This is an open-label, Phase 1/2a dose escalation study with an expansion phase to evaluate the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD), and preliminary efficacy of CORT125281 in combination with enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) to identify a recommended dose (RD) for Phase 2 studies.
CORT125281 is a selective glucocorticoid receptor (GR) antagonist. In this study, CORT125281 will be administered orally in combination with enzalutamide to patients with metastatic castration-resistant prostate cancer (mCRPC) to evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics, and preliminary efficacy of the regimen. The study consists of two phases: a dose-determination phase and an expansion phase. The dose determination phase is designed to determine dose-limiting toxicities and the RD of CORT125281 plus enzalutamide in patients with mCRPC. Once the recommended dosing regimen has been determined, the following expansion cohorts will be enrolled and treated with CORT125281 plus enzalutamide at the recommended dose level. Abi-Resistant Cohort: Patients who have progressed during treatment with abiraterone, and have received no other androgen receptor (AR)-blocking therapies ARant-Resistant Cohort: Patients who have progressed during treatment with enzalutamide or other second-generation AR inhibitors. The effect of food on CORT125281 PK will be assessed in a portion of the patients enrolled in the Expansion Phase. The two expansion cohorts will be enrolled in parallel. In each phase of the study, routine assessments of safety and tolerability will be performed and samples will be collected to determine standard PK parameters for CORT125281, enzalutamide, and their major metabolites. PD, quality of life evaluations and preliminary evaluations of anti-tumor activity of CORT125281 with enzalutamide will be performed throughout the study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
39
CORT125281 is supplied as capsules for oral dosing
Enzalutamide will be taken orally
Placebo capsules to match the appearance of the CORT125281
Scottsdale
Scottsdale, Arizona, United States
Detroit
Detroit, Michigan, United States
New York
New York, New York, United States
Portland
Portland, Oregon, United States
Maximum Tolerated Dose
Determine the maximum tolerated dose (MTD) and/or biologically active doses of CORT125281 in combination with enzalutamide to identify the recommended dose (RD) for Phase 2 studies based on the number of patients with dose limiting toxicities (DLTs) of CORT125281 in combination with enzalutamide
Time frame: 10 months
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
The safety of each treatment group will be assessed by evaluating the incidence of treatment-related adverse events according to CTCAE v4.03
Time frame: 24 months
AUC 0-last Pharmacokinetic (PK) parameter
Area under the plasma concentration-time curve calculated using linear trapezoidal summation from time 0 to time last, where "last" is the time of the last measurable concentration
Time frame: Cycle 1 Day 1 through Cycle 3 Day 1
AUC 0-24hr PK parameter
Area under the plasma concentration-time curve from 0 to 24 hours, calculated using linear trapezoidal summation
Time frame: Cycle 1 Day 1 through Cycle 3 Day 1
AUC 0-infinity PK parameter
Area under the plasma concentration-time curve from 0 to infinity, calculated using the formula: AUC0-ing = AUC0-last + Clast/ λz, where λz is the apparent terminal elimination rate constant (whenever possible)
Time frame: Cycle 1 Day 1 through Cycle 3 Day 1
Cmax PK parameter
Maximum observed plasma concentration
Time frame: Cycle 1 Day 1 through Cycle 3 Day 1
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Madison
Madison, Wisconsin, United States
London
London, England, United Kingdom
Southampton
Southampton, England, United Kingdom
Sutton
Sutton, Surrey, United Kingdom
Cmin,ss PK parameter
Minimum observed plasma concentration, at predose at steady-state
Time frame: Cycle 1 Day 1 through Cycle 3 Day 1
CL/F PK parameter
Apparent oral clearance
Time frame: Cycle 1 Day 1 through Cycle 3 Day 1
Tmax PK parameter
Time of the maximum plasma concentration (obtained without interpolation)
Time frame: Cycle 1 Day 1 through Cycle 3 Day 1
λz PK parameter
Terminal elimination rate constant (whenever possible)
Time frame: Cycle 1 Day 1 through Cycle 3 Day 1
Effect of food on the Cmax PK of CORT125281
Comparison of the fed state versus the fasted state comparison for the maximum observed plasma concentration (Cmax)
Time frame: Cycle 1 Day -7
Effect of food on the AUC0-t PK of CORT125281
Comparison of the fed state versus fasted state comparison for area under the plasma concentration-time curve
Time frame: Cycle 1 Day -7
Effect of food on the AUCinf PK of CORT125281
Comparison of the fed state versus fasted state comparison for area under the plasma concentration-time curve to infinity
Time frame: Cycle 1 Day -7
Objective Response Rate (ORR)
Determine the ORR by comparing the proportion of the patients who have either a complete response (CR) or partial response (PR)
Time frame: 12 months from the enrollment of the final subject
Reduction in prostate-specific antigen (PSA)
Determine the proportion of patients with a reduction in PSA level by \>50%
Time frame: 12 months from the enrollment of the final subject
Time to symptomatic skeletal event (SSE)
Determine the time to SSE defined as symptomatic fracture, radiation or surgery to bone, or spinal cord compression
Time frame: 12 months from the enrollment of the final subject
Radiographic progression-free survival (rPFS)
Determine rPFS defined as the time interval from first dose of study drug (CORT125281 and/or enzalutamide) to the date when the first site of disease is found to progress on CT, MRI, or radionucleotide bone scan per PCWG3, or death whichever occurs first; including the proportion of patients progression-free at 4, 6, and 12 months
Time frame: Baseline to 12 months
Time to prostate-specific antigen (PSA) progression
Assess time to PSA progression, including the proportion of patients progression free at 4, 6, and 12 months
Time frame: Baseline to 12 months
Time to clinical progression
Assess time to clinical progression, including the proportion of patients progression free at 4, 6, and 12 months
Time frame: Baseline to 12 months
Duration of Response (DOR)
Determine the DOR by the time from the first occurrence of a documented objective tumor response to the time of radiographic progression (per investigator using RECIST v1.1) or death from any cause on study, whichever occurs first
Time frame: 12 months from the enrollment of the final subject
Overall Survival (OS)
Determine OS by the time from the first dose of study drug (CORT125281 and/or enzalutamide) to the date of death from any cause
Time frame: 12 months from the enrollment of the final subject