Phase 1b - To assess the safety/tolerability of VERU-111 and to determine the maximum tolerated dose of VERU-111 in patients with metastatic, castration resistant prostate cancer who have failed a novel androgen blocking agent therapy (mCRPC). Phase 2 - To estimate the PSA50 response rate, defined as a decline in PSA to ≥50% of baseline level, confirmed with a second measurement at least 3 weeks apart (PCWG3).
Up to 7 sites in the US only with approximately 18 patients for Phase 1b portion (3 patients per dose group) of the study. Additional patients may be enrolled into the Phase 1b portion of the study depending on the safety and tolerability assessment in the dose escalation scheme. Approximately 26 patients will be enrolled in the Phase 2 portion of the study Phase 1b Approximately 18 patients for Phase 1b portion (3 patients per dose group) will be enrolled into the study. Additional subjects may be enrolled based on the assessment of safety and tolerability in the dose escalation scheme. VERU-111 will be administered orally for three 21-day cycles in which the patient will take the study drug (capsules) daily with food for 7 days and then have a 14-day treatment free period. Dose Escalation Criteria In Phase 1b, three patients will be planned at each dose level and followed for one 21-day cycle. * If 0/3 patients exhibit a dose limiting toxicity (DLT) after one 21-day cycle, the next patient will be treated at the next dose level. * If one patient out of the 3 exhibits a DLT related to the study agent, the cohort will be expanded to up to 6 patients. If 1 of 6 patients exhibits a DLT related to the study agent, then the next patient will enroll at the next dose level. * If 2 of the first 3 subjects OR 2 of the first 6 patients exhibit a DLT related to the study agent, the MTD is considered to have been determined and at least 3 additional patients will be entered at the dose level below the one at which DLT is observed. Dose escalations will occur no sooner than 3 weeks after the last patient on the dose level has begun therapy to allow for full assessment of DLT. No intra-patient escalation will be allowed. * If \<1 of 6 patients experience a DLT, this will be the recommended Phase 2 dose for the expansion cohorts. A Cohort Review Committee, consisting of investigators, the medical monitor and the sponsor, will monitor the trial on an ongoing basis for safety and will guide dose escalation decisions based on the occurrence of DLTs as described in this protocol. The planned dosing for VERU-111 in the Phase 1b portion will be: Treatment Group Daily dose Dosing Regimen 1. 4.5mg Daily dosing on Day 1-7 of each 21-day cycle for 3 cycles Treatment may continue past the planned three 21-day cycles until DLT or disease progression is observed. 2. 9mg Daily dosing on Day 1-7 of each 21-day cycle for 3 cycles Treatment may continue past the planned three 21-day cycles until DLT or disease progression is observed. 3. 18mg Daily dosing on Day 1-7 of each 21-day cycle for 3 cycles Treatment may continue past the planned three 21-day cycles until DLT or disease progression is observed. 4. 27mg Daily dosing on Day 1-7 of each 21-day cycle for 3 cycles Treatment may continue past the planned three 21-day cycles until DLT or disease progression is observed. 5. 36mg Daily dosing on Day 1-7 of each 21-day cycle for 3 cycles Treatment may continue past the planned three 21-day cycles until DLT or disease progression is observed. 6. 45mg1 Daily dosing on Day 1-7 of each 21-day cycle for 3 cycles Treatment may continue past the planned three 21-day cycles until DLT or disease progression is observed.Treatment may continue past the planned three 21-day cycles until DLT or disease progression is observed. 1 If after the first 21-day cycle for the 45 mg in Treatment Group 5 no DLT is observed, then additional dose levels and additional dosing schedules (i.e. 14 days of daily dosing followed by a 7-day treatment free period) may be considered. Phase 2 The maximum tolerated dose of VERU-111 identified in the Phase 1b portion of the study will be used in the Phase 2 portion of the study. The dosing regimen will be daily dosing for 7 days followed by a 14-day treatment free period (21-day cycle). Three 21-day cycles are planned in this study. However, treatment may continue past the planned three 21-day cycles until DLT or disease progression is observed.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
80
VERU-111
Colorado Urology
Golden, Colorado, United States
Universal Axon
Miami, Florida, United States
First Urology
Jeffersonville, Indiana, United States
Maximum Tolerated Dose
Patients will be assessed for toxicities at each clinical evaluation. Toxicities will be graded according to CTCAE v5.0 standardized grading scales. The incidence of grade 3-5 toxicities will be reported.Toxicities will be reported as a tabulated table by type and grade.
Time frame: 21 Days
PSA50 Response Rate
Decrease in the PSA to ≥50% less than the baseline PSA upon enrollment in the trial. The decrease must be confirmed by a second measurement at least 3 weeks apart. PSA values will be measured monthly during the trial. All patients who take at least one dose of VERU-111 will be considered evaluable for the primary endpoint. If patients do not have at least one follow-up PSA after initiation of VERU-111 due to stopping therapy for toxicity or withdrawing consent, then they will be replaced. PSA50 response rate will be estimated along with 95% confidence interval.
Time frame: 63 Days
PSA progression-free survival
PSA progression per PCWG3 will be used. PSA-PFS will be defined as an increase in 25% over a nadir value, confirmed by a follow-up PSA at least 3 weeks later. If patients are removed from study prior to PSA progression, then they will be censored at that time. We will use the Kaplan-Meier method to summarize the median PSA-PFS.
Time frame: 63 Days
Progression-free survival
Measured from the time of first dose to objective clinical or radiographic tumor progression as defined by PCWG3 for progressive disease or death and summarized using a Kaplan-Meier curve. The time to progression will be the earliest observed time of progression. Patients whose disease has not progressed at follow-up will either be censored at the date of follow-up or if they continue therapy after the planned 3 cycles, they will be followed for progression. A Kaplan-Meier method will be used to summarize the median PFS.
Time frame: 63 days
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Regional Urology
Shreveport, Louisiana, United States
Sidney Kimmel Comprehensive Cancer Center at John Hopkins
Baltimore, Maryland, United States
Chesapeake Urology
Towson, Maryland, United States
Associated Medical Professionals of NY, PLLC
Syracuse, New York, United States
Sargon Research
Canton, Ohio, United States
Urologic Consultants
Bala-Cynwyd, Pennsylvania, United States
Urology Clinics of North Texas
Dallas, Texas, United States
...and 3 more locations
Percentage of Patients who achieve Objective Response Rate
Percentage of patients who achieve an objective response by RECIST1.1 criteria (i.e. Complete response or Partial Response) to VERU-111. The objective response rate and the exact 95% confidence interval will be estimated for the population of patients with RECIST evaluable disease.
Time frame: 63 Days
Number of participants with treatment related adverse events (Safety and Tolerability)
Standard safety summaries will be provided for treatment exposure, patient disposition, adverse events leading to discontinuation, serious adverse events, and all events resulting in death, including those up to 28 days after treatment discontinuation. The incidence of adverse events will be tabulated and reviewed for potential significance and clinical importance using CTCAE v5.0 grade ≥3 toxicities experienced by patients on the trial.
Time frame: 91 Days