This partially randomized phase I/II trial studies the side effects and best dose of enzalutamide and mifepristone when given together and to see how well they work in treating patients with metastatic hormone resistant prostate cancer. Androgens can cause the growth of prostate cancer cells. Antihormone therapy, such as enzalutamide and mifepristone, may lessen the amount of androgens made by the body. It is not yet known whether enzalutamide is more effective with or without mifepristone in treating patients with prostate cancer.
PRIMARY OBJECTIVES: I. To establish the safe and pharmacologically active doses of mifepristone and enzalutamide to use in combination. (Phase I) II. To determine if mifepristone in combination with enzalutamide prolongs time to prostate-specific antigen (PSA) progression compared to enzalutamide alone in patients with metastatic castration resistant prostate cancer. (Phase II) SECONDARY OBJECTIVES: I. To evaluate the effect of mifepristone on endocrine biomarkers such as serum cortisol and thyrotropin. II. To determine the effect of mifepristone on enzalutamide clearance and steady state enzalutamide exposure. III. To determine if mifepristone affects PSA response rate when added to enzalutamide. IV. To determine if mifepristone when added to mifepristone prolongs radiographic and clinical progression free survival according to standard working group criteria. V. To explore the role of glucocorticoid receptor (GR) and androgen receptor (AR) protein expression within circulating tumor cells as a pharmacodynamic biomarker for mifepristone and enzalutamide in castration resistant prostate cancer (CRPC). VI. To explore the expression of GR and down-stream AR/GR targets in metastatic tumor specimen prior to combination drug administration and at clinical progression. OUTLINE: This is a phase I, dose-escalation study followed by a phase II study. PHASE I: Patients receive enzalutamide orally (PO) on days 1-57 and mifepristone PO on days 29-57. Treatment continues in the absence of disease progression or unacceptable toxicity. PHASE II: Patients receive enzalutamide PO for 12 weeks per standard of care. Patients are then randomized to 1 of 2 treatment arms. ARM I: Patients receive enzalutamide PO per standard of care. ARM II: Patients receive enzalutamide PO and mifepristone PO. In both arms, treatment continues in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up for 1 year.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
88
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, United States
Cancer Care Specialists of Central Illinois (Decatur) /Decatur Memorial Hospital
Decatur, Illinois, United States
NorthShore University Health System
Evanston, Illinois, United States
Wayne State University Karmanos Cancer Institute
Detroit, Michigan, United States
PSA Progression-free Survival
PSA progression was defined as a PSA that is ≥1.25 times (25% increase) the PSA at randomization (week 12) and an absolute 5 ng/ml increase. PSA progression-free survival is PSA progression or death from any cause.
Time frame: Up to 3 years, measured from randomization
Radiographic PFS
Radiographic progression or death from any cause.
Time frame: Up to 3 years, measured from randomization
Number of Participants With Positive AR Expression Within Circulating Tumor Cells (CTCs)
Positive/negative classification with positive defined as a cytokeratin cell for whom there was an androgen receptor \> 0
Time frame: Week 12 (randomization)
Number of Participants With Positive GR Expression Within Circulating Tumor Cells (CTCs)
Positive/negative classification with positive defined as a cytokeratin cell for whom there was an glucocorticoid receptor \> 0
Time frame: Week 12 (randomization)
Testosterone
Change from week 12 to week 16
Time frame: 12 to 16 weeks
Thyroid Stimulating Hormone
Change in log(TSH) from week 12 to week 16
Time frame: 12 to 16 weeks
Cortisol
Change in log(Cortisol) from week 12 to week 16
Time frame: 12 to 16 weeks
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