This phase I trial studies the side effects and best dose of metformin hydrochloride when given together with enzalutamide in treating patients with prostate cancer that has not responded to previous treatment with hormones. Hormone therapy using enzalutamide may fight prostate cancer by lowering the amount of androgens the body makes and blocking the use of androgens by the tumor cells. Metformin hydrochloride, used for diabetes, may also help kill tumor cells. Giving enzalutamide together with metformin hydrochloride may kill more tumor cells.
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) of enzalutamide when given in combination with metformin (metformin hydrochloride) to patients with castration resistant prostate cancer (CRPC), where fewer than 33% of patients experienced dose limiting toxicity (DLT) attributable to the study regimen and to recommend a phase II dose for the combination. SECONDARY OBJECTIVES: I. To determine prostate-specific antigen (PSA) response in patients with CRPC with given enzalutamide in combination with metformin. II. To determine PSA progression in patients with CRPC with given enzalutamide in combination with metformin. III. To investigate the feasibility and safety of enzalutamide when given in combination with metformin hydrochloride to patients with CRPC. IV. To obtain preliminary evidence of efficacy for this combination. TERTIARY OBJECTIVES: I. To collect computed tomography (CT)-guided biopsies of metastatic soft tissue or bone tumor tissue for analysis of androgen receptor (AR) gene signature as an integrated biomarker (University of California San Francisco \[UCSF\] to conduct analysis). II. To collect serum samples for the measurement of PSA levels and bone re-absorption markers. OUTLINE: This is a dose-escalation study of metformin hydrochloride. Patients receive enzalutamide orally (PO) once daily (QD) and metformin hydrochloride PO twice daily (BID). Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 4, 8, and 12 weeks.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
25
Given PO
Given PO
University of California Davis Comprehensive Cancer Center
Sacramento, California, United States
DLT graded accorded to the National Cancer institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Time frame: 28 days
Incidence of adverse events graded according to NCI CTCAE version 4.0
The safety analysis population will consist of patients who received any amount of study drug. Clinical and laboratory adverse events will be summarized by coded term and severity. Laboratory values will be plotted over time.
Time frame: Up to 12 weeks after last dose of study treatment
PSA response rate as determined by percent of patients achieving >= 50% PSA decline following initiation of treatment
Confidence intervals for the PSA response rate will be calculated using the Clopper-Pearson method, and the PSA response rate will be tested against a null response rate of 50% using an exact binomial test.
Time frame: Up to 12 weeks after last dose of study treatment
PSA progression by Prostate Cancer Working Group (PCWG) 2, defined as the date that a 25% or greater increase and an absolute increase of 2 ng/mL or more from the nadir is documented, which is confirmed by a second value obtained 3 or more weeks later
PSA progression by PCWG2 will be assessed and described.
Time frame: Up to 12 weeks after last dose of study treatment
Radiographic disease progression, determined by Response Evaluation Criteria in Solid Tumors version 1.1
Time frame: Up to 12 weeks after last dose of study treatment
Progression-free survival
Time frame: Time from study entry to disease progression in PSA, bone or soft-tissue, symptoms, or death, assessed up to 12 weeks after last dose of study treatment
Time to treatment failure which includes discontinuing therapy because of disease progression, toxicity, or patient withdrawal
Time frame: Up to 12 weeks after last dose of study treatment
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