The combination treatment of protein kinase B (AKT) inhibitor, afuresertib, with androgen synthesis enzyme inhibitor, LAE001, may provide an effective treatment for metastatic castration resistant prostate cancer (m-CRPC) patients who have progressed/drug resistant following prior standard care treatments of any anti-androgen. This study intends to identify the most appropriate combined doses of LAE001/prednisone and afuresertib in m-CRPC patients who have progressive disease or are intolerant of 2 prior standard treatments of any anti-androgen or anti-androgen treatment plus chemotherapy.
The Phase I part of this study will perform a dose-escalation to identify the recommended Phase II dose of LAE001/prednisone plus afuresertib in m-CRPC patients. In the Phase II part of this study, the anti-tumor efficacy of LAE001/prednisone plus afuresertib and docetaxel/prednisone plus afuresertib will be assessed in mCRPC patients with PTEN loss and/or PIK3CA/AKT/PTEN alteration who have progressed on, or who are intolerant of, 1-3 prior standard treatments for mCSPC, or nmCRPC, or mCRPC, including at least one antiandrogen treatment and no more than one chemotherapy. Participants will be assigned to one of the two study cohorts, based on the investigator's clinical judgement. Cohort 1 will receive LAE001/prednisone plus afuresertib using RP2D established in the Phase I study. Cohort 2 will receive docetaxel/prednisone plus afuresertib, with a safety run-in period during the first cycle in the first 6 patients. These study results will provide preliminary efficacy and safety information of the combination of LAE001/prednisone plus afuresertib and docetaxel/prednisone plus afuresertib as requested in the Food and Drug Administration (FDA) combined therapy guideline. Whether to move one or both combination therapies to the pivotal study will be based on the PFS improvements of the combination therapy versus historical controls of abiraterone or docetaxel monotherapies in mCRPC patients who failed 1-3 lines of standard of care therapies.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
49
In the Phase I portion of the study will identify the RPD2 of the combined therapy. In the Phase II will evaluate LAE001/prednisone + afuresertib at the RP2D (Cohort 1) and docetaxel/prednisone + afuresertib (Cohort 2).
Urological Associates of Southern Arizona
Tucson, Arizona, United States
California Cancer Associates for Researh & Excellence, Inc
Encinitas, California, United States
Eastern Connnecticut Hematology/Oncology Associates
Norwich, Connecticut, United States
Piedmont Columbus Regional Research Institute
Columbus, Georgia, United States
University of Chicago
Chicago, Illinois, United States
Cotton-O'Neil Clinical Research Center
Topeka, Kansas, United States
Associated Medical Professionals of NY
Syracuse, New York, United States
Oregon Urology Institute
Florence, Oregon, United States
Greenville Hospital System
Greenville, South Carolina, United States
Mary Crowley Cancer Research Centers
Dallas, Texas, United States
...and 7 more locations
Phase II: Radiological progression free survival (rPFS) based on change in tumor per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
Based on investigator reviewed radiographic tumor assessment.
Time frame: At the end of each 28 day treatment cycle and within 15 days of last treatment
Phase I: Demonstrate safety and tolerability of LAE001/prednisone and afuresertib as combination therapy.
Frequency and severity of AEs.
Time frame: Through study completion for an average of 12 months
Phase II: Radiological progression free survival (rPFS) based changes per Prostate Cancer Working Group 3 (PCWG3)
Based on investigator reviewed radiographic tumor assessment.
Time frame: At the end of each 28 day treatment cycle and within 15 days of last treatment
Phase II: Overall Response Rate (ORR) based tumor changes per RECIST 1.1
Based on investigator reviewed radiographic tumor assessments and death from any cause.
Time frame: At the end of each 28 day treatment cycle and within 15 days of last treatment
Phase II: Overall Response Rate (ORR) based tumor changes per PCWG3
Based on investigator reviewed radiographic tumor assessments and death from any cause.
Time frame: At the end of each 28 day treatment cycle and within 15 days of last treatment
Phase II: Duration of Response (DOR) based on tumor changes per RECIST 1.1
Based on investigator reviewed radiographic tumor assessment and death.
Time frame: At the end of each 28 day treatment cycle and within 15 days of last treatment
Phase I: Duration of Response (DOR) based on tumor changes per RECIST 1.1
Based on investigator reviewed radiographic tumor assessment and death.
Time frame: At the end of the 28 day treatment cycle for cycles 2,4 and 6 and then every 3 cycles after cycle 6 and within 15 days of last treatment
Phase II: Duration of Response (DOR) based on tumor changes per PCWG3
Based on investigator reviewed radiographic tumor assessment and death.
Time frame: At the end of each 28 day treatment cycle and within 15 days of last treatment
Phase I: Duration of Response (DOR) based on tumor changes per PCWG3
Based on investigator reviewed radiographic tumor assessment and death.
Time frame: At the end of the 28 day treatment cycle for cycles 2,4 and 6 and then every 3 cycles after cycle 6 and within 15 days of last treatment
Phase II: Disease Control Rate (DCR) based on tumor changes per RECIST 1.1
Based on investigator reviewed radiographic tumor assessment and death.
Time frame: At the end of each 28 day treatment cycle and within 15 days of last treatment
Phase II: Disease Control Rate (DCR) based on tumor changes per PCWG3
Based on investigator reviewed radiographic tumor assessment and death.
Time frame: At the end of each 28 day treatment cycle and within 15 days of last treatment
Phase II: Overall Survival (OS)
Based on investigator reviewed radiographic tumor assessment and death.
Time frame: At the end of each 28 day treatment cycle and within 15 days of last treatment
Phase II: Changes in Prostate Specific Antigen (PSA) levels
Analysis of blood samples to be drawn at baseline and end of treatment
Time frame: End of Treatment as compared to baseline
Phase I: Changes in Prostate Specific Antigen (PSA) levels
Analysis of blood samples to be drawn at baseline and end of treatment
Time frame: Day 1 Cycle 2 (each cycle is 28 days) and all subsequent cycle and End of Treatment for an avergae of 12 months as compared to baseline
Phase II: PSA response
A \>/=50% reduction in PSA from baseline
Time frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 months
Phase I: PSA response
A \>/=50% reduction in PSA from baseline
Time frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 months
Phase I: Secondary PSA response
A \>/=30% reduction
Time frame: Baseline to>/=12 weeks after study treatment; confirmed 4 weeks later
Phase II: Best PSA response
According to PCWG3
Time frame: Through study completion for an avergae of 12 months
Phase I: Best PSA response
According to PCWG3
Time frame: Through study completion for an average of 12 months
Phase II: Time to PSA progression
According to PCWG3
Time frame: Through study completion for an average of 12 months
Phase I: Time to PSA progression
According to PCWG3
Time frame: Through study completion for an average of 12 months
Phase II: % patients with PSA progression or death from any cause
Patients with PSA progression or have died 12 weeks after treatment
Time frame: At 12 weeks from start of study treatment
Phase II: Frequency and severity of AEs
Findings on physical examination, ECGs, vital signs and laboratory results based on CTCAE v5.0
Time frame: Through study completion for an average of 12 months
Phase I: Evaluate PK characteristics of study drug in combination treatment
Assess PK parameters as various timepoints
Time frame: Cycle 1 (each cycle is 28 days) Day 1 and Cycle 1 Day 15
Phase I: Describe pharmacodynamics of study drugs
Based on changes in blood levels on adrenal hormone and testosterone levels
Time frame: Cycle 1 (each cycle is 28 days) Days 1,8,15 and 22 and Day 1 of subsequent cycles
Phase I: Radiographic tumor response based on Prostate Cancer Working Group 3 (PCWG3)
Based on investigator reviewed radiographic tumor assessment.
Time frame: At the end of each 28 day treatment cycle for cycles 2,4 and 6 and then every 3 cycles after cycle 6 and within 15 days of last treatment
Phase I: Radiographic tumor response based on RECIST 1.1
Based on investigator reviewed radiographic tumor assessment.
Time frame: At the end of each 28 day treatment cycle for cycles 2,4 and 6 and then every 3 cycles after cycle 6 and within 15 days of last treatment
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