetaxel, and prednisone.
4. To determine time to progression in patients with metastatic hormone-refractory prostate cancer treated with cediranib, docetaxel, and prednisone.
5. To determine overall survival in patients with metastatic hormone-refractory prostate cancer.
6. To perform correlative marker studies measuring serum levels of VEGF, PDGF, sICAM, bFGF, interleukin (IL)-6, and IL-8.
7. To perform a pilot study of [F18]FMAU positron emission test (PET) imaging on patients receiving cediranib, docetaxel, and prednisone.

Entry Criteria

Disease Characteristics:

• Histologically confirmed adenocarcinoma of the prostate
  • Clinical/radiologic metastases with objective evidence of disease progression by imaging or by rising prostate-specific antigen (PSA) despite androgen deprivation therapy
    • Rising PSA must be determined based on a rising trend with 2 successive elevations at a minimum interval of 1 week
• Meets 1 of the following criteria:
  • Measurable disease, with any level of PSA
    • At least 1 unidimensionally measurable lesion (longest diameter to be recorded) ≥ 20 mm by conventional techniques or ≥ 10 mm by spiral CT scan
  • Nonmeasurable disease
    • PSA ≥ 5 ng/mL OR new areas of bony metastases on bone scan
• Castrate levels of testosterone < 50 ng/dL must be maintained and documented
  • Luteinizing hormone-releasing hormone (LHRH) agonist therapy must be continued, if required to maintain castrate levels of testosterone
• No untreated unstable brain or meningeal metastases
  • Patients with radiological evidence of stable brain metastases are eligible provided they are asymptomatic and do not require corticosteroids or have been treated with corticosteroids and show clinical and radiological evidence of stabilization at least 10 days after discontinuation of steroids

Prior/Concurrent Therapy:

• See Disease Characteristics
• Patients must be off flutamide antiandrogen therapy for ≥ 4 weeks (6 weeks for bicalutamide or nilutamide)
• No prior chemotherapy for metastatic prostate cancer
• No major surgery within the past 14 days or a surgical incision that is not fully healed
• No HIV-positive patients on combination antiretroviral therapy
• No conditions requiring concurrent use of drugs or biologics with proarrhythmic potential
• No other investigational agents within 30 days prior to study enrollment

Patient Characteristics:

Inclusion criteria:

• ECOG performance status (PS) ≤ 2 or Karnofsky PS 60-100%
• Life expectancy > 12 weeks
• Leukocytes ≥ 3,000/mcL
• Absolute neutrophil count ≥ 1,500/mcL
• Platelet count ≥ 100,000/mcL
• Total bilirubin normal
• AST and ALT ≤ 2.5 times upper limit of normal
• Creatinine normal OR creatinine clearance ≥ 60 mL/min
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• Proteinuria ≤ 1+ and urine protein:creatinine ratio ≤ 1.0 OR 24-hour urine protein < 1,000 mg

Exclusion criteria:

• Peripheral neuropathy ≥ grade 2
• Uncontrolled intercurrent illness including, but not limited to, any of the following:
  • Ongoing or active infection
  • Symptomatic congestive heart failure
  • Unstable angina pectoris
  • Cardiac arrhythmia
  • Psychiatric illness/social situations that would limit compliance with study requirements
• Congestive heart failure, second or third degree heart block, or recent myocardial infarction within the past 6 months
• QTc prolongation > 500 msec OR other ECG abnormality noted within 14 days of treatment
• New York Heart Association class III or IV cardiac disease
  • Class II disease controlled with treatment and monitoring allowed
• History of poorly controlled hypertension (e.g., resting blood pressure > 150/90 mm Hg with or without hypertensive therapy)
• History of a curatively treated malignancy with a survival prognosis of less than 5 years or concurrent malignancy except for adequately treated basal cell or squamous cell skin cancer or carcinoma in situ
• History of significant gastrointestinal impairment, as judged by the investigator, that would significantly affect the absorption of cediranib
• History of severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80
• Known hypersensitivity to cediranib or any of its excipients
• Significant hemorrhage (30 mL bleeding/episode in previous 3 months) or hemoptysis (5 mL fresh blood in previous 4 weeks)
• Prior enrollment or randomization of treatment in the present study

Expected Enrollment

Outcomes

Progression-free survival rate at 6 months

Prostate-specific antigen (PSA) response duration
PSA control duration
Time to progression
Overall survival
Levels of the various serum correlative markers and positron emission test (PET) imaging correlates

Outline

This is a multicenter study. Patients are stratified by participating institution. Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients receive oral cediranib once daily on days 1-21, docetaxel IV over 1 hour on day 1, and oral prednisone twice daily on days 1-21.
• Arm II: Patients receive docetaxel and prednisone as in arm I.

In both arms, courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Archival paraffin-embedded tissue blocks or slides from time of diagnosis (or subsequent, but prior to therapy) are evaluated for expression of molecular targets relevant to this study. Blood specimens from baseline, after courses 1 and 2, and after completion of study treatment are analyzed for protein markers. Samples are analyzed by ELISA and IHC for angiogenesis-associated plasma proteins, plasma levels of VEGF, tumor expression of PDGFR, and interleukin (IL)-6 and IL-8 plasma levels. Patients also undergo positron emission test (PET) scans utilizing fluorodeoxyglucose (FDG) at baseline and after course 1.

After completion of study treatment, patients are followed every 3 months for 52 weeks.

Trial Contact Information

Trial Lead Organizations

Barbara Ann Karmanos Cancer Institute

Elisabeth Heath, MD, Protocol chair		Ph: 313-576-8715; 800-527-6266 Email: heathe@karmanos.org

U.S.A.
Colorado
	Aurora
	University of Colorado Cancer Center at UC Health Sciences Center
		Clinical Trials Office - University of Colorado Cancer Center	Ph:  720-848-0650
Maryland
	Baltimore
	Greenebaum Cancer Center at University of Maryland Medical Center
		Clinical Trials Office - Greenebaum Cancer Center at University of Maryladn Medical Center	Ph:  800-888-8823
Michigan
	Ann Arbor
	Saint Joseph Mercy Cancer Center
		Contact Person	Ph:  734-712-5658 888-474-4673
	Detroit
	Barbara Ann Karmanos Cancer Institute
		Clinical Trials Office - Barbara Ann Karmanos Cancer Institute	Ph:  313-576-9363
	Sinai-Grace Hospital
		Elisabeth Heath	Ph:  313-576-8717
	Veterans Affairs Medical Center - Detroit
		Contact Person	Ph:  313-576-1000
	Lansing
	Breslin Cancer Center at Ingham Regional Medical Center
		Clinical Trials Office - Breslin Cancer Center at Ingham Regional Medical Center	Ph:  517-334-2765
Ohio
	Columbus
	Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center
		Ohio State University Cancer Clinical Trial Matching Service	Ph:  866-627-7616
			Email: osu@emergingmed.com

Registry Information
Official Title		A Randomized, Phase II Trial of AZD2171, Docetaxel, and Prednisone Compared to Docetaxel and Prednisone in Patients with Metastatic, Hormone Refractory Prostate Cancer
Trial Start Date		2007-11-21
Trial Completion Date		2011-07-01 (estimated)
Registered in ClinicalTrials.gov		NCT00527124
Date Submitted to PDQ		2007-08-23
Information Last Verified		2009-11-13
NCI Grant/Contract Number		CA62487, CA22453

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