Despite recent advances in the treatment of Castrate-Resistant Prostate Cancer (CRPC), there remains an unmet medical need to identify and optimise additional treatment for those patients with early prostate cancer who are at greatest risk of relapse following first-line treatment with curative intent. This is a phase I study investigating the feasibility and tolerability of a short course of neoadjuvant treatment with olaparib, either as a monotherapy or in combination with degarelix) given in the window-of-opportunity prior to radical prostatectomy in men with early, localised intermediate-/high- risk prostate cancer. Our primary objective is to determine the pharmacodynamic biomarker effects of olaparib (a PARP inhibitor) in this patient population. Participants will receive either single agent olaparib or olaparib in combination with degarelix (androgen deprivation) for two weeks prior to routine radical prostatectomy. We will use immunohistochemistry to quantify changes in the levels of biomarkers of PARP inhibition, e.g. PAR, gamma H2AX, pH2A(s129) and Rad51 foci, using tumour samples taken at baseline and at the time of radical prostatectomy. An intra-operative prostate biopsy will permit us to examine biomarker variability between the samples. The incidence and severity of Adverse Events will be documented and we will assess the number of trial participants who undergo surgery on schedule. We will assess preliminary evidence of tumour response, e.g. pathological changes and Prostate Specific Antigen (PSA). We also intend to investigate changes to the ctDNA profile by comparing blood samples collected throughout the study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
20
Addenbrooke's Hospital, Cambridge University Hospitals Foundation Trust,
Cambridge, Cambridgeshire, United Kingdom
Determination of PARP Inhibition
Measure the degree of PARP inhibition by comparison of tumour samples taken from men with early prostate cancer at baseline and following treatment with olaparib (either alone or in combination with degarelix). Inhibition of PARP will be measured by the change in IHC levels of biomarkers such as PAR, gamma H2AX, pH2A(s129), Rad51 foci, FancD2 foci and ATM/ATR/CHK1/2.
Time frame: Two week olaparib therapy (alone or in combination with degarelix)
Incidence and Severity of Adverse Events
Determine the incidence and severity of adverse events caused by treatment for 14 days with olaparib (either alone or in combination with degarelix) prior to radical prostatectomy. The severity of adverse events will be assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE v4.03).
Time frame: Two week olaparib therapy (alone or in combination with degarelix)
Feasibility of treatment approach
Assess the number of patients who undergo radical prostatectomy on schedule after 14 days of treatment with olaparib (either alone or in combination with degarelix).
Time frame: Two week olaparib therapy (alone or in combination with degarelix)
Clinical benefit rate
To assess preliminary evidence of tumour response, e.g. pathological changes and Prostrate Specific Antigen (PSA) levels, following 14 days treatment with olaparib (±degarelix).
Time frame: Two week olaparib therapy (alone or in combination with degarelix)
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