Background:
- A phase III trial demonstrated that combining docetaxel and androgen deprivation
therapy (ADT) significantly improved survival (57.6 vs 44.0 months (hazard ratio
HR=0.56, (0.44- 0.70), p <0.0001) for men with metastatic castration sensitive
prostate cancer (mCSPC). The greatest benefit was seen in men with high volume
disease (visceral disease or 4+ bone lesions with at least one beyond the pelvis and
spine.)
- Docetaxel has limited efficacy in metastatic castration resistant prostate cancer
(mCRPC) patients who have already progressed on anti-androgen therapy (abiraterone
or enzalutamide).
- Intensification of treatment in de novo mCSPC patients by adding abiraterone to
docetaxel and ADT has been shown in a phase III trial to significantly improve OS
(0.82, (0.69 - 0.98) p=0 (Summation)030) and rPFS (HR=0.54,(0.41-0.71) p <0.0001)
- Clinical data have indicated that PSA <=0.20 ng/ml eight months after starting
androgen deprivation therapy (ADT) is prognostic for overall survival based on data
from the phase III trial.
- Preclinical data demonstrates that docetaxel increases uptake of M9241, an IL-12
immunocytokine that targets necrosis.
- Additional preclinical data demonstrates the potential anti-tumor synergy of M9241
when combined with docetaxel.
Objectives:
Phase I:
To evaluate safety and tolerability of docetaxel in combination with M9241 in
participants who have metastatic prostate cancer.
Phase II:
-Determine clinical efficacy in adults with prostate cancer treated when standard of care
is combined with M9241. For mCSPC the standard of care is docetaxel + abiraterone. For
mCRPC the standard of care is docetaxel.
- For mCSPC participants: Clinical efficacy will be measured by prostate specific
antigen (PSA <0.2 ng/ml) eight months after start of androgen deprivation therapy
(ADT).
- For mCRPC participants: Clinical efficacy will be measured by an increase in their
median progression free survival (PFS).
Eligibility:
- Men age >=18 years
- Histopathological confirmation of prostate cancer. If no pathologic specimen is
available, participants may enroll with a pathologist s report showing a histologic
diagnosis of prostate cancer and a clinical course consistent with the disease.
- Participants must have metastatic disease
- mCSPC participants must be within 134 days of starting ADT.
- mCRPC participants must have been previously treated with ADT.
Design:
- Open-label, single-center, non-randomized Phase I/II study
- To ensure safety of the combination before using in larger numbers of mCSPC and
mCRPC participants, M9241 will be escalated from a starting dose of 12 mcg/kg and a
second dose level of 16.8 mcg/kg along with docetaxel. mCSPC participants will
receive a maximum of 6 cycles. mCRPC participants will continue until progression or
unacceptable toxicity.
- The remaining participants will be enrolled onto the trial in the following
expansion cohorts, each of which will receive the determined safe dose of M9241. ADT
will be maintained/given per standard of care throughout the study.
- mCSPC participants: Once ADT established, simultaneous docetaxel 75 mg/m^2
(given every 3 weeks x 6 cycles starting at Cycle 1), with M9241 at the RP2D,
given every 3 weeks from cycle 2 through cycle 6). Abiraterone will be given in
addition to docetaxel from the start of cycle 1 at a dose of 1000mg by mouth
once daily. Prednisone will be given orally at 5 mg twice a day and will not be
optional.
- The first 6 participants in the mCSPC arm including abiraterone will be
evaluated as a safety lead-in of M9241 at 12 mcg/kg. If there are 2 or more
DLTs within these initial 6, then the doses will be de-escalated and 6
additional participants will be evaluated at this lower dose of M9241 at 8
mcg/kg.
- mCRPC participants: docetaxel 75 mg/m^2 (given every 3 weeks starting at Cycle
1) with M9241 at the RP2D, given every 3 weeks from cycle 2 onwards until
disease progression or unacceptable toxicity. Prednisone will be given 5 mg
twice a day for each dose or 10 mg once a day.
- It is anticipated that approximately 4 years may be required for accrual of up to 80
participants.