Overview

This trial is active, not recruiting.

Condition prostatic neoplasms
Treatments docetaxel, thalidomide, prednisone, bevacizumab, polymorphism analysis, immunoenzyme technique, laboratory biomarker analysis, pharmacological study
Phase phase 2
Target VEGF
Sponsor National Cancer Institute (NCI)
Start date August 2004
End date December 2011
Trial size 73 participants
Trial identifier NCT00089609, 04-C-0257, 040257, NCT00091364

Summary

This is a Phase II study of docetaxel, bevacizumab, prednisone and thalidomide in patients with androgen independent metastatic prostate cancer who are previously untreated with chemotherapy. The primary objective of this study is to determine if the combination of docetaxel, thalidomide and bevacizumab is able to be associated with a sufficiently high proportion of patients with a prostate-specific antigen (PSA) response to be worthy of further investigation in metastatic prostate cancer. We will also be looking at multiple secondary endpoints. These will include possible pharmacokinetic interactions among the study agents, potential correlation between patient genotype and efficacy of treatment. We will also be looking for circulating tumor cells in blood before and after treatment. Additionally we will be monitoring the tolerability of the regimen and survival duration as endpoints as well. We hope to use this trial to build on the promising results seen in our thalidomide/docetaxel protocol where there was a significant PSA decline and a trend toward survival benefit.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation non-randomized
Endpoint classification safety/efficacy study
Intervention model parallel assignment
Masking open label
Primary purpose treatment
Arm
(Experimental)
Docetaxel 75 mg/m^2 intravenously over 60 minutes on cycle 1 day 1 repeated every 21 days. Thalidomide 200 mg by mouth daily throughout the cycle. Prednisone 10 mg by mouth daily throughout the cycle. Bevacizumab 15 mg/kg intravenously on cycle 1 day 1 every 21 days.
docetaxel Taxotere
Docetaxel 75 mg/m^2 intravenously over 60 minutes on cycle 1 day 1 repeated every 21 days.
thalidomide Thalomid
Thalidomide 200 mg by mouth daily throughout the cycle.
prednisone Deltasone
Prednisone 10 mg by mouth daily throughout the cycle.
bevacizumab Avastin
Bevacizumab 15 mg/kg intravenously on cycle 1 day 1 every 21 days.
polymorphism analysis
Two buffy coat tubes (two 7mL blue tiger top tubes) will be obtained and wrapped in foil when the patient enters onto the study. DNA (deoxyribonucleic acid) will be isolated only for the purpose of genotype analysis of enzymes with putative relevance for docetaxel or thalidomide disposition.
immunoenzyme technique
The PBMC (peripheral blood mononuclear cells) of patients will be analyzed pre-treatment and post cycle 2 for any changes in the function of regulatory T cells. The following analysis will be performed: flow cytometry analysis, CD4 CD25 T cell enrichment, and immunosuppression assay.
laboratory biomarker analysis
Serum and urine samples will be collected at baseline and monthly to measure VEGF (vascular endothelial growth factor) levels.
pharmacological study
Plasma concentrations of docetaxel and thalidomide will be determined to assess interactions between docetaxel (and thalidomide) and the concomitant therapy.The analysis will be performed using a validated method based on liquid chromotography with mass-spectrometric detection.
(Experimental)
Docetaxel 75 mg/m^2 intravenously over 60 minutes and Bevacizumab 15 mg/kg intravenously was given for 2 cycles. After two cycles Prednisone 10 mg by mouth daily and Thalidomide 200 mg by mouth daily was added.
docetaxel Taxotere
Docetaxel 75 mg/m^2 intravenously over 60 minutes on cycle 1 day 1 repeated every 21 days.
thalidomide Thalomid
Thalidomide 200 mg by mouth daily throughout the cycle.
prednisone Deltasone
Prednisone 10 mg by mouth daily throughout the cycle.
bevacizumab Avastin
Bevacizumab 15 mg/kg intravenously on cycle 1 day 1 every 21 days.

Primary Outcomes

Measure
Number of Participants Who Had a Prostate-specific Antigen (PSA) Response
time frame: 21.6 months
Immune Response
time frame: 6 weeks

Secondary Outcomes

Measure
Number of Participants With Adverse Events
time frame: 79 months

Eligibility Criteria

Male participants at least 18 years old.

- INCLUSION CRITERIA: Androgen-independent metastatic adenocarcinoma of the prostate defined as progressive metastatic disease while on gonadotropin releasing hormone (GnRH) agonists or post surgical castration Histopathological documentation of prostate cancer confirmed in the National Cancer Institute (NCI) Laboratory of Pathology at the National Institutes of Health, the Pathology Department at Walter Reed Medical Center or the Pathology Department at National Naval Medical Center, prior to starting this study. In addition, patients whose slides are lost or unavailable will be eligible for the study if they provide documentation of prostate cancer and if they meet criteria of clinically progressive prostate cancer as outlined in section 3.1.1.3. Clinically progressive prostate cancer documented prior to entry. Progression must be documented by at least one of the following parameters: - Two consecutively rising prostate-specific antigen (PSA) levels. The first rising PSA must be a minimum of one week from a reference value. It is recognized that PSA fluctuations are such that the confirmatory PSA value might be less than the previous one. In these cases, that patient would still be eligible provided the next PSA was greater than the first rising PSA value. Patients must have PSA greater than or equal to 5.0. - At least one new lesion on bone scan. - Progressive measurable disease. Patients must have undergone bilateral surgical castration or must continue on GNRH agonist. Those patients receiving an anti-androgen agent and are entering the trial due to a rise in PSA must demonstrate a continued rise in PSA 4 weeks after stopping flutamide and 6 weeks after stopping bicalutamide or nilutamide. Patients may not have received any chemotherapy for metastatic prostate cancer Age greater than or equal to 18 years Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 2 Life expectancy of greater than 3 months Patients must have adequate organ and marrow function as defined below: Leukocytes- greater than or equal to 3,000/microliter Absolute neutrophil count- greater than or equal to 1,500/microliter Platelets- greater than or equal to 100,000/microliter Hemoglobin- greater than or equal to 8.0g/L - transfusions acceptable Total bilirubin- less than or equal to 1.5 times the institutional upper limits of normal Aspartate aminotransferase (AST)serum glutamic oxaloacetic transaminase(SGOT) and alanine aminotransferase (ALT)serum glutamic pyruvic transaminase(SGPT) - less than or equal to 2.5 times the institutional upper limits of normal Creatinine or Creatinine clearance- less than or equal to 1.5 times the institutional upper limits of normal or greater than or equal to 40 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal. Recovered from any toxicity from surgery or radiotherapy Must be willing to travel from their home to the National Institutes of Health (NIH) for follow-up visits Able and willing to follow instructions and conform to protocol. Patients may have had no other active malignancy within the past 2 years with the exception of non-melanoma skin cancer and superficial bladder carcinoma No history of myocardial infarction within the past 6 months, uncontrolled congestive heart failure (CHF) or uncontrolled angina pectoris Patients must agree to use adequate contraception (abstinence; hormonal or barrier method of birth control) for the study and at least 2 months after completion. Ability to understand and the willingness to sign a written informed consent document. EXCLUSION CRITERIA: Present clinical signs or symptoms of brain and/or leptomeningeal metastases confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) brain scan. Uncontrolled, intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure (American Heart Association (AHA) Class II or worse), unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements Persistent systolic blood pressure greater than or equal to 170 mmHg or diastolic blood pressure greater than or equal to 100 mmHg. Human immunodeficiency virus (HIV)-positive patients receiving combination anti-retroviral therapy are excluded from the study because of possible pharmacokinetic interactions with docetaxel, bevacizumab, and/or the combination. Proteinuria, as demonstrated by a urine, protein, creatinine (UPC) ratio greater than or equal to 1.0 at screening, required to be assessed if urine dipstick is greater than or equal to 1+. Urine protein should be screened by urine analysis for Urine Protein Creatinine (UPC) ratio. For UPC ratio > 0.5, 24-hour urine protein should be obtained and the level should be < 1000 mg for patient enrollment. Note: UPC ratio of spot urine is an estimation of the 24 urine protein excretion - a UPC ratio of 1 is roughly equivalent to a 24-hour urine protein of 1 gm. UPC ratio is calculated using one of the following formula: - [urine protein]/[urine creatinine] - if both protein and creatinine are reported in mg/dL - [(urine protein) x 0.088]/[urine creatinine] - if urine creatinine is reported in mmol/L Therapeutic anticoagulation with coumadin, heparins, or heparinoids. Greater than Grade 2 peripheral neuropathy at baseline. History of transient ischemic attacks (TIA) or cerebrovascular accident (CVA) within the past 2 years. History of allergic reaction to docetaxel, prednisone, thalidomide and/or bevacizumab or related products. Patients who are on concurrent investigational agent(s) Patients who are unable to ingest oral medication. INCLUSION OF WOMEN AND MINORITIES Men of all races and ethnic groups are eligible for this trial. Every effort will be made to recruit minorities in this study. Women are ineligible for this study.

Additional Information

Official title A Phase II Trial of Docetaxel, Thalidomide, Prednisone and Bevacizumab in Patients With Androgen-Independent Prostate Cancer
Principal investigator William L Dahut, M.D.
Description This is a Phase II study of docetaxel, bevacizumab, prednisone and thalidomide in patients with androgen independent metastatic prostate cancer who are previously untreated with chemotherapy. The primary objective of this study is to determine if the combination of docetaxel, thalidomide and bevacizumab is able to be associated with a sufficiently high proportion of patients with a PSA response to be worthy of further investigation in metastatic prostate cancer. We will also be looking at multiple secondary endpoints. These will include possible pharmacokinetic interactions among the study agents, potential correlation between patient genotype and efficacy of treatment. We will also be looking for circulating endothelial cells in blood before and after treatment. Additionally we will be monitoring the tolerability of the regimen, time to disease progression, and survival duration as endpoints as well. We hope to use this trial to build on the promising results seen in our thalidomide/docetaxel protocol where there was a significant PSA decline and a trend toward survival benefit.
Trial information was received from ClinicalTrials.gov and was last updated in May 2014.
Information provided to ClinicalTrials.gov by National Institutes of Health Clinical Center (CC).