After failure of initial ADT, addition of an anti-androgen is established to treat castration resistant prostate cancer (CRPC). Substitution of the first anti-androgen and anti-androgen withdrawal results in treatment responses in 25-40% of patients for 4-6 months. A more effective second line treatment after failure of first ADT could prolong the time until the state of symptomatic HRPC, which is currently treated with docetaxel and accompanied by significant side effects. Since the importance of the IGF-signaling in PC is not only indicated by preclinical results but also by clinical efficacy of somatostatin analogs, further clinical research with the new somatostatin analog pasireotide is warranted. This study is designed to define the maximum tolerated dose (MTD) of pasireotide LAR in patients with castration resistant prostate cancer (CRPC). It also aims for a preliminary efficacy evaluation of pasireotide within the dose expansion part at the MTD. Preliminary efficacy will be assessed by evaluation of different measures of prostate cancer e.g. changes in PSA, disease control rate (RECIST 1.1), symptoms and changes of biomarkers linked to the mode of action of pasireotide LAR. The study will also explore characteristics of patients who might benefit most from this treatment approach
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
9
Novartis Investigative Site
Berlin, Germany
Novartis Investigative Site
Dresden, Germany
Novartis Investigative Site
Hamburg, Germany
Novartis Investigative Site
Tübingen, Germany
Escalation phase: Frequency of dose-limiting toxicities (DLTs) at each dose level associated with monthly administration of pasireotide LAR during the first two treatment cycles by CTCAE version 4.03.
DLT is defined as an adverse event or abnormal laboratory value assessed as unrelated to disease progression, intercurrent illness, or concomitant medications as defined per study prototol. These will be evaluated according to the CTCAE v4.03.
Time frame: Day 56
Expansion phase: Proportion of patients without PSA-progression at 6 months compared to baseline.
Progression is defined as a PSA-increase of at least 25% and an absolute increase of at least 2 ng/ml from a nadir value, confirmed by a second value four weeks later.
Time frame: 6 months
Incidence of adverse drug events, overall and by severity and incidence of serious adverse events and laboratory abnormalities
Adverse events will be coded using MedDRA.
Time frame: 3 - 6 months
Changes in laboratory assessments, and assessment of physical examinations such as vital signs and electrocardiograms
Abnormalities according notable criteria (i.e., newly occurring CTC grade 3 or 4 laboratory toxicities) will be identified.
Time frame: 3 - 6 months
Percentage and absolute changes from baseline values in PSA and IGF-1
Time frame: 3 - 6 months
Area Under Curve (AUC)
Time frame: pre-dose, day 21 post dose
Proportion of patients without progression at 6 months, defined as PSA-progression (see above) and symptomatic progression of disease and/or progression documented by imaging according to RECIST 1.1
PSA progression is defined as an increase in PSA of at least 25% compared to baseline and an absolute increase of 2 ng/ml or more from a nadir value. Symptomatic progression is defined at the investigator's discretion. Radiological progression is assessed according to RECIST 1.1
Time frame: 6 months
Median progression-free survival (PFS)
Progression-free survival (PFS) is defined as the time from date of start of treatment to date of event defined as the first documented progression or death due to any cause.
Time frame: 3 - 6 months
Median overall survival (OS)
Overall survival (OS) is defined as the time from date of start of treatment to date of death due to any cause.
Time frame: 6 - 15 months
Disease Control Rate by RECIST 1.1 after 6 months
Disease control rate (DCR) is the proportion of patients with a best overall response of CR or PR or SD.
Time frame: 6 months
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