Overview

This trial is active, not recruiting.

Conditions hormone-resistant prostate cancer, metastatic prostatic adenocarcinoma, prostate adenocarcinoma, recurrent prostate carcinoma
Treatments biopsy of prostate, docetaxel, laboratory biomarker analysis, phenelzine sulfate
Phase phase 2
Sponsor OHSU Knight Cancer Institute
Collaborator National Cancer Institute (NCI)
Start date July 2010
End date January 2017
Trial size 20 participants
Trial identifier NCT01253642, 5688, IRB00005688, MR00045508, MR46390, NCI-2010-02037, OHSU-5688, P30CA069533, SOL-09105-LM, e5688

Summary

This phase II trial studies how well giving phenelzine sulfate together with docetaxel works in treating patients with prostate cancer that is growing, spreading, or getting worse after first-line therapy with docetaxel. Phenelzine sulfate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Phenelzine sulfate may also help docetaxel work better by making tumor cells more sensitive to the drug. Giving phenelzine sulfate together with docetaxel may kill more tumor cells.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Endpoint classification efficacy study
Intervention model single group assignment
Masking open label
Primary purpose treatment
Arm
(Experimental)
Patients receive phenelzine sulfate PO QD on days -7 to -4, and then BID on days -3 to 21. Patients receive docetaxel IV over 60 minutes on day 1. Treatment repeats every 21 days for at least 12 weeks in the absence of disease progression or unacceptable toxicity.
biopsy of prostate Prostate Biopsy
Undergo TRUS-guided prostate biopsy OR image-guided (CT or ultrasound) core bone or soft tissue biopsy
docetaxel Docecad
Given IV
laboratory biomarker analysis
Correlative studies
phenelzine sulfate Nardil
Given PO

Primary Outcomes

Measure
Proportion of patients who experience a PSA decline of at least 30%
time frame: Within 12 weeks

Secondary Outcomes

Measure
Duration of progression free survival after initiation of combination phenelzine and docetaxel therapy
time frame: Up to 6 years
Frequency of MAOA overexpression in CRPC tumors that are progressing on docetaxel
time frame: Baseline
HIF-1alpha expression in circulating tumor cells as a potential measure of MAO activity
time frame: Up to 6 years
MAOA expression in circulating tumor cells and comparison to biopsy MAOA expression
time frame: Up to 6 years
Maximum change in PSA
time frame: 12 weeks
Response rate in measurable disease by RECIST criteria
time frame: Up to 6 years
Time to death from all causes
time frame: Up to 6 years
Toxicity of the regimen
time frame: Up to 6 years

Eligibility Criteria

Male participants at least 18 years old.

Inclusion Criteria: - Histological or cytological diagnosis of adenocarcinoma of the prostate - Radiographic evidence of regional or distant metastases with suspected tumor in an area that is safe to biopsy - Willingness to undergo tumor biopsy - Evidence of CRPC indicated by history of progression despite standard hormonal therapy (by PSA and/or imaging studies) - Planned or recent initiation of standard docetaxel therapy; patients may be enrolled after receiving standard docetaxel therapy as long as the patient has not demonstrated evidence of progression for more than 45 days before enrollment ("late enrollers") - For patients who have been on anti-androgen therapy and had evidence of response to the addition of an anti-androgen (i.e., PSA reduction), patients must have discontinued anti-androgen therapy for at least six weeks (4 weeks for flutamide) without current evidence of an anti-androgen withdrawal response - Serum testosterone levels < 50 ng/dL (unless surgically castrate); patients must continue androgen deprivation with an luteinizing hormone releasing hormone (LHRH) agonist if they have not undergone orchiectomy - Eastern Cooperative Oncology Group (ECOG) performance status =< 2 - Has recovered from all therapy-related toxicity to =< grade 2 (except alopecia, anemia and any signs or symptoms of androgen deprivation therapy) - Absolute neutrophil count >= 1500/uL - Platelets >= 100,000 - Creatinine =< 1.5 times upper limit of normal (ULN) - Bilirubin =< 1.5 times ULN (if total bilirubin elevated, but direct is within normal limits [WNL], patient is eligible) - Alanine aminotransferase (ALT) =< 2.5 times ULN - PSA > 2 ng/mL (at the time of enrollment or prior to initiation of docetaxel) - Life expectancy > 3 months - Signed informed consent Exclusion Criteria: - Significant peripheral neuropathy defined as grade 2 or higher - A second active malignancy except adequately treated non-melanoma skin cancer or other non-invasive or in situ neoplasm - Significant active concurrent medical illness or infection precluding protocol treatment or survival - Current uncontrolled hyperthyroidism - Pheochromocytoma - Carcinoid Syndrome - Known or suspected brain metastases - Treatment with radiotherapy within the past 4 weeks or radiopharmaceutical therapy (strontium, samarium) within the past 8 weeks - Concurrent therapy with a Selective Serotonin Reuptake Inhibitor (SSRI), tricyclic antidepressant, or Monoamine Oxidase Inhibitor (MAOi); clinical judgment should be used in a decision to discontinue antidepressants; a minimum of a 1 week washout period is required for any tricyclic or related antidepressant, or any SSRI (2 weeks for paroxetine or sertraline, 5 weeks for fluoxetine); minimum 2 week washout for any MAOi - Concurrent therapy with any excluded medications that cannot be safely discontinued prior to initiation of combination therapy; discontinuation prior to enrollment is not required, but discontinuation prior to combination therapy must be possible - Caution should be exercised in patients who are regularly taking narcotic analgesics, particularly higher doses; the doses of narcotic analgesics may need to be reduced, patients may need to be monitored closely for drug interactions, and the risks and benefits of participation in the study should be considered; clinical judgment should be exercised to manage this potential drug interaction

Additional Information

Official title A Phase II Study of MAOA Inhibitor Plus Docetaxel in Patients Receiving and Progressing on Docetaxel Therapy
Principal investigator Tomasz Beer
Description PRIMARY OBJECTIVES: I. To determine the proportion of patients who experience a prostate specific antigen (PSA) decline of at least 30% within 12 weeks of initiation of combination therapy when phenelzine (phenelzine sulfate) is added to docetaxel in patients who have evidence of progression on standard docetaxel. SECONDARY OBJECTIVES: I. To determine duration of progression free survival after initiation of combination phenelzine and docetaxel therapy. II. To determine the response rate in measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria after initiation of combination phenelzine and docetaxel therapy. III. To report the maximum change in PSA from baseline to 12 weeks (or earlier in patients who discontinue early) by waterfall plot after initiation of combination phenelzine and docetaxel therapy. IV. To determine the toxicity of the combination regimen in castration-resistant prostate cancer (CRPC) previously treated with docetaxel. V. To determine time to death from all causes. VI. To determine the frequency of monoamine oxidase A (MAOA) overexpression in CRPC tumors that are progressing on docetaxel. VII. To compare the level of MAOA expression in primary diagnostic tissue (e.g. biopsy or radical prostatectomy) with CRPC tumors that are progressing on docetaxel. VIII. To correlate MAOA overexpression in CRPC tumors with response to combination study treatment. IX. To collect blood and tissue specimens for future molecular correlative studies. X. To validate MAOA assessment in circulating tumor cells. XI. To assess correlation with tissue expression of MAOA. XII. To measure hypoxia-inducible factor (HIF)-1alpha expression and other potential biomarkers in circulating tumor cells as a potential measure of MAO activity. TERTIARY OUTCOMES: I. To measure expression of lysine-specific histone demethylase 1 (LSD1) in CRPC tumors that are progressing on docetaxel and correlate with the endpoints described in the primary objective and secondary objectives I, II, III, and V. II. To conduct gene expression studies in CRPC tumors that are progressing on docetaxel and correlate them with and correlate with the endpoints described in the primary objective and secondary objectives I, II, III and V. OUTLINE: This is a dose-escalation study of phenelzine sulfate. Patients receive phenelzine sulfate orally (PO) once daily (QD) on days -7 to -4, and then twice daily (BID) on days -3 to 21. Patients receive docetaxel intravenously (IV) over 60 minutes on day 1. Treatment repeats every 21 days for at least 12 weeks in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 6 months.
Trial information was received from ClinicalTrials.gov and was last updated in September 2016.
Information provided to ClinicalTrials.gov by OHSU Knight Cancer Institute.