This research study is studying a combination of hormonal therapy, chemotherapy, and immunotherapy as a possible treatment for metastatic hormone-sensitive prostate cancer. The names of the study drugs involved in this study are: * Androgen deprivation therapy (ADT) with a drug of your physician's choice. This may include leuprolide (Lupron), goserelin acetate (Zoladex), or degarelix (Firmagon). * Docetaxel * Nivolumab
This research study is a Phase 2 clinical trial. Phase 2 clinical trials test the safety and effectiveness of investigational drug(s) to learn whether the drug(s) work in treating a specific disease. "Investigational" means that the drug(s) are being studied. The U.S. Food and Drug Administration (FDA) has not approved nivolumab for hormone sensitive prostate cancer. However, nivolumab has been approved for other uses, including for advanced melanoma, lung cancer, head and neck cancer, kidney cancer, and bladder cancer. The U.S. FDA has not approved docetaxel as a treatment option for hormone sensitive prostate cancer. However, docetaxel is approved for advanced hormone resistant prostate cancer and other cancers. There is also evidence from a high quality, phase 3 randomized clinical trial supporting the use of docetaxel in metastatic hormone sensitive prostate cancer patients who have a high burden of metastasis. Docetaxel is an off-label indication for hormone sensitive prostate cancer. The U.S. FDA has approved androgen deprivation therapy (ADT) agents, including leuprolide (Lupron), goserelin acetate (Zoladex), or degarelix (Firmagon), as a treatment option for hormone sensitive prostate cancer. The combination of ADT, also called hormonal therapy, with docetaxel chemotherapy and nivolumab immunotherapy is considered investigational. ADT cuts off the supply of testosterone and is the standard of care for hormone sensitive prostate cancer. The addition of docetaxel chemotherapy has been found to prolong life for prostate cancer patients starting hormonal therapy for the first time for metastatic disease, who also have a large volume of cancer. Another anti-cancer treatment modality is called immunotherapy. The immune system can kill cells that are recognized as different or dangerous, such as infected cells and cancer cells. Nivolumab is an antibody (a type of human protein) that work to stimulate the body's immune system to recognize and fight cancer cells. Hormonal therapy and chemotherapy may make cancer cells more recognizable to the immune system, and make cancer cells more susceptible to immunotherapy. The goal of this study is to examine the activity and safety of hormonal therapy combined with docetaxel chemotherapy and nivolumab immunotherapy for hormone sensitive prostate cancer. The study is designed to enrich for patients whose tumors may be more most responsive to this treatment strategy. All patients will receive the same treatment of ADT combined with docetaxel chemotherapy and nivolumab immunotherapy.
Given per standard care for duration of study. Regimens include Leuprolide (Lupron Depot) intramuscularly every 3 months, Goserelin acetate (Zoladex) subcutaneously every 4 weeks, or degarelix (Firmagon) subcutaneously every month per standard of care.
Given once per every 3 weeks for cycle 1-6 intravenously and then every 4 weeks during subsequent cycles, at predetermined dosage; up to 28 cycles total.
Given once every 3 weeks intravenously at pre determined dosage for cycle 1-6.
University of California, San Diego
La Jolla, California, United States
H. Lee Moffitt Cancer Center
Tampa, Florida, United States
The Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Dana Farber Cancer Institute
Boston, Massachusetts, United States
Percentage of Subjects With Prostate Specific Antigen (PSA) Less Than or Equal to 0.2 ng/mL at 7 Months From Start of Chemoimmunotherapy
Summarized as percentage with 80% two-sided exact binominal confidence interval (CI) for each cohort
Time frame: 7 months from the start of chemoimmunotherapy
Percentage of Subjects With PSA Less Than or Equal to 0.2 ng/mL During the Chemoimmunotherapy Combination
Time frame: From the start of chemoimmunotherapy until the end of treatment or initiation of new anti-cancer therapy, whichever occurred first, for a maximum duration of 2 years.
Best Objective Response Rate in Subjects With Measurable Disease Per RECIST 1,1 Criteria
Objective response includes "complete response" or "partial response" to the chemoimmunotherapy per RECIST 1.1 criteria.
Time frame: From the start of chemoimmunotherapy until the end of treatment or initiation of new anti-cancer therapy, whichever occurred first, for a maximum duration of 2 years.
Overall Survival Rate at 3-years
Overall survival rate at 3-years was estimated by the Kaplan-Meier methodology.
Time frame: Time from the start of chemoimmunotherapy to death due to any cause, or censored at date last known alive, up to 3-years
Castration Resistant Disease-free Rate at 12 Months
Castration resistant disease-free rate at 12 months was estimated from the Kaplan-Meier methodology.
Time frame: Time from the chemoimmunotherapy initiation to date of documented clinical or serological progression with castrate-level testosterone <50 ng/dL, or censored at date of last disease assessment before the start of new anti-cancer therapy, up to 12 months
Clinical Progression Free Rate at 7 Months
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Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
47
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States
University of Wisconsin
Madison, Wisconsin, United States
Clinical progression free rate at 7 months will be estimated by the Kaplan-Meier methodology.
Time frame: Time from the chemoimmunotherapy initiation to documented clinical or radiographic progression per RECIST 1.1 criteria, or censored at the date of last disease assessment before the start of new anti-cancer therapy, up to 7 months
Serologic Progression Free Rate at 12 Months
Serum Prostate-Specific Antigen (PSA) progression was defined as ≥50% increase in serum PSA (with a confirmatory increase with PSA above 4 ng/mL. or with starting a new anti-cancer therapy following PSA 50% increase if no confirmatory increase), with the lowest PSA level (nadir) as reference. Serologic progression free rate at 12 months was estimated by the Kaplan-Meier methodology.
Time frame: Time from the start of chemoimmunotherapy to the date of documented serum PSA progression, or censored at the date of last PSA test before start of new anti-cancer therapy, up to 12 months
Number (%) of Subjects With Grade 3 or Higher Treatment-related Adverse Events (TrAE) as Assessed by CTCAE v5.0
Treatment-related adverse events (TrAEs) included toxicities deemed possibly, probably, or definitely related to nivolumab or docetaxel.
Time frame: From the start of chemoimmunotherapy until 6-weeks after the last dose of nivolumab or until resolution or stabilization of the adverse event, up to 31 months