This phase II trial studies how well giving bicalutamide with or without Akt inhibitor MK2206 works in treating patients with previously treated prostate cancer. Androgens can cause the growth of prostate cancer cells. Antihormone therapy, such as bicalutamide, may lessen the amount of androgens made by the body. Akt inhibitor MK2206 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether bicalutamide is more effective with or without Akt inhibitor MK2206 in treating prostate cancer.
PRIMARY OBJECTIVES: I. To compare the two regimens on the proportion of patients with undetectable prostate-specific antigen (PSA) level (\< 0.2 ng/mL) at 44 weeks. SECONDARY OBJECTIVES: I. To assess the proportion of patients with PSA decline \>= 85% at 44 weeks on the combination therapy arm compared to that of bicalutamide monotherapy arm. II. To assess the distribution of best PSA response in each study arm. III. To assess the time to PSA progression in each arm of the study. IV. To assess the time to PSA nadir in each arm of the study. V. To assess the duration of PSA response in each arm of the study. VI. To characterize the PSA slope pre-study, during treatment, and off treatment. VII. To evaluate the safety and tolerability of MK-2206 (Akt inhibitor MK2206) in this patient population. VIII. To determine whether Gleason score has any effect on PSA response to treatment. IX. To determine whether prior hormonal therapy has any effect on PSA response to treatment. TERTIARY OBJECTIVES: I. Samples of the primary tumor specimen will be retrieved for banking and future analysis of the molecular profile of the primary prostate cancer (PC) tissues with emphasis on the androgen receptor (AR) and protein kinase B (Akt) upstream and downstream signaling pathways. OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM A: Patients undergo observation on weeks 1-12. Patients then receive bicalutamide\* orally (PO) once daily (QD) on weeks 13-44. Patients with a PSA decline of \>= 50% may continue on bicalutamide until week 72 in the absence of disease progression or unacceptable toxicity. ARM B: Patients receive Akt inhibitor MK2206\*\* PO once per week on weeks 1-44 and bicalutamide\* PO QD on weeks 13-44. Patients with a PSA decline of \>= 50% may continue on MK2206 and bicalutamide until week 72 in the absence of disease progression or unacceptable toxicity. NOTE: \*Patients may begin bicalutamide on weeks 4-11 if the disease worsens. NOTE: \*\*Patients on Akt inhibitor MK2206 with a PSA \< 0.2 ng/mL by week 12 do not receive bicalutamide until PSA rises to \>= 0.2 ng/mL. After completion of study therapy, patients are followed up every 3 months for 2 years, every 6 months for 3 years, and then every year for up to 10 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
108
Given PO
Given PO
Undergo clinical observation
Correlative studies
Stanford Cancer Institute Palo Alto
Palo Alto, California, United States
VA Palo Alto Health Care System
Palo Alto, California, United States
The Medical Center of Aurora
Aurora, Colorado, United States
Boulder Community Foothills Hospital
Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado, United States
The Proportion of Patients With Undetectable PSA Level (< 0.2 ng/mL) at 44 Weeks
The proportion of patients with undetectable PSA level (\< 0.2 ng/mL) at 44 weeks, defined as number of patients with undetectable PSA level at 44 weeks divided by number of patients randomized.
Time frame: 44 weeks
Proportion of Patients With PSA Decline > 85% at 44 Weeks
Proportion of patients with PSA decline \> 85% at 44 weeks from baseline, defined as number of patients with PSA decline \> 85% at 44 weeks from baseline divided by number of patients randomized.
Time frame: 44 weeks
Proportion of Patients With PSA Response
PSA complete response (CR) is defined as a PSA \<0.2 ng/mL confirmed on two consecutive additional determinations taken at least 4 weeks apart. PSA partial response (PR) is defined as a reduction in PSA ≥ 50% from baseline without evidence of progression (confirmed on two consecutive additional determinations taken at least 4 weeks apart). Either CR or PR is considered as a PSA response.
Time frame: Assessed every 3 months for 2 years, every 6 months for 3 years, and then annually up to 10 years
Time to PSA Progression
Time to PSA progression was defined as the time from randomization to PSA progression or date of last disease assessment showing progression-free. Development of clinical progression is also considered as an event. * For patients (pts) who achieved a ≥ 50% decline in PSA (confirmed on two consecutive determinations taken at least 4 weeks apart), progression is defined as an increase in PSA by 50% above baseline or nadir, whichever is lowest, confirmed by a 2nd PSA rise at least two weeks later. The PSA rise must be \>= 5 ng/mL. * For pts with an undetectable PSA nadir (\< 0.2 ng/mL confirmed on two consecutive determinations taken at least 4 weeks apart), progression is defined as PSA ≥ 0.2 ng/mL confirmed by a 2nd PSA rise at least 2 weeks later. * For pts whose PSA has not decreased by 50%, progression is defined as an increase in PSA of ≥ 50% of baseline or nadir PSA, whichever is lowest, confirmed by a repeat PSA at least 2 weeks later. The PSA must have risen by \>= 5 ng/mL
Time frame: Assessed every 3 months for 2 years, every 6 months for 3 years, and then annually up to 10 years
Time to PSA Nadir
Time to PSA nadir was defined as the time from randomization to the date that PSA nadir, the lowest PSA value achieved after randomization, was documented. This analysis was performed among patients whose PSA level decreased after randomization compared to baseline.
Time frame: Assessed every 3 months for 2 years, every 6 months for 3 years, and then annually up to 10 years
Duration of PSA Response
Duration of PSA response was defined as the time from the date PSA criteria were met for complete response (CR) or partial response (PR), whichever status was recorded first, to the date of PSA progression. Patients without documented PSA progression were censored at the date of last disease assessment. Duration of PSA response is analyzed among responders (PSA CR or PR).
Time frame: Assessed every 3 months for 2 years, every 6 months for 3 years, and then annually up to 10 years
PSA Slope Prior to Randomization
PSA slopes were assessed by multiple PSA values prior to randomization. Linear regression was used to calculate PSA slope using natural log-transformed PSA values on the time of PSA measurements for each patient.
Time frame: Baseline (pre-randomization)
PSA Slope After Randomization and Before Starting Bicalutamide
PSA slopes were assessed by multiple PSA values from randomization to starting bicalutamide treatment. Linear regression was used to calculate PSA slope using natural log-transformed PSA values on the time of PSA measurements for each patient.
Time frame: After randomization and prior to starting bicalutamide
PSA Slope After Starting Bicalutamide Treatment
PSA slopes were assessed by multiple PSA values after starting bicalutamide treatment. Linear regression was used to calculate PSA slope using natural log-transformed PSA values on the time of PSA measurements for each patient.
Time frame: Assessed every 3 months for 2 years, every 6 months for 3 years, and then annually up to 10 years
The Association Between Gleason Score and PSA Response
The association between PSA response (responder vs non-responder) and Gleason score (\<7, 7 vs. \>7) was evaluated by logistic regression with adjustment for treatment assignment. Based on the biopsy sample, a Gleason grade is assigned to the most predominant pattern in the biopsy and a second Gleason grade is assigned to the second most predominant pattern. The two grades will then be added together to determine the Gleason score. Gleason scores range from 2-10. The higher the Gleason score, the more aggressive the cancer is likely to be.
Time frame: Assessed every 3 months for 2 years, every 6 months for 3 years, and then annually up to 10 years
The Association Between Prior Hormonal Therapy and PSA Response
The association between PSA response (responder vs non-responder) and prior hormonal therapy (yes vs. no) was evaluated by logistic regression with adjustment for treatment assignment.
Time frame: Assessed every 3 months for 2 years, every 6 months for 3 years, and then annually up to 10 years
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